षडङ्ग.यूष

Ingredients
1. कर्कारु
2. यव
3. कुलत्थ
4. शुण्ठी
5. दाड़िम
6. आमलकी
7.आज मांसरस

Method of preparation :-
1 part of ingredients from 1 - 6 (Ingredients from 1 -6 should take in equal quantity.)

8 part of Goat's Meat

8 parts (to all the mixture ) of water  . Boil well , reduce to 1/4 th ; add topping of plain ghee / suitable to the disease.

Indication:-
शोष , पीनस

Reference :-
रावण संहिता

त्रयो दशांग पानीय

Ingredients
1.धान्यक
2. पिप्पली
3. शुण्ठी
4. दशमूल

Paneeya is made and used for pana

Indication :-
पार्श्वशूल , ज्वर, श्वास ,पीनस .

Reference :
रावण संहिता

VAMANA

ETYMOLOGY OF VAMANA:

According to Vachaspatyam the word "Vamana" is derived as follows:

Vam - Udgare yakset avamit vamana Vamane lyut (Pullinga) mardane - chardane - nihsarane cha svargabhisyanda vamanam kumarh. Ahrtau (Visva) vamathu vam - Athucha. The word "vama" is used to denote Udgara. According to Monnier William Vama means ejection, spitting out, vomiting, giving out, emitting, saliva, belching, sound, roaring, echo, flowing out, issuing out etc.,

The word "vamati" is derived from the root 'Vama' which means the act of vomiting. The word "Vamana" is formed from the 'vama' Dhatu by adding the ‘Lyut’ Pratyaya and belongs to Masculine gender of which four meanings are given in Vachaspatyam. These are Mardane, chardane, nihsarane and svargabhisyand, and Vamana.

According to Monnier William it means the cotton shrub, the act of vomiting or ejecting from mouth, emission, causing vomiting, offering, oblation to fire & pain or paining.  Vaidyaka Kalpa Sindhu says Vamana means Urdhvamukha Doshaharana. Vama is Udgirana by Amara Kosha. It is obvious from the foregoing that the word vama - vamana - vamathu - vami means the act of vomiting.

1. Mardane - derived from the root “mrd” = Curnanam, Samvāhanam = Forceful expulsion

2. Chardane- derived from the root “chard” = Vamane = Vomiting

3. Āhṛtau- derived from the root “ahru” = Forceful Extraction

4. Niḥsāraṇe- 'niḥ' (out or away from) +‟sāraṇa” (running) = running away from expulsion or evacuation.

5. Sargābhiṣyandavamanaṃ – sarga = gati, gamanam

Abhiṣyand = oozing, flowing, running at, Retching

Synonyms:

The word Vamana having synonyms of vama, vamana, vami, vamathu, ullekhana, udgirana, urdhvamukha doṣaharaṇa.

Definition:

                       

.                       Tatra doṣaharaṇām ūrdhvabhāgaṃ vamana sajñyakam. [ca.ka.1/4]

The process of expulsion of doṣas through ūrdhvabhāga is called as vamana.

                    Apakva pitta śleṣmāṇāṃ balād ūrdhvaṃ nayetu yat.

                     Vamanam taddhi vijñeyaṃ madanasyaphalaṃ yathā. [śā.pū.4/8]

Vamana may be defined as forceful expulsion of apakva pitta- kapha through mouth as caused by Madanaphala.

The above definitions conclude following aspects:-

1) Route of expulsion – “ūrdhva”- refers to mouth.

2) Way of expulsion –“balāt”- prabhāva sūcaka – forceful expulsion

3) Doṣa expelled – kapha / kapha-pitta

4) Phase of the doṣa- apakva avasthā- It is of two types; pitta apakva avasthā and kapha apakva avasthā.

Pitta apakva avasthā This refers to vidagdha avasthā where pitta attains amlī bhāva and such a pitta leads to symptoms like tikta - amlodgāra leading to vidagdhājīrṇa and vamana is the vyādhi pratyanīka cikitsā in case of vidagdhājīrṇa. Even in case of Amlapitta the Uṣṇa and amlaguṇa of pitta is increased because of Vidagdha avasthā (mā.ni.II/51.1). Kapha apakva avasthā- This mainly refers to kaphotkliṣṭa avasthā. Features like hṛllāsa, praséka, gaurava, hṛtpīḍā, etc. and utkliṣṭa kapha are the essential factors in case of Vamana.

5) Fate of the drug According to Āḍhamalla, apakva specifies to the fate of the drug. The drug produces Vamana by its vyavāyī, vikāsī and prabhāva guṇa. Before the drug gets digested it will be expelled out. So muhūrta is the kālāvadhi for vamana, on delay it may lead to complications.

6) Phase of Doṣa and Anna: As per the gūḍārthadīpika commentary vamana helps to expel the apakva pitta, kapha and anna.

PLACEMENT OF VAMANA KARMA:

        Catuṣ prakāra saṃśuddhi  ca su 22/8

        Śodhanaṃ śamanaṃ ceti dvidhā tatrāpi langhanaṃ A H su 14/4

According to Acharya Carakā, vamana is in the ten types of langhana.

Vāgbhatta includes Vamana in panchavidha śodhana

BENEFITS OF VAMANA KARMA:

Vamanaṃ śleṣma harāṇām – ca su 25/40

(1) Vamana Karma, the first measure amongst Pancakarma has been considered                as the best line of treatment for Kaphaja disorders.

(2) Suṣrutā asserts that just like the flower, fruits and branches, which are destroyed at once as soon as the mother tree is rooted out, the diseases originated due to excessive Kapha are subdued after the elimination of Kapha through the process of Vamana.

(3) A person who undergoes timely Vamana Karma will be prevented by following diseases like Kāsa (cough), Upalepa (stickiness in the throat),Swarabheda (hoarseness of voice), Atinidrā (sleepiness), Tandrā, Āsya-daurgandhya (foul smell in mouth), Kapha Praséka, Viṣa Upasarga (afflictions produced because of toxins) and Grahani Doṣa.

DOṢIKA FIELD OF VAMANA KARMA:

upasthite śleṣma pitte vyādhi āmaśyaśraye

Vamanartham prayunjītam bhishak dehamadushayan (cha su 2/8 

Vamana Karma should be conducted when Kapha and Pitta become Utkliṣṭa and  comes in Āmāṣaya which is the main site of Kapha.

According to Vāgbhatta, Vamana is indicated in the disorder of Kapha and in the dominancy of Kapha-Pitta and Kapha-Vata Vikārā, in the following conditions as:

ü  Excessive increase in the levels of Kapha.

ü  Aggravation of Kapha in its own sites.

ü  Kapha combined with Pitta or Vata, which is present in a small proportion.

ü  Vata or Pitta invading the sites of Kapha.

Thus, the indications for Vamana Karma are wide, because it can be applied in the above mentioned Doṣik condition present in any type of disease.

Vamana as Ādyopakrama: “Pūrvaṃ vamana vidhiṃ ācaṣte” among the śodhana karma, vamana stands first because sthānāsthita doṣa has to be cleansed accordingly i.e. āmāṣaya sthita kapha / kapha pitta doṣas. Any change will lead to complication. “Hṛta kaphasyāhi samyak virikto bhavati” therefore āmāṣaya sthita kapha has to be expelled first and thereby the other doṣas.

VAMANA VIDHI:

The Vamana methodology can be divided under 3 main headings

ü Pūrvakarma (Pre Vamana Procedure)

ü Pradhānakarma (Vamana Procedure)

ü Paścātkarma (Post Vamana Management)

Pūrvakarma (Pre Vamana Procedure)- Before starting any of the śodhana procedure the basic requirements must be made available. During the crucial situation one should not search for these things. So pūrvakarma is the foundation for the entire procedure.¹⁴² It can be studied under the following headings:

a) Basic requirements

Vamana Theatre setup- The room should be auspicious, spacious, with attached toilet, it should be built by consulting the architect and it should be strong, it should be protected from external dust, air, light and disturbing sounds.

Utencils - Pātra (vessel), ācamanīya (spoon), Udakoṣṭa (water tub), mānika and ghaṭa (Big and small earthen pot), piṭara (frying pan), prayoga (boiling pan), kuṃbhī kuṃbha (small and big pitchers), kunda (bowl), śarāva (saucer), dārvi (ladle), paripācana (cooking pan), carmacīla (leather), sūtraka (thread), kārpāsa (cloth).

Paricāraka- To perform abhyaṅga, snāna and assist during the pradhāna karma.

b) Medicine requirements

They are mainly divided into three main sections

A] Vāmaka Drugs:  Produces or initiates the act of vomiting.E.g. Madanaphala, Jīmutaka etc.

Posology of Vāmaka drugs:

Factors to be considered before Dose fixation and its importance:

 The physician has to assess the factors of doṣa, dūṣya, bala, kāla etc ten factors before fixing the dose. Suśruta states that only vyādhibala, agnibala and puruṣabala has to be considered before dose fixation (Su.sū.40/10). Considering different pathological conditions and other factors like vaya, bala one has to formulate the Yoga and fix the dose, any miscalculation may lead to complication leading to death.

Subjective Parameter for Dose fixation

“Phalapippalīnām antarnakha muṣṭi pramāṇam”

i.e the quantity of madana pippli which can be held in the fist of the patient undergoing Vamana is said to be the correct dose for him.

Objective parameters for dose fixation

i. Posology on the basis of Formulation

Formulation / Dosage	Maximum	Moderate	Minimum
Kvātha	9 Prastha	6 Prastha	3 Prastha
Kalka	3 Pala	2 Pala	1 Pala
Cūrṇa	3 Pala	2 Pala	1 Pala
Lehya	3 Pala	2 Pala	1 Pala

ii. Posology on the basis of Diseases/ Age / Strength

Dose	Disease /Age / Strength
Maximum dose	Viṣa, Kuṣṭa, Kāsa, Śvāsa, Taruṇāvastha, Balavanta
Moderate dose	Madhyama Prāṇa vayasī
Minimum dose	Alpa prāṇa (prāṇa refers to Śārīra bala and satva bala) and vṛddha

iii. Posology on the basis of Koṣṭa¹⁶³

Koṣṭa Sthiti	Dose of Medicine
Mṛdu	Less
Madhyama	Medium
Krūra	Large

B] Vamanopaga Drugs:

They are the supportive drugs to enhance and make easy the process of vomiting.They help to minimize the complication, which may arise during, Vamana.e.g. Yastimadhu phanta, Ikṣu rasa etc.

C] Ākaṇṭapāna dravya

Generally Kṣīra / Maṇḍa / Īkṣurasa / Māṃsarasa / Dadhi /Takra / Tuṣodaka are selected, specifically in case of bāla, vṛddha, abala, klība, and bhīru personalities Niranna snigdha yavāgu or maṇḍa should be given for ākaṇṭapāna. Importance of ākaṇṭapāna: (Bhe.si.1/1) Administration of medicine in empty stomach will lead to vāta prakopa and plīha etc internal organs will be dislodged from its place leading to immediate death.

c) Examination of Patient

General examination:

 “Samīkṣya doṣa auṣada deśa kāla sātmya agni satvādi vayobalāni.

  Basti prayukta niyataṃ guṇāya syāt sarvakarmāṇi ca siddhimanti.” [ca.si.3/6]

All the above factors need to be examined before any Śodhana procedure can be administered.

Specific examination –

Depending upon the stage of disease, Doṣa Avasthā, Roga Mārga etc, either Sneha Pūrva Vamana Karma is followed or Asneha Pūrva Vamana.

If Sneha Pūrva Vamana is done the following are the steps-

 Koṣṭa parīkṣa has to be done twice during Vamana karma.

i. Before snehapāna- On the basis of doṣa predominance

ii. Just before Vamana administration - Specific for Kapha predominance

d) Preparation of the Patient

Pācana and Dīpana: Prior to sneha pana and śodhana cikitsa the doṣa should be in the form of nirāma avasthā. So conversion of sāma to nirāma avasthā is done by prescribing pācana drugs.

Snehana and Svedana

The hidden doṣa which is devoid of sāma condition has to be increased qualitatively / quantitatively and bought to the koṣṭa then only śodhana has to be administered and these are brought by Snehana and Svedana.

Snehana Method:

a) Ābhyantara Snehapāna

b) Sneha mātra

c) Ārohaṇa Vidhāna.

a) Ābhyantara Snehapāna

Koṣṭa	Mṛdu	Madhyama	Krūra
Days	3	5	7

                 

b) Sneha mātra

For the śodhana either 12hrs/ 9hrs digested must be given. The dose must be fixed after administering the Hṛsīyasi mātra.

c) Ārohaṇa Vidhāna

Ārohaṇa Snehapāna vidhāna can be defined as administration of sneha in the increment dosage. A clear reference of ārohaṇa snehapāna is available in Kalyāṇakāraka, where he has quoted that the individual should drink ghṛta or taila in the increment dosage for 3, 5 or 7 days. Ārohaṇa method is mentioned by Vaṅgasena also.

Svedana method

“Snigdhāyadeyaṃ vamanam” here snigdha refers to bāhya snehana and svedana.

After snehapāna one day break should be given and Bāhya snehana svedana is done on gap day and next day just- before Vamana is to be done.

e) Diet and regimen during Pūrvakarma.

There are two specific diet prescriptions during Vamana Karma, they are:-

i) Diet during snehapāna.

ii) Diet on the previous day of vamana karma

i) Diet during snehapāna

 Repeated intake of uṣṇa udaka till sneha jīrna takes place. After the sneha jīrṇa, maṇḍa has to be consumed or any other drava, uṣṇa, alpasnigdha, anabhiṣyandi āhāra has to be consumed.

ii) Diet on the previous day of vamana karma

Ācaryas have advised to consume “Kapha Utkleśakara āhāra” on the previous day of Vamana. It is the only one context were “samaśana” is mentioned

Food articles described by different texts:

i) Grāmya, Ānūpa and Audaka māṃsa

ii) Kṣīra and Dadhi

iii) Māṣa, śākadidrava āhāra, Tila kalka.

According to Suśruta, dadhi and māṣa are considered as mahābhiṣyandi. Here utkleśa refers to quantitative increase of Kapha doṣa in the gastrium, leading to symptoms like Kapha Niṣṭhīvana, Hṛllāsa etc. It is a clear reference that these food articles won’t aggravate the disease entity by increasing Kapha in systemic level rather they increase Kapha only in the gastrium and thereby facilitate Vamana.

If Asneha Pūrva Vamana is done the following are the steps-

 When Kapha Doṣa is in Utkliṣṭa stage, Vamana is performed without giving Snehapana. It gives instant relief to the patient.

Such Vamana can be performed in many conditions, eg- Kaphaja Jvara with Kapha Utkleśa lakṣaṇas, Śvāsa roga, Atisāra, Amla-Pitta, Viṣa, etc.

All the examination procedures and Koṣṭa parikśa is done as described earlier. Procedures of Pūrvakarma, Pradhānakarama and Paścātkarma are the same as described previously. Only difference is that no sneha pana is done during the Pūrva Karma.

Preparation of the Patient

   (i) Diet on the previous day of vamana karma

Ācaryas have advised to consume “Kapha Utkleśakara āhāra” on the previous day of Vamana.

Pradhāna Karma (Procedure of Vamana)

“Samyak prayoga nimittāḥ hi sarva karmāṇāṃ siddhiriṣṭā.” [ca.sū.15/4]

This is the most significant aspect of the entire procedure. All the four limbs of the treatment i.e. Vaidya, Bheṣaja, Paricāraka and Ātura have to actively participate during this phase. Each and every aspect that has to be followed during this phase of the treatment has been elaborately explained in our texts. The time specified for the procedure is Pūrvāhna “Pūrvāhne śleṣma vṛddhi kāle prathama yāma eva” i.e. 1st yāma of the day is the ideal time for Vamana. This phase can be studied under following headings:

1) Preparation of the patient

2) Administration of Medicine

3) Events during the procedure

4) Management during Vamana

5) Assessment criteria of Vamana

1) Preparation of the patient

Evacuation of bowel: “Suprajīrṇa bhakta”- Proper digestion of food and evacuating of the urges.

Bāhya snehana and svedana: “Snigdhāya deyaṃ vamanam”[Ca.si.1/10] here snigdha refers to abhyañga and svedana followed by śirasnāna on the day just before the Vamana.

Cosmetic aspect: In the form of Gatrānulepana, śubhravastra dhāraṇa.

 Psychological support: Ānūpahata mana- Free from fear complex, devatārcaṇa, maṅgala and svasthi vācanā at an auspicious muhūrta, mantrābhi mantraṇa to medicine and mantra during the consumption of the auṣadha.

Posture during the procedure: “Jānu sama tulya asaṃkīrṇa āsana” Vamana seat (vamana pīṭa) should have a height upto the level of knee joint and it must be comfortable. He may be covered with a clean cloth so that the clothes may not get spoiled by the vomitus.

Examination of the patient: Vāghbhaṭa specifies that just before the administration of the medicine, again koṣṭa has to be assessed (vamane koṣṭasya bodhavyam).

Aruṇadutta states –

Excessive Śleṣma – Mṛdu koṣṭa

Moderate Śleṣma – Madhyama koṣṭa

 Mild Śleṣma – Krūra koṣṭa.

Accordingly dose has to be fixed.

2) Administration of Medicine

Administration of Ākaṇṭhapāna:  Vāghbhaṭa specifies that loading dose of liquid food articles must be given just before the administration of medicine. Generally Kṣīra / Dadhi / Madya / Īkṣurasa / Māṃsarasa / Takra / Tuṣodaka are selected. Specifically in case of bāla, vṛddha, abala, klība, bhīru personalities’ niranna snigdha yavāgu or maṇḍa should be given for ākaṇṭhapāna.

Administration of Vāmaka Yoga:

Generally, the Yoga is selected according to the disease. According to Caraka, vāmaka drug is used in the liquid media.

Madhu and saindhava in Vāmaka yoga: Caraka clearly mentions that whatever may be the vāmaka yoga it has to be mixed with Madhu and saindhava. Mixing the madhu with lukewarm vāmaka yogas will not cause any toxicity because the drug will be expelled out immediately. Madhu is known for the Kapha chedana and yogavāhi property so adding madhu will facilitate in the Vamana procedure. Lavaṇa is known for its viṣyanda nature, meaning liquefaction and expulsion therefore, adding lavaṇa will increase the volume and force of expulsion. Thus Madhu and Lavaṇa are having adjuvant action with Vāmaka drug.

Administration of Vamanopaga dravya

“Bheṣajam vamanārthīnāṃ prāyaḥ āpitta darśanāt” Medicine in the form of Vamanopaga kaṣāya should be give to the patient repeatedly until the expulsion of Pitta is seen.

3) Events during the procedure

“Pītavantaṃ tu kālenaṃ muhūrtaṃ anukāṃkṣayet” There are two schools of thoughts regarding the word “anukāṃkṣayet”;

i. After the administration of the medicine the physician has to wait for a period of one muhūrta and later Vamana has to be carried out.

ii. After the administration of the medicine Vamana has to be completed within a span of one muhūrta.

Among these two the 2nd school of thought seems to be more practical because after the administration of the medicine specifically in liquid form the bouts will be started immediately and Pittānta will be seen within one muhūrta. During this span of period physician has to observe for certain specific symptoms which are suggestive of physiological stages during Vamana. The whole concept is based on Anumāna pramāṇa.

Symptoms during Vamana

Symptoms	Physiological stage during Vamana
Sveda- profuse sweating	doṣa pravilāyana- Liquefaction
Lomaharṣa - Horripulation.	sthanebhyaḥ pracalita - Dislodging
Ādhmāna – Abdominal discomfort	kukṣi anugata – Entry towards the gut
Hṛllāsa āsyaśrava ṇa- Nauseating sensation.	ūrdhvamukhī bhūta – Premonitory sign before vomiting.
Hṛdayopamarda- discomfort in chest	Ūrdhvamukhī bhūta – Premonitory sign before vomiting.

4) Management during Vamana

It mainly consists of two aspects

1. Convincing the Patient

2. Manipulating the Patient

Convincing the Patient-

“Suhṛdo anumataḥ” physician has to convince the patient regarding his cooperation during the procedure. “Apatra paniyāḥ - Alajja viṣaya” the patient should not hesitate during the procedure. The patient should be asked to flex his trunk, head and neck forwards. Vomiting without flexing head leads to pain in pṛṣṭa and hṛdaya, vomiting with over flexed head leads to pain in koṣṭa, vomiting with laterally flexed head leads to pain in pārśva, koṣṭa, hṛdaya and jatru.

Manipulating the Patient:

Paricāraka has to do following things:-

Lalāṭa pratigrahe: When patient bend forwards to vomit, his forehead has to be held.

Pṛṣṭa pārṣva kaṇṭopagrahaṇe: The flanks and neck has to be supported.

Nābhi prapīḍana: This will increase the intra abdominal pressure and facilitate Vamana.

Pṛṣṭa Unmardana: Aruṇadutta says massage from sacral junction towards the upward direction.

Efforts for Vega pravartana^{205, 206, 207}: Vyāyāma is the word quoted by Caraka for the effort made to facilitate Vamana.

Efforts for vega pravartana

Efforts for Pravarta vegas	Efforts for Apravarta vegas
"Pravartayan pravṛttacśca" Pravarta vegas has to be facilitated by bending the head and trunk forwards.	Stimulating the Kaṇṭha/ Gala/ Tālu with the help of 2 fingers or with the Nala (Soft pipe like structures) of Kumuda/ Utpala/ Saugandhika puṣpa

5. Assessment criteria of Vamana:

The outcome of the vamana procedure is in the form of either samyak yoga or ayoga or atīyoga, all the three outcomes are dependent on vegas produced during the procedure.

“Vega viśeṣa darśaṇāddhi kuśalo yoga atīyoga ayoga viśeṣaṃ upalabhyate”. So the clever physician has to concentrate more on Vega assessment. Samyak yoga, Ayoga and Atīyoga are assessed under two headings on the basis of features of Vega and symptomatology.

I .General Assesssment

II. Specific Assesment

I General Assessment of Samyak yoga, Ayoga and Atīyoga

Samyak yoga				Ayoga				Atīyoga
	C	S	V		C	S	V		C	S	V
Kāle Pravṛtti	+	-	+	Apravṛtti	+	-	+	Atī pravṛtti	+	-	-
Anatimahativyatha	+	-	+	Auṣadha Pravṛtti	+	-	+	Phenila Vamana	+	-	+
Yathākramadoṣaharaṇa	+	+	+	Vega Vibandha	+	-	+	Rakta yukta	+	-	+
Svayam Avasthāna	+	+	+	Pratiloma pravruti	+	-	-	Candrikāyukta	+	-	+
Samyak Pravṛtti	+	-	-	Alpa Pravṛtti	+	-	-	Pittāti yoga	-	+	-

Specific Assessment of Samyak yoga, Ayoga and Atīyoga

Samyak yoga

Ayoga

Atīyoga

C

S

V

C

S

V

C

S

V

Hṛdaya śuddhi

+

+

+

Hṛdaya Aviśuddhi

+

+

+

Nidrā hāni

+

-

-

Pārṣva śuddhi

+

-

-

Srota Aviśuddhi

+

-

-

Bala hāni

+

-

+

Mūrdha śuddhi

+

+

-

Kapha Praseka

+

+

+

Hṛt pīḍa

-

+

-

Śroto śuddhi

+

-

-

Jvara

-

+

+

Kaṇṭha pīḍa

-

+

+

Indriya śuddhi

+

-

-

Kaṇḍu

+

+

+

Tṛṣa

+

-

+

Kaṇṭha śuddhi

-

+

-

Guru Gātrata

+

-

-

Dāha

-

+

+

Kapha saṃśrāva

-

+

-

Sphoṭa

+

-

-

Vāta Prakopa

+

-

+

Laghuta

+

+

-

Koṭha

+

-

+

Bhrama

-

-

+

Kārśya

+

-

+

-------------

Tamaḥ Praveṣa

-

-

+

Daurbalya

+

-

-

-------------

Moha

+

+

-------------

Mūrchā

+

+

-------------

Mṛtyu

-

-

+

Samyak yoga, Ayoga and Atīyoga can again be assessed under two headings on the basis of clinical manifestation.

A. Immediate manifestations

B. Late manifestations

Immediate manifestations

Samyak yoga	Ayoga	Atīyoga
Kapha saṃśrava	Kapha Praseka	Bala hāni
Kārśya	Jvara	Hṛt pīḍa
Daurbalya	Guru Gātrata	Kaṇṭha pīḍa
		Tṛṣā
		Dāha

Late manifestations

Samyak yoga	Ayoga	Atīyoga
Hṛdaya śuddhi	Hṛdaya Aviśuddhi	Nidrā hāni
Pārṣva śuddhi	Śrotas Aviśuddhi	Vāta Prakopa
Mūrdha śuddhi	Kaṇḍu	Bhrama
Śroto śuddhi	Sphoṭa	Tamaḥ Praveṣa
Indriya śuddhi	Koṭa	Moha
Kaṇṭha śuddhi		Mūrchā
Laghuta		Mṛtyu

Assessment of Śuddhi Lakṣaṇa

Cakrapāṇi contributes that assessment of samyak śuddhi is made fewer than 4 headings viz. Vegikī - Mānikī – Āntikī - Laiṅgikī. All these four may be explained in a chronological whole of the procedure is assessed by laiṅgikī criteria.

Among these - Vegiki and Mānikī are the Quantitative assessment

            - Āntiki and Laiṅgikī are the Qualitative assessment

Śuddhi Lakṣaṇa of Vamana

Vamana	AVARA ŚUDDHI	MADHYAMA ŚUDDHI	PRAVARA ŚUDDHI
Vegikī	4 Vega	6 Vega	8 Vega
Mānikī	1 prastha	1 ½ Prastha	2 prastha
Āntikī	Pittānta	Pittānta	Pittānta
Laiṅgikī	SIGNS OF SYMPTOMS OF SAMYAK VAMANA

Vegikī Śuddhi-

Indu defines vega as the bout collected in a bowl after an effortless expulsion (A.S.S.27/18). The vegikī criteria is nothing but to observe vega (bouts) for its nature, force and speed of expulsion once the medicine is administered immediately after that Hṛllāsa, āsyasrāva etc are observed. So this has to be differentiated and should not consider as Vega. Upavega is one more entity which has to be differentiated from Vega. Upavega means one which is nearer to Vega which can be explained as one which is lesser in every aspect than Vega²¹⁴ Kāśyapa says a author named Koṭha says 2-3 vegas is Kanīyasī śuddhi, 4-5 vegas is Madhyama śuddhi 6-7 vegas is Uttama śuddhi. Mānikī Śuddhi- Voluminous assessment of the vomitus is considered as Mānikī. Caraka while explaining the Hīna , Madhyama and Pravara śuddhi explained that the doṣa expelled in the quantitative manner i.e. 1, 1½ and 2 prasthas respectively. Cakrapāṇi considers them under mānikī parīkṣa. According to him, 1 prastha is equal to13 ½ palas. 1 prastha = 13 1/2 pala (54 tola) 1tola = 12gms, So 54 tola = 648 ml Mānikī Parīkṣa

Mānikī Śuddhi of Mānikī Śuddhi of Vamana

Hīna  śuddhi	648 ml
Madhyama śuddhi	972 ml
Pravara śuddhi	1296 ml

Cakrapāṇi states “Vamanetu Pītam” – It refers to Volume obtained in excesses.

 Āntikī śuddhi

 Āntikī śuddhi refers towards the end stage of vamana. It is one of the important qualitative assessment criteria to stop the procedure. The sequllae of expulsion of doṣa is considered under Mānikī criteria. Bhela includes Rakta in āntikī criteria. Ḍalhaṇa states auṣadha, pitta and anila are expelled accordingly.

Āntikī śuddhi features

Vomitus	Indicative features
Lalā Śrāva	Praseka
Auṣadha	Consumed medicine is expelled
Kapha	Gastric contents are evacuated
Pitta	Criteria to stop Vamana
Udgāra	Refers to Vāta śuddhi

Laiṅgikī criteria- The word laiṅgikī means some signs, symptoms or some symbol. So the lakṣaṇas exhibited after the proper vamana is considered under the laiṅgikī criteria. The laiṅgikī criteria also includes āntikī criteria. Though ācāryas have explained 4 types of śuddhi all gave more importance to laiṅgikī śuddhi, only Cakrapāṇi says both samyak vamana and pittānta feature together comprise “laiṅgikī criteria. Other variety of criteria may change from person to person according his strength, age, body constituent, but laiṅgikī criteria will not change. So it is considered best to assess the samyak yoga.

Paścāt Karma (Post Vamana Management) Vamana paścāt karma may be considered under 2 headings

I. Immediate paścāt karma

II. Later paścāt karma

I. Immediate Paścāt Karma

ü Immediately after the vamana patient has to wash his face, hands and legs.

ü He has to take rest for a period of one muhūrta. Aruṇadutta states cold air should be blown for one muhūrta.

ü Afterwards one is advocated to inhale the smoke from any one of the three types of dhūmapāna i.e. Snaihika (unctuous), Vairecanika or Prāyogika, which will be suitable for him. Ḍalhaṇa specifies that “Śroto Vilagna Kapha” is expelled by Dhūmapāna.

Types of Dhūma

Selection according to Prakṛti	Types of Dhūma
Vāta	Snaihika
Kapha Pitta Prakṛti and utkliṣṭa doṣa	Vairecanika
Samadoṣa Prakṛti, Svastha	Prāyogikam

Again mouth has to be washed

·       Kalyāṇakāraka says Nasya, Gaṇḍūṣa, Netrāñjana has to be done to expel the śirogata kapha

·       Uṣṇa jala snāna/ Pariṣeka is advised by Suśruta.

·       Patient should be shifted to ward (Nivāta āgāram)

II. Later Paścāt Karma- Observing for the śuddhi features will not end the Vamana procedure but the physician has to take care of the “ātura” or "svastha" in several aspects like diet regimen etc.

The Later paścāt karma can analysed under 4 headings:

1. Āhāra

2. Parihāra viṣaya

3. Bṛmhaṇa cikitsā

4. Succeeding śodhana protocol

Āhāra vidhāna after Vamana Āhāra is the only one entity to bring back the homeostasis. It acts as a medicine (bṛmhaṇa) for the śodhita puruṣa. So it is a very specific diet chart in case of post vamana management. Patient may start to take the food on the evening hours or on the next day of Vamana. If he has tīkṣṅāgni then saṃsarjana may be started on the same day or in case mandāgni it should be started from next day. Suśruta states that Kulattha / Mudga / Ödana /Jāṅgala māṃsarasa may be given to the patient on the day of Vamana. According to Ḍalhaṇa anna saṃsarjana should started with,

Doṣa	First āhara after Vamana
Atyanta Kapha	Pèya
Vātabhūyeṣṭa, Dīptāgni	Māṃsa rasa
Alpa Kapha	Yūṣa

Āhara vidhāna can be grouped under 3 headings.

1. Saṃsarjana Krama

2. Rasa saṃsarjana krama

3. Tarpaṇādi krama.

Saṃsarjana Krama Saṃsarjana krama is to be planned, based on the type of purification done by Vamana.

Duration of Saṃsarjana karma

Śuddhi	Days
Avara śuddhi	3 days
Madyama śuddhi	5 days
Pravara śuddhi	7 days

Suśruta keeps an eye over the Bala and Agni of the patient, it is as follows

Anna kāla based on Bala / Agni

Bala / Agni	Anna kāla
Uttama Bala/ Agni	3
Madyma Bala/ Agni	2
Alpa Bala/ Agni	1

Peyādi Saṃsarjana Vidhāna

Days	Annakāla	Pravara Śuddhi	Madhyama Śuddhi	Avara Śuddhi
I day	1 morning	-	-	-
	2 evening	Peya	Peya	Peya
II day	1 morning	Peya	Peya	Vilepi
	2 evening	Peya	Vilepi	Kṛtākṛta Yūṣa
III day	1 morning	Vilepi	Vilepi	Kṛtākṛta māṃsarasa
	2 evening	Vilepi	Akṛta Yūṣa	Normal diet
IV day	1 morning	Vilepi	Kṛta Yūṣa	-
	2 evening	Akṛta Yūṣa	Akṛta Māṃsarasa	-
V day	1 morning	Kṛta Yūṣa	Kṛta Māṃsarasa	-
	2 evening	Kṛta Yūṣa	Normal diet
VI day	1 morning	Akṛta Māṃsarasa	-	-
	2 evening	Kṛta    Māṃsarasa	-	-
VII day	1 morning	Kṛta Māṃsarasa	-	-
	2 evening	Normal diet	-	-

Vāghbhaṭa very specifically says that raktaśāli should be used to prepare Peyādi food articles²³¹ śodhita puruṣa has to strictly avoid viruddha, ajīrṇa, asātmya, akāla, pramita, atī, Hīna , and guru bhojana if consumed may lead to dāruṇa vyādhi.

Rasa saṃsarjana karma- Suśruta opines that even after śodhana there is a chance of vitiation of doṣa because of dīptāgni, in order to prevent that one has to follow rasa saṃsarjana. According to Cakrapāṇi rasa saṃsarjana has to be included in Peyādi saṃsarjana krama but Ḍalhaṇa says it has to be followed after anna saṃsarjana.

So this concept is bifurcated under 2 headings.

Caraka

·        Snigdha amla svādu- Vāta śamana

·        Amla Lavaṇa –Agni Saṃdhūkṣaṇa

·        Svādu Tikta- Pitta praśamanārtham

Suśruta

·        Svādu Tikta– Pitta vāta Jayārtam

·        Agni Samīkaraṇārtam

·        Snigdhāmla lavaṇa kaṭu-Vāta Kapha Jayārtam

·        Agni Saṃdhukṣaṇārtam

Tarpaṇādi karma: Tarpaṇādi krama is a specific diet prescription in case of following conditions. When Kapha, Pitta are eliminated improperly during samśodhana. - In alcoholic patients. - Patient having Vāta Pitta prakṛti. The above-mentioned categories are prone to Abhiṣyanda when peya is advised. According to Cakrapāṇi “Svaccha tarpaṇa” can be served instead of peya and “Ghana tarpaṇa” instead of vilepi. Jejjaṭa says due to similarities, mudga yūṣa and māmsa rasa can be given as tarpaṇa. Commentators of Suśruta and Vāghbhaṭa clearly explain tarpaṇa on the basis of Annakāla

Tarpaṇādi Krama:

Commentators opinion	Annakāla
	I.	II	III
Ḍalhaṇa	Lājā Sakthu	Yūṣa		Bhakta
Aruṇadutta	Lājā Sakthu	Jīrṇa Śāli Ödana		Māṃsarasa + Ödana
Parameśvara	Lājā Sakthu	Yūṣa + Anna		Māṃsarasa + Anna

Parihāra viṣaya in Vamana Karma

Parihāra related to behavioural aspects- Loud speeches, sitting in one position for long duration, standing in one position for long duration, long walks should be avoided, sexual intercourse sleeplessness in the nights, sleeps during day time, to retain strong urge or provocation of the urges- Aṣṭa mahāvarjyakarabhāvas.

Parihāra related to environmental aspects- Exposure to excessive cold or heat or dew, exposure directly to flowing winds, long journey. Parihāra related to psychological aspects- krodha, śoka and cinta.

Bhṛmhaṇa cikitsa

Śodhana cikitsa obviously will lead to doṣa kṣaya as well as dhātu kṣaya avasthā. In order to restore them Bṛmhaṇa cikitsa in 2 specific methods is advised.

Āhāra : Consumption of Ghṛta, Kṣīra, Māṃsarasa, Yūṣa and other hṛdya drugs.

Cikitsa: Abhyaṅga, Utsādana and Anuvāsana basti. Prescription of śamana auṣadha is mentioned by Kalyāṇakāraka.

 Succeeding śodhana protocol-

 There are 3 concepts regarding the time gap between one śodhana to other.

i) Fifteen days gap.

Vamana- I day

Saṃsarjana - Next 7days

Viśrāma- On 8th day (1+7)

Snehapāna-9th 10th 11th day

Svedana-12th 13th 14th day

Virécana-15^th day

ii) On the Basis of Ṛtu Śodhana:

According to Ṛtu śodhana concept Vamana is administered in Vasanta and virecana in Śarat, therefore the gap period will be approximately 120 (minimum) days.

iii) On the Basis of Prakṛti gata Lakṣaṇa: Caraka specifies certain systemic features which are suggestive of normalcy, restored after śodhana viz “Sarvakṣama, asaṃsarga, ratiyukta, sthirendriya, balavān, satvasaṃpanna”. Once these features are observed next śodhana may be planned accordingly. Importance of saṃsarjana:

1)                          Caraka reveals importance by giving example that small sources of fire, if simulated by adding small and light fuel, later on become so big that it can burn anything. Similarly by following saṃsarjana krama Jāṭharāgni can be increased to such an extent that it can digest all types of food.

2)                          To restore the strength of Agni and Prāna, Peyādi saṃsarjana krama should be followed.

3) Saṃsarjana also acts on restoration of bala and agni, gradual habituation of all the rasas and finally to have prākṛta bhojana.

4) Agni is governed by kledaka kapha, pācaka pitta and samāna vāta. This agni will be hampered by expulsion of vitiated kledaka kapha, pācaka pitta during the Vamana karma, hence in order to normalise agni saṃsarjana is mandatory.

5) Agnimāndya caused during Vamana is a physiological and transitory entity, so this has to be corrected by specific āhara vidhāna and not by medicine