Amavata vamana-pk

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COMPARATIVE STUDY TO EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY MADHANAPHALA KALKA AND MADHANA PHALA KSHEERAPAKA IN AMAVATA
BY Dr. RIYAS K.A., DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA
S. D. M. COLLEGE OF AYURVEDA, UDUPI

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Amavata vamana-pk

  1. 1. COMPARATIVE STUDY TO EVALUVATE THE EFFECTIVENESS OFVAMANA KARMA BY MADHANAPHALA KALKA AND MADHANA PHALA KSHEERAPAKA IN AMAVATA BY Dr. RIYAS K.A. B.A.M.SDissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka. In partial fulfillment of the regulations for the degree of AYURVEDA VACHASPATI DOCTOR OF MEDICINE (Ay u) In PANCHAKARMA GUIDE: Dr.NIRANJAN RAO. M D (Ayu) G.A.U Professor Department of Panchakarma CO-GUIDE: Dr.SHREEKANTH. U M.D (Ayu) G.A.U Professor, Former Dean, H.O.D Department of Panchakarma DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA S. D. M. COLLEGE OF AYURVEDA, UDUPI 2010 – 2011
  2. 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore DECLARATION BY THE CANDIDATEI hereby declare that this dissertation thesis entitled “COMPARATIVE STUDY TOEVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BYMADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA INAMAVATA” is a bonafide and genuine research work carried out by me under theguidance Dr. Niranjan Rao M.D (Ayu) G.A.U. Professor, Dept of Panchakarma, Co-Guide Dr. Shreekanth U. M.D.(Ayu) G.A.U, Professor, Former Dean & Head, Dept ofPanchakarma, S.D.M.C.A, Udupi. Date: Signature of the Candidate Place: Udupi Dr. Riyas K.A. Department of Panchakarma S.D.M.C.A.,Udupi
  3. 3. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “COMPARATIVE STUDY TOEVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BYMADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA INAMAVATA” is a bonafide research work done by Riyas.K.A” in partialfulfillment of the requirement for the degree of Doctor of Medicine in Ayurveda,under my guidance Dr.Niranjan Rao M.D. (Ayu) GAU.Date: Signature of the GuidePlace: Udupi. Dr Niranjan Rao GAU M.D (Ayu) Professor Department of Post graduate Studies in Panchakarma S.D.M.C.A. Udupi
  4. 4. Rajiv Gandhi University of Health Sciences, Karnataka, BangaloreENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “COMPARATIVE STUDY TOEVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BYMADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA INAMAVATA” is a bonafide research work done by Riyas.K.A under the guidanceof Dr.Niranjan Rao. M.D. (Ayu) G.A.U, Professor and Co- Guide Dr Shreekanth.U.M.D (Ayu) G.A.U, professor, Former Dean, H.O.D, Department of panchakarma. Signature of H.O.D Signature of Principal Dr. Shreekanth U, M.D. (Ayu) Dr.U.N Prasad, M.D. (Ayu) Professor, Former Dean & HOD Principal Dept of Panchakarma SDMCA,Udupi Date: Date: Place: Udupi Place: Udupi COPYRIGHT
  5. 5. Declaration by the CandidateI hereby declare that the Rajiv Gandhi University of health Sciences,Bangalore, Karnataka shall have the rights to preserve, use anddisseminate this dissertation in print or electronic format for academic /research purpose.Date: Signature of the CandidatePlace: Udupi Dr. Riyas.K.A © Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. Acknowledgements ACKNOWLEDGEMENTS On the occasion of the successful completion of this assigned dissertation work, it is withdeep sense of gratitude to the almighty for providing me smooth and successful completion ofthis dissertation. I express my gratitude to my esteemed parents Mr. K.S Aliyar and Mrs.Suhara.P.A for taking pain to bring up me to this position. I am highly obliged for theirblessings, support and sacrifice. I most sincerely convey my thanks and gratitude to my Guide Dr.Niranjan Rao M.D. (Ayu),Professor, and my Co-Guide Dr.Shreekanth U. M.D. (Ayu), Professor, Former Dean, H.O.D.Department of Panchakarama, Dr.Rajalaxmi. M.D. (Ayu), Assistant Professor, Dr.Padmakiran. M.D.(Ayu), Lecturer, for their valuable guidance, timely remarks, and helpful suggestions throughoutstudy. I wish to express my sincere thanks to Principal Dr.U.N.Prasad, & Dean of P.G. StudiesDr.Govinda Raju. I acknowledge my sincere gratitude to my friends Dr Rahul, Dr Girija, Dr Greeshma,Dr Prakash, Dr Nishanth for their needful help and support. I also take pleasure to thankDr Manu K.N. for their valuable help. I express my sincere whole hearted thanks to my beloved seniors, Dr.Vinay kumar,Dr.Prajwal, Dr.Sandeep, Dr.Prashanth, Dr.Avinash, for their assistance in the work, whichhelped me to conduct the work smoothly. I thank my juniors Dr varun, Dr Raksha,Dr Vignesh, Dr vishwanath, Dr shankar for their kind co-operation during the completion of thisthesis work. I would like to thank all Library staffs for their timely help. I whole heartedly express mythanks to all the Panchakarma hospital staffs mainly Mr.Ravi, Mr Monthu D’silva, Mr.Jayaramand Mr.Sherif, also to all my patients who participated in this work, and Mr. Sachin Samruddi,Udupi for their assistance in DTP.Date:Place: UDUPI DR. RIYAS K.A. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and I Madhanaphala Ksheerapaka in Amavata
  7. 7. Abbreviations ABBREVIATIONS OF REFERENCES 1.Cha. : Charaka Samhita 2. Su. : Sushruta Samhita 3. A.S. : Ashtanga Sangraha 4. A.Hr. : Ashtanga Hridaya 5. B.P. : Bhava Prakasha 6. M.N. : Madava nidana 7. Sha. : Sharangadhara Samhita. 8. B.S : Bhela Samhita 9. H.S. : Harita Samhita 10. Ka. : Kashyapa Samhita 11. Van. : Vangasena 12. Y.R. : Yogaratnakara 13. G.D. : GadaNigraha 14. Bhai.Rat : Bhaishajya Ratnavali 15. Nig.A. : Nighantu Adarsha 16. Su. : Sutra Sthana 17. Ni. : Nidana Sthana 18. Vi. : Vimana Sthana 19. Chi. : Chikitsa Sthana 20.K : Kalpa Sthana 21. Si. : Siddhi Stana 22. Pu. : PurvaKhanda 23. M : Madyama Khanda 24. U : UttarKhanda   IIComparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  8. 8. Abbreviations 25. Nig. : Nighantu 26. AT1 : After deepana & Paachana 27. AT2 : After Sneha paana 28. AT3 : After swedana karma 29. AT4 : After Virechana 30. AT5 : After samsarjana krama 31. AT6 : After the follow up period 32. BT : Before treatment 33. Cm : Centimetres 34. d : Difference 35.DC : Differential Count 36. ESR : Erythrocyte Sedimentation Rate 37. CRP : C Reactive Protein 38. RA Factor : Rheumatoid factor 39.Hb : Hemoglobin 40. No. : Number 41. SD : Standard Deviation 42. SEM : Standard Error Mean 43. TC : Total Count 44. Yrs. : Years 45. MPK : Madanaphala kalka 46. MPKs : Madanaphala Ksheerapaka   IIIComparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  9. 9. Abstract ABSTRACT Amavata is a pain predominant joint disorder which if not managed in time may provecrippling. Rheumatoid Arthritis is a disorder where in a lot of similarity is seen with Amavata.Joints are precious jewels of our body and maintaining their health is like acquiring a greattreasure. The mechanical properties of these joints are related with their adequate construction.Any slightest change in the interior constitution of these joints, hampers the disciplines ofmovement. Often the joints get exploded due to wide range of causative factors during differentphases of one’s life. Amongst the derangements of joints Amavata is commonest disease. The figures of prevalence vary substantially ranging from 0.3% to 2.1% of the population.Indian data suggests the prevalence to be around 0.65% to 0.75% of the population. 1% to 3% ofwomen may develop Rheumatoid Arthritis in their life time. Around twice as many women asmen are affected. The incidence and prevalence of Rheumatoid Arthritis generally rising withincreasing age until about 70 years and then declines. About 60% of Rheumatoid Arthritispatients are unable to work 10 years after the onset of their disease. Estimation of life spanshortening in Rheumatoid Arthritis varies from 5 to 10 years. Family history is an important riskfactor. First degree relatives prevalence rate is 2 to 3%.Amavata is a vyadhi havingBahudoshawastha, where kapha, vata, pitta dosha are predominantly involved. Its udbhavasthanais amashaya, vyakthastana is sandi. Vamana karma is considered as an ideal treatment for morbidkapha, its associated condition and in kapha sthanagata doshas. In Amavata mainly kapha sthanalike sandi is affected. Langhana is considered as the prime line of treatment for amavata.Vamana is considered under shodana variety of langhana by charaka. Here an attempt is made toevaluate the efficacy of vamana karma in Amavata.OBJECTIVE OF THE STUDY :To evaluate the action of vamana karma in patients of Amavata. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and IV Madhanaphala Ksheerapaka in Amavata
  10. 10. AbstractSTUDY DESIGN : It is a comparative clinical study with pre-test and post-test design where in minimum of22 patients diagnosed as Amavata of either sex will be selected. All the patients falling in theinclusion criteria shall be subjected to Vamana karma. Patients were subjected to deepanapachana with vadavanala choorna 5gms with hot water before food thrice daily till amapachana.After proper amapachna arohana snehapana with moorchitha gritha was administered tillobtaining samyak snigda lakshans(3-7days). After that they were subjected to abhyanga withsaindhavadi taila followed by bashpa sweda for two days. On the previous day of VamanaKaphothkleshakara diet was prescribed. Vamana was induced with Madanphala Yoga. AfterVamana Haridra dhumapana was done and proper assessments were taken. Patients weresubjected to Samsarjana krama based on their shudhi lakshanas. The assessment criteria werenoted before, during and after Samsarjana kramaRESULTS:- • The average time taken for Samyak Snigdata was 4 days. • The average time taken for completion of vamana karma was 43.28 minutes. • All patients had Samyak Vamana Yoga • 80.05% in group A and 68.56% in group B improvement seen in general symptoms of Amavata.Key Words: Amavata, Vamana Karma, Bahudoshawastha, Madanaphala kalka(MPK),Madanaphala Ksheerapaka(MPKs). Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and V Madhanaphala Ksheerapaka in Amavata
  11. 11. TABLE OF CONTENTS CONTENTS PAGE NO. ACKNOWLEDGEMENT I ABBERAVITIONS II-III ABSTRACT IV-V LIST OF TABLES VI-XI LIST OF FIGURES/GRAPHS XII-XIII INTRODUCTION 1-2 OBJECTIVES 3PART 1 CONCEPTUAL STUDY 4 - 66PART 2 DRUG REVIEW 67 - 87PART 3 METHODOLOGY 88 - 102 OBSERVATIONS ANDPART 4 103 - 195 EFFECT OF THERAPIESPART 5 DISCUSSION 196 - 208PART 6 CONCLUSION 209 - 210PART 7 SUMMARY 211 BIBLIOGRAPHY 212 - 230 ANNEXURE
  12. 12. List of Tables LIST OF TABLES SR.NO. NAME OF TABLE PAGE NO. 1 Indications of Vamana 12 2 Contraindications of Vamana 14 3 Causes behind avoiding Vamana in Avamya: 16 4 Utility of Vamana karma 17 5 Vamaka Aushadhi 23 6 Vamana Kalpa according to Caraka 23 7 Koshtha sthiti and Dose 25 8 Dosage of emitics according to Sharangadhara 25 9 According to Bhela the dosage 25 10 Sneha Prakarsha Kala 27 11 Anupanas of Sneha 28 12 Observation of Sneha Jeeryamana and Jeerna Lakshana 29 13 Samyak Snigdha Lakshanas 29 14 Asnigda Lakshanas 30 15 Atisnigda Lakshanas 30 16 Samyaka Yoga Lakhanas of Vamana 37 17 Atiyoga Lakshnas of Vamana 38 18 Ayoga Lakshanas of Vamana 38 19 Observation of shuddi lakshana 39 20 Manaki Pariksha 41 21 Laingiki criteria 41 22 Appearance of Pitta 42 23 Dhumapana with respect to doshas 44 24 Peyadi Krama 46 25 Peyadi Kalpana 46 26 Tarpanadi Krama 48 27 Rasadi samsarjana krama 49 28 Vamana vyapath 51 29 Ayoga of vamana and Upadrava in certain condition 53 30 Vamana vyapath 58 31 Lakshanas of ama 69Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and VI Madhanaphala Ksheerapaka in Amavata
  13. 13. List of Tables 32 Samanya and Pravridha Lakshanas of Ama 79 33 Classification of Lakshanas 80 34 Classification based on Dosha Bheda 82 35 Prognosis based on Doshasthiti 83 36 Triphala Kashaya 103 37 Vadavanala churna 104 38 Murchita Ghrita 105 39 Rasapancaka of saindhavadi taila 105 40 Drugs for Swedana 107 41 Rasa Panchaka of Madana phala 109 42 Yashti Madhu 112 43 Drug used for Dhumapana 114 44 Age group 125 45 Sex 125 46 Religion 126 47 Marital status 126 48 Education 127 49 Socio economic status 127 50 Occupation 128 51 Desha 128 52 Chronicity of disease 129 53 Addiction 129 54 Diet 130 55 Sleep pattern 130 56 Prakrithi 131 57 Satva 131 58 Rasa satmya 132 59 Samhanana 132 60 Sāra 133 61 Abhyavarana śakti 133 62 Jarana shakti 134 63 Vyayama shakti 134Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and VII Madhanaphala Ksheerapaka in Amavata
  14. 14. List of Tables 64 Vaya 135 65 Koṣta 135 66 Day of attainment of Samyak Snigda Lakshnas 136 Samyak Snigdha Lakshanas observed on last day of 67 136 Snehapana 68 Average amount of Ghrita required 137 69 Average Time Taken for Digestion of Sneha 137 70 Appearance of Samyak Snigdha Lakshana 138 71 Samyak Swinna Lakshana 139 72 Time taken to expel first Vega 139 73 Symptoms after Administration of Vamaka yoga 139 74 Changes observed in Blood pressure 140 75 Changes observed in the Pulse rate 141 76 Time taken to complete the process of Vamana 142 77 Average value of Vega observed 142 78 Vaigiki Shuddhi 142 79 Laingiki Shuddhi 143 80 Antiki signs & symptoms 143 81 Quantitative study showing the drug Input viz drug Output 144 82 Samyak and Asamyak Yoga (Laingiki shuddhi) 145 83 Samsarjana Krama 145 84 Changes in the weight due to Vamana karma 145 85a Effect on Sandhi sula Group A 146 85b Paired T test on Sandhi sula Group A 146 86a Effect on Sandhi shotha Group A 147 86b Paired T test on Sandhi shotha Group A 148 87a Effect of the therapy on Stabdhata Group A 149 87b Paired T test on Stabdhata Group A 149 88a Effect of the therapy on Tenderness Group A 150 88b Paired T test on Tenderness Group A 150 89a Effect on the Range of joint Movements Group A 151Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and VIII Madhanaphala Ksheerapaka in Amavata
  15. 15. List of Tables 89b Paired T test on Range of joint Movements Group A 152 90a Effect of the therapy on hand grip power Group A 153 90b Paired T test on hand grip power Group A 153 91a Effect of the therapy on foot pressure Group A 154 91b Paired T test on foot pressure Group A 154 92a Effect of the therapy on knuckle swelling Group A 155 92b Paired T test on knuckle swelling Group A 156 93a Effect of the therapy on circumference of arms Group A 157 93b Paired T test on circumference of arms Group A 157 94a Effect of the therapy on circumference of forearms Group A 158 94b Paired T test on circumference of forearms Group A 158 95a Effect of the therapy on circumference of thighs Group A 159 95b Paired T test on circumference of thighs Group A 160 96a Effect of the therapy on circumference of calf Group A 161 96b Paired T test on circumference of calf Group A 161 97 Effect on general symptoms Group A 162 98a Effect on Total score of General symptoms Group A 163 98b Paired T test on General symptoms Group A 163 99a Effect on Sandhi Sula Group B 164 99b Paired T test on Sandhi Sula Group B 165 100a Effect on Sandhi shotha Group B 166 100b Paired T test on Sandhi shotha Group B 166 101a Effect of the therapy on Stabdhata Group B 167 101b Paired T test on Stabdhata Group B 167 102a Effect of the therapy on Tenderness Group B 168 102b Paired T test on Tenderness Group B 169 103a Effect on the Range of joint Movements Group B 170 103b Paired T test on Range of joint Movements Group B 170 104a Effect of the therapy on hand grip power Group B 171 104b Paired T test on hand grip power Group B 172 105a Effect of the therapy on foot pressure Group B 173Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and IX Madhanaphala Ksheerapaka in Amavata
  16. 16. List of Tables 105b Paired T test on foot pressure Group B 173 106a Effect of the therapy on knuckle swelling Group B 174 106b Paired T test on knuckle swelling Group B 175 107a Effect of the therapy on circumference of arms Group B 176 107b Paired T test on circumference of arms Group B 176 108a Effect of the therapy on circumference of forearms Group B 177 108b Paired T test on circumference of forearms Group B 177 109a Effect of the therapy on circumference of thighs Group B 178 109b Paired T test on circumference of thighs Group B 179 110a Effect of the therapy on circumference of calf Group B 180 110b Paired T test on circumference of calf Group B 180 111 Effect on general symptoms Group B 181 112a Effect on Total score of General symptoms Group B 182 112b Paired T test on General symptoms Group B 182 113 Effect on Sandhi sula Group B 183 114 Comparative effect on Sandhi Sula 184 115 Comparative effect on Sandhi shotha 184 116 Comparative effect of the therapy on Stabdhata 185 117 Comparative effect of the therapy on Tenderness 185 118 Comparative effect on the Range of joint Movements 186 119 Comparative effect of the therapy on hand grip power 186 120 Comparative effect of the therapy on foot pressure 187 121 Comparative effect of the therapy on knuckle swelling 187 122 Comparative effect of the therapy on circumference of arms 188 Comparative effect of the therapy on circumference of 123 188 forearms. Comparative effect of the therapy on circumference of 124 189 thighs 125 Comparative effect of the therapy on circumference of calf 189 126 Comparative effect on Aruchi 190 127 Comparative effect on malabhadhatha 190 128 Comparative effect on Angamarda 191Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and X Madhanaphala Ksheerapaka in Amavata
  17. 17. List of Tables 129 Comparative effect on sadhana 191 130 Comparative effect on Alasya 192 131 Comparative effect on Anaha 192 132 Comparative effect on Trushna 193 133 Comparative effect on Hasta pada daha 193 134 Comparative effect on Jwara 194 135 Comparative effect on Shareera gaurava 194Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and XI Madhanaphala Ksheerapaka in Amavata
  18. 18. List of Graphs LIST OF FIGURES / GRAPHS SR.NO. NAME OF FIGURES / GRAPHS: PAGE NO. 1. Age 125 2. Sex 125 3. Religion 126 4. Marital Status 126 5. Education 127 6. Socio-Economic Status 127 7. Occupation 128 8. Desha 128 9. Chronicity of Disease 129 10. Addiction 129 11. Diet 130 12. Sleep Pattern 130 13. Prakriti 131 14. Satva 131 15. Satmya 132 16. Samhanana 132 17. Sara 133 18. Ahara-Abhyavaharana Shakti 133 19. Ahara- Jarana Shakti 134 20. Vyayama Shakti 134 21. Vaya 135 22. Koshta 135 23. Day of attainment of Samyak Snigda Lakshnas 136 24. Time Taken for Digestion of Sneha 137 25. Appearance of Samyak Snigdha Lakshana day wise 138 26. Changes observed in Blood pressure during Vamana 140 27. Changes observed in the Pulse during the Vamana 141 28. Samsarjana Krama 145 29. Effect on Sandhi Shoola 147 30. Effect on Sandhi shotha 148 31. Effect on Stabdhata 150 32. Effect on Tenderness 151Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and XII Madhanaphala Ksheerapaka in Amavata
  19. 19. List of Graphs 33. Effect on the Range of joint Movements 152 34. Effect on Hand grip power in mm of 154 35. Effect on Foot Pressure in kgs 155 36. Effect on knuckle swelling 156 37. Effect on Circumference of Arms 158 38. Effect on Circumference of Forearms 159 39. Effect on Circumference of Thighs 160 40. Effect on Circumference of Calf 162 41. Effect on general symptoms 163 42. Total effect on general symptoms 164 43. Effect on Sandhi Shoola 165 44. Effect on Sandhi shotha 167 45. Effect on Stabdhata 168 46. Effect on Tenderness 169 47. Effect on the Range of joint Movements 171 48. Effect on Hand grip power in mm of 172 49. Effect on Foot Pressure in kgs 174 50. Effect on knuckle swelling 175 51. Effect on Circumference of Arms 177 52. Effect on Circumference of Forearms 178 53. Effect on Circumference of Thighs 179 54. Effect on Circumference of Calf 181 55. Effect on general symptoms 182 56. Total effect on general symptoms 183Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and XIII Madhanaphala Ksheerapaka in Amavata
  20. 20. Introduction 1 INTRODUCTION The interaction and exchange between Loka and Purusha continues in a natural way asthe man breaths air, drinks water and consume food articles available in nature. As long as thisinteraction is wholesome the man is in optimum health, when there is any set back in thisharmonious relationship the disease state ensues. Here, Ayurveda should be accepted as clinicalmethodology rather than a set of fundamental principle to determine life pattern for maximumhealth, vitality and harmony. The changing life style of human being by means of dietic andbehaviour pattern plays a major role in the manifestation of several disorders. Thus, this type ofpattern may also lead to the development of the disease Amavata. The disease rheumatoid arthritis can be presented as very similar to Amavata. The diseaseR.A. is chronic in nature and affects mostly the middle aged group. It is one of the commondebilitating disease by the virtue of its chronicity and implications. The onset of disease isfrequent during 4th and 5th decade of life with 80% of patients developing the disease between35 - 50 years of age. Community prevalence study shows that female are more sufferers thanmale and the ratio of occurrence between them is 3:1. It is also noted that frequency is oftenassociated with remission of the disease in last trimester with subsequent relapses after delivery. The spectrum of disease that results due to Ama ranges from acute conditions likeVisuchika, Alsaka, Vilambika etc. to the chronic disorders like Amavata, Grahani and Amatisaraetc. In Amavata, Vata as a Dosha and Ama are chief pathogenic factors. They are contradictoryin nature and thus possesses difficulty in planning the line of treatment. It is mostly the disease ofMadhyama Roga Marga and having Chirkari Swabhava. Sometime it can also be manifested asthe acute case. Due to their similar mode of presentation, the disease rheumatoid arthritis can bebroadly grouped under the heading Amavata. The treatment proper is also not unidirectional, fore.g: the antagonistic treatment of Kapha and Vāta must be carried out simultaneously,gambiradhātu (asthi),uttānadhatu (rasa),makes the treatment more a puzzle. Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required ināmavāta Vamana is one such śodhana procedure fulfilling the above criteria.(Ch.Su. 16/20.)Caraka has said that the dosas controlled by Samśamana are having the possibility ofreoccurrence while such a prospect is absent when it is managed by Samśodhana.     Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  21. 21. Introduction 2Only one treatment protocol will not help to curtail the disease. The author opines that a fullplanned course of śodhana measures like vamana, virecana, basti along with the use of otherexternal and internal treatments will help over a period of time to curb this grave disease. The conceptual study includes three separate chapters. The historical aspect of the diseaseAmavata is elaborated in the chapter on historical review. Nidana panchaka as well as treatmentof this disease is made clear in the second chapter. Madhana phala kalka and Madhana phalaksheera paka is used for Vamana karma. Here in kapha utklishta avastha vamana is the besttreatment considered rather than other Samshodana therapies. The details of the present research work that include material and methods, observation,results and statistical analysis all are methodically presented in chapter entitled clinical study.General symptoms of Amavata were decreased significantly by 80.05% in group A(madanaphalakalka) and 68.56% in group B (madanaphala ksheerapaka). The conclusion drawn from this clinical study is listed in the final chapter summary andconclusion.     Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  22. 22. Objectives 3 OBJECTIVE OF THE STUDY To evaluate the action of vamana karma in patients of Amavata.Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  23. 23. Conceptual Study 4 CONCEPTUAL STUDYHistorical aspects of VamanaVeda Kala: Ayurveda is based on the fulcrum of Atharva Veda and is considered as its Upaveda.Vamana was popular in Vedic period. Atharvaveda has advised to perform Vamana Karma withMadana Phala (Randia dumatorum) in treatment of poisoning. Further, in the snake bitepoisoning, the use of Katutumbi (Lagenariasiceraria) and Dhamargava (Luffa acutangula) forVamana has been eluded.Atharva Veda1 : One of the prominent Sutra belonging to Atharvaveda i.e. Kaushika Sutra states thatemetic drug should be prescribed in case of persons injured by poisoned arrow. While referringto the treatment of Poisoning in Visha chikitsa it has been mentioned that Madanaphala shouldbe used for Vamana. Vinaya Pitaka is one of the important and popular literatures of Buddha period. In thistreatise, abundant references of Shodhana are available. Physician of Buddha named Jivaka,performed Vamana therapy where ever necessary.Purana Kala :Garuda Purana :In Garuda Purana Vamana Karma has been advised to combat all types of Kustha. VamanaDravya such as Dhamargava (Luffa acutangula), Madanaphala (Randia dumatorum), Indrayava(seeds of Holarrhena antidysentrica) have been mentioned in Garuda Purana.Agni Purana2 :In Agni Purana, it has been quoted that Vamana is of great importance in the patients sufferingfrom Adhoga Raktapitta. A recipe for Vamana Karma in the form of Kwatha and Kalka ofVamaka and Vamanopaga drugs have been mentioned. Vamana Therapy is considered as one ofthe best line of treatment for disorders of Kapha.Manu Smriti3 :Vamana karma is explained and snana is advised after the completion of the therapy. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  24. 24. Conceptual Study 5Vamana In Ayurvedic Literature There are some chapters in the Ayurvedic classics which mainly deals with either theprocess of Vamana or the drug used for it. These chapters are the main source material forVamana Karma. Therefore only such references found in the Ayurvedic texts, which are relatingto either process or drugs used in Vamana Karma in general are being mentioned here.Charaka Samhita Charaka Samhita is the most important classic of Kayachikitsa. Few chapters of SutraSthana, Kalpa Sthana, and Siddhi Sthana describe Vamana Karma in general, the details ofwhich are as follows - A) Sutra Sthana In first chapter of Sutra Sthana named "Dirghanjivaniya Adhyaya",4 some emetic rootsand fruits are mentioned and in the second chapter named "Apamargatanduliya Adhyaya"5 someimportant emetic drugs are quoted. In the fourth chapter entitled "Shad Virechana ShatasritiyaAdhyaya"6, after mentioning the number of preparation which can be obtained from the majorVamana drugs, the Vamanopaga Dravyas are stated. Besides these, in fifteenth chapter under theheading "Upakalpaniya Adhyaya"7, describes broadly about different aspects of Vamana. Itenlights the information about the collection of equipment required (Sambhara Sangraha),Process of Vamana, Dose of Madana Phala, Lakshanas produced due to Ayoga and Atiyoga ofVamana, complications produced due to fault of physician, drugs, nurse and Patient, Dhumapanato be done after completing the Vamana process and Samsarjana Krama with its importance.Further in the 20th chapter the use of Vamana Karma in the Nanatmaja disorders of Kapha hasbeen emphasized8. B) Vimana Sthana In the eighth chapter of Vimana Sthana named "Rogabhisakjitiya Vimanadhyaya",9various Vamana and Vamanopaga Dravyas are mentioned under the heading of Vamana DravyaKalpa Sangraha". C) Kalpa Sthana In Kalpa Sthana, first six chapters are devoted to describe emetic drugs. First Chapterentitled "Madanphala Kalpa Adhyaya"10 has explicated the intricate pharmacological action of Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  25. 25. Conceptual Study 6emetic drugs. Same chapter discuss the different Kalpana of Madanphala to be administered indifferent stages of the diseases and to the patients having different body constitution. Next fivechapters are also fully devoted to discuss the Kalpana of Vamana drugs they are JeemoothakaKalpa, Ikshvagu Kalpa, Dhamargava Kalpa, Vatsaka Kalpa and Krithavedhana Kalpa11,12,13,14,15respectively. D) Siddhi Sthana Some verses of the first chapter entitled "Kalpana Siddhi"16 are related to Kaphakara andUtkleshakara diet, Samsarjana Krama and its importance to increase Agni. In the same chapterPradhana, Madhyama and Hina Shuddhi Lakshanas are mentioned along with the Lakshanasproduced due to Ayoga, Atiyoga and Samyakyoga. Indications and contraindications arediscussed in detail in second chapter named as "Panchakarma Siddhi Adhyaya."17 Sixth Chapterentitled "Vamana Virechana Vyapad"18 deals with Vyapad manifested due to Ayoga and Atiyogaalong with its treatment. In addition to these references, use of Vamana while describing the treatment ofdifferent disease in chikitsa Sthana been dealt with at length taking into consideration the stagesof that particular disease and the strength of the patients and Dosha.Sushruta Samhita Vamana has been dealt in detail in Sushruta Samhita. Lots of references are available inSutra Sthana, Kalpa Sthana and Chikitsa Sthana. A) Sutra Sthana Forty first chapter of Sutra Sthana named "Dravya Vishesha VijnaniyaAdhyaya"19 describe the upward direction of emetic drugs. While fortieth chapter entitled"Vamana Dravya Vikalpaniya Adhyaya"20 is devoted to describe Kalpanas of emetic drugs andKalpanas, particularly pertaining to Madana phala which is considered as one of the best emeticdrug. B) Chikitsa Sthana Chikitsa Sthana, thirty first chapter mentions some emetic drugs. Thirty third chapter ofChikitsa Sthana under the heading "Vamana Virechana Sadya Upadrava"21 deals with Vamanaprocess, in which pharmacological action of emetic drugs is given. The same chapter also Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  26. 26. Conceptual Study 7describes Vamana process, Kaphakara diet, Ayoga, Atiyoga and Samyakyoga of Vamana andDhumapana to be taken after Vamana. Along with these aspects indications, contraindicationsand Shodhana measures which are to be done after Vamana have also been stated. VamanaVyapad has been dealt along with Virechana Vyapad, in thirty-fourth chapter "VamanaVirechana Vyapad".22 Thirty ninth chapter entitled "Aturaupadrava Chikitsa Adhyaya"23mentions the Samsarjana Krama to be followed after Vamana. In addition to these, variousscattered references are also available in Sushruta Samhita.Kashyapa Samhita Description of Vamana is given in detail in Siddhi Sthana and Khila Sthana. A) Siddhi Sthana The third chapter of Siddhi Sthana named as "Vamana Virechana Adhyaya"24 deals withthe process of Vamana, Hina, Madhyama and Uttama Shuddhi, regimen to be followed afterVamana, importance of Vamana in Balaroga, Shuddhi lakshanas and Vyapad of Vamana. Itsseventh chapter explains indications and contra-indications of Vamana25. B) Khila Sthana In Khila Sthana "Samshuddhi Vishesiniya Adhyaya"26 mentions the Vamana process indetail along with Samsarjana Krama.Astanga Sangraha Vriddha Vagbhata has mentioned one chapter in Sutra Sthana and two chapters in KalpaSthana mainly for Vamana Karma. A) Sutra Sthana Twenty seventh chapter of Sutra Sthana entitled as "Vamana Virechana VidhiAdhyaya"27 gives details of Vamana process, properties of emetic drugs along with theirpharmacological actions. Apart from these aspects indication, contraindication and process ofVamana are fully described along with Shuddhi Lakshanas in the same chapter. B) Kalpa Sthana In Kalpa Sthana, first chapter named "Vamana Kalpa Adhyaya"28 mentions Madanphala, asone of the best emetic drug. In this chapter depending upon, Dosha, Dushya etc. different Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  27. 27. Conceptual Study 8Kalpanas are discussed. Another chapter of Kalpa Sthana entitled "Vamana Virechana VyapadSiddhi Adhyaya"29 is fully devoted to the Vyapad..Astanga Hridaya Three chapters of this text describe fully different aspects of Vamana. A) Sutra SthanaEighteenth Chapter of Sutra Sthana, states the process of Vamana, while the chapter of KalpaSthana named as "Vamana Kalpa Adhyaya"30 gives the information about the Kalpas of emeticdrugs. Vyapad are described in third chapter, under the heading of "Vamana Virechana VyapadAdhyaya"31.Bhela Samhita A) Kalpa Sthana It has narrated the Kalpanas of Madana Phala (Randia dumatorum), Ikshvagu(Langenaria Siceraria), Dhamargava (Luffa acutangula) and Kutaja (Holarrhena antidysentrica)in Kalpa Sthana33. B) Siddhi Sthana Siddhi Sthana provides two chapters to describe Vamana. The first chapter of SiddhiSthana mentions idea regarding the diet to be taken on the previous day of Vamana, dose ofdecoction, expulsion of Kapha, Pitta, Vata and Rakta respectively and Lakshanas produced byAyoga and Samyakyoga34. Vyapad are mentioned in the fourth chapter of Siddhi Sthana entitled"Vamana Virechana Siddhi"35.Chakradatta In this text, only one chapter is devoted for the description of Vamana Karma. The sixty-ninth chapter named "Atha vamanadhikar"36 deals with the preparation of patient and process ofVamana. Different Vamana Dravyas and their Kwatha are mentioned along with Lakshanasproduced due to Atiyoga, Ayoga and Samyakyoga, Samsarjana Krama, indication andcontraindication are also described. It is mentioned that Prastha in Shodhana chikitsa should beconsidered as thirteen and half Palas. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  28. 28. Conceptual Study 9Harita Samhita No Separate chapter is devoted for the description of Vamana in Harita Samhita availablenow a days. However Vamana is advised as line of treatment at many places in differentdisorders37.Sharngadhara Samhita A) Purvakhanda Definition of Vamana is given in the fourth chapter of Purvakhanda38. B) Uttarkhanda In the third chapter of Uttarkhanda39, Vamana Karma has been described in detail. Theprocess of Vamana for children, emaciated (Krisha), aged (Vriddha) and delicate (Sukumara)person is mentioned. In this chapter the indications, contraindication, doses of Kalka and Kwathaare stated; management of Vyapad caused by Atiyoga and Ayoga, prescribed diet to be taken,diet to be restricted are also mentioned in this chapter of Uttara Khanda.Vangasena One separate chapter entitled "Vamana Adhikara Adhyaya"40 has been devoted inVangasena. In this chapter indication, contraindications, proper season for Vamana, preparationof patient, process of Vamana, some emetic decoction and symptoms produced due to over andunder administration of Vamana are dealt with. The use of Nasya along with Dhumapana hasparticularly been mentioned to remove the Doshas after Vamana.Bhavaprakasha A) Purvakhanda Sixth chapter named "Mishraka Prakarana Adhyaya" in Purvakhanda deals with thedefinition, proper season for Vamana, indications, Contraindications, preparation of patient andimportance of Kapha Utkleshakara diet, madhu and saindhava in the emetic preparation, Hina,Madhyama and Uttama Shuddhi lakshanas; over and under administration of Vamana and itstreatment are also described. In addition the specific diets which are to be given and not to begiven after Vamana have also been explained in this chapter41. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  29. 29. Conceptual Study 10 Yogaratnakara: A) Poorvardha It has explained about vamana kala, Indication, contraindication, doshanusara karma, briefdescription of vamana42DefinitioniÉ§É SÉãwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇ¥ÉMüqÉç || (Ca Ka 1/4)43 Charaka defined Vamana as a process in which waste products or Toxins (Dosha) areeliminated through upper channels i.e. mouth.uÉqÉlÉÇ vsÉãwqÉWûUÉhÉÉqÉç ||qÉSlÉTüsÉÇ uÉqÉlÉ AÉxjÉÉmÉlÉ AlÉÑuÉÉxÉlÉ EmÉrÉÉåÌaÉlÉÉqÉç || (Cha su 25/40)44 As per as expulsion of Shleshma is concerned Vamana is the Agroushadha &Madanaphala is best drug to produce Vamana.AmÉYuÉÇ uÉqÉlÉÇ SÉãwÉÇ mÉcrÉqÉÉlÉÇ ÌuÉUãcÉlÉqÉç|ÌlÉWïûUã²qÉlÉxrÉÉiÉ: mÉÉMüÇ lÉ mÉëÌiÉmÉÉsÉrÉãiÉç || (Cha Ka 12/62)45 Vamana is one such procedure which expels the Apakva Dravyas therefore one shouldcomplete the procedure before the drug attains Paka Avastha.AmÉYuÉ ÌmɨÉvsÉãwqÉÉhÉÉÇ oÉsÉÉSÕkuÉïÇ lÉrÉããiÉÑ rÉiÉç |uÉqÉlÉÇ iÉÌ® ÌuÉ¥ÉãrÉÇ qÉSlÉxrÉTüsÉÇ rÉjÉÉ || ( Sha.sam.p 4/ 8)46 Vamana is a process in which Apakva Dravyas are removed forcefully through upperchannels by the act of vomiting.The above mentioned definitions conclude following aspects:-a) Route of Expulsion- ‘Urdhva’- refers to Mouthb) Way of Expulsion-‘Balaat’-Prabhava suchaka – Forceful Expulsionc) Dosha Expelled – Kapha / Kapha-Pittad) Phase of the Dosha- Apakva Avastha- Its of 2 types 1)Pitta Apakva avastha 2)Kapha Apakva avastha Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  30. 30. Conceptual Study 11Pitta Apakva avastha47- Apakva of pitta refers to Vidagdha avastha where pitta attains AmliBhava & such pitta leads to symptoms like Tikta-Amlodgara leading to Vidagdhajeerna &Vamana is the Vyadhi pratyanika chikitsa in case of Vidagdhaajeerna.Even in case of Amlapittathe Ushna & Amlaguna of pitta is increased because of Vidagdha Avastha (Ma.ni.II/51.1).Kapha Apakva avastha- Mainly refers to Kaphotklishta Avastha. Features like Hrulasa, Praseka,Gaurava Hrutpida etc & Utklishta Kapha is the essential fator in case of Vamana.e) Fate of the Drug48: According to adamalla Apakva specifies to fate of the drug. The drugproduceses Vamana by its vyavaee vikasi & Prabhava nature atlast before it gets digested it willbe expelled out. So Muhurta is the Kalaavadhi for vamana, if delayed it may lead tocomplications.f) Phase of Dosha & Anna49: As per the gudarthadipika commentary vamana helps to expel theApakwapitta, Apakwa kapha & Apakwa anna.Synonyms For Vamana : Samsodhana. Sodhana, Virecana, Vireka, Chardi, Chardana, Vami, Ullekhana, Lekhana.Vamana Guna:“uÉqÉlÉÇ iÉÑ xÉuÉÉãïmÉ¢üqÉãprÉÈ vsÉãwqÉÍhÉ mÉëkÉÉlÉiÉqÉÇ qÉlrÉliÉã ÍpÉwÉeÉÈ ||” (Cha.su 20/19) Vamana karma is the first measure amongst Panchakarma, has been considered as thebest line of treatment for the Kaphaja disorders.“vÉUÏUeÉÉlÉÉÇ SÉãwÉÉhÉÉÇ ¢üqÉãhÉ mÉUqÉÉæwÉkÉqÉç|uÉÎxiÉÌuÉïUãMüÉã uÉqÉlÉÇ iÉjÉÉ iÉæsÉÇ bÉ×iÉÇ qÉkÉÑ||” (A.Hr.Su 1/14) Vagbhata also repeated that Vamana is the most ideal treatment for morbid Kapha.Sushruta asserts that just like the flower, fruit and branches which are destroyed at once as soonas the mother tree is rooted out, the disease originated due to excessive Kapha are subdued afterthe elimination of Kapha through the process of Vamana. VAMANA KARMA – ONE AMONG CHATUSH PRAKARA SAMSHUDHI Charaka explains that Vamana is Shodana procedure under the heading of “ChatushPrakara Samshudhi”50. This procedure is capable to expel the Shareeragatha Doshas. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  31. 31. Conceptual Study 12 While differentiating the major procedure from the minor procedures Chakrapani clearlyelaborate Vamana etc procedures capable to do. 1. Bahudosha Nirharana51 2. Bahu iti Kartavyata51 Bahudosha Nirharana: Indication of the Vamana clearly shows the procedure havingdefinite impact on Kapha and associated Kapha conditions so Acharyas are explaining theconditions like Utkristha Kapha, Pitta Samsristha Kapha, Pitta- sthanagata Kapha, Pitta, Vatacondition etc. Bahu iti Kartavyata: Here Chakrapaani may be keeping the meaning that benefit of theVamana in different aspect that is Vamana is Shodhana, Shamana, at the same time it isRasayana also.INDICATIONS OF VAMANA: Vamana is indicated in cases of Bahudoshavasta e.g-Prameha, Kusta etc. In case of morbid aggravated kapha in their own seat.e.g kasa,swasa etc In case of kapha combined with pitta In case of kaphastanagata vata and pitta. In general it is indicated in disease where we need shodana.e.eg-unmada,apasmara.etc In disease where prathimargahara shodana told e.g-adhoga raktapitta. In kaphapradhana vyadhis. INDICATIONS OF VAMANA: 52,53,54,55,56,57 Table No: 1 Diseases Cha SU A.H A.S SHA.S V.Se Pinasa + + + - + - Kustha + - + + + + Nava Jwara + + + + + + Rajayaksma + + + + - - Kasa + + + + + + Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  32. 32. Conceptual Study 13 Swasa + + + + + + Galaganda + - - + - - Galagraha + - - - - - Slipada + + + + + + Prameha + - + + + + Mandagni + + - + + - Viruddajeerna + + - + + - Visuchika + - - + - - Alasaka + - - + - - Vishapeeta + + + + + Adoga raktapitta + + + + - - Murcha + + + + - - Hrullasa + + + + + + Aruchi + + + + + - Avipaka + - - + - - Apachi + - - + - - Granthi - - - + - - Apasmara - + + + - - Unmada - + + + - - Atisara + + + + + - Pandu + - - + - - Mukhapaka + + - + - - Stanyadusti + + + + + - Arbuda - - + + + - Vidarika - + + - Medoroga - + + + + -Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  33. 33. Conceptual Study 14 Hridroga - + - - + - Visarpa - + + + + - Chitta Vibhrama - + - - - - Vidradhi - + - - - - Kantapaka - + - - - - Karma srava - + - - - - Adhi jihwika - + - - - - Galasundhika - + - - + - Kaphadikya + + - + + - Pittaja roga - - - - - + Asroja roga - - - - - + Urdwajatru roga - - - - - +CONTRAINDICATIONS OF VAMANA:58,59,60,61,62,63 Here maily diseases like Hrdgraha, Udavarta etc seen. Some individuals who are emaciated weak,aged, The disease involving marma sthana. Disease having similar gati to that of vamana.e.g-urdvaga raktapitta. Table No:2 Diseases Cha SU A.H A.S SHA.S V.Se kshataksheena + + + + + + Ati Sthula + + + + + + Ati Krsa + + + + + + Ati Baala + + + + + + Ati Vriddha + + + + + + Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  34. 34. Conceptual Study 15 Sukumara + - - + - - Kshyama + - - - - - Durbala + + + + - - Sranta + + - + - - Ksudhita + + + + + - Pipasita + + + + - - Karmahata + - - - - Bharavahaka + - - + - - Upavasita + - - + - - Maithuna + - - + - - Prasakta Adhyayanakala + - - + - - Garbhini + + + + + + Vyayama + - - + - - prasaktha Chinta + - - + - - prasakta Samvrita kosta + + + + Duschardana + + + + + Krimi kosta + + + + + Urdvaga + + + + + - raktapitta Urdva vata + + + + - Asthapita + + + + + - Anuvasita + + + + - - Hrdroga + + + + - - Udavartha + + + + + -Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  35. 35. Conceptual Study 16 Mutraghata + + + + - - Pliha roga + + + + - - Gulma + - + + + + Udara + + + + + + Ashteela + + + + - - Timira + + + + + + Shankaka + + - + - - Siraha shoola + - - + - - Arsha - - + + - + Parshva shoola - - + + - - Navamaya - - - - - + Pandu - - - - - + Abhigata - - - - - + Atirooksha - - - - - + Ardhita - - - - - + Akshepaka - - - - - + CAUSES BEHIND AVOIDING VAMANA IN AVAMYA: 64 Table No: 3Sr. Avamya Causes for Contra-indicationNo.1. Ksataksina Due to excess strain profuse haemorrhge may occur.2. Ksheena, Atisthula, Krisha, Bala, Vriddha, Durbala Unable to tolerate the procedure, may lead danger to their lives or cause death.3. Shranta, Pipasita, Kshudita, Similar afflictions.4. Persons broken by constant labour, load lifting and Vayu gets aggravataed, haemorrhage or Injury to way-faring, weakened by constant fasting, sexual lungs. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  36. 36. Conceptual Study 17 indulgence, study, exercise and worry Complications of pregnancy, abortion of immature5. Garbhini fetus and incidence of severe diseases. Due to strain in his heart severe haemorrhage may6. Sukumara take place through upper and lower routs. Morbid doshas get stimulated but not eliminated,7. Samvrita koshta accumulate in the alimentary tract and causes internally acute spreading affections, stasis, dullness, fainting or even death.8. Urdhwaga Raktapitta, Prasakta Chardha It may provoke Udana Vata and take away the life or cause profuse bleeding.9 Urdhva-Vata, Anuvasita, Asthapita Increase in Upward movement of Vata10 Hrdroga Will lead to cardiac arrest.11 Udavarta Aggravation of condition which may quickly cause death12 Mutraghata Manifestation of colic pain or more of acute origin.13 Timira There will be further vitiation of the condition14 Shira shoola Leads to excessive aggravation of pain. UTILITY OF VAMANA KARMA IN VARIOUS CONDITIONS : Table No: 4 Disease Explanations When Uthklishta Dosha is seen.65 Jwara In Pakwa (purana) jwara66. Raktha pitta Vamana can be given in Adhogatha Rakthapitta67. Gulma In Kaphaja gulma.68 Prameha In case of Kaphaja Meha.69 Atisara When morbid Kapha is there.70 Prameha Pitaka When Medas is involved.71 Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  37. 37. Conceptual Study 18 Kushta Every 15 days Vamana is advised72 in kaphaja stage.73 Rajayakshma Tikshna Vamana after considering strength ,doshas74. Unmada Kaphaja Unmada.75 Apsmara Vamana advised in Kaphaja stage.76 In shvayathu Vamana is advised.77 Kaphaja Udara Vamana advised.78 Udara In Jalodara.79 Arshas Kaphaja arshas80. Grahani When Ama is seen,pittaja & kaphaja grahani.81 Tikshna Vamana can be done Pandu In case of Mrithbhakshna janya Pandu.82 When swasa associated with Kasa, Chardi, Swasa Hrithgraha83. Kasa In kaphaja, pittaja kasa84 Chardi Vamana is advised in vitiated condition of Kapha.85 Visarpa In Kaphaja,pittajaVisrpa Ullekhana is advised.86 Trishna Kaphaja trishna.87 In Kaphaja type of Keeta visha88 In 2nd Visha vega of Rajeemanta 89 In third Visha vega of Mandaleena90 Visha Darveekara in4th vega91 Vrischeeka92 Lutha visha93, Gara visha94, Akhu visha.95 Madatyaya Kaphaja madatyaya – Ulekhana96 In vruna chikitsa One among 36 upakrama 97 Udavartha In case of Udavarta due to Chardi Nigraha98 Mutra krichra In Kaphaja type99Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  38. 38. Conceptual Study 19 Hridroga In Kaphaja type of Hridroga100 Peenasa In kaphaja type where uthklishta kapha is seen.101 Paridhara102 Mukha roga Rohini103 Upakusha 104 Arochaka In Kaphaja verity105 Swara bedha In Kaphaja type.106 Avarana In Kaphavritha Vata.,Annavritha Vata107 Vata Rakta Kaphavrita vata mild Vamana is advised108 Yoni roga Acc to dosha vamana given.109 Pratyadmana Vamana advised 110 Vidradhi Kaphaja verity111 Apachi Industa Apachi 112 Glaganda Kaphaja Galaganda113 Shotha Acc to involvement of doshas.114 Kaphaja Prathisyaya,115 Nava Prathishyaya116 Nasa roga Kaphaja Pinasa.117 Karna roga Karna paka,118 Karnapali roga,119 Karna nada120 Shiro roga Kaphaja type121 Kukshi shula Vamana advised122 Sleshma dusta datri123 Datri In Gridrasi124 Vata Vyadi In Arditha125 In Pakshaghata- mild vamnana126 Arumshika If not controled by other means.127 Kukunaka Vamana advised.128Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  39. 39. Conceptual Study 20 Pakshma kantaka Vamana advised 129 Yauvana pidaka Vamana advised 130 Mukha dushika Vamana advised 131Importance of Vamana Karma Panchakarma therapy in Ayurveda has attracted the attention of the people world wide asit is a unique type of treatment of various chronic, auto immune, hormonal, degenerativedisorders etc. where other sorts of treatments have no satisfactory answer as well equallybeneficial for the promotion and preservation of health. Acharya Charaka has highlighted, therole of Panchakarma therapy by stating that the disease treated by Shodhana will never recurwhereas those treatment with Shamana therapy may recur in due course of time. In addition ifthe Shamana drugs are administered after taking the proper course of Shodhana then it providesadditional relief and thus helps in eradicating the diseases completely. Vamana Karma is firstmeasure amongst Panchakarma and has been considered as the best line of treatment for theKapha disorders. Following points show the importance of Vamana amongst the other measuresof Panchakarma. • The first act is emesis, which is performed immediately after birth, for elimination of Garbhodaka. Charaka, Sushruta and Vagbhata have advised to use the mixture of Ghrita and Rock salt for this purpose • Acharyas mentioned the upper part of body as a Kapha Sthana. This portion contains major vital parts of body like lungs, brain, pituitary gland, eyes, thyroid gland etc. In the diseases of the Urdhvabhaga (Kapha Sthana) which are related to above organs, Vamana Karma is the main treatment. • It has been mentioned that Virechana therapy should be preceded by Vamana Karma; otherwise the prevailing Kapha Dosha by involving Graham may produce complications.Vamana procedure Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  40. 40. Conceptual Study 21 Generally any measure of Shodhana therapy cannot be under taken directly withoutpreparing the patient. Vamana is somewhat strainful process to the patient and may causecomplications also (if not performed properly). Therefore it is necessary that all the aspectsshould be taken into consideration before performing this Karma. Shodhana therapy is generallyapplied mostly in chronic diseases where vitiated Doshas are at their higher level & whereShamana drugs may not have significant role. In this situation we have to take care at every stepof treatment and procedure. Some processes should be done before treatment as Poorvakarmaand some are after treatment as "paschat Karma. Following points require consideration in thisregard.Purvakarma A. Sambhara Sangraha B. Selection and examination of the patient C. Snehana and Svedana D. Dietic regimen before Vamana Karma E. ManasopacharaA. Sambhara Sangraha It is necessary to collect all the required equipment; drugs, articles etc. well in advance,so that Vamana Karma may be performed safely and if any complication arises during thetherapy, then it can be treated immediately. Patient should always be hospitalized for VamanaKarma.Upakalpaneeyam:132 Acharya Caraka in Upakalpaneeya chapter is explaining about the collection of necessaryequipments before going for the Pancha karma chikitsa for the purpose of smooth and easypractice. Following points has to be incorporate before going for the Vamana karma.Vamana room: In Upakalpaneeya context treatment room is also explained. It should be constructed accordingto Vasthu shastra. Gangadhara also elaborate this point on his commentary. • Dridham: the room should be constricted firmly. Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  41. 41. Conceptual Study 22 • Nivatham Pravathamekadesham: the room should not be affected with much air. So the outlet of air should be only through one way. • Sukha pravicharam: the room should be spacious that one can carry out the activities comfortably. • Anupapatyakam: it should be away from other building i.e. it has to be placed in a comfortable area devoid of any disturbances. • Dhuma athapa rajasam Anabhigamneeyam: it should be protected from external dust, air, light and disturbing sound.Equipments: • Vamana Peedam: Caraka explains Vamana Peetha should have the height of knee joint (janu thulya samam). It must have arms and capable to relax the patient when they are debilitated.(Asamkeernam). • Equipments like vessels for the collection of vomitus. For storage of drug, etc has to be made available.Drugs: • Drugs used for Vamana, Akanthapana, and Vamanopaga. Drugs for the management of complication are also made available priory. • Stalk of eranta or Kamalanala for the purpose of induction of Vamana.Foods: • It necessary that diet articles starting from Pachan Deepana to Smasrjana Karma has to be collected priory.Other rooms: Also Caraka suggesting that to attach a Shouchalaya and Mahanasa (toilet andkitchen) to treatment room. Which are the primary things for the conduction of the procedure.Present day: For the present day practice of Vamana it is better to incorporate assessment ofvital data, so it is better to keep Sphygmomanometer and Stethoscope. For the purpose ofinduction of Vamana can be taken the help of Red rubber catheter. 133Dravyas for Akantapaana: Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  42. 42. Conceptual Study 23 Arunadatta comments that administration of Akantapana should be based on the assessment of the diseases. Further says, patients who are having fear for Vamana, less strength, increased age, very young age etc has to be administered Akanthapana of Yusha, Ikshurasa, Ksheera, Mamsarasa, Madhya, Tushodaka, Yavaagu, Manda. Medicines for Vamana karma: 1.Vamaka Aushadhi 2.Vamanopaga Aoushadhi Vamaka Aushadhi:134 Table No.5 Madana phala (Catunaregum spinosa) Jeemuthaka (Luffa echinata) Ishwaku (Lagenarea leucantha) Dhamargava (Luffa aegyptioca) Kutaja (Holarrhena antidysentrica) Krita vedana (Luffa acutangula) Caraka narrate above-mentioned vamaka Aushadhies. Based on these six drugs Caraka has explained 355 formulations in Kalpa stahna. It can be administered in different forms like Kashayas, Ksheera, Ghritha, Phanita, and Churna etc. Table No. 6 Vamana Kalpa according to Caraka:Type of Madana Krita Jeemutaka Ikshwaku Dhamargav KutajaFormulation Phala VedhanaKashaya 9 19 9 20 9 22Matra 8 8 8 - - -Ksheera 4 6 8 4 - 4Ghrita 1 1 1 1 - 1Phanita 1 - - - - -Churna 1 - - - 5 -Ghreya 1 - 1 - - 1Varti 6 - - - - 6 Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  43. 43. Conceptual Study 24Leha 20 - 5 10 - 8Modaka 20 - - - - -Utkarika 20 - - - - -Shadava 10 - - - - -Sashkuli 16 - - - - -Apupa 16 - - - - -Suramanda - 1 1 1 - 1Swarasa - 4 - - - -Dadhimastu - - 1 - - -Takra - - 1 - - -Palala - - 1 - - -Taila - - 1 - - -Vardhamana - - 6 - - -Mandha - - 1 - - -Mamsarasa - - 1 - - 7Pallava - - - 9 - -Sakridrasa - - - 12 - -Kalka - - - 1 - -Anna - - - 1 - -Salila - - - - 3 -Krisara - - - - 1 -Picha - - - - - 10Ikshurasa - - - - - 1Total 133 39 45 60 18 60 Dosage: For Madanaphala churna Caraka explained, as “Antarnakha Musthi”135 i.e. when the medicine is kept inside the fist and firmly closed and the nail should not expose out. This much Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  44. 44. Conceptual Study 25has to be considered as the dose. It can be considered or standardized as 5 gms.While explainingthe dosage for Madanaphala Kashaya, Caraka explains that Samshodhana dosage has to be fixed“ Pratipurusha Apekshitavyani ”136 so Acharya indirectly objects the pre fixed dose forShodhana. Chakrapani comments on it as disease, status of Agni and Strength of the patient hasto be assessed before deciding the dosage of Vamana drugs. Chanranandana used to incorporatestatus of the kostha before deciding the dosage which is given as follows, Table No.7 Koshtha sthiti and Dose: Kostha sthithi Dosage Mridu kostha Lesser dosage Madhyama kostha Medium Krura kostha High dosage Table No.8 Dosage of emitics according to Sharangadhara:137 Formulation Utama matra Madhyama matra Kaniyasi matra Kwatha 9 Prastha 6 Prastha 3 Prastha Kalka Avaleha 3Pala 2 Pala 1Pala Churna Table No.9 According to Bhela the dosage is as follows:138 Individual status Dosage Young age, Good strength, affected by poison, Skin disorder, Shwasa Uttama Disease in moderate stage with moderate strength Madhyama Disease having involvement of minimum morbidity of doshas and lesser Avara strengthVAMANOPAGA AUSHADHI:139 Vamanopaga drugs are supportive drugs which helps in easy vomiting by generating theVegas Vamanopaga drugs explained are Yasthimadhu, Karbudara, Nipa, Vidula, Bimbi, Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  45. 45. Conceptual Study 26Shanapupshi, Sadapushpi and Pratyakpushpi. Chakrapani advocate to administer Vamana drugs,then go for the Vamanopaga drugs till the Antiki features appear.DEEPANA AND PACHANA: Pachana and Deepana is the prime step before the practise of any Shodhana. AacharyaVagbhata is giving the warning that practise of Shodana in presence of Ama will destroy bodyjust like extracting the juice from an unripened fruit. Sharangdhara explains Deepana is the process of Augmentation of Agni where as Pachanawill helps in the digestion of Ama140. Pachana has to be done till the Niarma lakshnas areobtaind. Augmented Agni has to be tested by digestive power (Agnim Jarana Shaktya ).B. Selection and Examination of the patientCharaka States that, the difference in the variation of humeral discordance, drug, place, time,strength, body, food homologation, mind, constitution and age are so minute that they baffle theunderstanding of even those whose intellect is clear and broad. Patient should be examinedthoroughly. First of all it should be decided that the patient is fit for Vamana Karma or notindicated as a Vamya or Avamya by Acharyas. The patient should be examined by Ashtavidhaand Dashavidha Pariksha141 followed by abdomen examination, respiratory system examination,cardiovascular system examination, central nervous system examination and special examinationof disease for which Vamana is being done. Pulse, blood pressure, temperature and respiratoryrate are also to be monitored as Vital Data. The tests like; pathological, E.C.G. etc. should beused for excluding the disease where Vamana is contraindicated. If the patient is not examinedfully and some points are missed in relation of the patients then complications may occur duringor after performing the Vamana Karma.SNEHANA AND SWEDANA: Snehana and Swedana are the purvakarma, which is a mandatory step before going for theVamana and Virechana.It will be harm full for the body if one who practice “Shodhana therapy”without theses Poorva karma. Caraka compared this with just bending a piece of dry wooden rod.Abhyantara Snehapana: Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  46. 46. Conceptual Study 27 According to Chakrapani, Snehana should be considered as Snehapana and Abhyanga.142Snehapana should be administered till Samyak Snigdha Lakshanas are obtained. The aim ofAbhyantara Snehapana therapy is to prepare the body for Shodhana Karma i.e. the Doshassituated in Shakha are to be brought down to Kostha, so that they can be easily expelled out.Charaka gives simile that as content from a container smeared with oil, easily separate withoutany effort; similarly Doshas are easily expelled out from the Snigdha body.Sneha Prakarsha kala: Shodhananga Snehapana is a process of administering Doshotkleshana within a speceificnumber of days. Acharya Caraka mentioned that 3,5,7 days are required for attain ‘SamyakSnigdha Lakshanas’ in Mridu, Madhyama, and Krura Kostha respectively.143But Dalhana is quoting an anonymus reference for the prakarasha kala that is as follows: Table No.10 Sneha Prakarsha Kala:144 Mridikostha Madhyama kostha Krura kostha Mrudutama-1day Madhyatama-4days Kruratama-9days Mrudutara-2days Madyatara-5days Kruratara- 8days Marudu-3days Madhyama-6days Krura-7days Bhoja opines that person having Kaphaja Pittaja and Vataja Prakriti needs 3, 5and7days Snehapana respectively. On the other hand Vagbhata emphasizes that ShodhanangaSnehapana should be continued till Samyak Sningdha Lakshanas are obtained irrespective of anytime limit.If Shodhananga Snehapana continued more than 7 days Sneha becomes Satmya andfail to produce Doshotklesha. Chakrapani opines that if the dose of Sneha administered less thenit will fail to produce desired effect in 7days.In such cases is there should be a small gap after the7th day.Snehapana - Methodology: Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
  47. 47. Conceptual Study 28A) Matra Anusara Snehapana- Arohana Snehapana:145b) Pravicharana Sneha- Sadhya Sneha146Matra Anuasara Sneha pana is not as such mentioned in anywhere in Samhitas. Acharya Charakadescribes, three doses of Snehapana i.e. Maximum (Pradhana), Moderate (Madhyama) andMinimum (Hrasva). Moderate dose has been prescribed .for Shodhana therapy because itconducts to oleation with ease. Sushruta mentions Madhyama matra which is digested in twelvehours (Ardha Divas). Vagbhata has same opinion. This Madhyama Matra may be given on thelast day of Snehapana because Sushruta mentions that, the first dose should be adjusted as perAgni otherwise it creates many complications. Vagbhata described Hrasiyasi matra (Test dose)which is digested with in the time limit of Hrasva matra. Increasing dose schedule of Snehapanais not described in any of Bhrihatatrayi. In Kalyankara (6th A.D.)145, it was clearly mentionedthat Sodhnartha Abhyantara Snehapana is to be given in increasing dose only. The Vangasena(9th A.D.) also recognizes Vardhmana matra. This Vardhmana Krama is practically used forSnehapana.Rules of Snehapana: Sneha should be taken in early morning hours when the diet taken on theprevious night will be completely digested and there should not be sensation of appetite. AcahryaSushrutha elobarate the exact time of Snehapana in the morning hours as “ Udaya Giri ShikharaSamsthithe Praptha Kanaka Nikara Peeta Lohite”147 that is during the day break when goldenyellow red colour appears on the sky. Caraka explaining that when Sneha taken in the earlymorning hours it is capable to produce Uthklesha in the body.Anupana:Anupana should be given along with sneha. It helps in easy digestion and proper assimilation andinstant diffusion of the sneha taken. A specific Anupana mentioned in the Samhitas are, Table No.11 Anupanas of Sneha:148,149 SNEHA ANUPANA For all Sneha except Tuvaraka and Bhallataka Ushnodaka taila Taila Yusha Vasa and Majja Manda For bhallataka and tuvaraka taila Sheeta jala Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata

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