Amavata vamana-pk

COMPARATIVE STUDY TO EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY MADHANAPHALA KALKA AND MADHANA

PHALA KSHEERAPAKA IN AMAVATA

BY

Dr. RIYAS K.A. B.A.M.S

Dissertation 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 (Ayu) 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 POST GRADUATE STUDIES IN PANCHAKARMA

S. D. M. COLLEGE OF AYURVEDA, UDUPI 2010 – 2011

Ayurmitra

TAyComprehended

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation thesis entitled “COMPARATIVE STUDY TO

EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY

MADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA IN

AMAVATA” is a bonafide and genuine research work carried out by me under the

guidance 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 of

Panchakarma, S.D.M.C.A, Udupi.

Date: Signature of the Candidate

Place: Udupi Dr. Riyas K.A.


S.D.M.C.A.,Udupi


CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “COMPARATIVE STUDY TO



AMAVATA” is a bonafide research work done by Riyas.K.A” in partial

fulfillment 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 Guide

Place: Udupi. Dr Niranjan Rao M.D (Ayu) GAU Professor Department of Post graduate Studies in Panchakarma S.D.M.C.A. Udupi


ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “COMPARATIVE STUDY TO



AMAVATA” is a bonafide research work done by Riyas.K.A under the guidance

of 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

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of health Sciences,

Bangalore, Karnataka shall have the rights to preserve, use and

disseminate this dissertation in print or electronic format for academic /

research purpose.

Date: Signature of the Candidate

Place: Udupi Dr. Riyas.K.A

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgements

Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and

Madhanaphala Ksheerapaka in Amavata I

ACKNOWLEDGEMENTS

On the occasion of the successful completion of this assigned dissertation work, it is with

deep sense of gratitude to the almighty for providing me smooth and successful completion of

this 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 their

blessings, 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 throughout

study.

I wish to express my sincere thanks to Principal Dr.U.N.Prasad, & Dean of P.G. Studies

Dr.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 thank

Dr 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, which

helped 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 this

thesis work.

I would like to thank all Library staffs for their timely help. I whole heartedly express my

thanks to all the Panchakarma hospital staffs mainly Mr.Ravi, Mr Monthu D’silva, Mr.Jayaram

and 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.

Abbreviations

Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata

II

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

Abbreviations


III

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

Abstract


IV

ABSTRACT Amavata is a pain predominant joint disorder which if not managed in time may prove

crippling. 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 great

treasure. 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 of

movement. Often the joints get exploded due to wide range of causative factors during different

phases 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% of

women may develop Rheumatoid Arthritis in their life time. Around twice as many women as

men are affected. The incidence and prevalence of Rheumatoid Arthritis generally rising with

increasing age until about 70 years and then declines. About 60% of Rheumatoid Arthritis

patients are unable to work 10 years after the onset of their disease. Estimation of life span

shortening in Rheumatoid Arthritis varies from 5 to 10 years. Family history is an important risk

factor. First degree relatives prevalence rate is 2 to 3%.Amavata is a vyadhi having

Bahudoshawastha, where kapha, vata, pitta dosha are predominantly involved. Its udbhavasthana

is amashaya, vyakthastana is sandi. Vamana karma is considered as an ideal treatment for morbid

kapha, its associated condition and in kapha sthanagata doshas. In Amavata mainly kapha sthana

like 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 to

evaluate the efficacy of vamana karma in Amavata.

OBJECTIVE OF THE STUDY :

To evaluate the action of vamana karma in patients of Amavata.

Abstract


V

STUDY DESIGN :

It is a comparative clinical study with pre-test and post-test design where in minimum of

22 patients diagnosed as Amavata of either sex will be selected. All the patients falling in the

inclusion criteria shall be subjected to Vamana karma. Patients were subjected to deepana

pachana with vadavanala choorna 5gms with hot water before food thrice daily till amapachana.

After proper amapachna arohana snehapana with moorchitha gritha was administered till

obtaining samyak snigda lakshans(3-7days). After that they were subjected to abhyanga with

saindhavadi taila followed by bashpa sweda for two days. On the previous day of Vamana

Kaphothkleshakara diet was prescribed. Vamana was induced with Madanphala Yoga. After

Vamana Haridra dhumapana was done and proper assessments were taken. Patients were

subjected to Samsarjana krama based on their shudhi lakshanas. The assessment criteria were

noted before, during and after Samsarjana krama

RESULTS:-

• 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).

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 3 PART 1 CONCEPTUAL STUDY 4 - 66 PART 2 DRUG REVIEW 67 - 87 PART 3 METHODOLOGY 88 - 102

PART 4 OBSERVATIONS AND EFFECT OF THERAPIES 103 - 195

PART 5 DISCUSSION 196 - 208 PART 6 CONCLUSION 209 - 210 PART 7 SUMMARY 211 BIBLIOGRAPHY 212 - 230 ANNEXURE

List of Tables


VI

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 69

List of Tables


VII

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 134

List of Tables


VIII

64 Vaya 135

65 Koṣta 135

66 Day of attainment of Samyak Snigda Lakshnas 136

67 Samyak Snigdha Lakshanas observed on last day of Snehapana 136

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 151

List of Tables


IX

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 173

List of Tables


X

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

123 Comparative effect of the therapy on circumference of forearms. 188

124 Comparative effect of the therapy on circumference of thighs 189

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 191

List of Tables


XI

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 194

List of Graphs


XII

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 151

List of Graphs


XIII

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 183

Introduction


1

INTRODUCTION

The interaction and exchange between Loka and Purusha continues in a natural way as

the man breaths air, drinks water and consume food articles available in nature. As long as this

interaction is wholesome the man is in optimum health, when there is any set back in this

harmonious relationship the disease state ensues. Here, Ayurveda should be accepted as clinical

methodology rather than a set of fundamental principle to determine life pattern for maximum

health, vitality and harmony. The changing life style of human being by means of dietic and

behaviour pattern plays a major role in the manifestation of several disorders. Thus, this type of

pattern may also lead to the development of the disease Amavata.

The disease rheumatoid arthritis can be presented as very similar to Amavata. The disease

R.A. is chronic in nature and affects mostly the middle aged group. It is one of the common

debilitating disease by the virtue of its chronicity and implications. The onset of disease is

frequent during 4th and 5th decade of life with 80% of patients developing the disease between

35 - 50 years of age. Community prevalence study shows that female are more sufferers than

male and the ratio of occurrence between them is 3:1. It is also noted that frequency is often

associated 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 like

Visuchika, Alsaka, Vilambika etc. to the chronic disorders like Amavata, Grahani and Amatisara

etc. In Amavata, Vata as a Dosha and Ama are chief pathogenic factors. They are contradictory

in nature and thus possesses difficulty in planning the line of treatment. It is mostly the disease of

Madhyama Roga Marga and having Chirkari Swabhava. Sometime it can also be manifested as

the acute case. Due to their similar mode of presentation, the disease rheumatoid arthritis can be

broadly grouped under the heading Amavata. The treatment proper is also not unidirectional, for

e.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 in

āmavāta 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 of

reoccurrence while such a prospect is absent when it is managed by Samśodhana.

Introduction


2

Only one treatment protocol will not help to curtail the disease. The author opines that a full

planned course of śodhana measures like vamana, virecana, basti along with the use of other

external 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 disease

Amavata is elaborated in the chapter on historical review. Nidana panchaka as well as treatment

of this disease is made clear in the second chapter. Madhana phala kalka and Madhana phala

ksheera paka is used for Vamana karma. Here in kapha utklishta avastha vamana is the best

treatment 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(madanaphala

kalka) and 68.56% in group B (madanaphala ksheerapaka). The conclusion drawn from this clinical study is listed in the final chapter summary and

conclusion.

Objectives


3

OBJECTIVE OF THE STUDY

To evaluate the action of vamana karma in patients of Amavata.

Conceptual Study


4

CONCEPTUAL STUDY Historical aspects of Vamana

Veda 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 with

Madana Phala (Randia dumatorum) in treatment of poisoning. Further, in the snake bite

poisoning, the use of Katutumbi (Lagenariasiceraria) and Dhamargava (Luffa acutangula) for

Vamana has been eluded.

Atharva Veda1 :

One of the prominent Sutra belonging to Atharvaveda i.e. Kaushika Sutra states that

emetic drug should be prescribed in case of persons injured by poisoned arrow. While referring

to the treatment of Poisoning in Visha chikitsa it has been mentioned that Madanaphala should

be used for Vamana.

Vinaya Pitaka is one of the important and popular literatures of Buddha period. In this

treatise, 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. Vamana

Dravya 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 suffering

from Adhoga Raktapitta. A recipe for Vamana Karma in the form of Kwatha and Kalka of

Vamaka and Vamanopaga drugs have been mentioned. Vamana Therapy is considered as one of

the best line of treatment for disorders of Kapha.

Manu Smriti3 :

Vamana karma is explained and snana is advised after the completion of the therapy.

Conceptual Study


5

Vamana In Ayurvedic Literature

There are some chapters in the Ayurvedic classics which mainly deals with either the

process of Vamana or the drug used for it. These chapters are the main source material for

Vamana Karma. Therefore only such references found in the Ayurvedic texts, which are relating

to 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 Sutra

Sthana, Kalpa Sthana, and Siddhi Sthana describe Vamana Karma in general, the details of

which are as follows -

A) Sutra Sthana

In first chapter of Sutra Sthana named "Dirghanjivaniya Adhyaya",4 some emetic roots

and fruits are mentioned and in the second chapter named "Apamargatanduliya Adhyaya"5 some

important emetic drugs are quoted. In the fourth chapter entitled "Shad Virechana Shatasritiya

Adhyaya"6, after mentioning the number of preparation which can be obtained from the major

Vamana drugs, the Vamanopaga Dravyas are stated. Besides these, in fifteenth chapter under the

heading "Upakalpaniya Adhyaya"7, describes broadly about different aspects of Vamana. It

enlights the information about the collection of equipment required (Sambhara Sangraha),

Process of Vamana, Dose of Madana Phala, Lakshanas produced due to Ayoga and Atiyoga of

Vamana, complications produced due to fault of physician, drugs, nurse and Patient, Dhumapana

to 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 has

been emphasized8.

B) Vimana Sthana

In the eighth chapter of Vimana Sthana named "Rogabhisakjitiya Vimanadhyaya",9

various Vamana and Vamanopaga Dravyas are mentioned under the heading of Vamana Dravya

Kalpa Sangraha".

C) Kalpa Sthana

In Kalpa Sthana, first six chapters are devoted to describe emetic drugs. First Chapter

entitled "Madanphala Kalpa Adhyaya"10 has explicated the intricate pharmacological action of

Conceptual Study


6

emetic drugs. Same chapter discuss the different Kalpana of Madanphala to be administered in

different stages of the diseases and to the patients having different body constitution. Next five

chapters are also fully devoted to discuss the Kalpana of Vamana drugs they are Jeemoothaka

Kalpa, Ikshvagu Kalpa, Dhamargava Kalpa, Vatsaka Kalpa and Krithavedhana Kalpa11,12,13,14,15

respectively.

D) Siddhi Sthana

Some verses of the first chapter entitled "Kalpana Siddhi"16 are related to Kaphakara and

Utkleshakara diet, Samsarjana Krama and its importance to increase Agni. In the same chapter

Pradhana, Madhyama and Hina Shuddhi Lakshanas are mentioned along with the Lakshanas

produced due to Ayoga, Atiyoga and Samyakyoga. Indications and contraindications are

discussed in detail in second chapter named as "Panchakarma Siddhi Adhyaya."17 Sixth Chapter

entitled "Vamana Virechana Vyapad"18 deals with Vyapad manifested due to Ayoga and Atiyoga

along with its treatment.

In addition to these references, use of Vamana while describing the treatment of

different disease in chikitsa Sthana been dealt with at length taking into consideration the stages

of 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 in

Sutra Sthana, Kalpa Sthana and Chikitsa Sthana.

A) Sutra Sthana

Forty first chapter of Sutra Sthana named "Dravya Vishesha Vijnaniya

Adhyaya"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 and

Kalpanas, particularly pertaining to Madana phala which is considered as one of the best emetic

drug.

B) Chikitsa Sthana

Chikitsa Sthana, thirty first chapter mentions some emetic drugs. Thirty third chapter of

Chikitsa Sthana under the heading "Vamana Virechana Sadya Upadrava"21 deals with Vamana

process, in which pharmacological action of emetic drugs is given. The same chapter also

Conceptual Study


7

describes Vamana process, Kaphakara diet, Ayoga, Atiyoga and Samyakyoga of Vamana and

Dhumapana to be taken after Vamana. Along with these aspects indications, contraindications

and Shodhana measures which are to be done after Vamana have also been stated. Vamana

Vyapad has been dealt along with Virechana Vyapad, in thirty-fourth chapter "Vamana

Virechana Vyapad".22 Thirty ninth chapter entitled "Aturaupadrava Chikitsa Adhyaya"23

mentions the Samsarjana Krama to be followed after Vamana. In addition to these, various

scattered 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 with

the process of Vamana, Hina, Madhyama and Uttama Shuddhi, regimen to be followed after

Vamana, importance of Vamana in Balaroga, Shuddhi lakshanas and Vyapad of Vamana. Its

seventh chapter explains indications and contra-indications of Vamana25.

B) Khila Sthana

In Khila Sthana "Samshuddhi Vishesiniya Adhyaya"26 mentions the Vamana process in

detail along with Samsarjana Krama.

Astanga Sangraha

Vriddha Vagbhata has mentioned one chapter in Sutra Sthana and two chapters in Kalpa

Sthana mainly for Vamana Karma.

A) Sutra Sthana

Twenty seventh chapter of Sutra Sthana entitled as "Vamana Virechana Vidhi

Adhyaya"27 gives details of Vamana process, properties of emetic drugs along with their

pharmacological actions. Apart from these aspects indication, contraindication and process of

Vamana 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, as

one of the best emetic drug. In this chapter depending upon, Dosha, Dushya etc. different

Conceptual Study


8

Kalpanas are discussed. Another chapter of Kalpa Sthana entitled "Vamana Virechana Vyapad

Siddhi Adhyaya"29 is fully devoted to the Vyapad..

Astanga Hridaya

Three chapters of this text describe fully different aspects of Vamana.

A) Sutra Sthana

Eighteenth Chapter of Sutra Sthana, states the process of Vamana, while the chapter of Kalpa

Sthana named as "Vamana Kalpa Adhyaya"30 gives the information about the Kalpas of emetic

drugs. Vyapad are described in third chapter, under the heading of "Vamana Virechana Vyapad

Adhyaya"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 Siddhi

Sthana mentions idea regarding the diet to be taken on the previous day of Vamana, dose of

decoction, expulsion of Kapha, Pitta, Vata and Rakta respectively and Lakshanas produced by

Ayoga 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 of

Vamana. Different Vamana Dravyas and their Kwatha are mentioned along with Lakshanas

produced due to Atiyoga, Ayoga and Samyakyoga, Samsarjana Krama, indication and

contraindication are also described. It is mentioned that Prastha in Shodhana chikitsa should be

considered as thirteen and half Palas.

Conceptual Study


9

Harita Samhita

No Separate chapter is devoted for the description of Vamana in Harita Samhita available

now a days. However Vamana is advised as line of treatment at many places in different

disorders37.

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. The

process of Vamana for children, emaciated (Krisha), aged (Vriddha) and delicate (Sukumara)

person is mentioned. In this chapter the indications, contraindication, doses of Kalka and Kwatha

are 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 in

Vangasena. In this chapter indication, contraindications, proper season for Vamana, preparation

of patient, process of Vamana, some emetic decoction and symptoms produced due to over and

under administration of Vamana are dealt with. The use of Nasya along with Dhumapana has

particularly been mentioned to remove the Doshas after Vamana.

Bhavaprakasha

A) Purvakhanda

Sixth chapter named "Mishraka Prakarana Adhyaya" in Purvakhanda deals with the

definition, proper season for Vamana, indications, Contraindications, preparation of patient and

importance of Kapha Utkleshakara diet, madhu and saindhava in the emetic preparation, Hina,

Madhyama and Uttama Shuddhi lakshanas; over and under administration of Vamana and its

treatment are also described. In addition the specific diets which are to be given and not to be

given after Vamana have also been explained in this chapter41.

Conceptual Study


10

Yogaratnakara:

A) Poorvardha

It has explained about vamana kala, Indication, contraindication, doshanusara karma, brief

description of vamana42

Definition

iÉ§É SÉãwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇ¥ÉMüqÉç || (Ca Ka 1/4)43

Charaka defined Vamana as a process in which waste products or Toxins (Dosha) are

eliminated 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 should

complete the procedure before the drug attains Paka Avastha.

AmÉYuÉ ÌmÉ¨ÉvsÉãwqÉÉhÉÉÇ 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 upper

channels by the act of vomiting.

The above mentioned definitions conclude following aspects:-

a) Route of Expulsion- ‘Urdhva’- refers to Mouth

b) Way of Expulsion-‘Balaat’-Prabhava suchaka – Forceful Expulsion

c) Dosha Expelled – Kapha / Kapha-Pitta

d) Phase of the Dosha- Apakva Avastha- Its of 2 types

1)Pitta Apakva avastha

2)Kapha Apakva avastha

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11

Pitta Apakva avastha47- Apakva of pitta refers to Vidagdha avastha where pitta attains Amli

Bhava & 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 Amlapitta

the 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 drug

produceses Vamana by its vyavaee vikasi & Prabhava nature atlast before it gets digested it will

be expelled out. So Muhurta is the Kalaavadhi for vamana, if delayed it may lead to

complications.

f) Phase of Dosha & Anna49: As per the gudarthadipika commentary vamana helps to expel the

Apakwapitta, 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 the

best 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 soon

as the mother tree is rooted out, the disease originated due to excessive Kapha are subdued after

the 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 “Chatush

Prakara Samshudhi”50. This procedure is capable to expel the Shareeragatha Doshas.

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12

While differentiating the major procedure from the minor procedures Chakrapani clearly

elaborate Vamana etc procedures capable to do.

1. Bahudosha Nirharana51

2. Bahu iti Kartavyata51

Bahudosha Nirharana: Indication of the Vamana clearly shows the procedure having

definite impact on Kapha and associated Kapha conditions so Acharyas are explaining the

conditions like Utkristha Kapha, Pitta Samsristha Kapha, Pitta- sthanagata Kapha, Pitta, Vata

condition etc.

Bahu iti Kartavyata: Here Chakrapaani may be keeping the meaning that benefit of the

Vamana in different aspect that is Vamana is Shodhana, Shamana, at the same time it is

Rasayana 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 + + + + + +

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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 - + + + + -

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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 + + + + + +

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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 + + + + + -

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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: 3

Sr.

No. Avamya Causes for Contra-indication

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

way-faring, weakened by constant fasting, sexual

Vayu gets aggravataed, haemorrhage or Injury to

lungs.

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17

indulgence, study, exercise and worry

5.

Garbhini

Complications of pregnancy, abortion of immature

fetus and incidence of severe diseases.

6.

Sukumara

Due to strain in his heart severe haemorrhage may

take place through upper and lower routs.

7.

Samvrita koshta

Morbid doshas get stimulated but not eliminated,

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 Vata

10 Hrdroga Will lead to cardiac arrest.

11 Udavarta Aggravation of condition which may quickly

cause death

12 Mutraghata Manifestation of colic pain or more of acute

origin.

13 Timira There will be further vitiation of the condition

14 Shira shoola Leads to excessive aggravation of pain.

UTILITY OF VAMANA KARMA IN VARIOUS CONDITIONS :

Table No: 4

Disease Explanations

Jwara When Uthklishta Dosha is seen.65

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

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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

Udara Kaphaja Udara Vamana advised.78

In Jalodara.79

Arshas Kaphaja arshas80.

Grahani When Ama is seen,pittaja & kaphaja grahani.81

Pandu Tikshna Vamana can be done

In case of Mrithbhakshna janya Pandu.82

Swasa When swasa associated with Kasa, Chardi,

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

Visha

In Kaphaja type of Keeta visha88

In 2nd Visha vega of Rajeemanta 89

In third Visha vega of Mandaleena90

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 type99

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Hridroga In Kaphaja type of Hridroga100

Peenasa In kaphaja type where uthklishta kapha is seen.101

Mukha roga

Paridhara102

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

Nasa roga Kaphaja Prathisyaya,115 Nava Prathishyaya116

Kaphaja Pinasa.117

Karna roga Karna paka,118 Karnapali roga,119 Karna nada120

Shiro roga Kaphaja type121

Kukshi shula Vamana advised122

Datri Sleshma dusta datri123

Vata Vyadi

In Gridrasi124

In Arditha125

In Pakshaghata- mild vamnana126

Arumshika If not controled by other means.127

Kukunaka Vamana advised.128

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Pakshma kantaka Vamana advised 129

Yauvana pidaka Vamana advised 130

Mukha dushika Vamana advised 131

Importance of Vamana Karma

Panchakarma therapy in Ayurveda has attracted the attention of the people world wide as

it is a unique type of treatment of various chronic, auto immune, hormonal, degenerative

disorders etc. where other sorts of treatments have no satisfactory answer as well equally

beneficial for the promotion and preservation of health. Acharya Charaka has highlighted, the

role of Panchakarma therapy by stating that the disease treated by Shodhana will never recur

whereas those treatment with Shamana therapy may recur in due course of time. In addition if

the Shamana drugs are administered after taking the proper course of Shodhana then it provides

additional relief and thus helps in eradicating the diseases completely. Vamana Karma is first

measure amongst Panchakarma and has been considered as the best line of treatment for the

Kapha disorders. Following points show the importance of Vamana amongst the other measures

of 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

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21

Generally any measure of Shodhana therapy cannot be under taken directly without

preparing the patient. Vamana is somewhat strainful process to the patient and may cause

complications also (if not performed properly). Therefore it is necessary that all the aspects

should be taken into consideration before performing this Karma. Shodhana therapy is generally

applied mostly in chronic diseases where vitiated Doshas are at their higher level & where

Shamana drugs may not have significant role. In this situation we have to take care at every step

of treatment and procedure. Some processes should be done before treatment as Poorvakarma

and some are after treatment as "paschat Karma. Following points require consideration in this

regard.

Purvakarma

A. Sambhara Sangraha

B. Selection and examination of the patient

C. Snehana and Svedana

D. Dietic regimen before Vamana Karma

E. Manasopachara

A. 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 the

therapy, then it can be treated immediately. Patient should always be hospitalized for Vamana

Karma.

Upakalpaneeyam:132

Acharya Caraka in Upakalpaneeya chapter is explaining about the collection of necessary

equipments before going for the Pancha karma chikitsa for the purpose of smooth and easy

practice. 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 according

to Vasthu shastra. Gangadhara also elaborate this point on his commentary.

• Dridham: the room should be constricted firmly.

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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 and

kitchen) 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 of

vital data, so it is better to keep Sphygmomanometer and Stethoscope. For the purpose of

induction of Vamana can be taken the help of Red rubber catheter.

Dravyas for Akantapaana: 133

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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

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

Formulation

Madana

Phala Jeemutaka Ikshwaku Dhamargav Kutaja

Krita

Vedhana

Kashaya 9 19 9 20 9 22

Matra 8 8 8 - - -

Ksheera 4 6 8 4 - 4

Ghrita 1 1 1 1 - 1

Phanita 1 - - - - -

Churna 1 - - - 5 -

Ghreya 1 - 1 - - 1

Varti 6 - - - - 6

Madana phala (Catunaregum spinosa)

Jeemuthaka (Luffa echinata)

Ishwaku (Lagenarea leucantha)

Dhamargava (Luffa aegyptioca)

Kutaja (Holarrhena antidysentrica)

Krita vedana (Luffa acutangula)

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Leha 20 - 5 10 - 8

Modaka 20 - - - - -

Utkarika 20 - - - - -

Shadava 10 - - - - -

Sashkuli 16 - - - - -

Apupa 16 - - - - -

Suramanda - 1 1 1 - 1

Swarasa - 4 - - - -

Dadhimastu - - 1 - - -

Takra - - 1 - - -

Palala - - 1 - - -

Taila - - 1 - - -

Vardhamana - - 6 - - -

Mandha - - 1 - - -

Mamsarasa - - 1 - - 7

Pallava - - - 9 - -

Sakridrasa - - - 12 - -

Kalka - - - 1 - -

Anna - - - 1 - -

Salila - - - - 3 -

Krisara - - - - 1 -

Picha - - - - - 10

Ikshurasa - - - - - 1

Total 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

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has to be considered as the dose. It can be considered or standardized as 5 gms.While explaining

the dosage for Madanaphala Kashaya, Caraka explains that Samshodhana dosage has to be fixed

“ Pratipurusha Apekshitavyani ”136 so Acharya indirectly objects the pre fixed dose for

Shodhana. Chakrapani comments on it as disease, status of Agni and Strength of the patient has

to be assessed before deciding the dosage of Vamana drugs. Chanranandana used to incorporate

status 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

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

strength Avara

VAMANOPAGA AUSHADHI:139

Vamanopaga drugs are supportive drugs which helps in easy vomiting by generating the

Vegas Vamanopaga drugs explained are Yasthimadhu, Karbudara, Nipa, Vidula, Bimbi,

Formulation Utama matra Madhyama matra Kaniyasi matra

Kwatha 9 Prastha 6 Prastha 3 Prastha

Kalka Avaleha Churna

3Pala

2 Pala

1Pala

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Shanapupshi, 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. Aacharya

Vagbhata is giving the warning that practise of Shodana in presence of Ama will destroy body

just like extracting the juice from an unripened fruit.

Sharangdhara explains Deepana is the process of Augmentation of Agni where as Pachana

will helps in the digestion of Ama140. Pachana has to be done till the Niarma lakshnas are

obtaind. Augmented Agni has to be tested by digestive power (Agnim Jarana Shaktya ).

B. Selection and Examination of the patient

Charaka 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 the

understanding of even those whose intellect is clear and broad. Patient should be examined

thoroughly. First of all it should be decided that the patient is fit for Vamana Karma or not

indicated as a Vamya or Avamya by Acharyas. The patient should be examined by Ashtavidha

and Dashavidha Pariksha141 followed by abdomen examination, respiratory system examination,

cardiovascular system examination, central nervous system examination and special examination

of disease for which Vamana is being done. Pulse, blood pressure, temperature and respiratory

rate are also to be monitored as Vital Data. The tests like; pathological, E.C.G. etc. should be

used for excluding the disease where Vamana is contraindicated. If the patient is not examined

fully and some points are missed in relation of the patients then complications may occur during

or after performing the Vamana Karma.

SNEHANA AND SWEDANA:

Snehana and Swedana are the purvakarma, which is a mandatory step before going for the

Vamana 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:

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According to Chakrapani, Snehana should be considered as Snehapana and Abhyanga.142

Snehapana should be administered till Samyak Snigdha Lakshanas are obtained. The aim of

Abhyantara Snehapana therapy is to prepare the body for Shodhana Karma i.e. the Doshas

situated 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 without

any effort; similarly Doshas are easily expelled out from the Snigdha body.

Sneha Prakarsha kala:

Shodhananga Snehapana is a process of administering Doshotkleshana within a speceific

number of days. Acharya Caraka mentioned that 3,5,7 days are required for attain ‘Samyak

Snigdha Lakshanas’ in Mridu, Madhyama, and Krura Kostha respectively.143

But Dalhana is quoting an anonymus reference for the prakarasha kala that is as follows:

Table No.10 Sneha Prakarsha Kala:144

Bhoja opines that person having Kaphaja Pittaja and Vataja Prakriti needs 3, 5and

7days Snehapana respectively. On the other hand Vagbhata emphasizes that Shodhananga

Snehapana should be continued till Samyak Sningdha Lakshanas are obtained irrespective of any

time limit.If Shodhananga Snehapana continued more than 7 days Sneha becomes Satmya and

fail to produce Doshotklesha. Chakrapani opines that if the dose of Sneha administered less then

it will fail to produce desired effect in 7days.In such cases is there should be a small gap after the

7th day.

Snehapana - Methodology:

Mridikostha Madhyama kostha Krura kostha

Mrudutama-1day

Mrudutara-2days

Marudu-3days

Madhyatama-4days

Madyatara-5days

Madhyama-6days

Kruratama-9days

Kruratara- 8days

Krura-7days

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A) Matra Anusara Snehapana- Arohana Snehapana:145

b) Pravicharana Sneha- Sadhya Sneha146

Matra Anuasara Sneha pana is not as such mentioned in anywhere in Samhitas. Acharya Charaka

describes, three doses of Snehapana i.e. Maximum (Pradhana), Moderate (Madhyama) and

Minimum (Hrasva). Moderate dose has been prescribed .for Shodhana therapy because it

conducts to oleation with ease. Sushruta mentions Madhyama matra which is digested in twelve

hours (Ardha Divas). Vagbhata has same opinion. This Madhyama Matra may be given on the

last day of Snehapana because Sushruta mentions that, the first dose should be adjusted as per

Agni 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 Snehapana

is not described in any of Bhrihatatrayi. In Kalyankara (6th A.D.)145, it was clearly mentioned

that 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 for

Snehapana.

Rules of Snehapana: Sneha should be taken in early morning hours when the diet taken on the

previous night will be completely digested and there should not be sensation of appetite. Acahrya

Sushrutha elobarate the exact time of Snehapana in the morning hours as “ Udaya Giri Shikhara

Samsthithe Praptha Kanaka Nikara Peeta Lohite”147 that is during the day break when golden

yellow red colour appears on the sky. Caraka explaining that when Sneha taken in the early

morning 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 and

instant 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 taila

Ushnodaka

Taila Yusha Vasa and Majja Manda For bhallataka and tuvaraka taila Sheeta jala

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Table No.12 Observation of Sneha Jeeryamana and Jeerna Lakshana:

Sneha Jeeryamana

Lakshana150

Sneha Jeerna Lakshana151

Shiroruja Shirorujadi Jeeryamana Lakshana prashamana

Bhrama Vatanulomana

Nisthiva Swasthyata

Murcha Kshuta

Sada Trishna

Arati Udgara shuddhi

Klama, Trishna, Daha Laghuta

Observation of Snigdha, Asnigdha, Atisnigdha Lakshanas:

The knowledge of Asnigdha, Atisnigdha and Samyak Snigdha Lakshans is a basic tool

for the assessment of Snehana they are as follows,

Table No.13 Samyak Snigdha Lakshanas: 152,153,154,155

Lakshana Ch.

Sa. Su.

Sa. Ah.

Hr. Sh.S Lakshana Ch.

Sa. Su.

Sa. Ah.

Hr. Sh.S

Vatanulomana + - + + Vit Shaithilya - + - -

Deepta agni + - + + Glani - + - +

Snigdha varcha + - + + Angha laghava - + - +

Asamhatha

Varcha + - + + Adhastat sneha

darshana - + - -

Angha Mardava + - + + Snehodwega - + - +

Snigdha anga + - + + Vimalendriya - - - +

Snigdha twak - + - -

Table No.14 Asnigda Lakshanas:156,157,158,159

Lakshana Ch.

Sa. Su.

Sa. Ah.


Sa. Su.

Sa. Ah.

Hr. Sh.S

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Grathitha

purisha + + - - Uro vidaha _ + - -

Ruksha

purisha + + - - Daurbalya _ + - -

Agnimandya + + - - Dur varna - + - -

Vayu

pratiloma + + - - Krichrat anna

Pachana _ + - -

Khara gatra + _ - - Susnigdha

Lakshana Viparyaya

_ _ + +

Ruksha Gatra

+ - - -

Table No.15 Atisnigda Lakshanas: 160,161,162,163

Lakshana Ch.

Sa. Su.

Sa. Ah.


Sa. Su.

Sa. Ah.

Hr. Sh.S

Pandutha + - - - Guda srava - + + -

Gaurava + - - - Ghrana srava - + -

Jadya + - - - Guda daha + + - +

Avipakwa

Purisha + + - - Bhakta dwesha - + - +

Tandra + - - - Pravahika - + - +

Aruchi + + - - Purishaati

pravritti - + - -

Utklesha + - - - Purishaati

pravritti - + - -

Mukha srava + + + +

Benefits of Snehana:

Caraka explains “Snehoanilam Hanti Mrudumkaroti Deha

Malanam Vinihanti Sangam”164 the concept is explained as follows

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1) Snehoanilam Hanti: This directly refers to Vatashamaka property of Sneha. As sneha is

having exactly opposite Gunas to tha of Vata Dosha, Sneha insist the proper functioning

of Vata and this can be clearly observed through the occurance of Vatanulomana as the

very first Samyak Snigdha Symptom. Vitiated Vata Dosha will be coming back to

normalcy and most of the derangement sets right. To bring the morbid Doshas which

were situated in the Shakhas to the Kostha, Vata nigraha is one of the modality

mentioned by Caraka.

2) Mrudukaroti Deham: Snigdha and Mrudu are important property of Sneha Dravyas. In

the definition of Snigdha Sushruta says ‘Sneha Mardavakrit’ mardava means softness

which can be clearly assessed by Gatra Mardava.

3) Malanam Vinihanti Sangam: To cut out the Srotorodha is again the prime importance

regarding the Shodhanartha Snehapana, Malasnga generally occurs due to Rukshata in

the Koshtha, Sneha over come this Rukshata by Snigdha property and Sanga sets right.

Bahya Snehana and Swedana:

Charaka says after the Sneha pana one-day gap should be given during which, he will be

subjected to Snehana and Swedana. Chakrapani says Snehana and Swedana should be done two

or threee days ie; on the day Snehapana is completed. On the rest day and on which is to be

administerd. Caraka states that Swedana helps in Draveekarana (liquifaction) of Doshas, which

stuck up in various srotas in the body. Dalhana mentions that Doshas which are lodged in the

Shakha are made to move towards the Kostha by means of Snehana and Svedana. Vagbhata

mentions that the waste products are removed from the body by Snehana and Svedana in the

same way, as the dirt of cloth is removed with the help of soap and hot water. Sweda has the vital

role in carriying of the vamana karma. It functions as follows,

1) Srotasu abhi Vileeyate- it helps to dissolve the Shleshma, which is in the Grathita form

step the srotas firmly.

2) Khani Mardavamayati: It makes the srotas soften which vata can flow through in

Anuloma gati.

3) Shleshmaha Vishyandhati: it increases the secreation of vitiated Shleshma through the

Srotas.

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Dietetic Regimen

It can be categorized into following 3 groups.

A. Diet during the days of Snehapana

Snehapana is done during the time of Sunrise. During Snehapana, patients are advised to

have the diet of Drava (liquid), Ushna(hot), Anabhisyandi properties in appropriate

quantity165. The food must not have too unctuous material mixed in it. Also it should not

contain the articles having the property to provoke any other dosha. Rice soup or ganji

will be more preferable for the diet.

Patient should be advised to consume ushnambu whenever needed.Chandranandana is having the

opinion that due to Kaphotklesha ‘Dosha Prachyavana’ is going to happen. Parameshwara make

it more clear that ‘Kapham Swasthanath Sanchalathi’ i.e, movement of Kapha from its sites.

B. Diet for previous day of Vamana for Utkleshana

Food articles described by different texts:

♦ The meat of the animals of Gramya, Anupa & Audaka origin

♦ The articles made of milk

♦ Sesame, Black gram, Curds, Milk, Jaggery, Fishes, Mutton soup etc.

♦ Above articles + Sali rice

Dalhana comments over the word 'Sambhojayet" as the meal containing both Pathya and

Apathya together (Samasana)

Thus it should have the properties like heavy, liquid and ability to produce secretions

(Abhisyandi).

Purpose

Arunadatta mentioned that this diet helps doshas, which are provoked due to proper

snehana & svedana to move towards Kostha due to their similar nature with latter.

This diet also has the property to excite Kapha dosha (Kaphotklesa)166 and to minimize

the pain & produces the vomiting with much less efforts.

Dalhana advised to inspect the dosas which are flowing freely after losing bonds with the

channels & arrange the meals accordingly. He further mentioned that dosas which have

already become provoked, if associated with new ones excited by this type of diet, they

will produce "Samyak Yoga" otherwise "Ayoga" will occur.

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Gangadhara strokes a brilliant string by stating that "This type of diet is served so that

Kapha should neither turn desiccated nor become dense or solidified". Thus to maintain

the liquified stage of the humors, achieved by Snehana & Svedana during Poorvakarma,

this diet should be provided.

Diet just proceeding to Vamana karma:

Generally on the day of Vamana, patient should be in empty stomach. Acharya Vagbhata

suggests that one has to go for the administration of “Nirannam Ishad Snigdha Yavagu”.

Arunadatta comments as “Nirannam Akruthaharam”167 unprocessed gruel and “Athurvashadwa

Kinchitth Snigdham” at the time of administration physician has to be added little amount of

Ghrita in it. This may even consider for Akanthapana.

Manasopachara

Purpose

Vamana is the process which depends much more upon the mental strength of the patient.

It progresses fluently when the patient will be satisfied regarding several doubts in one's

mind about the process and prepared mentally for the same.

This process can be divided in three sections.

A. Counseling before Vamana

In the present days, there is misimpression about the process of Vamana. Patient already

has a lot of wrong information received from other people. So mental counseling by

physician keeps much more importance.

Before Vamana, patient must be instructed about Snehapana, Svedana, Dietary regimen,

administration of Vamana and Vamanopaga drugs by Physician.

He should be informed about the whole procedure and proper understanding of each step

& its benefits which will encourage him.

B. Preparation of patient before Vamana

Charaka advised to carry out the process under auspicious Constellation, Day, Karana,

and Muhurta. He also says that before Vamana, "Svastivacana"168 should be performed

by Brahmins.169 Patient should be sanctified by holy blessings. For the purpose, he should

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worship the deity, Fire. Patient should be allowed to have a full bath, anoint his body

with several essences, wear a garland.

Charaka also advocated vaidya to create an atmosphere by displaying Homa, Mangala,

Prayascitta, Bali etc. for well being of patient before Vamana.

C. During Vamana

During Vamana process, patient is advised to concentrate on Vamana process, by keeping

Kama, Krodha, Lobha, and Irsya etc. factors aside.

Parmeswara, commentator of A.H. provided a reason behind all the auspicious proceedings

as "Vyapad bahulatvat" that means Vamana has a plenty of complications with it.

PRADHANA KARMA

The whole procedure, which is performed from the period of oral administration of

Vamana drugs up to the completion of Vamanavega, may be taken as Pradhana karma, this is

described as follows,

a.Administration of Vamana Yoga:

Time of administration of Vamana Yoga:

Acharya Vagbhata is advising to conduct Vamanakarma in “Poorvahnna”. Arunadatta

commented that “Poorvahnna” is “Pratha Kala”170 i.e. morning hours. Further Parameswara

specifying the time by stating “ Poorvahnne Sleshma Vruddhi Kale Prathama Yama eva”. So the

first Yama of the day it is prone to Sleshma Vruddhi is to be considered as ideal time for

Vamanakarma.

Preparatory procedures:

On the day of Vamana, after performing the Snehana and Swedana successfully, patient has

to take full bath and wear clean cloth anoit the body with a garland. The patient is asked to seat

in a comfortable chair. Patient should be covered with a clean cloth.

A big sized round vessel should be kept in front of the patient for the collection of vomitus.

It should not be placed neither too down nor too up. Acharya Caraka is advocated to keep some

Paricharaka to assist the physician during the procedure. Paricharaka is having the following

works171

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1) Lalata pratigrahe: Holding at the forehead, when patient will bow down to expel the

vomitus, which help to relax one’s over streached neck muscles.

2) Parsvopagrahane: The muscles at the side of the chest wich mainly originating from the

back region and help to keep the body straight.

3) Prushtonamardane: Doing the gentle massage in the opposite direction over the

muscles of spine, which is again the process to relax the same muscles.

4) Nabhi prapidana: this will induce pressure over the abdominal muscles and diaphragm

so the upward movement will be facilitated.

So the Paricharaka should be friend or any intimate to the patient. Before starting the procedure

physician has to make sure that all the necessary equipments and medicines need for the

procedure is kept ready.

b. Examination of vital data

Pulse, blood pressure, respiration & temperature should be recorded prior to

administration of Vamana drugs. An ECG reports of patient before the procedure will help to

avoid any cardiac manifestations. It is advised to record pulse & blood pressure at regular

intervals during Vamana.

c. Administration of Vamaka drugs

For Akhanta pana ksheera, yavagu, ikshurasa, mamsa rasa etc can be used.

Caraka says the akhanta pana dravyas must be in the state of nirranna,naathisnigdha.Then one

has to go for the administration of madhana phala choorana in Antarnakha

mustipramana,whichis processed in the yastimadhu etc kashayas.Shushrutha says one may go for

ksheera ,ikshurasa,dadhi,takra for akhantapana in case of krisha,vridha,bala followed by

administration of vamaka yoga.

Arunadatta advised the ksheera, ikshurasa isgiven bhavana with vamaka drugs and administered.

Importance of adding Madhu and Saindhava lavana in vamaka yoga172:-

Caaka in kalpa sthana says “Sarveshu tu’ i.e in all vamaka yogas one has to add madhu and

lavana.It is added for the kapha vilayana and kapha chedana purpose.It facilitate the liquification

and separation of adhesion of kapha.Further he says the honey should not be heated as it is

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viruddha173 but it may be added to the heated vamaka yoga.Because as the honey is vomited out

in apakwa stage along with the medicine before its digestion during vamana.It also helps in

elimination of morbid doshas.

Administration of Vamanopaga:-174

Caraka explains that Bhavana of Kwatha of Vamanopaga drugs such as Yasthimadhu,

Karbudara, Nipa, Vidula,Bimbi etc should be given to Madanaphalapippali, and this processed

poweder of Madanapippali should be given along with Saindhava Lavana, Madhu and Phanita.

Yashtimadhu Phanta is commonly practiced as Vamanopaga.

d. Observation During Vamana Karma

After the administration of Vamana drug, physician has to observe the whole process

carefully. In the beginning the physician should continue to apply his warmed palm to the face

and back. Caraka opeins “Peethavantham thu Khaluenam Muhurtham Anukamkshet”175

According to Dalhana “Muhurtham Ghatika Dwayam” This can be taken approximately as 45

minutes. So Patient should be kept in this position for one Muhrtha or till he gets the Vega of

Vamana, which ever is earlier.

Action of medicine:

Appearance of sweat on the fore head of the patient indicates that Doshas are liquefying in

srotas and Romaharsha (horipulation) shows that doshas were sarted moving towards Koshtha.

When Doshas reaches the koshtha there will be Kukshi Adhmana (distension of abdomen). Then

Hridayopamarda, Praseka and Hrillasa giving the signal that Doshas are in Urdhwa Gathi and

ready to eliminate.

The oncoming urge may be excited by tickling the throat with two well-manicured

fingers or with the stalk of Eranda (Stalk of Eranda). When the salivation appears patient is

asked to bend forward. Thereafter the paricharakas assistant should hold the forehead and chest

of the patient. Caraka suggests that Nabhi region of the patient should be pressed and back of the

patient massaged in Pratiloma direction. The patient should be instructed to open his mouth on

the feeling of vomiting. Forceful uninterrupted expulsion has to be counted, as Vegas and

upavegas are those, which occur in between the Vegas.176

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Vruddha Vagbhata advises that patient should not bow too down too more or lesser

extent.177 It may lead to complication Hemadri explains extreme stretch deposition of neck create

pain in back and chest region. Extreme forward bending causes Headache and abdominal

discomfort, extreme tilting on lateral sides produces pain in the side of chest, abdominal region

heart and upward region.

During the procedure Vamanopaga can be administered repeatedly till the appearance of

pittanta Vamana. If Heena Vega (Under bouts) happence then it is adviced to give Kalka of

Pippali, Amalaki and Sarshapa or Ushnodaka mixed with Saindhava Lavana178. Kashyapa says

one should not give any rest in between the Vegas.

Table No. 16 Samyaka Yoga Lakhanas of Vamana179,180,181,182,183

Lakshana Ch. Sa Su. Sa As.Hr. As.Sa. Sh.S

Kale Pravrutti + - + - -

Elimination of Kapha Pitta and Vata respectively

+ + + - -

Svayam Avasthana + + + - -

Hridaya Shuddi + + + - +

Parsva Shuddi + - - - -

Murdha Shuddi + + - - +

Srotas Shuddi + - - - +

Indriya Shuddi + - - - -

Laghuta + + - + +

Karsya + - + + -

Daurbalya + - - + -

Kantha shuddhi - + - + +

Kapha samsrava - + - - -

Anati mahati vyatha + - + + -

Jatha Kala kshudha, Pipasa - - - - -

Jathagnita - - - - +

Ashebairasyavada - - - - -

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Ashya shuddhi - - - + -

Table No. 17 Atiyoga Lakshnas of Vamana184,185,186,187,188

Lakshana Ch. Su. As.Hr As.Sa. Sh.S

Phenila Vamana + - + - -

Rakta Candrikayukta + - + - +

Trisha + - + + +

Moha + + + + -

Murcha + + - + -

Vata Prakopa + - + + -

Nidra hani + - - + -

Bala hani + - + + -

Hrid pida - + - - -

Kantha pida - + + - +

Tamah Pravesha - - + - -

Brama - - + - -

Pittati yoga - + - - -

Daha - + + - -

Udgaradhikya - - - + +

Hikka - - - + +

Hanustambha - - - + +

Mrityu - - + - -

Table No. 18 Ayoga Lakshanas of Vamana189,190,191,192,193

Lakshana Ch. Su As.hr As.Sa. Sh.S

Apravritti + - - + -

Only Aushadha Pravrutti + - + + -

Vega Vibandha + - + + -

Hridaya Avishuddhi + + + + -

Srotas Avishuddhi + - - - -

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Guru Gatrata + - - + -

Sphota + - - + -

Kandu + + + + +

Kapha Praseka + + + + +

Jvara - + + + -

Kota + - + + +

ASSESSMENT OF VAMANA:

To assess the quantity and nature of the doshas and to assess the effect achieved after

Sasmshodhana Chakrapani is giving some parameters - Aantiki, Vaigiki, Maniki and Laingiki

criteria.194

Chakrapani quotes 4 criteria at first but later on counts Antiki shuddhi under the Laingiki.

Dalhana elucidate195 three criteria viz Laingiki, Vaigiki and Maniki not explained Antiki criteria.

Separately. At last both of them clearly conclude that laingiki shudhi is the most acceptable one

to practice the effect of Shodhana.

OBSERVATION OF SHUDDI LAKSHANA:

As classified by Chakrapani the assessment of samyak shudhi is studied under 4 headings

viz. Antiki, Maniki, Vaigiki and Laingiki196.

Table No 19

Vamana AVARA

SUDDHI

MADHYAMA

SUDDHI

PRAVARA

SUDDHI

Vaigiki 4 Vega 6 Vega 8 Vega

Maniki 1 prastha 1 ½ Prastha 2 prastha

Antiki Pittanta Pittanta Pittanta

Laingiki SIGNS OF SYMPTOMS OF SAMYAK VAMANA

Vaigiki criteria:

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Caraka describes three types of shuddhi naming them as Heena, Madhyama and Pravara

shuddhi.when 4, 6 and 8 Vegas come respectively.197

Kashyapa is quoting an anonymous reference according to that Shuddhi can be called as

Kaniyasi producing 2-3 Vegas, Madhyama having 4-5 Vegas and uttama having 6-7 Vegas.

Counting of Vega and Upavega:

The Commentator Indu define the Vegas as “Sukhadagataha Pratigraha prapto

Vegaucchyate”198 pratigraha means a bowl in which Vega is collected. The bout collected in a

bowl after an effort less expulsion is termed as Vega. Where as Upavega is nearer to Vega,

which can be explained, lesser in every aspect of Vega.

Dalhana199 is having the opinion that some times patient may not exhibit proper Antiki

feature even though many number of bouts, hence there are lacuna for considering this

measurement criteria as authoritative.

Importance of Assessment of Vegas:

Assessment of Vamana Vega carefully gives idea about Heena, Madhyama or Pravara

shuddhi and helps in planning the Samsarjana krama. It helps to identify change in colour,

consistency occurring after each vega to know about the movement of Dosha during Vamana

karma. Caraka mention to continue the procedure till Pitta comes. At that time he does not

emphasis on the quantity of Doshas expelled or number of Vegas occurred.

Maniki:

The criterion to assess the Doshas, which is expelled out, is called Maniki. While

explaining Heena, Madhyama and Pravara Shuddhi, Caraka explained the quantity obtained will

be 1,1 & 1/2, 2 Prasthas respectively. Chakrapani considered them under the term Maniki

Pariksha. So Maniki pariksha is the quantitative analysis of the morbid Kapha and Pitta, which is

expelled out. Aachary Caraka explained that “Vamane tu pitam”200 so, the difference between

input and output has to be considered here.

According to Dalhana the measurement of the vomitus varies form person to person.

Since Samhanana of the body depends on Deergha, Hrasva, Sthula, Krisha constitution the

amount of Dosha resides in the body is also going to vary. Hence Maniki is not an authoritative

criteria.201

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Maniki Pariksha highlights the quantitative analysis of the vomitus that is quantity of

Kapha or Pitta that is to be expelled out. The word Prastha indicates some quantity; hence one

can deal with Maniki criteria by considering the volume and also by weight. According to

Chakrapani

1 prastha = 13 1/2 pala (54 tola)

1tola = 12gms, So 54 tola = 648 ml

Table No. 20 Manaki Pariksha

Heena shudhi 648ml

Madhyama shushi 972 ml

Pravara shudhi 1296ml

Importance of Assessment of Maniki criteria: This criteria helps to guide us in

differentiating 3 types of Shuddhi i.e Heena Madhyaama and Pravara. And also helps to decide

the quantity of the Doshas expelled out. Finaly helps physician to judge directly the quantity of

Kapha and Pitta vomited during Vamana. The difference between input and out put can be

measured.

Laingiki:

The signs and symptoms featured in Samyak lakshana can be considered under Laingiki

criteria. Atiyoga, Ayoga, Samyak yoga, Lakshanas of Vamana has to be analyzed to predict this

criterion.

Table No. 21 Laingiki criteria can be classified as follows, 202

During Vamana After Vamana After Samsarjana

Kalepravritti Hridaya shrotoshudhi, indriya shudhi, Parshwashudhi, murdhwa shudhi

Swasthata

Yatakrama kapha pita vata dosha hara Laghuta, karshya, dourbalya Swaravishudhi

Swayamcha avasthana Kantha shudhi Laghhava

Anati mahati vyatha Kapha samsrava stithi Kostha tanutvam

Dalhana comments that Laingiki is the most acceptable criteria to assess the Vamana then that

of Maniki and Vaigiki.

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Anthiki:

End point of Vamana karma is termed as Anthiki. Charaka adviced to continue Vamana till

pitta appears.

Vruddha Vagbahta elaborated Antiki criteria. Giving following points,203

• Kapha Chedana: Complete removal of the morbid Kapha.

• Kevala Aushadha Pravritti: After the removal of the Kapha the medicine is going to expel

out

• Pittasya Darshanam va: Appearance of Pitta in the vomitus.

Indu comments that, all these above mentioned facts depend on strength of the patient and

strength of the disease. Parameshwara comments that “Peetabham jalam Drushyate” a yellow

coloured fluid is going to appear in the vomitus is the Pittanta.

"Pitta" is a Dravya, which has specific characteristics and functions. When one describes

'Pittanta,' Pitta appears with certain and shows some symptoms.

Table. No. 22 "Appearance of Pitta" can be perceived by all the Pramanas.

Pramanas "Appearance of Pitta"

Colour A greenish yellow

Taste Bitter or pungent taste (sour taste also)

Smell Usually have a metallic smell.

Symptoms It produces certain symptoms while coming

through Amashaya like burning sensation in

the chest or throat or eyes.

Acharya Kashypa in the context of Amlapitta- giving a slimile that when fresh milk will

be turned to curds when it is poured to a vessel containing curd in the same way morbid Pitta is

also going to spread in the body204. By considering this contaminating nature of Pitta

(Ashrayashrayee Sambandha with a Rakta) it has to be eliminated properly so in Vamana karma

expulsion of morbid Pitta is a mandatory step to attain maximum purity.

Conclusion

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When one goes through all the textual references regarding these criteria, there is a debate over

the point that which criteria must be followed for assessment. But, if studied critically, all these

four criteria have to be used by Vaidya while following the process.

Charaka when explained the process of Vamana in Kalpa Sthana, has mentioned to

continue the procedure till Pitta comes out. So Vaidya has to concentrates on Pittanta

Criteria while directing the process. At that time he does not emphasize on the quantity of

Doshas expelled or number of Vegas occurred.

After completion of process when time comes to set "The sequence for Samsarjana" one

review the quantity of dosas expelled (Maniki Pariksha) and counts the number of Vegas

(Vaigiki Pariksha) expelled. Decision over the nature of Shuddhi is taken and Samsarjana

Krama is set upon.

After completion of "Samsarjana Krama" when one has to-decide the 'treatment regimen'.

Now Vaidya considers all the 3 parameters, correlate them with the proportion and

placement or dosas, observe the symptoms and set the treatment regimen.

Paschath karma

When Vamana Karma is finished, patient should be looked after carefully till one would

not be subjected to the normal diet. Till then patient is kept on special dietetic and behavioral

restrictions which are considered as "Paschat Karma". This may be classified under three

divisions.

A. Dhumapana

Charaka stated that after Samyak Vamana, patient is advised to wash mouth, hands &

feet, then to rest for a Muhurta.205

Afterwards one is advocated to inhale the smoke from any one of the three types of

smoke i.e. Snaihika (unctuous), Vairecanika (errhine) or Upasamaniya (palliative), which

will be suitable for him.

Dalhana provides the reason behind it as smoke will help to separate Kapha which is

stuck to srotasas. Dalhana also categorized the three types of Dhumapana according to

Prakrti of the patient as:

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Table No. 23 Types of Dhumapana with respect to doshas206

Prakrti Type of smoke

Vata Snaihika

Kapha Pitta Prakrti and utklista dosa Vairecanika

Samadosa Prakrti Upasamaniya

Swastha Prayogika

"Pariharya Vishaya" (Dietetic and Behavioral Restrictions) after Vamana207

Behavioral Restrictions

Loud speeches, sitting in one position for long duration, standing in one position for long

duration, long walks should be avoided.

Exposure to excessive cold or heat or dew, exposure directly to flowing winds, long

journey, and sleeplessness in the nights, sleeps during day time, to retain strong urge or

provocation of the urges.

Dietetic Behavior

Virudha diets, diet during Ajeerna State, Apathya diet, meals at wrong times, Pramita diets,

excessive diet, less diet, heavy diet, Vishama diet should be averted.

Samsarjana Krama

Purpose

1. Due to Dosha elimination from the body after Samshodhana Karma, Agni becomes

weakened. So to restore the strength of Agni and Prana, Peyadi Samsarjana Krama

should be followed208

2. Vamana process mainly takes place in 'Amashaya'. Amashaya is the site of both Pitta &

Kapha. More correctly, it is the site of Kledaka Kapha & Pachaka Pitta. Vamana

removes the vitiated matter mixed with Kledaka Kapha & Pacaka Pitta.

3. Samana Vayu is the prime factor which controls the movements of this whole region. In

this whole process, drug is accepted in Kostha by Samana Vayu.

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But 'Virya & Prabhava of the Vamaka medicine' activate Udana Vayu & instead of

further progression of digestion of food, it is dragged backwards & expelled through mouth.

Thus, during Vamana process, the functions of Samana Vayu are hampered and it is propelled in

the reverse direction. All the three factors which regulate the functions of Agni are "interfered in

this arduous process. So, to normalize them Samsarjana Krama is planned. Hence, Samsarjana

Krama achieves normalization of the edifice of digestion i.e. Samana Vayu, Pacaka Pitta &

Kledaka Kapha.

4. Yogindranatha Sen mentions that during Vamana process doshas become 'Dravibhuta'

(Liquify), so that they can be expelled out easily through Vega.

By evaluating the number of Vega during Vamana, one can understand the proportion of Doshas

which are liquefied. During Vamana if Vegas are produced in more number, it indicates that

dosas in the body are in more with Drava guna. One can easily understand that if liquid

property is increased in excessive quantity & enter the Amashaya, more and more weakening of

Agni will happen. Thus during the Uttama Vaigiki Shuddhi, Agni will use more time to return to

normal position, so maximum days (7 days) are attributed to it.

Hence, the Samsarjana Krama is arranged in proportion to Shuddhi done during Vamana.

5. Vigorous Sodhana done by Vamana causes, weakness, loss of weight, freeness of

Sandhibandha, decrease in the Agni and emptiness in the respective ashayas due to

expulsion of Kapha, Pitta, Vata and Mala. Due to this reason patient cannot tolerate any

type of treatment or diet, other than the prescribed for purpose. So "Samsarjana Krama"

should be planned.

6. Haranacandra pointed a very empirical point that this mitigation of Agni lasts up to

maximum one week. So it should be lifted by light diet sequentially.

Commencement of Samsarjana Sequence

When Samyak Shuddhi occurs, Samsarjana Krama may be started on that day only. If a

little vitiation (Ashuddhi) is remained inside, Samsarjana Krama can be initiated from the next

day.

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Course of Samsarjana

The Samsarjana Krama to be planned, is based on the type of purification done by

vomiting i.e. for Avara Shuddhi, Madhyama Shuddhi and Hina Shuddhi, it is of 3 days, 5 days &

7 days respectively. 209

Samsarjana Krama according to the Strength210

Sushruta mentioned that Samsarjana sequence can be followed by keeping an eye over the

strength of the patient. He says as 3 types of bala exist, Samsarjana Course should also be

adopted accordingly. For the individuals having good strength, three Annakala are advocated,

two Annakala for the individuals of Medium Strength & the individuals with lesser strength only

one Annakala is advised. Dalhana mentions that here bala can be judged by one's "Upashaya".

Divisions of Samsarjana Krama

Charaka classified Samsarjana Krama into two divisions as

(A) Peyadi Samsarjana Krama

(B) Tarpanadi Krama

A. Peyadi Samsarjana Krama

Generally, in all the patients after Vamana process (Samshodhana Karma), the "Peyadi

Sequence" is advised as diet regimen as follows:

Table No. 24 Peyadi Krama208

Days Annakala Pravara Suddhi Madhyama Suddhi Avara Suddhi

I day 1 morning 2 evening

Peya

Peya

Peya

II day 1 morning 2 evening

Peya Peya

Peya Vilepi

Vilepi

KrtakrtYusa

III Day 1 morning

2 evening

Vilepi

Vilepi

Vilepi

Akrta Yusa

Krtakrt

Mamsarasa

Normal diet

IV 1 morning 2 evening

Vilepi Akrta Yusa

Krta Yusa Akrta Mansarasa

- -

Vday 1 morning Krta Yusa Krta mamsarasa -

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2 evening Krta Yusa Normal diet -

VI day 1 morning 2 evening

Akrta Mamsarasa Akrta

Mamsarasa - -

-

VII day 1 morning 2 evening

Krta Mamsarasa Normal diet - -

- -

Role of Maniki Shuddhi in the planning of Samsarjana Krama

Sushruta also suggested performing the Samsarjana Krama after considering quantity of dosas

expelled during Vamana. When dosas are expelled in one Prastha quantity, serve Yavagu which

is made from the rice in a lesser quantity. If dosas in Madhyama or Uttama quantity are

eliminated, then two and three Annakala are followed respectively211.

He further provided the recipe to make the Peya, Vilepi, Yusha and Audana.

Table No. 25 Peyadi Kalpana

Kalpana Kalpana mixed with controlled diet Properties Peya yavagu Rice in a lesser quantity with more water.

Vilepi

Used1/4th Audana+Velepi (Well boiled)

Apicchila

Asiddha Yusa

Mudgayusa + ½ Audana

Without unctuous Material

+ Without salt. Siddha Yusa Siddha Yusa +3/4th Audana Hrudya + tasty Mamsarasa Mamsarasa of Lava, Ena, Harin

etc.animals + Audana Full diet

B. Tarpanadi Krama

In the following patients, Charaka advised to follow "Tarpanadi Sequence" as' Samsarjana

Krama'.

1. The patients with increased Kapha and Pitta

2. When Kapha & Pitta are eliminated in a smaller quantity during Samsodhana.

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3. in the alcoholic patients.

4. The patients having Vata-Pitta Prakrti.

This is preferred against 'Peyadi Sarnsarjana Course' as it may produce 'Abhisyanda' again in the

srotasas (channels) of Vishodhita' (well purified) body. 212

Nature of Tarpanadi Krama

According to Chakrapani, 'Swaccha Tarpana' can be served instead of Peya and "Ghana Tarpana"

instead of "Vilepi". Jejjata says due to similarities, (i.e. Samana Jatiyatvat) Mudga Yusha &

Mamsa rasa can be given as Tarpana. But commentators of Vagbhata mentioned the diet regime

clearly pertaining to 'Annakala'.213

Table No. 26 Tarpanadi Krama

I II III

Arunadatta (A.D. on A.H. 18/40)

Laja + Saktu Jirna Sali +Audana Mamsarasa +Audana

Parameswara (A.H. 18/40) Laja + Saktu Yusa + Anna Bhojana Mamsarasa +Anna

Role of various types of tastes while preparing Peyadi or Tarpanadi recipe

During "Annasamsarjana Sequence", there are chances of excitation of doshas due to augmented

Agni. So to prevent such increase, dosas are fought by arranging "Taste of the recipe" in such a

series that the chances of increase will be lessened. It is elaborated by "Dalhana" and Chakrapani

as.

Table No. 27 Rasadi samsarjana krama214

Reason Probable effect of Dosa Taste Used

Susruta Caraka

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1. Augmented Agni 1. To pacify Vata Pitta & to

balance Agni 2. To pacify Vata situated in

pakwasaya

Sweet & Bitter Sweet, Sour

pleasant to heart,

unctuous

2. Taste opposite to

previous one 1. To pacify Vata & Kapha 2. To increase Agni Bala 3. To augment Agni in the

Upper site

Unctuous Sour, Salty

Pungent Sour & Salty

3. Increased Pitta due to

previous Taste 1. To pacify Pitta & Vata Sweet, Sour, Salty Sweet & bitter

Here unctuous & dry properties should be used alternatively in appropriate manner.

Chakrapani says that these properties can be planned through the means of Taste. When the taste

having unctuous property is applied, then the taste having dry property can be planned and the

same pattern is followed further. Unctuous & dry properties are mentioned here as symbolic ones

only. One can arrange heavy & light properties & further more in the same manner.

Benefits

1. Helps to regularize the body which is weakened due to purificatory process (Prakrti

Bhojanartham).

2. To provide strength to the debilitated humors

3. By arranging such plan, the diet comprised of all the tastes can be served through 12 meals

Vyapad (Complications)

"Vyapad" are the symptoms which are produced other than Samyak Lakshanas, causing harm to

the patient and increasing the symptoms of the disease.

Charaka explained them as Adhmana (distension of abdomen), Parikartika (gripping

pain), Srava (excessive discharge), Hridgraha (Cardiac spasm), Gatragraha (spasm of

limbs), Jivadanam (discharge of blood), Vibhramsha (improper action of medication),

Stambha (rigidity), Upadrava (Serious afflictions), and Klamah (Exhaustion). These are

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considered to be the 10 complications due to Ayoga orAtiyoga of the Vamana, due to the

defects of attendant, the medication, the physician or the patient215

Sushruta mentioned 15 complications, Out of which Adhmana, Jivadanam,

Hrdayopasaranam, Parikartika, Parisrava, Angagraha, Vibandha are common.

Savasesausadhatvam Jirnausadhatvam, Hina dosha, apahritatva and movement of the

humors in opposite direction are different in Sushruta which are included in the causes of

complication by Charaka.216

Vriddha Vagbhata explained 12 complications having some different afflictions like

Grathitatva, Gaurava, Doshotklesa, Dhatu Srava etc217.

Factors

Four elements that influence the occurrence of complaints during process of Vamana are

Helper (Nurse), Medicine, Physician & Patient himself

Before initiating any one of the processes in Panchakarma, Charaka warned

Physician to keep an eye on the aspects like Dosha, Oushadha

(Medicine), Desha (Place), Kala (Ritu, time), Satmya, Agni, Satva,

Vayah (Age) and bala (Strength of the patient). If one failed to judge

any of this objects, it will lead to Vyapad (Complications) as a result.

Types

While describing Vyapad or complications, Charaka categorized them into two broad

divisions.

A. Ayoga

B. Atiyoga

That means, whenever any complication will arise, it will be due to either Ayoga or

Atiyoga of the process influenced by other factors. Ten Complications explained in Siddhi

Sthana, may be divided into these two broad categories. But Chakrapani ruled out the law of

inclusion under *nese two, by a remark in which he says, "it is not mandatory that these

symptoms should be produced after Ayoga or Atiyoga of Vamana but they may be produced as

an 'Upadrava' of the act. Later on, he blended them in two divisions i.e. Ayoga & Atiyoga as,

Table No. 28 Vamana vyapath218

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Ayoga Atiyoga

Adhmana Parikartika

Srava Jivadanam

Hrdgraha Vibhramsa (Gudabhramsa

&vSanjnabhramsa)

Angagraha

Kandvadi Vibhramsa

Upadrava

Klama

Mithyayoga

While reasoning to exclude mithyayoga from the complications of Vamana, Chakrapani

analyzed whole concept brilliantly. He explains, "Though Ayoga, Atiyoga and Mithyayoga are

described accordingly everywhere in the texts, but in the case of Vamana & Virechana there is

no need to consider Mithyayoga as a separate entity. In these processes, expulsion occurs in four

different ways as

1. Atipravrtti - Excessive expulsion.

2. Asamyak Pravrtti - Expulsion by improper way.

3. Apravrtti - Cessation of process of expulsion.

4. Alpapravrtti - Expulsion in a lesser quantity.

Here, last 3 are covered under an umbrella of "Ayoga". As an "Asamyak Pravrtti" means

expulsion through opposite route, it indicates that expulsion of vitiated matter is not in a

quantity, which is expected. So it must be considered under the term of 'Ayoga" and not

"Mithyayoga"

In the verse Su Chi 34/22, which divides fifteen complications of 'Vireka' into Atiyoga,

Duryoga and Ayoga, Dalhana expresses the views as here Vireka includes both Vamana &

Virechana. He further mentions Jejjafa who nominated the form 'Vipaka' to 'complications'

meaning which ends producing misfortunes

(Vishama Paka Anishtam Phaia) can be called as 'Vipaka'.

It is again divided into 3 factors viz. Atiyoga, Duryoga & Ayoga.

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A. Atiyoga means excessive Vamana.

B. Duryoga means wrongly medicated (Duryojanam) or wrongly administered

(Dushprayoga, Mithyaprayoga).

He further divided this into 3 categories as

Vaidya Duryoga (wrong medication by physician) causing Vamana, Mithyaprayoga,

Virechana Mithyaprayoga, Parikartika.

Atura Duryoga (Wrong response by patient) producing Hridaya Upasaranam, Vibandha.

Ubhaya Duryoga (wrongly treated & wrongly responded) causing Pravatika, Vatashula.

C. Ayogaja: Administered in lesser quantity

Ayoga

Vriddha Vagbhata explains, Ayoga means

Apravrtti - the ingested material doesn't come out absolutely.

The medicine which is administered, that is coming out alone.

Vibandha - the vomitus coming out in small bouts slowly

Factors initiating ayoga219

1. Status of Bowel : Krura & Bahudosa

2. Medicine : Quality- Dry (Ruksha), insubstantial(Alpagunam)

State- Decrepit (Anavam or Jirnam)

Quantity- Inadequate (Alpam)

3. Status of individual : Not properly oleated (snigdha) & sweated (Swinna)

4. Status of appetite : Increased appetite (Diptagni), but medicine-

Ruksa & Jirna.

5. Dosha sthiti : 1. Dosha with in less excited (Utklista) condition.

2. If dosas are in large quantity and accumulated

in Kostha having medicine with less potency

and with less appetite.

Symptoms

They can be divided into 3 groups:

A. Classically explained as 'Ayoga'

B. Described in ten complications produced as "Upadrava'

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C. Emerged after influenced by certain condition

Table No. 29 Ayoga of vamana

Group A Group B Group C

Cessation of Vega, Adhmana Srava Hrdgraha Vibhramsa, Sotha,

Expulsion of Medicine only, Angagraha Kandvadi HikkaTamasah darsana,

Vegavibandha, Hrdya Vibhramsa Upadrva Klama Pindika udvestana, Kandu,

Asuddhi, Srotoguruta, Uruh Sada, Vivarnata,

Gurugatrata, Sphota, Kotha, Gauravam Utklesa, Hrdaya

Kandu, Kaphapraseka,Jvara Asudhi Vyadhi Vrdhi, Trsna

(Sita), Sopha, Pratisyaya Parsvasula, Chardi, Murcha,

Lomaharsa, Alasya, Sula Parvabheda, Hrllasa, Arati

Udgara Avisuddhi,

Ten Vyapadas explained by Charaka

1. Adhmana

(A) Patient : Less appetite, misperistalis

(B) Medicine : Less in a dose

(C) Physician : Has excess of morbidity, dehydrated

(D) Pathogenesis : Will rouse the morbid humors and obstruct

the body channels.

(E) Signs and symptoms : Great distension of abdomen, pain in back,

sides of the chest and head, serious

obstruction to breath, faces, urine and flatus

(F) Treatment : (1) Induction, (2) Sudation, (3) Suppository

and similar treatment, (4) evacuative and

unctuous enemata and ail treatment

curative of disorders of misperistalsis

(Udavarta).

2. Parikartika

(A) Patient : HardBowelled

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54

(B) Medicine : Strong

(C) Physician : Patient suffers from Ama morbidity,in a

person who is emaciated soft bowelled,

exhausted and is poor of vitiaily

(D) Pathogenesis : Reaches the rectum and eliminates

morbid matter along with chime

(E) Signs and Symptoms : Causes acute colic and gripping pain

accompanied with slimy and bloody discharge,

(F) Treatment : Langhana, pachana, Rookshoshna bhojana

a. Patients with Chyme morbidity starvation

Digestive medication, diet should be dry, hot and light articles

And in conditions of emaciation measures of roborant therapy

Medications prepared with drugs of sweet group are recommended.

b. if even after the digestion of Ama there is obstnation medication with acid and alkali,

Light diet.

3. Srava

(A) Patient : Stools with abnormal excessive

morbidity.

(B) Medicine : In a small dose.

(C) Physician : With excessive morbidity

(D) Pathogenesis : Rouses the humours

(E) Signs and symptoms : Causes frequent and scanty elimination

and gives rise to the pruritus, edema,

dermatitis, heaviness of the body,

impairment of gastric fire, nausea,

stiffness, anorexia anaemia.

(F) Treatment : Either treated with sedative drugs with

emetics of giving oneself oleation. Again one should

be administered a strong purgative and perfectly

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cleansed, may be given powders, medicated wines

prepared with suitable medications.

4. Hridgraha

(A) Patient : Suppression of urge in after taking the

emetic drug.

(B) Medicine : -

(C) Physician : -

(D) Pathogenesis : Vata and other humors getting provoked

and reaching the heart, causing severe

cardiac spasm.

(E) Signs and Symptoms : The person becomes, causing severe

cardiac spasm and pain in the sides of the

chest. He gets depressed. There is dribbling

from the mouth, agitation of the eyes, one

bites the tongue, fails unconscious and

gushes one's teeth.

(F) Treatment : If condition is serious (fainting) due to

excesss of Pitta, emesis should be given

prepared with drugs of sweet group. If it is

due to Kapha, drugs of pungent group can

be used,. Thereafter the residual morbidity

should be digested away by digestive

medications. Then one's body and vitality

should be systematically

Also, if the person while vomiting excessively, is by Vata, he should be given unctuous acid and

salt articles due to Pitta and Kapha-dry, pungent and bitter articles sh

5. Angagraha

(A) Patient : Suppression of the urges by a person who

has taken the purificatory dose

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56

(B) Medicine : ---

(C) Physician : ---

(D) Pathogenesis : Owing to obstruction of Vata by Kapha or

owing to purification done in excess. The

provoked Vata seizes the limbs

(E) Signs and Symptoms : Causes the stiffness, tremor, pricking pain.

Asthenia, cramps and churning

(F) Treatment : Oleation, sudation, and ail similar other

measures curative of Vata should be carried

out.

6. Discharge of live blood

(A) Patient : Soft bowelled

(B) Medicine : Strong medication

(C) Physician : Soft bowelled + Slight morbidity

(D) Pathogenesis : After elimination the morbid matter and

churning the system excessively.

(E) Signs and Symptoms : Causes the discharge of the live blood.

(F) Treatment : Measures curative of Pitta of treatment

behetical.in the cover action of purificatory

procedures. Give fresh blood of a live deer,

cow, buffalo or goat. May be given blood

churned with,sacrificial gross in the form of

an enema.

7. Vibhramsa

Prolapse of Rectum : (Gudabhramsa)

It should be replaced after constricting it with astringent medication.

Unconsciousness: (Sanjnabhramsa) Soothing songs and words should be uttered.

Symptoms due to agitation: (Laksanbhramsa)

If the purgative dose ceases to act immediately after elimination of faecal matter or the

emetic does is immediately vomited out, it causes only the agitation of the morbid humor but

Conceptual Study


57

does not eliminate it. Provoked humors cause pruritis and other diseases. This called condition of

wrongful action as medication in accordance with pathological features.

8. Stambha

(A) Patient : Undergone oleation procedures

(B) Medicine : An Unctuous portion

(C) Physician : -----

(D) Pathogenesis : It gets covered up by the morbid matjer

which is in softened condition and will be

unable to expel the morbid matter from its

habitat. It even obstructs those that have

been dislodged from their habitats.

(E) Sign and symptoms : Causes scanty and frequent elimination

accompanied with acute obstruction of

Vata. Stambha (rigidity) and pain in the

rectum.

(F) Treatment : Strong enemata or purgation preceded by

lightening and digestive measures.

9. Upadrava

(A) Patient : Lacking in unctuous property, debilitated

(B) Medicine : Ununctuous purgative medication

(C) Physician : ---

(D) Pathogenesis : Will provoke the Vata quickly and give rise

to severe complications.

(E) Signs and symptoms : Causes rigidity and severe pain in all limbs

and fainting.

(F) Treatment : Oleation sudation, similar measures

(treatment curative of Vata)

10. Klamah

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58

(A) Patient : Undergone the oleation procedure and soft

bowelled

(B) Medicine : Mild Medication

(C) Physician : ---

(D) Pathogenesis : Rouses up the Kapha and Pitta and

obstructs Vata.

(E) Signs and Symptoms : Heaviness, exhaustion.

(F) Treatment : Vamana, Langhana (lightening), Pacana

(Digestive remedies), Should be given

unctuous and strong purigicatpry measures

Vyapad

Table No. 30 Vamana vyapath according to different classics

Symptms/Samhita Caraka Susruta Vagbhata Bhela Kasyapa

Adhman + + - - -

Parikartikas + + + + +

Sarva + - - - -

Hrdgraha + - - - -

Gatragraha + - + + +

Jivadanam + + - + +

Vibhramsa + - - - -

Stambha + - - - -

Upadrava + - - - -

Kalma + - - - -

Ausadasya

Pratikula Parvatti + - - - -

Savasesausadhatva - + - - -

Jimaushadatva - + - - -

Hina dosaprtasya + - - -

Vatasula - + - - -

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Ayoga - + - - -

Atiyoga + - - - -

Pravahika - - - - -

Hrdayopasaranam - + - - -

Parisravah - + + - -

Vibandha - + - + +

Angamarda - + - - -

Paka - + - - -

Grathitatva - - + - -

Gaurava - - + - -

Dosatklesha - - + - -

Bhrsadhmana - - + - -

Sarvadhatusravana - - - + -

Gudaparisrava - - - + -

Pratisyaya - - - + -

Vamanasamprapti

Vamaka drugs possessing the properties like Usna, Tiksna, Suksma, Vyavayi,Vikasi

And with their ‘Swavirya’

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60

Move to ‘Hrdaya’

From there, through various “Dhamanis”

Lead to micro and macro channels in the body

Act over the vitiated complexes in the body

(i) With Agneya Property’-liquefy the complexes

(ii) With ‘Tiksana property’- Break them don into several particles

Liquified matter then glindes thorugh various unctuous or

Smooth channels to towards Kosha

Enter ‘Amasaya’ and then stimulated by ‘Udana Vaya’

Having the dominance of ‘Agni’ and ‘Vayu’ elements in the constitution

Along with self disposition (Prabhava)

Move in upward direction towards oral cavity

Expelled to outside through it

Vamana (Ca Ka1/5)

Flow chart 6

Vamana – Mode of Action

Properties of Vamana Drugs

Vamana Drug is a main tool for inducing the Vamana. Apart from the Vamana drugs

Vamanopaga Gana has also been described. Drugs included in Vamanopaga Gana help in

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enhancing the process of Vamana. These Vamana drugs have following characteristics for

producing Vamana.

Bhauthika Constitution:

All the Vamana drugs have dominance of Agni and Vayu mahabhuta.

Guna220,221: According to Charaka, Vamana Drug must have properties to reach at the site of the

Doshas and cause Sampraptivighatana. These gunas are Ushna, Tikshna, Sukshma, Vyavayi and

Vikasi. Apart from these Gunas, Sushruta mentioned Saratva Guna instead of Vyavayi. The role

of each Guna in producing the vomiting and thus relieving the Dosha is being discussed as here

under.

a)Ushna

Ushna is Agneya, which produces Dahana, Pachana and Sveriana Ushna drugs pfay

important role in the process of Visyandaha of the Dosha Sanghata responsible for the disease

Chakrapani comment that Vishyandayati means "Vilinam Kurvanti" According to Apte (1965),

Viiinam means to dissolve or to liquefy. Dalhana opines that Ushna drugs are capable to

dominate the Saumya drugs due to their Ushanata. In this way due to Ushna property, the drugs

used in Vamana Karma, liquefy the Dosha Sanghata.

b)Tikshna

Daha, Paka and Srava are produced by Tikshna. Tikshna acts for Vicchindana.

Chakrapani mentions that Vicchindanti is nothing but the breaking down of the morbid matter

into the small possible Particles. Dalhana explains that because of Tikshna property waste

Products (Dosha) oozes out immediately. Tikshna is also Agneya. It Produces Shodhana,

Pachana, Chedana and Sravana of Doshas in their Places.

c) Sukshma

The drugs can pass through minute srotas due to Sukshma Guna. Vayu, Akasha and Agni

Mahabhuta are dominant in its Bhauthika constitution. Due to Sukshma Guna, Vamana drugs

enter Sthula andAnu Srotas. Sharngadhara has mentioned the same. Dalhana is also of the same

opinion. Vamana drugs after breaking the Dosha Sanghata by its Ushna and Tikshna properties,

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62

due to their Anu-Pravanabhava brings, the Dosha into the Kostha. To enter the minute srotasas is

due to its anutva and to bring the Doshas from there to koshta is due to pravantva bhava.

d) Vyavayi

Vyavayi drugs are supposed to act directly on the body. It is generally considered that as

soon as these types of drugs are ingested, their action starts before digestion. Due to this

property, the Vamana drugs get absorbed and then act quickly. Dalhana mentions that due to

Vyavayi guna, Vamana drugs spread into the body without changing its form. Charaka attributes

Vyavayi Guna to Visha and Madva. Chakrapani comments, Vyavayi means spread out in whole

body in the Visha Chikitsa Adhyaya. In Madatyaya Chikitsa Sarva Vyapakatva is Mentioned for

Vyavayi Guna. So, on the basis of the above references, It can be said that, due to Vyavayi

property Vamana drugs spread out in whole body and starts the action of Ushna, Tikshna and

Sukshma gunas before its Pachana, like Visha and Madya.

e) Vikasi

The drugs, which are having Vikasi Guna, produce Saithilya in sandhi and especially in

Ojus. It has been mentioned in Sushruta Samhita that Vikasi are those which loosen

(Vimokshayet) the Dhatu Bandhana. Dalhana explains that Vamana drugs due to Vikasi property

also pervade through whole body without digestion like that of Vyavayi. Further he mentions

that loosening of Dhatu Bandhana means Dhatu Saithilya.

f) Saratva

Saratva Guna for Vamana is mentioned by Sushruta. Dalhana opines that due to Saratva

Guna Anulomana is possible. Gayi another expounder is of. the opinion that Saratva is Visarana

i.e. sliding, spreading. It is possible that due to Saratva Guna, malas which are brought towards

the Kostha from Shakha may be evacuated. Thus removal of Dosha may be enhanced.

g) Virya

Mostly all the Vamana drugs should have Ushna Virya. Due to Ushna virya, the Vamaka

Dravyas are Dahana, Svedana, and particularly pachana in nature; hence they are first brought to

Hridaya and further circulated through Dhamani to Sthula and Anu Srotas of the body. Thus

Ushna Virya helps the Vamana drugs in their circulation all over the body and also in breaking

up the Dosha Sanghata.

h)Vipaka

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Due to Vyavayi Guna, Vamana drugs get absorbed without their digestion so Vipaka

seems not to play any role in Vamana Karma.

i )Prabhava

Charaka clearly mentions that the main action of Vamana is due to its Prabhava. Charaka

said "Urdhva Bhaga Prabhavat Aushadhasya Urdhvam Utkshipyate". Elaborating Prabhava of

Vamana drugs, Chakrapani mentions that due to dominance of Agni and Vayu Mahabhuta in

their Panchabhautika constitution, there is a tendency of Urdhva Gati of Vamana drugs. It is

initiated by Udana Vayu. However Chakrapani emphatically mentions that it is the Prabhava of

Vamana drugs, which have important role in Urdhva Gati.

Role of Udana Vayu in Urdhva Gati

Charaka has mentioned the word, 'Udana Pranunno’,Chakrapani comments that Vamana

drugs are set in motion in upward direction (Urdhva Gati) by Udana Vayu. Astanga Sangraha

also has the same view.

SITE OF ACTIONS:222

Dhamani:

Caraka used the word “Dhamani” through which Vamana drugs spreads throughout the

body. Definition of Dhamani by Caraka is “Dhamanath Dhamanyah” that means Dhamana is

what which pulsates. Thus it is a structure resembling to artery. Chakrapani also comments that it

provide nourishment to the paramanus. So in the Vamana process, Dhamani is the medium

through which the Vamana drugs act in cellular levels.

Amashaya:

Since Amashaya is the site of both Kapha as well as Pitta it is significant in Vamana.

From the Shakas doshas reaching the Amashaya and is the site of production of Ama. So it has to

be expelled out. Removal of Doshas from its production site is appreciated by the Acharyas.

Hridaya:

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64

The drugs due to their so Virya reach to Hridaya from there it spread to all over the body

by aiming the dosha complex in micro level by a short period of time. So the word Hrudya

narrated here can be considerd in terms of both vital as well as chief organ i.e. heart and brain

Due to the property Ushna, Tikshna, Sukshma, Vyavayi, Vikashi and so virya (potency)

emetic drug reaches the heart and able to penetrate macro and micro srotas which are connected

to Dhamanies. It will then try to breakdown the complexes of accumulated doshas, which is

adhering to srotas. Due to Agneya and Tikshna nature it is going to liquefy as well extricate the

doshas. Then this liquefied and fragmented doshas are lead eloquently to Amashaya, flowing

through micro srotas without adhering to them. Caraka is giving a simile for better understanding

that water floats through the pot layered by unctuous material without sticking to the same.

Thereafter by the action of ‘Urdwabhaga prabhava’ of emetic drugs as well as with the action of

Udana Vayu the process Vamana taking place.

PHYSIOLOGY OF VOMITING 223

Vomiting is the forceful expulsion of contents of the stomach and often, the proximal small

intestine. It is a manifestation of a large number of conditions, many of which are not primary

disorders of the gastrointestinal tract. Regardless of cause, vomiting can have serious

consequences, including acid-base derangements, volume and electrolyte depletion, malnutrition

and aspiration pneumonia

The Act of Vomiting

Vomiting is usually experienced as the finale in a series of three events, which everyone reading

this has experienced:

Nausea is an unpleasant and difficult to describe psychic experience in humans and

probably animals. Physiologically, nausea is typically associated with decreased gastric

motility and increased tone in the small intestine. Additionally, there is often reverse

peristalsis in the proximal small intestine.

Retching ("dry heaves") refers to spasmodic respiratory movements conducted with a

closed glottis. While this is occurring, the antrum of the stomach contracts and the fundus

and cardia relax.

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65

Emesis or vomition is when gastric and often small intestinal contents are propelled up

to and out of the mouth. It results from a highly coordinated series of events that could be

described as the following series of steps

o A deep breath is taken, the glottis is closed and the larynx is raised to open the

upper esophageal sphincter. Also, the soft palate is elevated to close off the

posterior nares.

o The diaphragm is contracted sharply downward to create negative pressure in the

thorax, which facilitates opening of the esophagus and distal esophageal

sphincter.

o Simultaneously with downward movement of the diaphragm, the muscles of the

abdominal walls are vigorously contracted, squeezing the stomach and thus

elevating intragastric pressure. With the pylorus closed and the esophagus

relatively open, the route of exit is clear.

Figure No.1

Control of Vomition

The complex, almost sterotypical set of activities that culminate in vomiting suggest that control

is central. Within the brainstem are two anatomically and functionally distinct units that control

vomiting:

Bilateral vomition centers in the reticular formation of the medulla integrate signals from a

large number of outlying sources and their excitement is ultimately what triggers vomition.

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66

Electric stimulation of these centers induces vomiting, while destruction of the vomition centers

renders animals very resistant to emetic drugs. The vomition centers receive afferent signals

from at least four major sources:

• The chemoreceptor trigger zone.

• Visceral afferents from the gastrointestinal tract (vagus or sympathetic nerves) - these

signals inform the brain of such conditions as gastrointestinal distention (a very potent

stimulus for vomition) and mucosal irritation.

• Visceral afferents from outside the gastrointestinal tract - this includes signals from

bile ducts, peritoneum, heart and a variety of other organs. These inputs to the vomition

center help explain how, for example, a stone in the common bile duct can result in

vomiting.

• Afferents from extra medullary centers in the brain - it is clear that certain psychic

stimuli (odors, fear), vestibular disturbances (motion sickness) and cerebral trauma can

result in vomition.

The chemoreceptor trigger zone is a bilateral set of centers in the brainstem lying under the

floor of the fourth ventricle. Electrical stimulation of these centers does not induce vomiting, but

application of emetic drugs does - if and only if the vomition centers are intact. The

chemoreceptor trigger zones function as emetic chemoreceptors for the vomition centers -

chemical abnormalities in the body (e.g. emetic drugs, uremia, hypoxia and diabetic

ketoacidosis) are sensed by these centers, which then send excitatory signs to the vomition

centers. Many of the antiemetic drugs act at the level of the chemoreceptor trigger zone. To

summarize, two basic sets of pathways - one neural and one humoral - lead to activation of

centers in the brain that initiate and control vomition.

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AMAVATA The disease Amavata is named after the involvement of pathological factors -Ama and

Vata. These two are the central phenomenon of the disease.

Vyutpatti of Amavata

AmamCha VatamChaAmavatam M.N.25/2, madhukosa

The word Amavata comprises of two meaningful terms Ama and Vata which form the

pathogenic basis of the disease.

Amena Sahito Vata Amavata M.N.25/2, madhukosa

This derivation highlights the propulsion of Ama by Vata to produce Amavata.

Amo Apaaka Hetuh Vataha Swanaama Khyaata Rogavisheshaha” shabdakalapadruma

That which is the result of improper digestion is Ama and with Vata the disease is

popularly known as Amavata.

Definition

Yugapath Kupithavantaha Trikasandhi Praveshakau

Stabdham Cha Kuruthe Gatramamavathaha Sa Uchyate M.N 25/5 madhukosa

Amavata is a condition where Stabdhata of the body occurs due to lodging of vitiated

Ama and Vata in the Trika Sandhi.

Ama

The first of the pathological factors of Amavata, Ama is the root cause of all Vikaras

more so in Amavata and it prompts a detailed study as discussed below.

Etymology

1. "Am+Nich": 'Am' Dhathu with 'Nich' Pratyaya constitutes the word Ama.

2. Amyate Gamyate Pakadyartham Iti Amah.

⇒ The substance which goes into the process of digestion is Ama.

3. Amyate Ishath Pachyathe.

⇒ It means substance which is incompletely digested or uncooked is Ama.

4. Amyate Peedyate Srotas Samooho Anena Iti Ama.

⇒ Substance which harms a group of Srotas is Ama. This etymology of Ama is

nearer to the disease Amavata.

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Definition of Ama

In Samhitas various definitions of Ama are available. Some of them are:

Due to hypo-functioning of Ushma (Agni), the first Dhatu - the Rasa is not properly

formed; instead the Annarasa undergoes Fermentation or putrefaction (Dushta) and remains in

Amashaya. It is this state of Rasa which is spoken of as Ama. AH.SU.13\25

Three different opinions about Ama are compiled by Vijaya Rakshita. First view is about

the improperly digested food and the second describes the accumulation of Malas in the different

parts of the body. According to the third view, the first stage of Dosha Dushti is

Ama.MA.NI.25\1-4

Etiology of Ama224

The causative factors of Ama are described detailed in Charaka Samhita.

Aharaja Hetu :

Abhojana (not taking food), Atibhojana (excessive consumption of food) Ajeerna Bhojana

(taking food before the previous food gets digested), Asatmya Bhojana (taking unwholesome

food), Viruddha Bhojana (simultaneous consumption of food having antagonistic properties).

Dwishta Bhojana ((unpalatable), Ashuchi Ahaara (unclean food), Rooksha, Sheeta, Shushka,

Vishtambhi, Vidahi Bhojana.

Viharaja Hetu :

Improper administration of Samshodhana and Snehana, Vega Vidharana, Prajaagara and

Dukhashayya (sleeping on uneven mattress) can also initiate production of Ama.

Manasika Hetu:

Food consumed by a person in the state of Bhaya, Krodha, and Shoka also leads to Ama Utpatti.

Anya Hetu:

Desha, Kaala, Rutuvaishamya,Vyaadhikarshana are mentioned as the causative factors for Ama.

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Lakshanas of ama

The following explains the generalized symptoms with their etiopathogenesis of manifestation

which may be later modified by individual Doshas to show its specific presentations.

Table showing Lakshanas of ama225

Table - 31

Symptoms Etiopathogenesis

Srotodushti Picchila and Snigdha Guna of Ama

Balabramsha Mandagni causing lack of nutrients

Gourava Snigdha, Picchila, Guru Gunas of Ama

Aiasya Snigdha, Picchila, Guru Gunas of Ama

Malasanga Disturbance to Vata by Srotorodha

Anila moodhata Disturbance to Vata by Srotorodha

Apakti The qualities of Ama in turn leads to

Agnimandya forming a vicious cycle

Nishteeva Madagni causing Kaphotklesha

Aruchi As a result of Ajeerna

Klama . Due to Dhatvagnimandya

Above said symptoms are the general symptoms produced by Ama. Further, when this

Ama comes in contact with Dosha, Dushya and Mala it is termed as Sama Dosha, Sama Dushya

and Sama Mala

Concept of ama

In other words, Ama reflects the products of deranged homeostatic mechanisms in the

body. This clogs the controlling centers and pathways of normal physiologic functions marking

the beginning of pathogenesis in the form of sammurcchana of Nidana, Dosha and Dushya.

Hence, the total body homeostasis is the augmented effect of non-defective functioning of

the multiple organizations called Srotases. Each Srotas has a feeding point, a target point, a

controlling center (Srotomula) and a pathway (Srotas) and its function is appropriate

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transformation of the input raw material in to a finished product with elimination of the waste

product, effected by the transformative principle Agni.

Levels of existence of ama226

As mentioned above, the Ama exists at three levels in the body.

a) Ama at Jatharagni level

Amashaya is the substratum of Jatharagni, when the vitiated Agni acts upon the Ahara, it

fails to completely transform Ahara into nourishing moieties. The resulting Ahara Rasa is a

mixture of formed and unformed elements called Ama, which is thrown out of the Amashaya

through the Urdhwamarga by the Chardi (vomiting) and through the Adhomarga (Athisara), or it

may get displaced into the Grahani to remain stagnant. Due to prolonged stagnation, it may

assume the properties of Visha. Further Ama may associate with the Doshas, Dhatus and Malas

after getting absorbed from Amashaya and manifest symptoms related with each of them.

Dietetic indiscretions and emotional stresses may between them impair the functioning of

the neurohumoral mechanisms responsible for ensuring proper secretion of the digestive juices,

the disturbances of the pH in the gastro-intestinal environment and more often sluggish and

sometime hyper-motility of the stomach and intestine, thus leading to Shuktata or Shuktapaka

where food will be Avipakva, Asamyukta, Bahupicchila and Durgandha, due to fermentation and

putrefaction of the carbohydrate, fat and protein components. Thus causes the toxic state -

Visharupatvam.

This pathogenesis may cause the following metabolic disturbances

1) Toxic states

a) Intermediate toxic byproducts of metabolism

b) Superadded microbial action

2) Malnutritional states

a) Intermediate toxic by products of metabolism: It is clear from the texts that Sama Ahara

Rasa induces the production of various deranged metabolites like

1. Sama Dosha: In Avasthapaka, there will be Udeerana of

the Doshas i.e. Madhura Avasthapaka - Kapha (Amashaya), Amla Avasthapaka - Pitta

(Pittashaya) and Katu Avasthapaka-Vata (Pakvashaya)

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71

But, due to Apakva Ahara produced by Mandagni, there will be Udeerana of Dushita

Dosha called as Samadosha. Further in Nishthapaka, due to affliction of Rasa and Rakta Dhatu,

there will be further increase of vitiated Kapha and Pitta in the form of Mala thus contributing to

Sama Dosha.

Bhutagni and Dhatvagni Mandya : Jatharagnimandya will lead to Bhutagni and

Dhatvagni Mandya also. Jatharagni is the Poshaka to the different Agni of the body, but

Bhutagni and Dhatvagni can even get vitiated independently i.e. irrespective of

Jatharagnimandya.

Sama Dhatu : With affliction of both Avastha and Nishthapaka, the Dhatu Poshaka Rasa

produced is Vikruta. Thus, with production of Sama Rasa Dhatu, succeeding Dhatu will also get

vitiated producing Dhatu Pradoshaja Vikara. Sama Dhatu Utpatti is due to Bhutagni and

Dhatvagni Mandya but it can even be independent of Jatharagni status.

II. Sama Mala : The word Mala includes 2 entities.

a. Mala of Ahara Rasa i.e. Pureesha, Mutra and Sweda and also the other Dhatugata

Malas

b. Dushita Dosha and Dhatu are also called Mala

2. Superadded microbial action: Toxins in the intestines in the present days are greatly

attributed to the action of different microbes, thus leading to different manifestations like:

i) Infective gastro-enteritis

ii) Toxic gastro-enteritis

iii) Botulism

Intestinal flora in the human body exists in the state of symbiosis; these can be very well

compared with Sahaja Krimi. Chakrapanidatta explains them as the one which exists within the

body without causing diseases. Intestinal flora breaks the complex molecule which are not

broken by the body, metabolises them into simple molecules by 2 kinds of actions. They are

Fermentation and Putrefaction.

Putrefaction is similar to fermentation but it specifically refers to conversion of protein

substances to smaller molecules with the liberation of various gases viz. Indol, Skatole, Phenol,

Hydrogen sulphate and Ammonia that are characteristically pungent in odour. Fermentation is

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related to the Carbohydrate and fat metabolism by the microbes. Microbe's metabolism releases

few of the waste products vital for the body like Vit. Bgroups.

Among these microbes, there are some in borderline populations which under

circumstances become parasitic. There are other groups of virulent organisms which invade body

through food and drinks, producing abnormalities in the body, e.g.: Salmonella, Staphylococcus,

B. botulinus, B.typhosus and coma bacillus of Kochs. Hence, the normal food metabolism also

includes the metabolism by Intestinal flora (Sahaja Krimi).

Hence, different microbial infections occur in the body when it is made susceptible by

predisposing factors like metabolic abnormalities, emotional stress, overstrain and other

Agnimandyakara and Amotpattikara Nidana.

Malnutritional states

In chronic disorders, due to Agnimandya or Amotpatti, there will be predominant manifestation

of Dhatukshaya as it is told in Vatavyadhi context that the Avarana will cause Rasadi Dhatu

Kshaya. Depending on the speed of manifestation, disease can be

Acute

Sub-acute and Chronic

Acute conditions include Visuchika, Jwara, Atisara, Pravahika and so on. Sub-acute and chronic

conditions include Grahani Dosha, Udara roga, Pandu, Amavata, Prameha and so on.

a)Dhatvagni level

• The Ama at Dhatvagni level occurs due to vitiated Dhatvagni first as a result of a direct

influence from Jatharagni as the Dhatvagnis are derivatives of Jatharagni and Jatharagni

hyperfunction or hypofunction results in respective derangements of Dhatvagnis too

• Secondly, as a result of Dhatvagni malfunction independent of Jatharagni. The

hypofunction of Dhatvagni leads to morbid increase of the Dhatu involved and

hyperfunction leads to its morbid decrease. The Ama hence formed gets associated with

these morbid Dhatus to form Sama Dhatus resulting in manifestation of symptoms

explained under Dhatupradoshaja Vikara .

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b) Bhutagni level

The Ama at the Bhutagni level occurs as a result of Bhutagnimandya, the mechanism of

formation is similar to that mentioned under Dhatvagni level. The symptoms produced are

Shosha, Vrana, Vidradhi and similar diseases.

1. Ama as a result of Malasanchaya:

The Malas (waste products) produced at various levels in the body, when accumulates

beyond tolerable limits also constitutes Ama. The Mutra and Pureesha are the Malas of Ahara,

Kapha that of Rasa, Pitta of Rakta, Vasa and Khamala of Mamsa, Sweda of Medas, Loma, Asthi

and Tvacha Sneha and Akshi Vit of Majja

The excessive accumulation of these Malas (Mala Sanchaya) therefore gets to be called

Ama as they are harmful to the normal physiology of the body. The Shukra is the essence

of all Dhatus and it does not have any Malas.

Production of Ama independent of influence of Agni - as a result of Dosha Anyonya

Sammurcchana

Strangely, the Doshas exist in the body in equilibrium of mutually paradoxical Gunas of

Doshas; this equilibrium is inherent and compatible with the normal bodily functions. This has

been called as "Sahajasatmya"

An interesting feature of this concept is its close resemblance to the concept of auto

immunity in the modern parlance. The Major Histocompatibility Complex determined by Human

Leukocyte Antigens marks the surface proteins of all the cells of the body. This helps the T cells

(responsible for Cell mediated immunity) to recognize the self antigens from the non-self. When

this mechanism fails, the immune system starts secreting antibodies against body's self proteins

producing crippling and fatal diseases. They are called Auto immune diseases and Rheumatic

Fever is one among them

Nidana224

Identifying the causative factors and understanding the role of these causative factors in

the manifestation of the disease is utmost important to make a proper diagnosis, to predict

prognosis and to plan treatment.

Invariably two factors are responsible for the manifestation of the disease Amavata. As

the name indicates, Ama and Vata are those two factors. The Anjana Nidana author opines Ama

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and Vata get vitiated due to their own respective causes to promote disease. Hence, individual

etiological factors responsible for the vitiation of Vata and those etiological factors which

produce Ama may also be considered as etiological factors of Amavata.

Madhavakara has explained following Nidanas for Amavata

1. Viruddha Ahara (incompatible diet)

2. Viruddha Cheshta (Erroneous habit)

3. Mandagni (diminished digestive fire)

4. Nischalata (Sedentary habits)

5. Vyayama soon after Snigdha Ahara

Besides this, Harita opines consuming Guru Ahara, Kanda Shaka (tubers) in excess and

indulging in excessive Vyavaya is the Nidana of Amavata.

To sum up, the causative factors of Amavata can briefly be classified in to two.

1) Viruddha Ahara- unwholesome diet

2) Viruddha Cheshta- erroneous habit

Viruddha itself is the root cause of the disease Amavata. The factors which cause Dosha

Utklesha (vitiation) but do not have the capacity to eliminate those Doshas out of the body are

considered as Viruddha.

Charaka has elaborately mentioned regarding Viruddha Ahara and categorized these into

18 types.They are Desa (Habitat) Viruddha, Kala (season) Viruddjia, Agni (digestive power)

Viruddha, Matra (dose) Viruddha, Satmya (compatibility) Viruddha, Dosha Viruddha, Samskara

(processing) Viruddha, Veerya (potency) Viruddha, Koshta (bowels) Viruddha, Parihara

(proscription) Viruddha, Avastha (state of health) Viruddha, Krama (order) Viruddha, Upachara

(prescription) Viruddha, Paka (cooking) Viruddha, Samyoga (combination) Viruddha, Hrit

(palatability) Viruddha, Sampath (quality) Viruddha, Vidhi (rules of intake) Viruddha.

Viruddha Cheshta includes a wide variety of causative factors. They are consumption of

Snigdha Ahara and doing Vyayama immediately, Sheetoshna Vyatyasa (alternative use of Sheeta

and Ushna), use of Sheetodaka at once during Bhaya Shrama and so on, Vega Vidharana

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(suppression of natural urges), Vega Udeerana (provoking of natural urges), Diva Swapna (day

sleep), Ratri Jagarana (night vigil), Sahasa (act beyond capacity).

The causative factors of a disease operate in varied patterns in the body to cause the

disease. This depends upon the extent to which the environment is made favorable for the

interaction of Nidana, Dosha and Dushya.

The capacity of the body to resist this interaption is called Vyadhikshamatva/ Vyadhi

Pratyaneeka Bala. This Bala differs from person to person. That is why inspite of exposure to

Nidanas, some develop severe disease with negligible exposure while some people do not.

Samprapti227

The pathology of a disease involves various complex and sequential mechanisms. This

has to be unraveled for the proper understanding of the disease and then to plan successful

treatment. Mechanisms of the disease process are best understood by means of Samprapti of the

disease.

Madhavakara has explained the Samprapti of Amavata as follows. In the presence of

Mandagni, if one is exposed to Nidana then Ama is formed in the Amashaya along with vitiation

of Vata Dosha. This Ama circulates in the body propelled by the vitiated Vata exhibiting an

affinity to get lodged in the Shleshma Sthana i.e. Sandhi. Further, this circulating Ama in the

Dhamanis interact with the normally present Vata Pitta and Kapha Dosha giving rise to

variegated color to the virulent Ama. It becomes qualitatively heavy and viscous, facilitating

Sroto Abhishyandana and Srotorodha.

Alteration in the Srotas endures Sthana Samshraya leading to the manifestation of

symptoms like Hrutgourava, Dourbalya, Sandhi Shotha and Shoola etc.

Amavata is basically caused by the Viruddha Ahara as well as Cheshta. More over this

phenomenon of Viruddha Ahara may not be similar in every patient rather it is individual

specific. This etiology of Viruddha Ahara is said to be in connection with the establishment of

the disease. On exposure to Viruddha Ahara it may cause morbidity of Dosha, impair the

functioning of the Jataragni or else it may lead to the formation of more virulent Amavisha.

Similar to virudhahara, virudha cheshta also has got an important role. Chestas like

sedentary habits or doing tidious work or exercises just after having heavy or fatty meals affects

the proper digestion and metabolism This will accelerate the formation of ama visha in the body.

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Dosha Dushti :

Consumption of Viruddha Ahara precipitates morbidity of Doshas. Due to the deleterious

effect of the Viruddha Ahara, any Dosha may get vitiated or else any combination of the two

Doshas or all the three together. These vitiated Doshas in turn afflicting the specific Dushya

manifests as illness, pertaining to Amavata. By the deleterious effect of the Viruddha Ahara,

there occurs the morbidity of the Vata Dosha. The clinical manifestations like Anaha, Antrakuja,

Vibandha, Sandhi Sula, Sandhi Jadyata etc are suggestive of vitiation of Vata Dosha at different

levels.

Chesta

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Agni Mandya and Amotpatti

Intake of Viruddha Ahara has detrimental effect on the functioning ofthe Jataragni. As

mentioned byAcharya Charaka, intake of Viruddha Ahara leads to Agnimandya which in turn

generates the virulent Ama in the body. Invariable involvement of Ama is characteristic of the

disease Amavata. Both Koshtagata as well as Shareeragata Ama are the hallmarks of the

pathogenesis of Amavata. Reduction in the Abhyavaharana Shakti andJal-ana Shakti, symptoms

like Praseka, Aruchi, Apakti, Malasanga and similar other symptoms are indicative of

Koshtagata Ama. Shareeragourava, Alasya, Klama, Sandhi Shotha, Staimitya are the other

common clinical features of Amavata suggestive of Shareeragata Ama. Moreover, the symptom

complex of Amavata is more indicative of combined effect of Ama as well as morbid Vata and is

popularly known as Samavata state. Progressive involvement of the joints in the form of severe

pain and swelling, worsening of the symptoms by the application of the oil, more severity of the

symptoms at the time of sunrise, as well as on appearance of the clouds in the sky, all are the

typical features indicative of Samavata state in the disease Amavata.

Similar to virudhahara, virudha cheshta also has got an important part in the

pathogenesis.

The Ama and morbid Vata, from Amashaya circulates in the whole body. The properties

of the Samavata being similar to that of the Kapha Dosha, Ama and morbid Vayu exhibits an

affinity to get lodged in the Kapha Sthana, more particularly tend to get localized in the joint.

With in the joint, these two pathological factors undergo a pathological union with the naturally

present Doshas in the joints. It is said that by the interaction with the Doshas in the joint the Ama

and morbid Vata acquires further virulence and then manifests as Amavata. Here, the interaction

with in the joint causes the generation of Amavisha.

Perpetuation of the illness for a long duration destroying the joints is analogous to the

effect of Garavisha in the body. Progressive damage that occurs for long is very characteristic of

Garavisha.. Thus relating this to the causation of the illness, indulgence of Viruddha Ahara

ultimately culminates in the generation of Amavisha. This Amavisha gradually causes

destruction of the body. Later, during the course of the disease, permanent destruction of the

joints results in the Anga Sankocha, Jadyata, Anga Vaikalya etc, totally incapacitating the

patients and restricting him to the bed. Viruddha produces some alteration in the humoral activity

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of the body and results in the production of Ama. This Ama is antagonistic to the bodily tissues

(Dhatu Virodhi). Effect of this may be rapid or gradual.

Dhatu Dushti

Deleterious effect of the Viruddha Ahara is not restricted to the Dosha and Agni; rather it

badly influences the Dhatu even. This nature of the Viruddha Ahara is described as

Dhatupratyanika effect. It is worth mentioning here that the Viruddha Ahara is considered as an

etiology of Majjavaha Sroto Dushti and the Mula of the Majjavaha Srotas being Asthi and

Sandhi, this implies the detrimental effect of the Viruddha Ahara on the Asthi and Sandhi

wherein the disease Amavata manifests. The symptoms like Sandhi Shotha, Sandhi Shoola,

Bhedanavat Shoola in Asthi and Parva Pradesha, Mamsa Kshaya, Sandhi Sankocha etc. are

suggestive of Dhatu Dushti in the disease Amavata.

Samprapti Ghataka

Dosha : Tridosha-Vata kapha predominant

Dhatu : Rasa, Mamsa, Asthi, Majja

Upadhatu : Snayu, Sandhi

Srotas : Annavaha, Rasavaha, Asthivaha, Majjavaha,

Udakavaha, Purishavaha, Mutravaha

Srotodushti : Sanga, Vimargagamana

Udbhavasthana : Amashaya, Pakvashaya

Adhishtana : Sarvashareera

Vyakta Sthana : Sarva Shareera more particularly Sandhi

Avayava : Sandhi

Vyadhisvabhava : Chirakari

Roga Marga : Madhyama

Poorva Roopa228,229,230

The Poorva Roopa of Amavata is not explained in the Samhitas, we can consider few of

the Samanya Arnavata Lakshanas as its Poorva Roopa.

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In Amavata before the onset of disease, Ama is formed. The symptoms produced when

Ama only gets involved with Vata before getting lodged in the Shleshma Sthana, can be

considered as Poorva Roopa. The Samanya Lakshanas of Amavata though not very disease

specific to Amavata, likeAgnimandya, Aruchi, Angamarda and Gourava can be considered as

Poorva Roopa.

Roopa

Specific signs and symptoms of a disease when manifested conspicuously are considered

as Roopa or Lakshana of a disease.

Roopa is one of the key tool in arriving at the diagnosis.

Of course this is also helpful in assessing the Sadhyasadhyata and to plan the treatment.

The Lakshanas of Amavata have been explained in length in the classics.

Based on the stages of the disease the lakshanas are broadly classified into

Samanyalakshanas and Pravridha lakshanas.

Samanya and Pravridha Lakshanas of Ama231,232,233,234

Table No– 32

Samanyalakshanas Pravridha lakshanas

Angamarda Sandhi Soolam

Aruchi Sopham

Trishna Agnidourbalyam

Alasyam Prasekam

Gowravam Aruchi

Jwaram Gowravam

Apakam Utsahahani Soonathanganam Vairasyam

- Daham

- Bahumootrata

- Kukshi soolam

- Nidrviparyayam

- Trit

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- Chardi

- Bhramam

- Moorcha

- Hritgraham

- Vitbandham

- Jadhyam

- Antrakoojam

- Anaham

On keen observation and assessment of Lakshanas, they can be broadly classified into 3

categories.

1. Lakshana specific to involvement of Sandhi.

2. Lakshana specific to involvement of Ama.

3. Lakshanas produced as a consequence of the disease

process. They are elaborated below:

Classification of Lakshanas

Table No.-33

Lakshana specific to Lakshana specific to Lakshanas produced

involvement of Sandhi involvement of Ama as a consequence of the

disease process

Sandhi Shoola Chardi Nidraviparyaya

Sandhi Shotha Arochaka Bhrama

Shunata Anganam Aruchi Murcha

Sashabdha Sandhi Anaha

Gatrasthabdhata Angamarda

Jadyata Alasya

Sandhi Vikunchana

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Sankocha

Kanja

Though in this disease is Vata predominant, involvement of Ama is invariable. Hence, we

see Sama Vata Lakshanas in the patients of Amavata. This might be the reason for not

mentioning the disease Amavata separately byCharaka.

Doshanubandha Lakshanas

Vatanubandha : Sasularn

Pittanubandha : Sadaha, Saraga

Kaphanubandha : Stimitata, Guru, Kandu

According to Rasaratnasamuchaya, the lakshanas of Amavata are

Persistent pain the Katee pradesha (Katyam vyadha bhavennithyam), swelling in Sandhis

(sandhishu swayadhur bhaveth), inability to rise even from sitting position

(Uthanepyasamarthathwam) are the features of the disease.

Bheda

For a better understanding, the disease Amavata can be broadly classified into two

categories, the first, on the basis of clinical manifestation and the second, on the basis of

prognosis, with sub classification existing in each category. The details are as follows;

1. Based on clinical manifestations it is divided into:

a. Dosha Bhedena

In Amavata, the Pradhana Dosha is invariably Vafa. Due to some supportive factors other

two Doshas also get involved; accordingly, we can observe the symptoms. Madhavakara has

explained seven type of Amavata on the basis of Dosha Pradhanyata. They are as follows:

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Classification based on Dosha Bheda 235

Table No. - 34

Dosha Symptoms Guna

Vataja Shoola Sheeta ,Chala

Pittaja Raga, Daha Teekshna, Ushna

Kaphaja Sthaimitya, Guruta, Kandu Picchila, Sthira, Sheeta

Vatapittaja Shoola ,Raga, Daha Sheeta, Chala,Teekshna, Ushna

Vatakapha Shoola,Sthaimitya,Guruta, Sheeta,Chala, Picchila,

Kandu Sthira, Sheeta

Pittakapha Raga,Daha,Shoola, Teekshna, Ushna,Sheeta,

Sthaimitya,Guruta, Chala,Picchila, Sthira,

Kandu Sheeta

Sannipatika All the above All the above

c) Avastha Bhedena

Based on the different stages of the disease, Madhavakara has broadly classified Amavata

into two varieties they are,

1. Samanya

2. Pravruddha

The symptomatology of this has been discussed in Roopa Table No. 2.

d) Lakshana Bhedena

Acharya Harita's classification of Amavata has been unique. According to him, Amavata is

of four types.236

1) Vishtambhi : This type of Amavata presents with Shareera

Guruta, Adhmana, and Basti Shoola.

2) Gulmi Amavata : Amavata having Jatara garjana, Gulmavat

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peeda and Kati jadata is called as Gulmi.

3) Snehi : Here Gaatra snigdhata, Jadhya, Mandagni

and excretion of Vijala and Snigdha ama are characteristic.

4) Pakva ama : This variety of Amavata presents with

excretion of Shyava vijala pitta and Pakva ama along with

Shrama and Klama.

d) Based on prognosis237,238

Based on the general principle of Sadhyasadhyata, Amavata can be of two types.

1. Naveena: If the duration of disease is not more than one year, it is called Naveena Amavata

which is Sadhya.

2. Purana: If the duration of Amavata is more than one year, it is called Purana Amavata which

is difficult tatreat.

Prognosis based on Doshasthiti 239

Table No. -35

Dosha sthiti Prognosis

Ekadoshaja Dwidoshaja

Tridoshaja Sadhya Yapya Krichrasadhyam

Classical Management of Amavata240

The treatment of amavata was first described by Bhavamishra. The lisease has got two

stages namely ama stage and nirama stage. In the initial stage treatment is given to subside the

ama which is the causative factor of the disease. When ama has been subsided treatment is done

to alleviate Vata. Prophylactic treatment also should be done inorder to check the recurrence of

the disease. The line of treatment described by acharyas may be as follows.

1. Langhana

2. Swedana

3. Administration of deepana drugs which are having thikta and katu rasas

4. Virechana

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5. Sneha pana

6. Vasti

Treatment Principle

1. Langhana

In Amavata, ama is the primary cause of the disease. Agnimandya is responsible for the

formation of ama and vataprakopa. According to Ayurvedic authorities Langhana is one of the

best therapies for eliminating ama. By ama pachana the passages of vayu can be cleared, ie.the

vitiated vata come to normal stage.But as long as ama remains, the disease will not subside. So

ama must be eliminated first and then only other medicines for vata to be used.

Upavasa is recommended in Amavata. Amavata is caused by ama which is the result of

hypofunctioning of the digestive and metabolic enzymes. In such a condition, the body cannot

digest even light meals. If ingestions of food is not restricted the angimandya will continue and

the disease gets aggravated. Hence langhana in the form of Upavasa is the best treatment for

amapachana in amavata.

If the patient is weak complete fasting should be avoided and light food prepared with

deepana, pachana drugs should be given.

The samyaklanghita lakshanas are mentioned as follows.

Proper excretion of flatus, urine and faeces, lightness of the body, feeling of purity in

heart, purity in mouth and throat disappearance of drowsiness and exertion, appearance of sweet

taste for food, simultaneous hunger and thirst and contentment.

Yogaratnakara also explains in the case of ama vyadhi’s one may go for the

samshodana,in the form of vamana. It is also considered as shodana variety of langhana by

charaka.241

2. Swedana

Among the several types of swedanas mentioned in Ayurvedic classics, Ushma sweda, Tapa

sweda and Upanaha sweda are recommended inAmavata.

When the swollen joint is fomented the srotorodha is minimized and therby relieves pain

and inflammation. The fomentation relieves the local congestion and the redness is relieved, the

patient is able to move the joint with least trouble. Rooksha sweda which is usually carried out

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85

by valuka potali is recommended in this specific type of disease. Other ushna dravyas such as

kulatha could also be used for this purpose.

The principle underlying the use of valuka potali is that the arna along with vayu plays an

important role in the initial stage of the disease and creates unbearable pain in the joints. The

ama is guru-snigdha and sthira in nature and hence that type of fomentation which is exactly

antagonistic in nature is advised in this condition. It has been observed that by application of

sneha the symptoms will get aggravated. Sneha vivarjitha upanaha sweda also is recommended

in amavata by Bhavamishra.

Sweda karma is contra indicated in persons belonging to Pitha prakriti. In such a person

instead of direct swedana anagni sweda is recommended. The patient is asked to wear wollen

clothes, blankets etc. the same type of swedana can be given by keeping the patient in a closed

room where direct exposure to heat is, avoided. The drugs having the quality of ushna, rooksha

etc. are selected and made in to a paste, and to be applied in the inflamed parts. The lepas

commonly used in Amavata are Jadamaydi lepam, kottam chukkadi lepam and Ellumnisadi

lepam,

3. Administration of deepana drugs which are having both thikta and katu rasas Drugs having

katu, thikta rasas are used in Amavata. Amapachana is the important therapeutic measure

administered in this disease. Medicines having katuthikta rasas have both deepana and pachana

property; The selection of these two rasas is most significant. Ama is guru, pichila, snigdha and

sthira. pridhvi and jala are abundant in it. Tikta rasa is laghu and rooksha in nature and the

mahabhutas present in it is akasha and vayu.

Katu rasa contain Agni and Vayu in abundance. It is ushna veerya in nature and having deepana,

pachana and vataghna properties Thikta and katu rasa act antagonistically and hence medicines

having thikta and katu rasas are very useful for deepana and pachana.

The above mentioned therapies langhana, swedana, and administration of deepana

pachana drugs are helpful in the ama stage of the disease. In the nirama stage virechana,

snehapana and vasti are mentioned.

4. Virechana

Due to fasting, swedana and shamana chikihtsa the doshas attain nirama stage and reach koshta

and from there they are to be eliminated.

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Here virechana is done for the elimination of both pitha and kapha and for the anulomana of

vayu. Complete eradication of doshas by virechana will prevent the tendency to recur the disease

again and again.

Eranda thaila is the drug of choice for virechana in amavata. It has got the pachana, virechana

and vataghna property. According to Susruta it is deepana also. Hence it is considered as an

unchallangable drug of this disease.

This purgative should not be given in the initial stage of the disease because in that stage

the doshas are sama and are leena.in the dhatus. After attaining nirama stage and bringing the

doshas to pakwasaya, they should be thrown out gradually.

5. Snehapana

When the doshas became nirama kevala vatahara treatment is indicated. In kevala vata

sneha is the prime remedy.

Charaka says sneha pacifies vitiated vata, gives mridutwa for body and removes the

obstruction of malas. In amavata sneha medicated with deepana and pachana drugs are found to

be most effective.Both external and internal application of sneha is necessary in amavata.

External application such as abhyanga and moordha taila is indicated in this disease. For internal

use hriswa matra type of snehapana is suitable as the patients are weak due to the disease. Here

the sneha gives brimhanatwa to the patient. It also gives vata shamana, agni deepthi and koshta

shudhi to the patient. Bhavamishra suggests repeated administration of sneha in amavata

patients.

Pathya:- Harita explains that the pathya told in jwara roga should also be considered in amavata as in both

the disease involvement of rasavaha srotas is there.242All the ahara vihara which are Vata Kapha

hara, 0Amapachaka, Agnivardaka are useful.Yava ,kulatha, shyamaka, kodrava, rakthashali,

vastuka, shigru, karavaellaka, patola, ardraka, lashuna, ushnajala, takra, jangala

mamsa.Panchakola siddha jala,katu tikta phala, gokshura,varuna,arishtaka, purana

shali,sauveera, punarnava, lavamamsa processed in takrakulatha yusha ,jeerna

Madhya.balataka.243,244

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Apathyas:- The ahara vihara which cause agnimandya, abhishyandana, all the nidanas which are Vata and

Kapha kara in nature is apathya to amavata. Dadhi,matsya,guda,ksheera, mahapistaka, dushta

jala, virudhashana, satmya, vishamashana, guru adhishyandaahara,vegadharana, jagarana,

nischeshtata,Dwidala danya, goulya, taila, sheetala jala snana, ushna drava.245,246

Sapeksha nidana

Sapeksha nidana is the comparison of diseases having look alike feature.Amavata is a painful

joint disorder which has to be differentiated from other painful joint diseases like,

1. VATA RAKTA:247

In this disease as the name suggest involvement of rakta plays important role in causing

disease. Main feature of the disease is, it affects classically the big toe with some skin

manifestation. Pain will be like akoovisha

2. SANDHIGATA VATA:248

Here swelling occurs like air filled bladder in touch and pain during contraction and

extension of limb.

3. KROSHTUKA SHEERSHA:249

It is mainly due to vata and shonitha.It effect only knee joint. Pain is severe and the shape of

joint is shrigala mastakavath.( head of a jackal)

Disease Review

“Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata”

88

Rheumatoid arthritis250

Rheumatoid arthritis is an autoimmune chronic inflammatory disorder. Autoimmune

diseases are illnesses that occur when the body tissues are mistakenly attacked by it’s own

immune system. RA is characterized by an inflammation of the synovial joints leading to joint

and periarticular tissue destruction as well as a wide variety of extraarticular features. Patients

with autoimmune diseases have antibodies in their blood that target their own body tissues,

where they can be associated with inflammation. Because it can affect multiple other organs of

the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called

rheumatoid disease. While rheumatoid arthritis is a chronic illness, meaning it can last for years,

patients may experience long periods without symptoms. Typically, however, rheumatoid

arthritis is a progressive illness that has the potential to cause joint destruction and functional

disability.

Etymology of RA

According to collinns dictionary-Rheumatism is derived from the word – “Rheumatimos” a

Greek word designating ‘mucous’, an evil humor which flows from brain to the joints and other

portion of the body, producing pain(Hollander) -

• The term “Rheum” also means stiffness.

• The term Arthritis derived from – a Greek word “arthros” means joint. Arthritis means

inflammation of the joint.

Definition of RA

• RA is a chronic, multisystem disease of unknown etiology. Although there are a variety

of systemic manifestations, the characteristic feature of RA is persistent inflammatory

synovitis, usually involving peripheral joints in a symmetric distribution. The potential of

the synovial inflammation to cause cartilage destruction is the hallmark of the disease.

• RA is a systemic connective tissue disorder which affects predominantly the synovial

joints. Hence the term ‘rheumatoid arthritis’.

• RA is the most common form of chronic inflammatory joint disease. In its typical form

RA is a symmetrical, destructive and deforming. Poly arthritis affecting small and large

synovial joints with associated systemic disturbance, a variety of exra–articular features

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and the presence of circulating antiglobulin antibodies (rheumatoid factors).

Characteristically the course of the disease is prolonged with exacerbations and

remissions forms are not uncommon.

• RA is a systemic inflammatory disorder of a chronic nature that is characterized primarily

by the pattern of involvement of synovial joint. The inflammatory process may involve

soft tissue and may extend into bone. By virtue of inflammation that are involved in

rheumatoid process, systemic involvement of a generalized inflammatory nature affecting

different organs and structures may also be seen.

• Rheumatoid disease is an inflammatory condition in which immunological mechanisms

probably play an important role. Arthritis is its principal manifestation. (Chamberlain)

• RA is a systemic condition which produces intra-articular and periarticular inflammation.

Although the principal symptoms relate to the joints it is now regarded as a disease of

mesenchymal connective tissue which affects many organs-skeletal tissues including

bones, muscles, tendons, fescia, synovia, and bursae.

Historical review:

Regarding the disease Rheumatoid arthritis –

Hippocrates: Introduced the disease in the field of medicine.

Aretus: Give the clinical description of Rheumatoid arthritis.

Galen: Coined the word ‘Rheumatism’.

Pavlow: Distinguished acute arthritis from gout.

CLASSIFICATION OF RA

According to modern medicine – RA can be classified into three types.

1. Juvenile RA – (in children)

2. Adult RA

3. Psoriatic and atypical RA

Further on the basis of various features and factors – RA can be classified as

(1) According to chronicity – 2 type

(i) Type 1 – The less common form, lasts a few months at most and leaves no permanent

disability.

(ii) Type 2 – It is chronic and lasts for years, sometime for life.

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(2) According to ARA criteria – 4 type

(i) Possible RA – presence of 2 criteria for 3 wks.

(ii) Probable RA – 3 or 4 criteria for at least 6 wks.

(iii) Definite RA – 5 or 6 criteria for at least 6 wks.

(iv) Classical RA – 7 or more criteria.

(3) According to Pattern of onset249

(i) Acute RA or Explosive – (10%)

• Very rapid with severe symmetrical polyarticular involvement.

• Many patients with this type of onset do surprisingly well in long.

(ii) Palindromic RA

• Repeated attacks of acute self limiting synovitis affecting a variable number of joints.

• Inflammation develops over a few hours accompanied by erythema and swelling of affected

joints, resolves within 32-48 hours leaving no residual features.

• It is usually identified by presence of RF in blood.

(iii) Insidious RA – (70%)

• Cases of RA develop insidiously over weeks or months with gradually increasing joint

involvement. Progression is from predominantly peripheral small joint disease to the

involvement of the more proximal joints including the knee and hips.

(iv) Systemic RA

• It is usually seen in middle aged man.

• No articular features dominate, i.e. fever, myalgia, weight loss, anemia, pleural effusion and

vasculitis lesion may occur.

• RF usually present with high titer.

(4) According to number of joints involved

(i) Mono – articular RA

(ii) Oligo – articular RA

(iii) Poly – articular RA

(5) According to Radiological changes

(i) Erosive RA

(ii) Non-Erosive RA

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(6) According to RA factor

(i) Sero – positive RA

(ii) Sero – Negative RA

(7) According to presence of rheumatoid nodules

(i) Nodular RA

(ii) Non Nodular RA

Clinical pattern of different types of RA

(i) Palindromic – Attack of 24-98 hrs, 50% progress to pattern.

(ii) Transient – self limiting less than 12 months, not permanent.

(iii) Remitting – Remission after 3-5 years minimal residual damage.

(iv) Persistent – Relapsing and remitting case with variable disability.

(v) Chronic and progressive – heads to severe deformity and disability.

Abnormality in RA-Synovial joint

• When the synovial becomes inflamed in RA – the protein content of Synovial fluid increases.

• The concentration of hyaluronic acid (3.5. gm) and its molecular wt. are reduced.

• Fluid viscosity decreases.

PATHOLOGICAL CHANGES IN JOINTS IN RA:

• In RA synovium becomes inflamed causing warmth, redness, swelling and pain.

• As the disease progress the inflamed synovial invades and damages the cartilage and bone of

the joint.

• The destruction of ligaments and tendons by proliferation margins of inflamed synovial

referred to as pannus.

• surrounding muscles, ligaments and tendons become weakened, and unable to work normally.

• RA also can cause more generalized bone loss that may lead to osteoporosis.(Fragile bones

those are prone to fracture.)

AETIOLOGY OF RHEUMATOID ARTHRITIS:

The cause of RA is still unknown, even though infectious agents such as viruses, bacteria, and

fungi have long been suspected; none has been proven as the cause. The cause of rheumatoid

arthritis is a very active area of worldwide research. Some scientists believe that the tendency to

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develop rheumatoid arthritis may be genetically inherited. It is suspected that certain infections

or factors in the environment might trigger the immune system to attack the body's own tissues,

resulting in inflammation in various organs of the body such as the lungs or eyes.However

following are some of the speculations in this respect according to modern medical science.

• The disease is triggered by T-lymphocyte activation in genetically predisposed individuals with

defined HLA class-II halotypes. HLA-DRI is more important in Indians

• RA might be a manifestation of the response to an infectious agent like mycoplasma, Epstein

Barr virus, cytomegalovirus, rubella virus in a genetically susceptible host.

• A persistent infection of articular structure or retention of microbial products in the synovial

tissues generates a chronic inflammatory response.

• The microorganism or response to the microorganism might induce an immune response to

components of the joint by altering its integrity and revealing antigenic peptides (Harisson)

• The sensitization of self antigens could be a consequence of enzymatic or free radical damage

to proteins such as IgG or type-II collagen, the development of anti-idio type antibodies or a

defect in glycostation of IgG.

• Molecular mimicry - The infecting microorganism might prime the host to cross reactive

determinants expressed within the joint. There is recent evidence of similarity between products

of certain gram negative bacteria and HLA-DR molecule.

• Super antigen driven disorder-super antigens are proteins produced by a number of

microorganisms like staphylococci, streptococci and M. arthritis. They have capacity to bind

HLA-DR molecular and particular VB segments of heterodimeric T cell receptor and stimulate

specific T cells expressing the VB gene products (H P I M).

• Risk factors for the development of RA include obesity, smoking, high red meat consumption,

a previous blood transfusion and an adverse pregnancy outcome (Symmons DP Looking back:

rheumatoid arthritis--etiology, occurrence and mortality/Pubmed 16306475).

• Over work and psychological stress cause first attacks as well as relapses.

• Endocrine factors play a part in 20-25% cases which occur within a year of menopause (Savil

1988).

• Of all the potential environmental triggers, the only one clearly associated with the

development of RA is cigarette smoking.

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Pathogenesis of Rheumatoid arthritis:

There are three important factors in the pathogenesis of the RA.

1. Initiation of Disease: HLA-DR4 cell binds with the antigen. This may occur in 4 ways i.e.,

HLA-DR4 binds an endogenous peptide, HLA-DR4 binds an exogenous peptide, HLA-DR4

presents itself as an antigen and QKRRA and exogenous antigen share structural homology

(molecular mimicry). Once this binding occurs the main function of DR4 is to present the

antigen to CD4+ T cells. CD4 cells recognize the peptide antigen initiate the host response.

2. Autoimmune reaction within the synovial membrane: As the result of host response

appearance of CD4+ T cells is seen in the joint. There will be subsequent activation of the

endothelial cells of synovial capillaries. This process results in the transmigration and attachment

of inflammatory cells like neutrophils and macrophages. Neutrophils release reactive free

radicals and lysosomal enzymes. Activated macrophages release prostaglandins, cytokines and

chemokines such as IL-1, IL-6, TNF-_, and IFN-_. Whole of this leads to the activation of B

cells with antibody production, which results in the appearance of immune complexes in sera,

synovial fluid and synovial membrane.

3. Mediators of joint damage: As described above sensitized T cells, activated _cells,

macrophages, neutrophils, synoviocytes in the inflamed synovium leads to the release of the

cytokines and lysosomal enzymes like IL-1, IL-2, IL-3, IL-4, IL-6, IFN_, GM-CSF, TGF_, TNF-

_, TNF-_14. These will stimulate the cells of the pannus to produce collagenase and other neutral

proteases, and also activate chondrocytes in situ, stimulating them to produce proteolytic

enzymes that can degrade cartilage. These also cause the activation of osteoclasts, leading to

further bone demineralization

STAGES OF RHEUMATOID ARTHRITIS:

From the clinical point of view a rheumatoid arthritis can be divided into three stages:

1) Potentially reversible soft-tissue proliferations: In this stage .the disease is limited to the

synovium. There occurs synovial hypertrophy and effusion. No destructive changes can be seen

on X-Rays.

2) Controllable but irreversible soft –tissue destruction and early cartilage erosion:

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X-rays shows a reduction in the joint space, but the outline of the articular surfaces is

maintained.

3) Irreversible soft-tissue and bony changes: The pannus ultimately destroys the articular

cartilage and erodes the subchondral bone. The joint becomes ankylosed usually in a deformed

position (fibrous ankylosis).It may be subluxated or dislocate.

Joints affected in rheumatoid arthritis:

Common : MCP joints of hand

: PIP joints of fingers

: Wrists, knees, elbows, ankles

Less Common : Hip joint

: Temporo-mandibular joint

Uncommon : Atlanta-axial joint

: Facet joints of cervical spine

Deformities in Rheumatoid arthritis:

Hand : Ulnar drift of the hand

: Boutonniere deformity

: Swan-neck deformity

Elbow : Flexion deformity

: Early-flexion deformity

Late-Triple _ (Flexion, Posterior, and external rotation.) subluxation

Ankle : Equinus derformity

Foot : Hallux valgus, Hammer toe.

Pathology and pathologenesis of Rheumatoid Arthritis:

The earliest change is swelling and congestion of the synovial membrane and the underlying

connective tissues, which become infiltrated with lymphocytes espially (CD4T cells), plasma

cells and macrophages. Effusion of the synovial fluid into the joint space takes place during

active phase of the disease. Hypertrophy of the synovial membrane occurs with the formation of

lymphoid follicles resembling an immunologically active lymph node. The inflammatory

granulation tissue (pannus) is formed, spreading over and under the articular cartilage which is

progressively eroded and destroyed. Later, fibrous adhesions may from between the layers of

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pannus across the joint space and fibrous or bony ankylosis may occur. Muscles adjacent to the

inflamed joints atrophy and there may be focal infiltration with lymphocyte.Subcutaneous

nodules have a characterstic histological appearance. There is a central area of fibres, fibrinous

exudates and cellular debris, surrounded by a palisade of radially arranged proliferating

mononuclear cells. The nodules have a loose capsule of fibrous tissue. Similar granulomatous

lesions may occur in pleura, lung, pericardium and sclera. Lymph nodes germinal centre

numerous plasma cells in the sinuses.Immunofluorecene shows that plasma cells in the synovium

and lymph nodes synthesis rheumatoid factors.

PRODROMAL SYMPTOMS OF RA:

Symptoms like fatigue, weakness, anorexia, joint stiffness, vague arthralgia and myalgia are

seen as prodromal of rheumatoid arthritis.

Clinical Manifestation :

Presentation of the disease may vary from person to person. Amavata may present with the

predominance of the Samanya Lakshanas. The disease process may start with invovlement of the

joints where the Khavaigunya takes place. The disease may be presented with all the Pravruddha

Amavata Lakshanas depending upon the degree of Doshic vitiation.

There are 7 types of presentation of RA. They are as follows,

1. Classical: Pain, stiffness and swelling of small joints of hands and wrists. Symptoms fluctuate

in severity from day to day.

2. Palindromic: Intermittent episodes of pain, swelling and redness, usually single joint

followed by rapid return to normal after several days.

3. Systemic: Weight loss, pleurisy and pericarditis but minimal joint involvement.

4. Polymyalgic: Pain and stiffness in shoulders and hip with subsequent synovitis.

5. Monoarthitic: Single joint involvement usually knee.

6. Acute onset: Sudden overnight onset with stiffness and pain.

7. Lymphadenopathy: generalized As the rheumatoid arthritis advances, tendon sheath and

joint destruction results in joint instability and deformities. The flexion deformities of small

joints of hand & feet, the elbow and knee are characteristic deformities of RA. Ulnar deviation

of the fingers is usually associated with anterior subluxation of metacarpophalangel joints. Other

finger deformities like hyperextension of the proximal interphalengeal joint with fixed flexion at

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distal interphalengeal joints, i.e. swan neck deformity; fixed flexion of the proximal

interphalangeal joint and extension of terminal interphalangeal joint, i.e. button whole deformity;

and a Z deformity of thumb, lead to greater loss of hand function. Tenosynovitis and bursitis are

also common features of RA as tendon sheath and bursae are lined with synovium.

As RA is a systemic disorder it produces

1. Skin: Palmar erythema, psoriasis.

2. Subcutaneous nodules: Rheumatoid nodules develop in 20 to 30% of persons with RA.

Common locations include olecrenon bursa, proximal ulna, occurring over bony prominences at

site of pressure or function.

3. Systemic features: Fever, weight loss, fatigue, susceptibility to infection.

4. Haematological: Anaemia, thrombocytosis, eosinophilia.

5. Lymphatic: Splenomegaly, Fetty’s syndrome.

6. Myositis: Muscle wasting around inflamed joint.

7. Ocular: Episcleritis, Scleritis, Keratoconjunctivitis sicca.

8. Vasulitis: Purpuric rashes, pyoderma gangrenosum.

9. Cardiac: Pericarditis, myocarditis, endocarditis

10. Pulmonary: Pleuresy, pleural effusion, fibrosing alveolitis.

11. Neurological: Neuropathy, cervical nerve root compression, muscle wasting.

12. Amyloidosis

Remissions, exacerbations are the hallmarks of the disease. In a small percentage however, the

disease progresses relentlessly to joint destruction and crippling.

DIFFERENTIAL DIAGNOSIS:

Rheumatoid Arthritis differentiated from other diseases having similar features like Joint

Pain on the basis of presenting Signs and Symptoms & biochemical investigations. These

diseases are as follows:

1. Gout :

In pathological investigation high serum uric acid level is present. Response to

administration of Colchicine is found in this condition.

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2. Osteoarthiritis :

Radiological appearance differs, absence of subcutaneous nodules and R.A. factor. In typical

case, Heberdon’s nodes appear in relationship to DIP joints and ESR usually within normal

limits.

3. Polymyalgia Rheumatica :

In this condition ESR is very high and peripheral joint signs are minimal. (Onset of

Rheumatoid Arthritis in elderly mimic Polymyalgia Rheumatica)

4. Polyarthritis Nodosa :

May resemble Rheumatoid Arthritis, but radiological changes are minimal. Severe systemic

symptoms and necrotising vasculitis at early stage of polyarthritis may be present, but joint

erosions and typical Rheumatoid Arthritis deformity are rare in later stage.

5. Systemic Lupus Erythematosis :

It is characterized by the presence of numerous autoantibodies, circulating immune

complexes and widespread immunologically determined tissue damage. Chronic inflammatory

arthritis and tenosynovitis may lead to deformities and contractures, but erosive changes are very

uncommon.

6. Rheumatic Fever :

First, attacks are usually under 15 years of age in 70% of case. It is characterized by flitting

type of joint pain and sustained fever. Spindling of finger joint is rare. Myocarditis, endocarditis

and nodules on the different histological picture are present. Some other diseases are as follows

from which we have to differentiate the disease Rheumatoid Arthritis.

• Acute Suppurative Arthritis

• Tuberculous Arthritis

• Reiters Syndrome

• Hypertrophic Osteoarthropathy

• Chronic Arthropathy

• Sarcoid Arthritis

• Scleroderma

• Myeloma

• Arthritis with Erythema Nodosum

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• Spondylitis

• Psoriatic Arthritis

INVESTIGATION

Immunological assay:

No tests are specific to RA, but rheumatoid factors (RF) are found in the two-thirds of RA

patients. 5% of healthy individuals also have RF positive. Thus the presence of RF is more of

prognostic value than diagnostic value. Patients with higher RF titers found to have more severe

and progressive RA with extra-articular manifestations.

Blood picture:

Normochromic, normocytic aneamia is commonly found in RA patients. White blood cell

count may be normal or mild leukocytosis may be present.

ESR:

Erythrocyte sedimentation rate is increased in all most all the patients of active RA. In few

patients ESR level may be elevated even after the diseases activity subsides due to the raised

globulin levels.

Anti nuclear antibodies (ANA):

ANA positive increases the likely hood of auto-immune disease. Chief utility of this test is to

exclude the diagnosis of SLE when the test is negative.

C-reactive protein and ceruloplasmin:

The C-reactive protein and ceruloplasmin levels are elevated in inflammatory conditions and

gradually such elevations correlate with disease activity and the likely hood of progressive joint

damage. The findings can be useful as a simple index of the disease activity and treatment status.

Synovial Fluid Analysis:

Synovial fluid analysis confirms the presence of inflammatory arthritis. The synovial fluid is

turbid, with reduced viscosity, increased protein content, and a slightly decreased or normal

glucose concentration. The white cell count varies between 5 and 50,000/uL and

polymorphonuclear leukocytes predominate in the RA.

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Radiographic Evaluation:

Arthroscopy, Roentgenograms, Arthrographs, ultrasound, CT Scan, MRI, 99m TC

biophophonate bone scanning etc. are useful to establish the extent of local pathology in joints.

Roentgenograms:

Roentgenogram of the affected joint in early stages is not helpful in diagnosis. There may be

no changes during first few weeks of the disease manifestation. Evidence of soft tissue swelling

and joint effusion, erosions at joint margins, subchondral area and articular cartilage, slight

narrowing of the joint space and juxtra articular oesteopenia are seen after few weeks.

Generalized osteoporosis, pocketed erosions in the subchondral area, pseudo cysts in the articular

ends, marked narrowing of the joint space, subluxation and deformities are visualized in the later

stage of the disease (Harrison’s & Davidson’s).

Complications:

• Adverse effects on work and social life are common

• Many people with rheumatoid arthritis (RA) have restricted mobility and difficulties with

activities of daily living

• Depression is common

• Inability to work may occur early in the course of the disease, especially in someone with a

manual occupation

• Inflammatory conditions other than those involving joint and tendon

• Vasculitis, vasculitic ulcers

• Pleurisy/pleural effusions, pulmonary fibrosis

• Pericarditis

• Lymphadenopathy

• Dry-eye syndrome (keratoconjunctivitis sicca)

• Neuropathy

• Felty's syndrome (enlarged spleen and low white-cell count); can present with an infection or

leg ulcer

• Amyloidosis (rare)

• Anaemia

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• Orthopaedic complications: carpal tunnel syndrome, tendon rupture (particularly extensors of

fingers or thumb), cervical myelopathy (usually after severe and longstanding RA), osteoporosis

• Infectious complications: increased risk of infections. Pulmonary infection and generalized

sepsis are particular risks. Septic arthritis is a rare but serious complication.

CLINICAL COURSE AND PROGNOSIS:

The course of RA is quite variable and difficult to predict in an individual patient.Most

patients experience persistent but fluctuating disease activity, accompanied by a variable degree

of joint abnormalities and functional impairment. After 10 to 12 years,<20% of patients will have

no evidence of disability or joint abnormalities. Within 10years, ≈50% of patients will have work

disability.A number of features are correlated with a greater likelihood of developing joint

abnormalities or disabilities. These include :

• The presence of >20 inflamed joints

• A markedly elevated erythrocyte sedimentation rate

• Radiographic evidence of bone erosions

• The presence of rheumatoid nodules,

• High titers of serum rheumatoid factor

• The presence of functional disability

• Persistent inflammation

• Advanced age at onset

• Low socioeconomic status or educational level etc.

Remissions of disease activity are most likely to occur during the first year. Despite the decrease

in the rate of progressive joint damage with time, functional disability, which develops early in

the course of the disease, continues to worsen at the same rate, although the most rapid rate of

functional loss occurs within the first 2 years of disease.Drug therapy may also play a role in the

increased mortality rate seen in individuals with RA.

Factors correlated with early death include disability, disease duration or severity, glucocorticoid

use, age at onset, and low socioeconomic or educational status.

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DIAGNOSIS:

The diagnosis of RA is easily made in persons with typical established disease. In a majority

of patients, the disease assumes its characteristic clinical features within 1 to 2 years of onset.

The typical picture of bilateral symmetric inflammatory polyarthritis involving small and large

joints in both the upper and lower extremities with sparing of the axial skeleton except the

cervical spine suggests the diagnosis. Constitutional features indicative of the inflammatory

nature of the disease, such as morning stiffness, support the diagnosis.

TREATMENT:

General Principles:

The goals of therapy of RA are

(1) relief of pain,

(2) reduction of inflammation,

(3) protection of articular structures,

(4) maintenance of function and

(5) control of systemic involvement.

Management of patients with RA involves dealing with the various problems that these

individuals encounter with functional as well as psychosocial interactions.

1. Nonsteroidal anti-inflammatory drugs:

The first is the use of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and

simple analgesics to control the symptoms and signs of the local inflammatory process. NSAIDs

e.g. ibuprofen, indomethacin and Salicylates.NSAIDs produce symptomatic relief of pain and

stiffness – will not abolish pain.It has rapid onset of benefit and rapid loss of effect on cessation

of therapy. Has no effect on laboratory parameters. Affects cyclo-oxygenase path way of

arachidonic acid metabolism and thus inhibits prostaglandins. Salicylates are relatively safe,

inexpensive analgesic and anti-inflammatory and can still be a cornerstone of drug therapy. e.g. -

acetylsalicyclic acid (aspirin).

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2. Glucocorticoid therapy:

The second line of therapy involves use of low-dose oral glucocorticoids. Although low-dose

glucocorticoids have been widely used to suppress signs and symptoms of inflammation, recent

evidence suggests that they may also retard the development and progression of bone erosions.

3. Disease-modifying antirheumatic drugs:

The third line of agents includes a variety of agents that have been classified as the disease-

modifying or slow-acting antirheumatic drugs. Recently, combinations of disease- modifying

antirheumatic drugs (DMARDs) have shown promise in controlling the signs and symptoms of

RA.

4. Anti-cytokine agents:

A fourth group of agents are the cytokine-neutralizing agents, which have been shown to have

a major impact on the signs and symptoms of RA and also to slow progressive damage to

articular structures.

5. Immunosuppressive therapy:

A fifth group of agents are the immunosuppressive and cytotoxic drugs that have been shown

to ameliorate the disease process in some patients.

6. Surgery for severely damaged joint:

Surgery plays a role in the management of patients with severely damaged joints.Although

arthroplasties and total joint replacements can be done on a number of joints, the most successful

procedures are carried out on hips, knees, and shoulders.Although synovectomy may offer short-

term relief of symptoms, it does not appear to retard bone destruction or alter the natural history

of the disease. In addition, early tenosynovectomy of the wrist may prevent tendon rupture.

7. Exercise and Physiotherapy:

• Active Exercise: to restore muscle mass and maintain the normal joint movements.

• Passive Exercise : to prevent contracture

• Joint Splinting : reduces local inflammation

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DRUG REVIEW

FOR THE PRESENT STUDY 6 GROUPS OF DRUGS WERE USED :

1. Drug for Pachana& deepana

2. Drug for the Kostha pariksha

3 Drug for Sneha paana

4 Drug for Swedana karma

5. Drug for Vamana karma : Vaamaka & Vamanopaga

6. Drug for Dhumapana

1. Drug for the Kosta pariksha:-

Koshta pariksha was carried out with Triphala Kashaya 150 ml at 9.30 am after breakfast.

Table No.36

Drug Rasa Guna Veerya Vipaka Karma

Haritaki

(Terminalia

Chebula)

LavanaVarjitha

Pancharasa.Kashay

a Rasa Pradhana

Laghu

Ruksha

Ushna Madhur

a

Tridoshahara,

Srotoshodana

Amlaki

(Emblica

officinalis)

Lavana Varjitha

Pancharasa,Amla

Rasa Pradhana

Guru,

Ruksha

Sheeta

Sheeta Madhur

a

Tridoshahara

Vibhitaki

(Terminalia

Bellirica)

Kashaya Laghu

Ruksha

Ushna Madhur

a

Tridoshahara, Kapha

Vikara & Medo Vikara

2. Drug for Paachana Dipana: Vadavanala churna:251

Its is a unique combination of Saindhava Pippalimula Pippali Chavaya Chitraka Shunti

Haritaki in an increment increase in quantity. (1:2:3:4:5:6:7) respectively, which is specifically

quoted as Agni Deepaka.

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Table No.37

Drug Rasa Guna Veery

a

Vipaka Karma

Saindhava

(Sodi

Chloridium)

Madhur

Lavana

La

gh

u,

Snigdh

a

Sheeta

Katu Tridosha Shamaka

Deepana,Pachana

Ruchya,Vrushya

Pippalimula

(Pipper

longum)

Katu Laghu

Ruksa

Ushna katu Vatakapha Shamaka

Deepana

Pippali

(Pipper

longum)

Katu

Laghu

Ruksa

Ushna Katu Vatakapha Shamaka Deepana

Chavaya

(Pipper

Chaba)

Katu Laghu

Ruksa

Ushna Katu Kaphavatashamaka

pittavardaka & deepaka

Chitraka

(Plumbago

Zeylanica)

Katu Laghu

Ruksa

Ushna katu Kaphavata shamaka pitta

vardaka

Deepana Pachana

Shunti

(Zingeber

Officinalis)

Katu Guru

Ruksa

Ushna Madhur

a

Kaphavata Shamaka Deepana

pachana triptighna

Haritaki

(Terminalia

Chebula)

LavanaVarj

ita

Pancharasa

Laghu

Ruksh

a

Ushna Madhur

a

Tridoshahara, Srotoshodana

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3. Drug for the Snehapana: Murchita Ghrita:252

Ama is one such entity which is not only seen in Shareera but also in Dravya, so the ideal

formulation should be free from Ama. Gritha murchana is the technique to remove the Ama

present. The esters present in the raw ghee hinders the Absorption as well as it won’t allow other

active principles to mingle with the lipid molecule. Murchana process removes these unwanted

esters.

Table No.38


Ghrita Madhura SnigdhaSheeta Sheeta Madhura Vata pittahara

Tri phala ------------ --------- -------- --------- Kapha pittahara

Haridra

Curcumalonga

Tikta

Katu

Ruksha Laghu Ushna Katu Kaphavata shamaka

Matulunga

Citrus medica

Amla Laghu

Snigdha

Tikshna

Ushna Amla Kapha vata hara,

Dipana hrudya Ruchya

4. Drug used for Bahya snehana253

Drug selected for abhyanga - saindavadi taila

Rasapancaka of saindhavadi taila.

TableNo:39

Drug Latin name Properties

Rasa Guna Virya Vipaka Karma

Saindhava

Madhur Lavana

Laghu, Snigdha

Śīta Katu

Tridoṣa Śamaka Dīpana,Pācana Rucya,Vruśya

Devadaru Cedrus deodara Tikta Lagu Nigdh

Uśna Katu Vedanastapaka

Vaca Acorus calamus Katu Tikta

Lagu Uśna Katu Medhya Lekhana

Zingiber officinale Katu Laghu Uśna Madura Truptighna

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Śunti snigda Dīpana Katphala

Myrica nagi thumb Tikta Laghu Tiksna

Uśna Katu Rucya, Vedanasthapana

Śatahwa

Anethum sowa kurz Katu Snigdh Uśna Katu Dīpana,

Musta

Cyperus rotundus linn

Tikta, Katu

Rukśa, Laghu,

Śīta Katu Dipana-pācana

Cavya

Piper retrofractum Katu Lagu Rukśa

Uśna Katu Dīpana

Medha Polygonatum cirrhifoliumm

Madhura Guru Śīta Madhura Rasayana, balya

Jayapala Croton tiglian linn Katu Guru Uśna katu Virecana, Dīpana

Trivrith Operculina turpeethum

Tikta, Katu

Laghu, Rukśa

Uśna Katu Virecana

Hiijala twak

Barringtonia acutangula

Tiktha katu,

Laghu, rukśa

Uśna

Katu Vātahara, viśagna,

Netra bala Pavonia odorata Tikta Laghu Rukśa

Śīta Katu Balya, dīpana pācana, pittahara

Citraka Plumbago zeylanica Katu Lagu Rukśa tikśna

Uśna Katu Dīpana Lekhana

Bramhana estika

Clerodendron siphonatus

Tikta Laghu

Uśna Katu Dīpana pācana

Śati Kaempferia galangal linn

Tikta Tikśna

Uśna Katu Ruciprada

Vidanga Emblica Ribes

Katu Kaśay

Lagu Uśan

Uśna Katu

Kuśtagna Krimighna

Madhuka Gkycyrrhiza glabra linn

Madhura Guru snigdha

Śīta Madhura Tridoṣa hara, rasāyana, vruśya

Renuka Vitex negundo Katu tikta Laghu, rukśa

Uśna Katu

Vāta, kapha hara śulahara śopha hara

Aconitum Katu Uśna Uśna Katu Lekhana

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Ativiśa Hetrophyllum Tikta

Samgrahak Dīpana

Eraṇda Ricinus communis linn

Madura Snigdha Uśna Madura Recana, Vriśya

Ambasta Cissampelos pariera

linn

Tikta Laghu,

tīkśna

Uśna Katu Vāta kapha hara,

grahi, balya

Nilini

Indigofera tinctoria

linn

Tikta Laghu,

Rukśa

Uśna Katu Kapha vāta hara

Danti-mula Baliospermumontanum Katu Guru,tiksna Uśna Katu Recana,

Dipana

Marica Piper nigrum Katu Laghu

snigda

Uśna Uśna Śirovircana

Ajamoda

Carum roxburghian Katu

Tikta

Lagu

Rukśa

Uśna

tikśna

Katu Dīpana

Pippali Piper longum Katu Laghu

tikśna

Uśna Madura Dīpana truptighna

Kuśta

Saussurea lappa

Tikta

Katu

Lagu

rukśa

Uśna Katu Sukra śodaka

Lekhana

Rasna Alpinia officinarum

hance

Tikta Guru Uśna katu Ama pācana

Pippali

Mula

Piper longum Katu Lagu

Rukś

Uśna Katu Dīpana

5. Drugs for Swedana: Balamula kwatha was used for the purpose of Bashpasweda254

Table no:40


Bala (Sida acuta) Madhura Snigdha sheeta Ushna Madhura Kaphavatahara

vatavyadhi.

Drug Review


108

6. Drug for Vamana Karma:

There are innumerable disease complex because of dosha dushya combination & their

disunion is only possible by Vamanadi karma hence there are inumerable Vamaka Yogas. In the

present study Vamana was carried out with two distinct yogas.

1)GROUP- A Fresh raw powder of Madana phala pippali (4-6gms) mixed with vacha

choorna(2-3gms) Madhu(15ml)& Saindhava (5gms) adminishtered after Akanta pana with

Ksheera.255

2)GROUP - B Madana phala powder(4-6gms) is boiled in 8 parts of milk (50ml) with the

addition of 32 parts of water(200ml). The boiling is continued till the water gets evaporated and

milk alone is left(ksheeravashesha i.e 50ml)256.

Chemical constituents of Cow`s Milk 257

Nutritional value per 100gram

• Water – 87.8 gm

• Protein – 3.2 gm

• Carbohydrate – 4.8 gm

• Energy – 66 kcal

• Sugar (lactose) – 4.8

• Fatty acids

1. Saturated – 2.4 gm

2. Mono-unsaturated – 1.1 gm

3. Polyunsaturated – 0.1 gm

4. Cholesterol – 14 mg

5. Calcium – 120 IU

Madanaphala

“Vamane Madanam Shreshtam”258 From Vamana karma point of view Madana Phala is the

supreme drug because of two reasons.

i) ‘Nirapayatvat’ – when compared to other Vamaka drugs Madana is the safest one.

ii) ‘Vyadhivashat Anyasya’- Other Vamaka drugs specific to specific diseases. But where as

Madana is a broad spectrum emetic drug due to its synergetic action.

Drug Review


109

Rasa Panchaka of Madana phala acording to various authors

Table no:41

Text Varga Rasa Guna Virya Vipa

ka

Karma Rogaghnata

B.P Haritakyadi Madhur

a

Tikta

Ruksh

a

Laghu

Ushn

a

Katu Vamaka,Lekhan

a,

Vidradhi,pratishyaya,

Vrana, Kushta,

Kapha Anaha,

Shotha, Gulma

D.N Guduchyadi Katu

Tikta

- Ushn

a

- Vamaka &

Niruha

Shleshmajvara

Vidradhi pratishyaya,

Gulma Shotha

K.N Aushadhi Madhur

a

Tikta

Ruksh

a

Laghu

Ushn

a

- Vamanagri

Lekhana


Vrana, Shotha,

Gulma Kushta,Jwara

Anaha,

R.N Shalmalyad

i

Katu

Tikta

Laghu Ushn

a

- Vamaka

Lekhana

Kapha vatahara

Vruna hara

Shopha doshapaha

Sha.

N

Ashta varga Katu

Tikta

Madhur

a

Ruksh

a

Laghu

Ushn

a

Bhedaka

VamakaLekhan

a

Kapha vatahara,

Pakva-

Amashaya

shodhaka

Vishamajwara


Vrana, Kushta,

Kapha Anaha,

Shotha, Gulma

Drug Review


110

Aberration to Madana phala action:259 All the authors have considered that Madana phala is a

Shreshta Vamaka but in Arka prakasha it has been quoted that Arka of Madana is Chardighna.

certain other drugs like Jyotishmati, Dhatura, Hemahva, Naginiphala, Makshika, Devadali phalas

are considered as Vamaka Drugs & Vacha is the best Vamaka Drug

Part used and uses: The fruit of this is used by the natives as a fish poison, and is said to act in

man as an irritating emetic.

Fruits - Used as Emetic, fish poison, dysentery, anthelmintic, abortifacient, fevers.

Constituents:

Neutral and acid saponin (active constituent). 2. Acid resin. (36) – UHM.According to the

Pharmacographia Indica, each fruit contains about four grains (0.26 Gm.) of saponin, besides

valeric acid. The tincture has been used by James Sawyer (L. L., 1891) as an

antispasmodic.Oleanolic acid 3-/3-Glucoside (RDG-1) was isolated from the seeds of the plant

Randia dumetornm (Rubiaceae). The compound showed significant anti-inflammatory activity in

the exudative and proliferative phases of inflammation in the doses of 25 and 100 mg/kg orally.

Significant analgesia was observed only on thermal stimulus. It did not show any antipyretic

activity against Brewer’s yeast induced pyrexia in rats. The approximate oral LD were found to

be 3600 mg/kg and 1500 mg/kg in mice and rats respectively. –

Glycosides – Saponins

Glycosides are compounds containing a carbohydrate and a noncarbohydrate residue in the same

molecule.

Classification of Glycosides: these may be grouped under following headings.

1.Tanin Glycosides, 2. Cardio active Glycosides,3.Aldehyde Glycosides, 4.Anthraquine

Glycosides 5. Alcohol Glycosides, 6 Lactone Glycosides, 7. Cyanophore Glycosides,

8.Isotheocynate Glycosides, 9.Phenol Glycosides 10.Flavanol Glycosides, 11.Saponin

Glycosides

Saponin Glycosides: Saponins are the glycosides of 27 carbon atom steroids, or 30 carbon atom

triterpenes in plants. They are found in various parts of the plant: leaves, stems, roots, bulbs,

blossom, and fruit. They are characterized by their bitter taste, and their ability to hemolyze red

blood cells.

Drug Review


111

Properties: Saponins are the plants' immune system, acting as a natural antibiotic to protect the

plant against microbes and fungus.

Saponins dissolve in water to form a stable soapy froth; this is thought to be due to their

amphiphilic nature. The word sapon means 'soap', referring to the permanent froth saponins

make on being mixed with water.

Saponin glycosides are divided into 2 types based on the chemical structure of their aglycones

(sapogenins). Saponins on hydrolysis yield an aglycone known as "sapogenin".

Stucture of Saponin

Saponin = GLYCONE(Sugar-Carbohydrate compound) + AGLYCONE( sapogenin-Non

carbohydrate)

Type I:Neutral Saponin= Here GLYCONE is attached to steroid derivative of AGLYCONE

Type II Acid Saponin = Here GLYCONE is attached to tripeptinoids of AGLYCONE0.

Medicinal use

Soap nuts (sapindus), especially Sapindus mukorossi, are used medically as an

expectorant, Emetic, and for treatment of excessive salivation, epilepsy, chlorosis, and

migraines.

Saponins are believed to be useful in the human diet for controlling cholesterol. Bile

cholesterol is secreted into the intestine. Much of it is later reabsorbed into the body. Saponins

bind to bile acids and cholesterol, so much of it is not reabsorbed, and instead excreted from the

body. Digitalis-type saponins strengthens heart muscle contractions, causing the heart to pump

more efficiently.

Saponins inhibit some kinds of cancer cell tumor growth in animals, particularly lung and

blood cancers, without killing normal cells. Cancer cells contain more cholesterol compounds

than normal cells. Saponins bind to cholesterol, interfering with cell growth and division. In the

colon, bacteria metabolize primary bile acids into secondary bile acids, which are a cause of

colon cancer

Drug Review


112

Saponins stimulate the immune system and enhance both injected and oral vaccines.

Saponin kills protozoa in the intestines by causing it's cell membrane to lyse. Scientists are

experimenting with saponin-based antibiotics, fungicides, yeast disinfectants, and vaccines

against HIV.

Symptoms of saponin Poisoning

Saponins are highly toxic to cold-blooded animals, due to their ability to lower surface tension

Humans generally do not suffer severe poisoning from saponins

• irritated mucous membranes of the mouth and digestive tract -->

• reduced feed intake,

• low dietary protein quality (supplemental methionine will counteract this).

• the above factors lead to--> decreased performance and growth rate.

• increased excretion of cholesterol.

• anorexia

• weight loss

• rough hair coat

• gastroenteritis and diarrhea

Mode of action : Saponin cause vomiting by :-1) Directly stimulating the medullary

chemoreceptor trigger zone to induce vomiting.

2) Irritating the gastric mucosa and there by stimulating vagus nerve & causes Vomiting

6.b) Yashti Madhu:260,261,262,263,264,265 Synonyms of Yashti Madhu according to various Texts:

Yashti, Madhuka, Klitaka, Madhulika, Madhusrava, Yashtika, Yashtyahva, Madhuparni,

Madhuvalli, Vasusammitam, Saumya

Drug Review


113

Table no: 42

Text Varga Rasa Guna Virya Vipaka Karma Roga

B.P Guduchyadi Swadu Guru Shita Madhura Pitta

anilaasra

hara,

chakshushya

bala varna

kara

shukrala

Vruna

shotha

visha

chardi

trushna

glani

kshayapaha

D.N Guduchyadi Swadu - Shita - Pitta

vinashini

vrushya

Shosha

visha

chardi

kshaya

vinashi

K.N Swadu Guru

Snighdha

Shita - Vata pitta

kaphaapaha

-

R.N Pippalyadi Swadu

tikta

Guru Shita - Ruchya

chakshushya

pitta hara

Shisha

trushna

vrunapaha

Sha.N Ashtavarga Swadu Guru

Snighdha

Shita - - -

Sho.N Guduchyadi Swadu - - - - Shosha

hara

Drug Review


114

Yashti madhu Phanta Kalpana:

Here one pala of dravya is added to one Kudava of boiling water and kept closed. Only 2

pala of Phanta is administerd along with sugar candy /jagerry / Honey.

Many Phanta yoga’s are explained by Sharangadhara, among them Yasti madhu is one of

the important ingredient. And most of these Yogas are indicated in certain emergency

Conditions like Murcha, Bhrama, RaktapittaTushna, etc.so we may consider that using

Yastimadhu phanta in Vamana will prevent the chances of complications during the Procedure.

Pharmacological activity ;-

Smooth muscle depressant, antimicrobial, antiatherosclerotic hypotensive ,spasmolytic,

antipyretic ,anti oxidant expectorant.

6.C) SAINDAVA LAVANA :-

It is best drug in helping to induce the process of vomiting .it has got the gunas like

vishyandhi,aruksha,vyavayi,sukshma ,ushna. It has the capacity to penetrate to sukshma srotas

spreads quickly to the whole body.Caraka says its use when is mixed with vamaka dravya as it

helps in liqification of kapha dosha and separate it from minute channels.

ROCK SALT:266

The common name for the mineral ‘halite ‘ is the Rock salt .Its chemical formula is NaCl. It is

not K2So4. It is typically formed by the evaporation of salty water which contain dissolved

Na=and Cl- ions..

7. Drug used for Dhumapana: Haridra dhumapana

Table no:43

DRUG RASA GUNA VIRYA VIPAKA KARMA

Haridra

Curcumalonga

Tikta

Katu

Ruksha

Laghu

Ushna Katu Kaphavata shamaka

Kushtaghna

Methodology


115

CLINICAL STUDY Vamana karma is considered as an idyllic treatment in morbid kapha, its associated

conditions and in case of kapha sthanagatha doshas. In Amavata mainly kapha sthana like sandhi

is affected. Langhana is considered as the prime line of treatment for Amavata. Vamana is

considered under Shodhana Langhana by Charaka. Here an attempt is made to evaluate the

efficacy of vamana in Amavata by madhanaphala kalka and madhanaphala ksheerapaka.

OBJECTIVES OF THE STUDY:

To evaluvate the action of vamana karma in patients of Amavata

PATIENTS AND METHODS:-

SOURCE OF DATA:

Patients who were attending the OPD & IPD section of S.D.M. Ayurveda Hospital Udupi

fulfilling the criteria of selection were incorporated in the study irrespective of the caste, sex,

race, and religion. Patients were examined clinically. For this study 22 patients were selected.

METHODS OF COLLECTION OF DATA:

It is a comparative clinical study to evaluvate the effect of vamana karma in Amavata.Subjects

of either sex are based on the inclusion criteria and a detailed proforma will be prepared based on

the ayurvedic books and the patients shall be evaluvated accordingly.

INCLUSION CRITERIA:

1) Persons suffering from Amavata.

2) Person who is Vamana arha.

3) Patients in the age group of 16 to 70.

EXCLUSION CRITERIA:

1) Patients suffering from confirmative systemic diseases.

2) Patients who are unfit for vamana karma.

3) Patients suffering from Rheumatic fever.

Methodology


116

STUDY DESIGN :

It is a comparative clinical study with pre-test and post-test design where in 22 patients

diagnosed as Amavata of either sex will be selected. All the patients falling in the inclusion

criteria shall be subjected to Vamana karma.

DURATION OF STUDY :

• Deepana and pachana 3 – 7 days.

• Snehapana 3 – 7 days.

• Abhyanga and Swedana 2 days.

• Vamana karma for 1 day.

• Samsarjana krama 3 – 7 days.

Total duration of study; maximum 11 – 23 days.

INTERVENTIONS :

Poorva karma –

Kosta pariksha:

Triphala kvātha 150 ml was administered at 9.30 am after breakfast for the assessment of koṣṭa.

Deepana pacahana

3-5gms vadavanala choorna with sukhośna jala was administered to patients depending

on their status of Agni in terms of Sāma and Nirāmata for 3-7 Days till Nirāma Lakhṣanas are

seen.

Snehapana

The moorchita gritha was given to all the patients. The initial dose was 25ml (Hrisiyasi

matra) with Luke warm water as anupāna in early morning, after the digestion of the last night

meal.

During this period the patients were advised to consume little quantity of hot water in between

and to follow all the restriction of Snehapāna in terms of diet (Time of food intake, Nature of

food) , Sleep (Avoid Divasvapna & Rathri jagarana) etc.

Thus Ārohanakarma Snehapāna was administered still samyak snigdha laksana arises in all the

patients. Then patients were constantly observed for the appearance of Sneha Jīryāmana, Sneha

Jīrna features. Based on the time of Snehajīrna laksana the dose of Sneha for next day was

decided. As soon as Samyak Snigdha Laksana are seen, the Snehapāna was stopped.

Methodology


117

Vamana pūrva dina: Once the Samyak snigdha symptoms were achieved, intake of ghee was

stopped and later;

Abhyanga and Svedana :

Patient was subjected for abhyanga with lukewarm saindhavadhi for 35 min in 7 positions to the

whole body. After Abhyanga, patient was shifted to baspa sveda chamber. There patient was

given baspa sveda until samyak svinna laksana (usually 20-25 minutes). Patient was then advised

to take rest for 10 - 15 minutes and take a hot water bath. Later the patient was advised to have

complete rest on that day and not to wander outside.

Vamana pūrva dina bhojana vyavasta:

On the previous day, the individual was instructed to have lots of curds (up to 3 lts) along with

Blackgram and food articles like Idli, Vada, Dosa, etc as kaphotkleśakara āhāra.

Counseling:

On the previous evening of Vamana, a casual meeting was held to assure the patient about the

process and clear any anxiety or doubts in their mind.

On the Day of Vamana:

Patients was allowed to brush the teeth and were kept on empty stomach untill the process was

started. At 6.00 am, the patient was subjected for the abhyanga and svedana followed by snāna in

the similar manner like that on the previous day. After snāna, the patient was made to sit on a

chair and allowed to rest for 5 min to acclimatize with the atmosphere. Then systemic

examination was done and checked for the routine things like defecation, micturation, also tried

to rule out presence of any discomfort in any other part of the body. Vital data (pulse, blood

pressure, temperature, respiratory rate) were recorded.

PRADHĀNA KARMA:

Patients were made to sit comfortably in the chair and they were covered with a clean cloth.

Ākanthapāna:

For the purpose of ākanthapāna, milk (2-4 glass ≈ 700ml to 1400ml) was administered.

Administration of Vāmaka yoga:

Madanaphala yoga which is in the bolus form form/ksheerapaka was administered to the patient

and instructed to consume as early as possible. Meanwhile, if vegas started the time of beginning

Methodology


118

of first vega, was recorded. If no vega was observed for 10 minutes, for the purpose of inducing

vamana yastimadhu phanta was administered. The recording regarding quantity of the drug, time

at which the liquid is administered, was recorded. Patients were allowed to sit comfortably till

the first bout of vega comes out. Patient was asked to inform any symptoms which may be felt

during that resting period. Signs were observed carefully.

Continuation of process of Vamana with Vamanopaga dravya:

If Vamana did not start, 350 ml of yastimadhu phanta was administered. The time at which the

bout appeared after the administration of Vāmaka Yoga was noted. Then the process was

continued with the Vamanopaga medicine or sukhosna jala. During the bout, the individual was

asked to bow forward, to open the mouth widely for expelling the vomitus comfortably. Massage

over the back and on the sides of vertebral column was done in upward direction, forehead was

held to provide the support to neck, a gentle pressure was given over the abdominal region

around the umbilicus with the palms, sides of the chest were supported to avoid pain in the sides,

so that Vamana could go on effortlessly. At the end if the medicine was not coming outside

completely, patient was instructed to touch the pharynx with a finger or rubber catheter. When

the associated symptoms are suggestive of completion of Vamana, 1-2 glass of hot water served

in order to expel the remnant medicine.

PAŚCĀT KARMA:

After finishing Vamana, again blood pressure, pulse, temperature and weight were recorded.

Then a glass of warm water was provided for gargling and washing the hands and allowed to rest

for 45 minutes. Meanwhile the patient was asked for observation of symptoms.

Dhūmapāna:

Dhūmapāna was done with Haridrā cūrna.

Samsarjana Krama:

After analyzing the procedure, conclusion regarding the grade of purification was made. It was

judged whether the purification was Uttama, Madhyama or Hīna, and accordingly the sequence

of Samsarjana was planned. For the respective three types (Grades) of the purification, the

regimen of 7(Uttama), 5(Madhyama) and 3(Avara) days were opted for. In case of Hīna,

Madhyama or Uttama purification Peya-Vilepī-Mudga Yusa and Rice with Mudga Yusa were

served for one meal time, two meals time and three meals time respectively starting from the

Methodology


119

evening of the Vamana day. Peya and Vilepī were prepared from 50 gm of the rice, as per

standard methods. Mudga Yūṣa was cooked by 50 gm of green gram in the required quantity of

water. Finally, Odana prepared from 50 gm of rice along with Mudga Yusa prepared from 50 gm

of green gram was served.

ASSESSMENT CRITERIA:

Signs and symptoms of samyak vamita lakshana.

Patients will be evaluated for severity of illness during

and after the intervention.

SUBJECTIVE PARAMETERS :

Symptoms of Amavata.

Symptoms of samyak vamitha lakshana.

OBJECTIVE PARAMETERS:

• Joints(for movement, tenderness, temperature, Swelling)

• Ring test.

• Grip test.

• Foot pressure.

• Circumference.

• Goniometry test.

SUBJECTIVE PARAMETERS:

1. Pain in the joints:

Symptom Grading

No pain 0

Mild (on motion only) 1

Moderate (at rest) 2

Severe (wakes patient from sleep) 3

2. Morning stiffness (duration in hours):

Symptom Grading

0-5 min. 0

Methodology


120

5 min. - 2 hrs. 1

2 - 8 hrs. 2

8 hrs. or more 3

3. Swelling in the joints:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

4. Redness:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

5. Warmth:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

6. Tenderness in the joints:

Symptom Grading

No tenderness 0

Says tender 1

Patient winces 2

Winces and withdraws 3

Not allowed to be touched 4

Methodology


121

7. Alasya:

Symptom Grading

Fully active 0

Mild laziness, slow initiative in work 1

Initiative in some works, absent in others 2

Absolute lack of initiative even though capacity for work exists 3

8. Dourbalya:

Symptom Grading

No feeling of weakness 0

Slight weakness 1

Feeling of weakness but ability unimpaired 2

Ability to do duties affected 3

9. Knuckle swelling:

Jewellers rings were used to measure the knuckle swelling. The ring which passes

through knuckle with least resistance was noted. Any change in the number of the ring after the

treatment was recorded.

10. Muscle wasting:

The circumference of arm, fore arm, thigh and calf were measured in cms using a

measuring tape both before and after treatment to have an objective view of muscle wasting.

11. Malabaddhata/Vibandha (Constipation):

Symptom Grading

Absent 0

Slight with one motion per day 1

Marked constipation with one motion after two days or more 2

12. Jwara (in degree Fahrenheit):

Symptom Grading

No fever 0

Mild (990 F-1010 F) 1

Methodology


122

Moderate (1010 F-1030 F) 2

Severe (>1030 F) 3

13. Sadana - fatigue:

Symptom Grading

No fatigue 0

Works full-time despite some fatigue 1

Patient must interrupt to rest 2

Fatigued at rest 3

14. Bahumūtrata (frequency of micturition per 24 hours):

Symptom Grading

Absent (less than 4 times/24 hrs) 0

Mild (upto 6 times/24 hrs) 1

Moderate (6-10 times/ 24 hrs) 2

Severe (> 10 times/ 24 hrs) 3

15. Chardi (frequency of bouts per 24 hours):

Symptom Grading

Absent 0

Mild (upto 2 vegas/24 hrs) 1

Moderate (2-4 vegas/24 hrs) 2

Severe (4 vegas/24 hrs) 3

16. The other symptoms like Angamarda, Aruci, Gourava, Brama, Kukśiśoola, Hrithgraha,

Anaha, Praseka, Triśna, Hasta pada daha, Kandu are scored as mentioned below.

Grading

No symptoms 0

Mild symptoms 1

Moderate symptoms 2

Severe symptoms 3

Methodology


123

FUNCTIONAL ASSESSMENT:

To assess the objective improvements following functional assessments were carried out

in patients of Āmavāta.

Grip strength: The patient’s ability to compress the inflated ordinary Sphygmomanometer

cuff under standard conditions to assess the functional capacity of effected upper limb, both

before and after treatment.

Foot pressure: Foot pressure was recorded both before and after treatment by the ability

of the patient to press a weighing machine, to an objective view of functional capacity of lower

limb.

Range of joint movement: By using the Goniometer the range of movement of all

effected joints was noted both before and after treatment.

Total Duration of study: 23 days (max).

Patients were administered with Triphala kvātha 150 ml at 9.30am for the

assessment of koṣta. After assessing koṣta, vadavanala curṇa in the dose of 3-5 gms three times

a day with 100 ml of hot water before food till the appearance of nirāma lakṣanas. On the first

day of Snehapāna patients were given test dose 25ml of mūrcita gŗitha at around 6.00 to 6.30 am.

From second day onwards dose of gŗitha was decided on the basis of jīryamaana , jīrna lakṣana

.Thus the dosage of gŗitha was not fixed and the dose varied from person to person. When the

Subject attains samyak snigdha lakṣanas one day gap was given for consuming kapha

utkleshakara aharas and vamana is given on the next day . Saṁsarjana krama is advised

according to śuddi.

Patients are diagnosed on the basis of signs and symptoms of Āmavāta and criteria as

approved by ARA, 1987 revision.

Joints [for movements, tenderness, temperature, swelling]

Ring test

Grip test

Foot pressure

Circumference

Investigations: -

Blood - H.b%, T.C,. D.C, E.S.R ., R A Factor,ASO Titre, C Reactive. Protien.

Methodology


124

Samsarjana krama: -

After analyzing the procedure, conclusion regarding the grades of purification was made.

It was judged weather purification was uttama, madhyama, or heena yoga and accordingly the

sequence of samsarjana was palaned, 7, 5 & 3 days respectively. Rice gruel water, Rice gruel,

Rice with Green gram soup is used for Samsarjana krama Peya.

Observation


125

OBSERVATION

In this clinical study, 22 patients suffering from Amavata, fulfilling the inclusion criteria

were registered. The Following are detailed descriptive statistical analysis of the patients

included in the study.

Number of Individuals registered for the Study – 22

Number of Individuals completed the Study – 22

Number of Dropouts – Nil

AGE GROUP:

Table No:44 Graph No:1

Out of 22 patients of Āmavāta studied in this work, 27.27% patients were belonged to the age

group of 36-45 years & 46-55 years, 18.18% patients each in age group of 26-35years and 56-65

years, 9.09%patient from the age group of 16-25 years.

SEX: Table No:45 Graph No:2

AGE NO OF PATIENTS %

16-25 2 9.09 %

26-35 4 18.18 %

36-45 6 27.27 %

46-55 6 27.27 %

56-65 4 18.18%

SEX NO OF

PATIENTS %

MALE 6 27.27 %

FEMALE 16 72.72%

Observation


126

Among the 22 patients of this study 72.72% patients were females and 27.27% patients were

males.

RELIGION:

Table No: 46 Graph No:3

Among 22 patients of these series maximum 68.18% of patients were belonged to the Hindu

community, 18.18% from Christian religion and 13.63% from Muslim.

MARITAL STATUS:


Out of 22 patients of Āmavāta studied in this work. Maximum 90.90% of patients were married.

And 9.09% were unmarried.

RELEGION NO OF PATIENTS

%

HINDU 15 68.18%

CHRISTIAN 4 18.18%

MUSLIM 3 13.63%

MARITAL STATUS

NO OF PATIENTS %

MARRIED 20 90.90 %

UNMARRIED 2 9.09 %

Observation


127

EDUCATION :


Out of 22 patients of Āmavāta studied in this

work, maximum 45.45% were studied upto matric, 27.27% of the patients were graduates,

22.72% studied up to primary school, And 4.54% were uneducated.

SOCIO ECONOMIC STATUS:


Out of 22 patients of Āmavāta studied in this work, 36.36% of the patients belonged to upper

middle class, 27.27% belonged to middle class, 13.63% belonged to both lower middle class and

poor, and 4.54% belonged to rich class.

EDUCATION NO OF

PATIENTS %

UNEDUCATED 1 4.54 %

PRIMARY 5 22.72%

METRIC 10 45.45%

GRADUATE 6 27.27 %

SOCIO

ECONOMIC

STATUS

NO OF

PATIENTS %

Poor 3 13.63 %

Lower

middle class 3 13.63 %

Middle class 6 27.27 %

Upper

middle class 8 36.36 %

Rich 1 4.54 %

Observation


128

OCCUPATION:


Out of 22 patients of Āmavāta studied in this work, it was observed that maximum number of

patients were house wife I.e. 40.09%. 9.09 % were nurses, students and employees, and 4.54%

were teachers and business people.

DESHA


Out of 22 patients of Āmavāta studied in this work 72.72% of the patients belonged to anupa

desha, 22.27% belonged to jangala desha and 4.54% belonged to sadharana desha.

OCCUPATION NO OF

PATIENTS %

HOUSE WIFE 9 40.90%

NURSE 2 9.09%

TEACHER 1 4.54%

EMPLOYEE 2 9.09%

FARMER 5 22.72%

STUDENT 2 9.09%

BUSINESS 1 4.54%

DESHA NO OF

PATIENTS %

JANGALA 5 22.72 %

ANUPA 16 72.72 %

SADHARANA 1 4.54 %

Observation


129

CHRONICITY OF DISEASE:


Out of 22 patients of Āmavāta studied in this work maximum patients were suffering from the

disease less than 1 year i.e. 13.63% and 31.81% suffered since more than 2 years. And 54.54 %

were suffering the disease since 1 to 2 years.

ADDICTION :


Out of 22 patients of Āmavāta studied in this work, 95.45% were addicted to coffe/tea. And

4.54% were addicted to tobacco

DIET:

CHRONICITY NO OF

PATIENTS %

LESS THAN 1

YEAR 3 13.63 %

1-2 YEARS 12 54.54 %

MORE THAN

2 YEARS 7 31.81 %

ADDICTION NO OF

PATIENTS %

COFFEE /

TEA 21 95.45%

ALCOHOL 1 4.54 %

Observation


130


Out of 22 patients of Āmavāta studied in this work 86.36% were of mixed diet and 13.63%

vegitarians.

SLEEP PATTERN :


Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed sleep and

18.18% had sound sleep.

PRAKRITHI :

DIET NO OF

PATIENTS %

MIXED 19 86.36%

VEG 3 13.63 %

SLEEP

PATTERN

NO OF

PATIENTS %

SOUND 4 18.18 %

DISTURBED 18 81.81 %

Observation


131


Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 36.36% were Vāta

pittaja prakrithi and remaining 18.18% were kapha pittaja prakrithi.

SATVA :


Maximum of 81.81% of the patients were of madhyama satva, 18.18% were avara satva.

RASA SATMYA: Table No: 58 Graph No: 15

PRAKRITHI NO OF

PATIENTS %

VĀTA

KAPHA 10 45.45 %

KAPHA

PITTA 4 18.18 %

VĀTA

PITTA 8 36.36 %

SATVA NO OF

PATIENTS %

PRAVARA 0 0.00 %

MADHAYAMA 18 81.81 %

AVARA 4 18.18 %

Observation


132

Maximum of 36.36 %were of amla rasa satmya, and 27.27% were madhura rasa satmya 22.72 %

were katu rasa satmya and 13.63% were lavana rasa satmya.

SAMHANANA:


Maximum of 72.72% of the patients were of madhyama samhanana, 18.18% were avara, 9.09%

were pravara.

SĀRA : Table No: 60 Graph No:17

RASA NO OF

PATIENTS %

MADHURA 6 27.27 %

AMLA 8 36.36 %

LAVANA 3 13.63 %

KATU 5 22.72 %

SAMHANANA NO OF

PATIENTS %

PRAVARA 2 9.09 %


AVARA 4 18.18 %

Observation


133

Maximum of 59.09 % patients were twak Sāra, and 9.09% of rakta Sāra and 31.81 % māmsa

Sāra .

ABHYAVARANA ŚAKTI


Maximum of 86.36% patients were having madhyama abhyvarana śakti and 13.63% were having

avara abhyvarana śakti.

JARANA SHAKTI :


SĀRA NO OF

PATIENTS %

TWAK 13 59.09 %

RAKTA 2 9.09 %

MAMSA 7 31.81 %

Abhyavaraṇa

ŚAKTI

NO OF

PATIENTS %

Pravara 0 0.00 %

Madhayama 19 86.36 %

Avara 3 13.63 %

Observation


134

Maximum of 86.36% patients had madhyama jaraṇa shakti, 13.63% had avara jaraṇa shakti VYAYAMA SHAKTI :


Out of 22 patients taken for this study, Maximum of 72.72% patients had madhyama vyāyāma

shakti and the remaining 27.27 % had avara vyayama shakti.

VAYA :


JARANA

SHAKTI

NO OF

PATIENTS %

PRAVARA 0 0.00 %


AVARA 3 13.63 %

VYAYAMA SHAKTI

NO OF PATIENTS

%

PRAVARA 0 0.00 %

MADHAYAMA 16 72.72%

AVARA 6 27.27 %

Observation


135

It is observed that maximum of 86.36% of the patients taken for this study belongs to madhya

vaya, 13.63% belongs to vrudha.

KOSTA : Table No: 65 Graph No:22

Out of 22 patients taken for this study it is observed that maximum of 81.81% of the patients had

madhyama koṣta and 18.18% had mridhu kosta.

VAYA NO OF PATIENTS %

Bala 0 0.00 %

Madhya 22 100% %

Vrudha 0 0.00 %

KOSTA NO OF PATIENTS

%

KRURA 0 0.00%

MRIDHU 4 18.18 %


Results


136

EFFECT OF THERAPY

Day of attainment of Samyak Snigda Lakshnas

Table No.66 Graph. No .23

In this study maximum numbers of patients were 50% (11) attained Samyak Snigda Lakshanas

on 4 th day. Followed by 39.13% on 3rd day, 9.09% on 5th day. As shown in Table No.66 and

Graph No.23

Total number of Samyak Snigdha Lakshanas observed on last day of Snehapana

Table No.67 S.No Samyak snigda

Lakshanas Total number

of patients Percentage [%]

1 Vatanulomana 22 100 2 Deeptagni 22 100 3 Asamhata Varcha 19 86.36 4 Snigdha Varcha 22 100 5 Snigda tvak 22 100 6 Gatra mardava 16 72.72 7 Anga Laghava 15 68.18 8 Klama 16 72.72 9 Snehodvega 21 95.45

10 Adastath sneha darshana 22 100

Total number of Samyak Snigdha Lakshanas observed on last day of Snehapana in Arohana.The

above tables reveals that 100% patients showed the symptoms of Vatanulomana,Agni

deepthi,Sniga varcha,snigdha twak and Adastath Sneha darshana..The symptom Snehodvega

No of days

No. of Patients

%

3 9

39.13

4 11

50.00

5 2

9.09

Results


137

seen in 95.45% of patients, 86.36% showed Asamhatha Varchas, 72.72 % showed the symptoms

of Gatra Mardhava, Klama.and Angalaghava was noted in 68.18% of the patients.

Average amount of Ghrita required to attain Samyak Snigda Lakshanas

Table No.68

In this study mean of total amount of ghrita required were 335 ml however a minimum of 125 ml

and a maximum of 600 ml were administered in different patients.

Average Time Taken for Digestion of Sneha

Table No. 69 Graph. No.24

In the present study everyday observations were done on Sneha Jirna Kala i.e., time taken

for digestion of Sneha (Table-). On the first day the Hrasiyasi Matra (25ml) Sneha was given to

all, the mean duration for the digestion of sneha was 390 minutes. On 2nd day the mean duration

for the digestion of sneha was 452 minutes On 3rd daythe mean duration for the digestion of

sneha was 491 minutes On the 4th day he mean duration of the mean duration for the digestion of

sneha was 493min. On 5th day the the mean duration of the mean duration for the digestion of

sneha was 523minutes.

Total number

of patients Mean of total Ghrita required

to attain samyak snigdata 22 335 ml

No of day 1st 2nd 3rd 4th 5th

Minutes 390 452 491 493 523

Results


138

Appearance of Samyak Snigdha Lakshana day wise

Table No.70

No of days S.No Samyak Snigdha Lakshanas 1 2 3 4

5 1 Vatanulomana 14 21 21 10 1 2 Deeptagni 22 21 21 11 1 3 Asamhata Varcha 0 3 13 6 2 4 Snigdha Varcha 0 8 21 10 2 5 Snigdha Gatra 0 1 14 9 1 6 Mrdu Gatra 0 1 12 8 1 7 Anga Laghava 2 6 11 7 2 8 Klama 6 10 14 11 2

9 Snehodvega 1 9 21 11 1

10 Adastath Sneha darshana 0 0 11 11 2

Samyak Snigdha Lakshana:-Numbers in the above table depicits number of days In the

study 21 patients presented with Vata anulomana,Deeptagni,Snigda varcha, Sneha udvega on 3rd

day,snigdha gatra and klama was observed in 14 of Volunteers on 3rd day.In 12 Patients Mrudu

Gatra was observed on 3rd day, In 13 patients asamhata varcha was observed from 3rd day

onwards.In 11 patients Anga laghavata and adastath sneha darshana was observed on 3rd day.

Graph.No.25

Results


139

Samyak Swinna Lakshana

Table No.71

The above Table Shows that percentage of the patients attained Samyak Swinna Lakshana on

administrastion by Bashpa sweda for two days.

The average time taken to expel first Vega

Table No.72

No. of patients Average time taken for

Expulsion of first Vega

22 9.52 minutes

22 patients took an average of 9.52 minutes starting from Akanthapana to the first bout (Vega)

was noted. Maximum time noted was 12 minutes and minimum time was 3 minutes.

Symptoms after Administration of Vamaka yoga Table No. 73

SYMPTOMS NO OF PATIENTS %

1 ADHMANA 18 81.81 2 LALA SRAVA 7 31.81 3 SWEDAPRADURABHAVA 21 95.25 4 AKSHI SRAVA 4 18.18

S.No Samyak Swinna

Lakshanas No of patients %

1 Seetoparam 22 100 2 ShooluParam 22 100 3 Stambha Nigraha 22 100 4 Gourava Nigraha 21 91.3

5 Mardhavata 21 91.3

6 Laghuta 21 91.3

7 Sweda pradurbhava 23 100

Results


140

5 NASA SRAVA 6 27.27 6 HRILLASA 22 100 7 UDGARA 4 18.18 8 MADHURAASYATA 6 27.27 9 NISTIVANA 11 50 10 DAHA 7 31.81 11 KASA 2 9.09 12 ROMAHARSHA 5 22.72 13 SHIROGOURAVA 2 9.09

The above tables reveals that all patients i.e. 100% showed the Symptom(Hrllasa) and 95.25%

showed sweating (swedapravartanam) ,81.81% had Kukshi Adhmana, 50% had Nisteeva,31.81%

had Daha, Lala srava,27.27% showed Madhura asyata, Nasa srava,22.72% had Romaharsha,

18.18 % presented with Akshi srava and Udgara, 9.09% individuals exhibited Kasa and

Shirogaurava.

Changes observed in Blood pressure during the Vamana procedure: Table No. 74

Initial blood pressure (mean in mm of Hg)

During the procedure

(mean in mm of Hg ) After the procedure (mean in mm of Hg )

126.2 / 80.5 142.6/94.6 122.2/84

Graph No 26

Blood pressure was taken just prior to the procedure, and then continuously monitored during

the process. For calculation the peak increase in Blood pressure was taken for consideration to

Results


141

get exact idea of how much increase may be there during the procedure and after the cessation of

the procedure, the Blood pressure was again measured. Thus initially average value of Blood

pressure was 126.2/80.5mm of Hg, Which further rose up to 142.6/94.6 mm of Hg within 23

minuets and come down as the process came to end within 28 minuets. Showing the value of

122.2/84 mmHg.

Changes observed in the Pulse rate during the Vamana Karma Table No.75

Pulse before the procedure (Mean )

Pulse During the procedure

(Mean ) Pulse after the procedure

(Mean ) 80.4 106.7 82.4

Graph. No: 27

In the present study Pulse of the individual was examined continuously. It was measured initially

before starting the Vamana procedure, then monitored continuously thought the process to note

the variation occurring in it and at the end of the procedure, it was checked again. The mean

value of pulse of all the 22 patients at each level is considered here. Then mean value of the

pulse at the beginning was 80.4/min., which increased up to 106.7/min.within 23 minutes during

the process and then declined to 82.4/min. within 28 minutes at the end. As shown in Table

No.75 Graph No. 27

Results


142

Average time taken to complete the process of Vamana

Table No.76

No of patients Average time taken to complete the procedure

22 43.28min

Average time taken for the completion of Vamana was 43.28 minutes.

Average value of Vega observed in 22 individuals

Table No.77

No of patients No of Vega

22 4.954

In this study an average value of Vega observed was 4.954, minimum vega of 3 and maximum

vega of 7 was noted. As shown in Table No.77

Distribution of 22 patients according to Vaigiki Shuddhi

Table No.78

Out of 22 patients observed in the study 31.81% got pravara vegas (≤8).68.18 % subjects got ≤6

vega, 0.00% subject got vega ≤4. Table No.78

Shuddhi No of Vega

subjects %

Hina ≤4 0 0.00%

Madhyama ≤6 15 40.90%

Pravara ≤8 7 22.72%

Results


143

Laingiki Shuddhi in patients

Table No.79

Sr. No. Lakshana No of patients % 1 Kalepravritti 20 100 2 Anati mahati Vyatha 20 90.9 3 Yatha kramama kaphapitta vata dosha harana 22 100 4 Swayam cha avasthanam 22 100 5 Laghuta 22 100 6 Karshya 19 86.3 7 Dourbalya 22 100 8 Kantha shuddhi 20 90.9 9 Kapha samsrava 20 90.9

10 Hridaya shuddhi 17 77.2 11 Parshva shuddhi 15 68.1

12 Sroto shuddhi 17 77.2 13 Indriya shuddhi 15 68.1` 14 Murdha shuddhi 15 68.1

The study reveals 100% of individuals manifested Kale pravrithi,swayam avasthana ,

Yathakrama dosha harana ,Laghuta ,Dourbalya .Anathi mahathi vyatha, .Kanta shuddhi,Kapha

samsrava seen in 90.09 % of individuals,karshya in 86.3% of individuals, Murdha shuddhi seen

in 68.10% ,in 77.2% both Hridaya shuddhi, Sroto shuddhi was observed.

Distribution of "Antiki signs & symptoms" observed in 22 Patients

Table No.80

No of individuals

Signs& Symptoms Total %

1 Burning sensation in throat 22 100 2 Bitter taste in mouth 22 100 3 Pungent taste in mouth 13 59.09 4 Appearance of Pitta 22 100 5 Lightness in abdomen 22 100

Results


144

6 Lightness in head 19 86.36 7 Lightness in sides 19 86.36 8 Increase in freshness 21 95.45 9 Sweating 22 100 10 Spontaneous cessation of vomiting 22 100

To end Vamana, certain signs and symptoms are taken. In the present study; more emphasis

was given to the symptoms. No leading questions were asked suggesting the specific answers.

The signs and symptoms were noted randomly and assessed. At that time, When Pitta started

vomiting out 100% (22) of the patients’ experienced bitter taste in the mouth and experienced

burning sensation in the throat. Pittanta Vamana was observed in 100 % patients.Appearance of

Sweda,lightness of abdomen was also seen in all patients just after Pittanta. 95.45% (21) of the

patients were experienced increased fresh ness, lightness in the head and sides (86.36%). In

100% (22) of the patients had spontaneous cessation of the vomiting were observed (Swayam

cha Avasthanam). In 59.09% of patients pungent taste was observed.

Quantitative study showing the drug Input viz drug Output

Table No.81

Drug Input (Mean volume in ml)

Drug Output (Mean volume in ml)

Difference (Mean volume in ml)

4469.523 4740.95 271.427

To comprehend the quantity of drug was ingested, volume of the same were counted before

commencing to and after completion of the procedure. The difference between them provided us

that the amount of medicine that was ingested. The measurement helped us to estimate how

much quantity of medicine came out along with the vitiated doshas. The difference between

these two aggregate assisted us to conclude status of the ingested materials, weather it had come

out or remained inside. Average value of total ingested material of 22 patients is 4469.523 ml

and total expelled amount is 4740.95 ml. That means the amount of 271.427 ml was excess in

average.

Results


145

Samyak and Asamyak Yoga (Laingiki shuddhi)

Table No. 82 Yoga No.of Subjects % Samyak Yoga 22 100

100% of patientss attained Samyak yoga of Vamana .

Distribution of 22 patients according to Samsarjana Krama they followed

Table No.83 Graph. No.28

After the completion of the Vamana, sequence of the Samsarjana was adviced to the patients and

instructed them to follow it strictly. The factors like the nature of Vaigiki shuddhi and strength of

the patients were kept in mind while advising the sequence of samsarjana Krama. So maximum

patients 50% (21) were advised with 5 days of Samsarjana krama, whereas 31.81 % (6) advised

with 7 days of Samsarjana Krama.

Changes in the weight due to Vamana karma

Table No.84

Weight before the Vamana process ( in kg)

Weight after the Vamana process (in kg)

Mean defference (Weight loss in kg)

57.861 57.192 0.669

No.of days of Samsarjana Krama

No.of Patients

%

3 days 0 0.00

5days 15 68.18

7 days 7 31.81

Results


146

To analyze the changes taking place in weight due to the process of Vamana, the weight of the

patients was recorded before Vamana & after completion of the procedure. It was 57.861Kg

before & 57.192Kg. after completion of the karma mean loss of 0.669 kg.

Effect on the Cardinal signs and symptoms of Amavata:- The administration of vamana karma showed the following results:

GROUP A(MADHANAPHALA KALKA)

Effect on Sandhi Sula

Table NO: 85a

Mean N Std. Deviation Std. Error Mean BT 2.818 11 .405 .122 AT1 2.727 11 .467 .141 BT 2.818 11 .405 .122 AT2 2.545 11 .688 .207 BT 2.818 11 .405 .122 AT3 2.00 11 .632 .191 BT 2.818 11 .405 .122 AT4 1.636 11 .674 .203 BT 2.818 11 .405 .122 AT5 1.182 11 .405 .122

Table NO: 85 b

The change that occurred with the treatment is greater than would be expected by chance; there

is a statistically significant change (P = 0.341), (P=0.192) and at (P=<0.001)

Paired Differences

95% Confidence Interval of the Difference

Mean± % Std. Deviation

Std. Error Mean

Lower Upper

t Df Sig. (2-tailed)

BT-AT1 0.091 3.22 .467 .122 -.122 .293 1.00 10 P = 0.341 BT-AT2 0.273 9.68 .688 .207 - .162 .707 1.399 10 P = 0.192 BT-AT3 0.818 29.09 .632 .191 .413 1.223 4.500 10 P =<0.001 BT-AT4 1.182 54.58 .405 .203 .777 1.587 6.500 10 P = <0.001 BT-AT5 1.636 58.05 .674 .141 1.297 1.975 10.757 10 P = <0.001

Results


147

BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehapana, AT3- Before

vamana, AT4 – After vamana(evening),AT5 – After samsarjana karma.

There was significant reduction in the sandhi śūla .The improvement was of 3.22% during AT1

and during AT5 the improvement was 58.05%.

Graph No : 29

Effect on Sandhi shotha:

Table NO86a


Results


148

Table NO: 86b

Paired Samples Test

Paired Differences


Mean± %

Std. Deviation

Std. Error Mean

Lower Upper

t df Sig. (2-tailed)

.454 17.22 .405 .122 .104 .805 2.887 10 P = 0.016

.545 20.67 .539 .163 .195 .896 3.464 10 P = 0.006

.636 24.12 .447 .135 .297 .975 4.183 10 P = 0.002

1.00 37.93 .505 .152 .575 1.425 5.244 10 P = <0.001

1.454 55.15 .405 .122 1.104 1.805 9.238 10 P = <0.001

BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.016) (P=0.006)( P = 0.002) (P = <0.001)

Graph no : 30

There was significant reduction in the sandhi śotha i.e during AT1 the improvement was seen at

17.22% , during AT5 55.15% of improvement is seen.

Results


149

Effect of the therapy on Stabdhata Table NO: 87a

Mean N Std. Deviation Std. Error Mean BT 1.727 11 .467 .141 AT1 1.818 11 .603 .182 BT 1.727 11 .467 .141 AT2 1.727 11 .647 .195 BT 1.727 11 .467 .141 AT3 1.364 11 .505 .152 BT 1.727 11 .467 .141 AT4 1.182 11 .603 .182 BT 1.727 11 .467 .141 AT5 .727 22 .467 .141

Table NO: 87b

Paired Samples Test

Paired Differences


Mean± %

Std. Deviation

Std. Error Mean

Lower Upper


-0.865 5.26 .603 .182 -.293 .112 -1.00 10 P = 0.341

0.000 0.00 .647 .195 -.300 .300 .000 10 P = 1.000

0.363 21.01 .505 .152 .024 .703 2.390 10 P = 0.038

0.545 31.55 .467 .141 .195 .896 3.464 10 P = 0.006

1.000 57.90 .603 .182 0.000 0.000 0.000 10 P = 1.000


There was significant reduction in the stabdatha i.e during AT1 the improvement was seen at

5.26% , during AT5 57.90of improvement is seen.


is a statistically significant change (P = 1.000)

Results


150

Graph no : 31

Effect of the therapy on Tenderness

Table NO: 88a

Mean N Std. Deviation Std. Error Mean

BT 2.455 11 .820 .247 AT1 2.182 11 .751 .226 BT 2.455 11 .820 .247 AT2 2.0000 11 .775 .234 BT 2.455 11 .820 .247 AT3 1.636 11 .809 .244 BT 2.455 11 .820 .247 AT4 1.364 11 1.027 .310 BT 2.455 11 .820 .247 AT5 .545 11 .522 .157

Table NO: 88b

Paired Samples Test

Paired Differences


Mean± %

Std. Deviation

Std. Error Mean

Lower Upper

t df Sig.(2-tailed)

.273 11.12 .751 .226 -.041 .587 1.936 10 P = 0.082

.455 18.53 .775 .234 -.0073 .916 2.193 10 P = 0.053

.819 33.36 .809 .157 .413 1.223 4.500 10 P = 0.001

1.091 44.43 .522 .310 .620 1.562 5.164 10 P = <0.001

1.91 77.80 1.027 .244 1.438 2.380 9.037 10 P = <0.001


Results


151


is a statistically significant change (P = <0.001)

There was a significant reduction in the tenderness is observed. During AT2 18.53%, AT3

33.36%, AT5 77.80% of improvement is observed.

Graph no : 32

Effect on the Range of joint Movements

Table NO: 89a


BT 4522.727 11 426.54 128.464

AT1 4550.909 11 413.387 124.641

BT 4522.727 11 426.54 128.464

AT2 4770.00 11 368.619 111.143

BT 4522.727 11 426.54 128.464

AT3 4873.636 11 352.485 106.78

BT 4522.727 11 426.54 128.464

AT4 4090.00 11 3710.73 93.702

BT 4522.727 11 426.54 128.464

AT5 5249.091 11 300.015 90.458

Results


152

Table NO:89b

Paired Differences


Mean ±

% Std. Deviation

Std. Error Mean

Lower Upper


-28.18 0.62 413.387 124.641 -71.389 15.025 -1.453 10 P = 0.177 -247.27 5.46 368.619 111.143 -306.23 -188.315 -9.345 10 P = <0.001 -350.90 7.75 352.485 90.458 -414.67 -287.143 -12.26 10 P = <0.001 432.72 9.56 300.015 93.702 -587.19 -307.346 -7.122 10 P = <0.001 -726.36 16.06 3710.73 106.78 -906.83 -545.891 -8.968 10 P = <0.001

AT1 -BT AT2 -BT AT3-BT AT4-BT AT5-BT


is a statistically significant change (P<0.001)

There was a significant improvement is seen in the range of joints movement AT1 showed

0.62% and AT5 showed 16.06% of improvement .

Graph no : 33

Results


153

Effect of the therapy on hand grip power in mm of Hg Table NO: 90a


BT 79.091 11 6.348 1.914 AT1 79.818 11 6.838 2.062 BT 79.091 11 6.348 1.914 AT2 83.818 11 7.454 2.247 BT 79.091 11 6.348 1.914 AT3 87.636 11 7.632 2.301 BT 79.091 11 6.348 1.914 AT4 90.909 11 7.286 2.197 BT 79.091 11 6.348 1.914 AT5 104.18 11 12.082 3.643

Table NO: 90b

Paired Samples Test Paired Differences


Mean ±

% Std. Deviation

Std. Error Mean

Lower Upper


-0.727 0.919 6.838 2.062 -1.633 .179 -1.789 10 P = 0.104 -4.727 5.976 7.454 2.247 -6.832 -2.622 -5.004 10 P = <0.001 -8.545 10.80 7.632 2.301 -10.801 -6.290 -8.441 10 P = <0.001 -11.81 14.94 7.286 2.197 -13.834 -19.347 -9.734 10 P = <0.001 -25.08 31.72 12.082 3.643 -20.154 -12.027 -8.235 10 P = <0.001


Improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and after AT5

31.72% The change that occurred with the treatment is greater than would be expected by

chance; there is a statistically significant change (P<0.001)

Results


154

Graph no : 34

Effect of the therapy on foot pressure

Table NO: 91a Mean N Std. Deviation Std. Error Mean BT 33.00 11 4.980 1.502 AT1 33.273 11 4.839 1.459 BT 33.00 11 4.980 1.502 AT2 36.364 11 5.555 1.675 BT 33.00 11 4.980 1.502 AT3 36.909 11 5.873 1.771 BT 33.00 11 4.980 1.502 AT4 37.818 11 5.600 1.689 BT 33.00 11 4.980 1.502 AT5 41.909 11 7.816 2.357

Table NO: 91b Paired Samples Test

Paired Differences


Mean±

% Std. Deviation

Std. Error Mean

Lower Upper


-.273 .827 4.839 1.459 -.0.707 .1622 -1.399 10 P = 0.192

-3.364 10.19 5.555 1.675 -4.1716 -2.011 -5.540 10 P = <0.001

-3.909 11.84 5.873 1.771 -5.011 -2.807 -7.904 10 P = <0.001

-4.818 14.6 5.600 2.357 -6.121 -3.515 -8.237 10 P = <0.001

-8.909 26.99 7.816 1.689 11.829 -5.989 -6.798 10 P = <0.001


Results


155



There is significant improvement is seen in the foot pressure after AT1 the improvement is seen

at 0.827% which is statistically significant at P= 0.192 and after AT5 the improvement was of

26.99%

Graph no : 35

Effect of the therapy on knuckle swelling Table NO: 92a

Mean N Std. Deviation Std. Error Mean BT 112.364 11 7.553 2.277 AT1 112.364 11 7.553 2.277 BT 112.364 11 7.553 2.277 AT2 110.727 11 7.695 2.320 BT 112.364 11 7.553 2.277 AT3 108.909 11 7.395 2.230 BT 112.364 11 7.553 2.277 AT4 107.182 11 7.547 2.276 BT 112.364 11 7.553 2.277 AT5 106.273 11 7.240 2.183

Results


156

Table NO: 92b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.000 7.695 2.277 0.000 0.000 0.000 10 P = 1.000

1.637 1.456 7.553 2.320 .884 2.389 4.845 10 P = <0.001

3.455 3.074 7.395 2.230 1.972 4.938 5.190 10 P = <0.001

5.182 4.611 7.547 2.276 3.597 6.766 7.286 10 P = <0.001

6.091 5.420 7.240 2.183 4.699 7.483 9.752 10 P = <0.001


The change that occurred with the treatment is not great enough to exclude the possibility that

the difference is due to chance (P = <0.001),

The improvement is seen with only 1.45% after AT2 and 5.42% after AT5.

Graph no : 36

Results


157

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS

Table NO: 93a


BT 39.273 11 1.849 .557 AT1 39.273 11 1.849 .557 BT 39.273 11 1.849 .557 AT2 38.818 11 1.940 .585 BT 39.273 11 1.849 .557 AT3 38.091 11 1.446 .436 BT 39.273 11 1.849 .557 AT4 37.364 11 1.362 .411 BT 39.273 11 1.849 .557 AT5 37.364 11 1.433 .432

Table NO: 93b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.000 1.849 1.849 .000 .000 0.000 10 P = 1.00

0.455 1.15 1.940 1.940 .104 .805 2.887 10 P = 0.016

1.182 3.00 1.433 1.433 .677 1.686 5.221 10 P = <0.001

1.909 4.86 1.362 1.362 1.275 2.543 6.708 10 P = <0.001

1.909 4.86 1.446 1.446 1.438 2.380 9.037 10 P = <0.001


Here after dīpana and paachana i.e. AT1 there is no difference in the improvement. The

correlation and t cannot be computed because the standard error of the difference is 0.

After AT5 4.86% of the improvement is seen, The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Results


158

Graph no : 37

Effect of the therapy on circumference of forearms

Table NO: 94a



Table NO: 94b

Paired Differences


Mean % Std. Deviation

Std. Error Mean

Lower Upper


BT-AT1 0.000 0.000 1.700 .513 0.000 0.000 0.000 10 P = 1.000 BT-AT2 0.727 2.26 1.748 .527 .0494 1.405 2.390 10 P = 0.038 BT-AT3 1.727 5.38 1.849 .557 1.049 2.405 5.677 10 P = <0.001 BT-AT4 2.364 7.36 1.679 .506 1.743 2.985 8.480 10 P = <0.001 BT-AT5 3.818 11.89 1.690 .509 2.785 4.851 8.237 10 P = <0.001

Results


159

As the table shows after AT2 2.26% of the improvement at P=1.000 and after AT5 11.89% of

improvement is seen The change that occurred with the treatment is greater than would be expected by

chance; there is a statistically significant change (P = <0.001)

Graph no : 38

Effect of the therapy on circumference of thighs Table NO: 95a

Paired Samples Statistics



Results


160

Table NO: 95b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.182 0.237 5.336 1.609 -.0899 .454 1.491 10 P = 0.167

2 2.360 5.479 1.652 ..205 1.795 2.803 10 P = 0.019

2.918 3.80 5.968 1.799 1.662 3.975 5.429 10 P = <0.001

4.091 5.33 5.626 1.696 2.910 5.272 7.717 10 P = <0.001

6 7.81 5.924 1.786 5.099 6.901 14.832 10 P = <0.001


After AT1 only 0.237% of improvement is seen at P=0.167 and after AT5 7.81% of the

improvement is seen .The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = <0.001)

Graph no :39

Results


161

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF Table NO: 96a



Table NO: 96b

After AT1 only 0.966% of improvement is seen at P=0.138 and after AT5 12.35% of

improvement is seen .



Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper

t Df Sig. (2-tailed)

0.455 0.966 2.157 .650 -.173 1.083 1.614 10 P = 0.138

2.273 4.82 2.102 .685 1.418 3.127 5.926 10 P = <0.001

3.273 6.95 2.639 .796 2.031 4.515 5.871 10 P = <0.001

4.546 9.65 2.018 .634 3.258 5.833 7.866 10 P = <0.001

5.818 12.35 2.272 .608 4.623 7.013 10.849 10 P = <0.001


Results


162

Graph no : 40

EFFECT ON GENERAL SYMPTOMS Table NO: 97

PAIRED TEST

%

Symtoms BT AT1 AT2 AT3 AT4 AT 5 d

Aruchi 2.364 2.000 1.455 1.000 .818 .182 .364 88.37

Malabadhata .909 .818 .636 .455 .0909 .0909 .59091 92.85

Angamarda 2.364 2.273 1.727 1.364 .636 .273 1.81818 81.63

Sadana 1.909 1.545 1.182 1.091 .455 .364 1.45455 79.99

Alasya 1.818 1.818 1.182 1.182 .636 .182 1.18182 68.42

Anaha 2.091 2.000 1.273 1.182 .636 .455 1.18182 72.22

Praseka 2.000 2.000 1.273 1.000 .545 .273 1.45455 84.20

Truśna 1.727 1.727 1.636 .727 .636 1.727 1.40909 100

Hasta Pada

daha 1.818 1.818 1.455 1.000 .727 .0909 1.45455 91.42

Jwara .545 .0909 .000 .000 .000 .000 .3636 100

Śareera gowrava 2.091 1.909 1.545 1.000 1.818 .273 1.45455 78.05

The correlation and t cannot be computed because the standard error of the difference is 0

Results


163

Graph no: 41

Effect on Total score of General symptoms Table NO: 98a

Paired Samples Statistics Mean N Std. Deviation Std. Error Mean

BT 1.785 11 .568 .171 AT1 1.636 11 .634 .191 BT 1.785 11 .568 .171 AT2 1.215 11 .499 .150 BT 1.785 11 .568 .171 AT3 .909 11 .386 .116 BT 1.785 11 .568 .171 AT4 .636 11 .467 .141 BT 1.785 11 .568 .171 AT5 .356 11 .473 .143

Table NO: 98b



Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.149 8.34% .634 .191 .0353 .262 2.921 10 P = .015

0.573 32.10% .499 .150 .406 .734 7.744 10 P = <0.001

0.876 49.07% .386 .116 .700 1.052 11.111 10 P = <0.001

1.149 64.36 % .467 .141 .847 1.451 8.473 10 P = <0.001

1.429 80.05 % .473 .143 .972 1.887 6.968 10 P = <0.001


Results


164

The patients who are treated with Vamana karma showed significant improvement in the general

symptoms the percentage of improvement is increase from 8.33% during AT1 to 68.01% during

AT5.



Graph no : 42

GROUP B(MADHANAPHALA KSHEERAPAKA)

Effect on the Cardinal signs and symptoms of Amavata:-

The administration of vamana karma showed the following results:

Effect on Sandhi sula

Table NO: 99a


Results


165


is a statistically significant change (P = 0.053), (P=0.116) and at (P=<0.001)

BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehapana, AT3- Before

vamana, AT4 – After vamana(evening),AT5 – After samsarjana karma.

There was significant reduction in the sandhi śūla .The improvement was of 16.68% during AT1

and during AT4 the improvement was 59.99%.

Graph No :43

Table NO:99b

Paired Differences


Mean± % Std. Deviation

Std. Error Mean

Lower Upper


BT-AT1 0.455 16.68 .647 .195 -.0073 .916 2.193 10 P = 0.053 BT-AT2 0.455 16.68 .467 .141 .104 .805 2.887 10 P = 0.016 BT-AT3 0.818 29.99 .701 .211 .314 1.323 3.614 10 P =0.005 BT-AT4 1.455 53.35 .467 .141 .993 1.916 7.016 10 P = <0.001 BT-AT5 1.636 59.99 .302 .0909 1.297 1.975 10.757 10 P = <0.001

Results


166

Effect on Sandhi shotha

Table NO: 100a

Mean N Std. Deviation Std. Error Mean BT 2.273 11 .467 .141 AT1 2.182 11 .405 .122 BT 2.273 11 .467 .141 AT2 2.182 11 .405 .122 BT 2.273 11 .467 .141 AT3 1.818 11 .405 .122 BT 2.273 11 .467 .141 AT4 1.545 11 .522 .157 BT 2.273 11 .467 .141 AT5 1.000 11 0.000 0.000

Table NO: 100b

Paired Samples Test

Paired Differences


Mean± %

Std. Deviation

Std. Error Mean

Lower Upper


.0909 3.95 .405 .122 -.112 .293 1.000 10 P = 0.341

.0909 3.95 .405 .122 -.271 .453 .559 10 P = 0.588

.455 20.00 .405 .122 .104 .805 2.887 10 P = 0.016

.727 31.98 .522 .157 .199 1.255 3.068 10 P = 0.012

1.273 56.00 0.000 0.000 .959 1.587 9.037 10 P = <0.001




Results


167

Graph no : 44

There was significant reduction in the sandhi śotha i.e during AT1 the improvement was seen at

3.95% , during AT5 56.00% of improvement is seen.

Effect of the therapy on Stabdhata Table NO: 101a

Mean N Std. Deviation Std. Error Mean BT 2.182 11 .751 .226 AT1 2.000 11 .632 .191 BT 2.182 11 .751 .226 AT2 1.727 11 .647 .195 BT 2.182 11 .751 .226 AT3 1.727 11 .647 .195 BT 2.182 11 .751 .226 AT4 1.273 11 .467 .141 BT 2.182 11 .751 .226 AT5 .909 11 .302 .0909

Table NO: 101b

Paired Samples Test

Paired Differences 95% Confidence Interval of the Difference

Mean± %

Std. Deviation

Std. Error Mean Lower Upper


.182 8.34 .632 .191 -.0899 .454 1.491 10 P = 0.167

.455 20.85 .647 .195 .104 .805 2.887 10 P = 0.016

.455 20.85 .302 .195 .104 .805 2.887 10 P = 0.016

.909 41.65 .467 .141 .438 1.380 4.303 10 P = 0.002

1.273 58.34 .647 .0909 .838 1.707 6.528 10 P =<0.001


Results


168

There was significant reduction in the stabdata i.e. 20.85% of improvement is seen during AT2,

41.65% during AT4, 58.34% of improvement is seen during AT6



Graph no : 45

Effect of the therapy on Tenderness

Table NO: 102a


BT 2.364 11 .674 .203 AT1 2.273 11 .647 .195 BT 2.364 11 .674 .203 AT2 2.0000 11 .632 .191 BT 2.364 11 .674 .203 AT3 1.727 11 .647 .195 BT 2.364 11 .674 .203 AT4 1.182 11 .751 .226 BT 2.364 11 .674 .203 AT5 .636 11 .505 .152

Results


169

Table NO: 102b

Paired Samples Test

Paired Differences


Mean± %

Std. Deviation

Std. Error Mean

Lower Upper


.0909 3.84 .647 .195 .271 .453 .559 10 P = 0.588

.364 15.39 .632 .191 -.0893 .817 1.789 10 P = 0.104

.636 26.90 .505 .152 .183 1.089 3.130 10 P = 0.011

1.182 50.00 .751 .226 .677 1.686 5.221 10 P = <0.001

1.727 73.05 .647 .195 1.199 2.255 7.286 10 P = <0.001





26.90%, AT5 73.05% of improvement is observed.

Graph no :46

Results


170

Effect on the Range of joint Movements

Table NO: 103a


BT 4310.909 11 549.990 165.828

AT1 4361.818 11 502.271 151.440

BT 4310.909 11 549.990 165.828

AT2 4575.455 11 454.937 137.169

BT 4310.909 11 549.990 165.828

AT3 4731.818 11 456.439 137.621

BT 4310.909 11 549.990 165.828

AT4 4850.000 11 414.150 124.871

BT 4310.909 11 549.990 165.828

AT5 5076.364 11 359.980 108.538

Table NO: 103b

Paired Differences


Mean ±

% Std. Deviation

Std. Error Mean

Lower Upper


-50.909 1.18 502.271 151.440 -113.24 11.425 -1.820 10 P = 0.099 -264.54 6.13 454.937 137.169 -391.77 -137.314 -4.633 10 P = <0.001 -420.90 9.76 456.439 137.621 -557.84 -283.970 -6.849 10 P = <0.001 -539.09 12.50 414.150 124.871 -694.87 -383.311 -7.711 10 P = <0.001 -765.46 17.75 359.980 108.538 -938.96 -591.941 -9.829 10 P = <0.001

AT1 -BT AT2 -BT AT3-BT AT4-BT AT5-BT



There was a significant improvement is seen in the range of joints movement AT1 showed

1.18% and AT5 showed 17.75% of improvement .

Results


171

Graph no : 47

Effect of the therapy on hand grip power in mm of Hg Table NO: 104a



Results


172

Table NO: 104b



Mean ±

% Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.00 13.159 3.968 0.000 0.000 0.000 10 P = 0.100 -7.455 9.82 19.601 5.910 -12.798 -2.111 -3.108 10 P = 0.011 -10.36 13.66 19.482 5.874 -15.384 -5.343 -4.599 10 P = <0.001 -11.81 15.58 20.314 6.125 -17.565 -6.072 -4.582 10 P = 0.001 -14.90 19.66 23.053 6.951 -22.447 -7.371 -4.407 10 P = 0.001


Improvement is seen after AT2 is 9.82% statistically significant at p=0.100 and after AT5


chance; there is a statistically significant change (P<0.001)

Graph no : 48

Results


173


Table NO: 105a


BT 30.727 11 3.379 1.019 AT1 31.455 11 3.475 1.048 BT 30.727 11 3.379 1.019 AT2 34.273 11 2.533 .764 BT 30.727 11 3.379 1.019 AT3 35.091 11 4.036 1.217 BT 30.727 11 3.379 1.019 AT4 37.818 11 4.687 1.413 BT 30.727 11 3.379 1.019 AT5 38.364 11 4.653 1.403

Table NO: 105b

Paired Samples Test

Paired Differences


Mean±

% Std. Deviation

Std. Error Mean

Lower Upper


-.727 2.36 3.475 1.048 -1.405 -.0494 -2.390 10 P = 0.038

-3.545 11.53 2.533 .764 -4.241 -2.850 -11.353 10 P = <0.001

-4.364 14.20 4.036 1.217 -5.683 -3.045 -7.372 10 P = <0.001

-6.091 19.82 4.687 1.413 -8.116 -4.065 -6.700 10 P = <0.001

-7.636 24.85 4.653 1.403 -9.343 -5.930 -9.969 10 P = <0.001






16.25%

Results


174

Graph no : 49

Effect of the therapy on knuckle swelling Table NO: 106a

Mean N Std. Deviation Std. Error Mean BT 113.909 11 3.754 1.132 AT1 113.636 11 3.802 1.146 BT 113.909 11 3.754 1.132 AT2 112.545 11 4.591 1.384 BT 113.909 11 3.754 1.132 AT3 111.182 11 3.910 1.197 BT 113.909 11 3.754 1.132 AT4 110.364 11 5.201 1.568 BT 113.909 11 3.754 1.132 AT5 110.00 11 4.899 1.477

Results


175

Table NO: 106b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


.273 0.23 3.802 1.146 -0.162 0.707 -1.399 10 P = 0.192

1.364 1.197 4.591 1.384 .611 2.116 4.038 10 P = 0.002

2.727 2.394 3.910 1.197 1.381 4.074 4.512 10 P = 0.001

3.545 3.112 5.201 1.568 1.709 5.382 4.302 10 P = 0.002

3.909 3.431 4.899 1.477 2.046 5.772 4.675 10 P = <0.001


The change that occurred with the treatment is not great enough to exclude the possibility that

the difference is due to chance (P = <0.001),

The improvement is seen with only 0.23% after AT1 and 3.43% after AT5.

Graph no : 50

Results


176

Effect of the therapy on circumference of arms

Table NO: 107a



Table NO: 107b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.000 2.773 .836 .000 .000 0.000 10 P = 1.00

.727 1.85 2.803 .845 .413 1.041 5.164 10 P = <0.001

1.545 3.95 2.464 .743 1.195 1.896 9.815 10 P = <0.001

2.000 5.11 2.625 .791 1.480 2.520 8.563 10 P = <0.001

2.364 6.04 2.901 .875 1.911 2.817 11.628 10 P = <0.001


Here after dīpana and paachana i.e. AT1 there is no difference in the improvement. The

correlation and t cannot be computed because the standard error of the difference is 0.

After AT5 6.04% of the improvement is seen, The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Results


177

Graph no : 51

Effect of the therapy on circumference of forearms Table NO:108a



Table NO: 108b

Paired Differences 95% Confidence Interval of the Difference

Mean %

Std. Deviation

Std. Error Mean Lower Upper


.182 0.55 3.157 .952 -.0899 0.454 1.491 10 P = 0.167

.818 2.47 2.822 .851 .231 1.405 3.105 10 P = 0.011

1.455 4.40 3.205 .966 .993 1.916 7.016 10 P = <0.001

1.545 4.68 3.202 .966 1.183 2.089 8.050 10 P = <0.001

BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5 1.636 4.95

2.945 88 1.084 2.007 7.405 10 P = <0.001

Results


178

As the table shows after AT1 0.55% of the improvement at P=0.167 and after AT5 4.95% of

improvement is seen The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = <0.001)

Graph no : 52

Effect of the therapy on circumference of thighs

Table NO: 109a



Results


179

Table NO: 109b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.00 3.950 1.191 0.000 0.000 0.000 10 P = 1.000

0.273 0.35 4.292 1.294 -.041 .587 1.936 10 P = 0.082

0.727 0.93 4.452 1.342 .199 1.255 3.068 10 P = 0.012

1.273 1.63 4.384 1.322 .473 2.073 3.545 10 P = 0.005

1.364 1.74 4.411 1.330 .499 2.228 3.516 10 P = 0.006


After AT2 only 0.35% of improvement is seen at P=0.082 and after AT5, 1.74% of the

improvement is seen .The change that occurred with the treatment is greater than would be

expected by chance; there is statistically no significant change (P = 0.006)

Graph no : 53

Results


180

Effect of the therapy on circumference of calf Table NO: 110a



Table NO: 110b

After AT2 only 3.09% of improvement is seen at P=0.100 and after AT5 7.15 % of improvement

is seen .



Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


0.000 0.000 3.550 1.070 0.000 0.000 0.000 10 P = 1.000

1.455 3.09 3.934 1.186 .535 2.374 3.525 10 P = 0.005

2.364 5.02 3.957 1.302 1.269 3.458 4.812 10 P = <0.001

3.182 6.17 3.790 1.143 2.290 4.074 7.946 10 P = <0.001

3.364 7.15 4.319 1.193 2.401 4.327 7.783 10 P = <0.001


Results


181

Graph no :54

Effect on general symptoms

Table NO: 111

PAIRED SAMPLE TEST %

Symtoms BT AT1 AT2 AT3 AT4 AT 5 d %

Aruchi 1.545 1.455 1.00 .545 .455 .455 .364 88.37

Malabadhata .455 .455 .455 .455 .182 .182 .59091 92.85

Angamarda 2.091 1.727 1.364 1.182 .545 .364 1.81818 81.63

Sadana 1.727 1.182 .909 .636 .455 .545 1.45455 79.99

Alasya 1.636 1.455 .636 .636 .636 .636 1.18182 68.42

Anaha 1.273 1.273 .727 .727 .545 .545 1.18182 72.22

Praseka 1.455 1.364 .909 .909 .455 .455 1.45455 84.20

Truśna 1.091 1.091 1.091 .545 .545 .545 1.40909 100

Hasta Pada

daha 1.364 1.364 1.182 .545 .364 .182 1.45455 91.42

Jwara .182 .182 .000 .000 .000 .000 .3636 100

Śareera

gowrava 1.636 1.636 1.455 1.273 .909 .636 1.45455 78.05

a. The correlation and t cannot be computed because the standard error of the difference is 0

Results


182

Graph no :55

Effect on Total score of General symptoms

Table NO: 112a


BT 1.314 11 .559 .169 AT1 1.199 11 .475 .143 BT 1.314 11 .559 .169 AT2 .884 11 .419 .126 BT 1.314 11 .559 .169 AT3 .678 11 .351 .106 BT 1.314 11 .559 .169 AT4 .463 11 .235 .0709 BT 1.314 11 .559 .169 AT5 .413 11 .209 .0629

Table NO: 112b

Paired Samples Test

Paired Differences


Mean %

Std. Deviation

Std. Error Mean

Lower Upper


.116 8.82% .475 .143 -.00683 .238 2.104 10 P = .062

.430 32.72% .419 .126 .201 .658 4.187 10 P = 0.002

0.636 48.40% .351 .106 .395 .878 5.879 10 P = <0.001

0.851 64.76 % .235 .0709 .575 1.127 6.870 10 P = <0.001

0.901 68.56 % .209 .0629 .603 1.199 6.728 10 P = <0.001


Results


183



AT5.



Graph no : 56

Effect on the Cardinal signs and symptoms of Amavata:-

COMPARISON BETWEEN 2 GROUPS

Effect on Sandhi sūla

Table NO: 113

Mean Std Dev SEm Diff Lo UP T Sig.(2 tailed

AT4K 1.727 .647 .195 AT4Ks 1.273 .467 .141

0.3636 - .162 .707 1.399 P = 0.192

AT5Ks 1.545 .522 .157 Sandhi śūla

AT5K 1.091 .302 .0909 .455 .413 1.223 4.500 P =<0.001

The difference in the mean values of the two groups is not great enough to reject the possibility

that the difference is due to random sampling variability. There is not a statistically significant

difference between the input groups (P = 0.073).

The difference in the mean values of the two groups is greater than would be expected by

chance; there is a statistically significant difference between the input groups (P = 0.021).

Results


184

Effect on Sandhiśotha Table NO: 114

Mean Std Dev SEm Diff Lo UP T Sig.(2

tailed AT4K 1.636 .603 .152 AT4Ks 1.545 .467 .157

.0909 -.366 .548 .415 P = <0.682

AT5Ks 1.000 .467 0.00 Sandhi shotha

AT5K 1.000 .302 0.00 0.000 0.000 0.000 0.000

P = 1.000







Effect of the therapy on Stabdhata

Table NO:115


tailed AT4K 1.182 .647 .182

AT4Ks 1.273 .467 .141 -.0909

-.571

.389 -.395

P = 0.697

AT5Ks .727 .522 .141 Stabdhata

AT5K .909 .302 .0909 -.182

-.531 0.168 -1.08

P = 0.291







Results


185

Effect of the therapy on Tenderness Table NO: 116


tailed AT4K 1.364 1.027 .310

AT4Ks 1.182 .751 .226 .182

-.618

.982 .474 P = 0.641

AT5Ks .727 .786 .237 Tenderness

AT5K .636 .505 .152 .0909

-.497

.678 .323 P = 0.750






difference between the input groups (P = 0.750)

Effect on the Range of joint Movements: Table NO.117





tailed

Range f j i t

AT4K 4942.72

339.06

102.23 92.70 243 429. .575 P =

AT4Ks 4850.00

414.15

124.87

AT5Ks 5142.72

365.95

110.33

AT5K 5076.36

359.98

108.53

66.36 256.49

429.32

.429 P = <0.673

Results


186




Effect of the therapy on hand grip power in mm of Hg:

Table NO: 118

Mean Std Dev SEm Diff Lo UP T Sig.(2 tailed

AT4K 90.909 7.286 2.197

AT4Ks 87.636 20.314 6.125 3.273

-10.30

-16.84 0.503 P= .62

AT5Ks 104.182 12.082 3.643 Hand grip

AT5K 90.727 23.053 3.643 13.455

-2.915

29.824 1.715 P= .10








Table NO:119


tailed AT4K 37.818 1.689 .195 1.000

AT4Ks 36.818 1.413 .141 3.545

-3.59

5.593 .454 P = 0.65

AT5Ks 41.909 2.357 .157 1.000

foot pressure

AT5K 38.364 1.403 .0909 3.545

-2.17

9.267 1.293 P = 0.21




Results


187




Effect of the therapy on knuckle swelling Table NO: 120


tailed AT4K 107.18 7.54 2.27

AT4Ks 110.36 5.20 1.56

-3.18

-8.94

2.583 -1.15

P= 0.263

AT5Ks 106.27 7.24 2.18 knuckle swelling

AT5K 110.00 4.89 1.47

-3.72

-9.22

1.771 -1.41

P= 0.173







Effect of the therapy on circumference of arms Table NO: 121


tailed AT4K 37.364 1.362 .411

AT4Ks 37.091 2.625 .791 0.273

-1.58

2.133 0.306 P= <0.763

AT5Ks 37.364 1.433 .432 Circumference of arms

AT5K 36.727 2.901 .875 0.636

-1.39

2.672 0.652 P= 0.522

Results


188







Effect of the therapy on circumference of forearms Table NO: 122


tailed AT4K 29.727 1.679 .506

AT4Ks 31.364 3.202 .966

-1.63

-3.91

0.63 -1.50

P = 0.149

AT5Ks 28.273 1.849 .557

circumference of forearms

AT5K 31.455 2.945 0.888

-3.19

-5.36

-0.99

-3.03

P= 0.007





chance; there is a statistically significant difference between the input groups (P = 0.007)

Effect of the therapy on circumference of thighs Table NO: 123


tailed AT4K 72.636 5.626 1.696

AT4Ks 76.727 4.384 1.322

-4.09

-8.57

0.63 -1.50

P= 0.149

AT5Ks 70.727 5.968 1.799

circumference of thighs

AT5K 76.636 4.411 1.330

-5.90

-10.5

-1.24

-2.64

P= <0.016

Results


189






Effect of the therapy on circumference of calf

Table NO: 124


tailed AT4K 42.545 2.018 .608

AT4Ks 43.818 3.790 1.143 1.273

-3.97

1.428 -0.98

P= 0.337

AT5Ks 41.273 2.102 .634

circumference of calf

AT5K 43.636 3.957 1.193 -2.36

-5.18

.454 -1.75

P= 0.095







EFFECT ON GENERAL SYMPTOMS

Effect on Aruchi

Table NO: 125


tailed AT4K .818 .603 .182 AT4Ks .455 .522 .157

.364 -.138 .865 1.512 P=0.146

AT5Ks .182 .405 .122 Aruchi

AT5K .455 .522 .157 -.273 -.688 .143 -

1.369 P=.186

Results


190







Effect on malabhadhatha Table NO: 126


tailed AT4K .0909 .302 .0909 AT4Ks .182 .405 .122

-.090 -.408 .226 -

.598 P=0.557

AT5Ks .0909 .302 .0909 Malabhadhatha

AT5K .182 .405 .122 -.090 -

.408 .226 -.598 P=0.557







Effect on Angamarda

Table NO: 127


tailed AT4K .635 .809 .244 AT4Ks .545 .820 .247

.0909 -.634 .815 .262 P=0.796

AT5Ks .273 .467 .141 Angamarda

AT5K .364 .505 .152 -.0909 -.523 .342 -.439 P=0.666

Results


191







Effect on sadhana

Table NO:128


tailed AT4K .455 .522 .157 AT4Ks .455 .522 .147

.000 -.465 .465 .000 P=1.000

AT5Ks .364 .505 .152 sadhana

AT5K .545 .522 .157 -.182 -.639 .275 -.830 P=0.416







Effect on Alasya Table NO:129


tailed AT4K .636 .674 .203 AT4Ks .636 .505 .152

.000 -.530 .530 0.000 P=1.00

AT5Ks .182 .405 .122 Alasya

AT5K .636 .505 .152 -.455 -.861 -

.0478 -2.331 P=0.030




Results


192



Effect on Anaha Table NO: 130


tailed AT4K .636 .505 .152 AT4Ks .545 .522 .157

.0909 -.366 .548 .415 P=0.682

AT5Ks .445 .522 .157 Anaha

AT5K .545 .522 .157 -.0909 -.555 .374 -.408 P=.687







Effect on praseka Table NO: 131


tailed AT4K .545 .522 .157 AT4Ks .455 .522 .157

.0909 -.374 .555 .408 P=0.687

AT5Ks .273 .467 .141 praseka

AT5K .455 .522 .157 -.182 1.622 .259 -.861 P=0.400







Results


193

Effect on Trushna Table NO:132


tailed AT4K .636 .505 .152 AT4Ks .545 .522 .157

.0909 -.366 .548 .415 P=.682

AT5Ks .000 .000 .000 Trushna

AT5K .545 .522 .157 -.545 -.874 -.217 -

3.464 P=0.002






Effect on Hasta pada daha Table NO: 133


tailed AT4K .727 .647 .195 AT4Ks .364 .505 .152

.364 -.152 .879 1.470 P=0.157

AT5Ks .0909 .302 .0909

Hasta pada daha

AT5K .182 .405 .122 -.0909

-0.408 .226 -.598 P=.557







Results


194

Effect on Jwara Table NO: 134


tailed AT4K .000 .000 .000 AT4Ks .000 .000 .000

.000 .000 .000 .000 P=1.000

AT5Ks .000 .000 .000 Jwara

AT5K .000 .000 .000 .000 .000 .000 .000 P=1.000







Effect on Shareera gaurava Table NO:135


tailed AT4K 1.818 .603 .182 AT4Ks .909 .831 .251

-.0909 -.737 .555 -.294 P=0.772

AT5Ks .273 .467 .141 Shareera gaurava

AT5K .636 .674 .203 -.364 -.879 .152 -

1.470 P=0.157







Results


195

THE RESULTS OF THE STUDY

Parameters MPK MPKs Sandhi sula Significant Significant Sandhi shota Significant Significant

Stabdhata Significant Significant Tenderness Significant Significant

Range of joint movements Significant Significant Hand grip power Significant Significant

Foot pressure Significant Significant Knuckle swelling Significant Significant

Circumference of arms Significant Significant Circumference of forearms Significant Significant

Circumference of thighs Significant Not Significant Circumference of calf Significant Significant

Aruchi Significant Significant Malabadhata Significant Significant Angamarda Significant Significant

Sadana Significant Significant Alasya Significant Significant Anaha Significant Significant Praseka Significant Significant Truśna Significant Significant

Hasta pada daha Significant Significant Jwara Significant Significant

Śareera gowrava Significant Significant

Discussion


196

DISCUSSION Conceptual Study

Vamana is mentioned as an ideal choice in disorders caused by Kapha Dosha, Pitta

Samsrushtha Kapha and Pitta sthanagata Kapha.Vamana karama will helps to eliminate the

morbidity which is particularly related with Kapha.

Among the joint disorders amavata is considered to be most serious, owing to its chronicity,

crippling nature and pain. Amavata is distressing and frustrating ailment both for the patient and

the physician as well.

Amavata being a disease having the predominance of morbid Kapha and Ama running in

Shleshmasthana, requires potent Vatahara, Kaphahara and Rasayana procedure through which

disease may be controlled.

Amavata is a bhahudoshavastajanya vyadhi where simple treatment like Langhana,

Langhana Pachana is not beneficial.So one has to go for Shodana procedure.

As in this disease mainly Ama and Kapha dominancy is seen and also the Shleshma sthana is

affected the Vamana which is a Shodana & langhana is beneficial.

Complete management of systemic diseases caused by Kapha can be attained by vamana

karma. Amashaya particularly Urdva Amashaya is the seat of Kapha. The active principle of

Vamaka drug taken orally is absorbed from the stomach into circulatory system from where it is

circulated all over the body reaching at the site of Dosha Sanghata, it breaks the dosha dushya

samurchana and bring back the harmful substances thus released into the stomach, where from

they are expelled out of the body by the action of vomiting.

Mode of Action of vamana Aushadhi: The vamana aushada is comprised of qualities like

Ushna, Tikshna, Sukshma, Vyavayi, and Vikasi.and formed with predominance of agni and

Vayu Mahaboota. But the main action is attained by the urdhvabhaga hara prabhava possessed

by these drugs.The drugs due to their virya will reach hridaya, and dhamani there by reaches

Stula and anu srotas of body. The vyavayi Guna of the drug will help in quick absorption and

movement of the drug. Vikasi Guna will helps in breaking the binding of dosha and dushya. Due

to Ushna Guna drug will cause vishyandhana and due to Tikshna Guna causes Chedhana of

Doshas. The Sukshma Guna helps to reach minutest channels.

Discussion


197

The agni and Vayu mahabhutha because of its qualities like laghutva and tendency to move

upwards will help in bringing Vamaka effects. More importantly Prabhava of the drug is

especially responsible in brining about the Vamaka action.

The assessment of Vamana is done based on Vaigiki, Maniki, Laingiki and Antiki lakshana.

Here the laingiki and antiki lakshana are indicative of samyak yoga or Ayoga of the Vamana.

Where as Maniki, Vaigiki lakshanas are helpful to assess Pravara, Madhyama and Avara

shuddhi. These measures are also helpful in planning Samsarjana Krama.

CLINICAL STUDY:

A total of 22 patients suffering from Amavata fulfilling the inclusion criteria were studied.

Statistical analysis was done based on Sigma Stat version 3.1. The observations and the results as

well as statistical analysis of these are elaborated below.

Number of patients registered in study -22

Number of patients completed the study - 22

Number of dropout - 0

Discussion on observations (Demographic Data):

AGE: - Out of 22 patients of Āmavāta studied in this work, 27.27% patients were belonged to

the age group of 36-45 years & 46-55 years, 18.18% patients each in age group of 26-35years

and 56-65 years, 9.09%patient from the age group of 16-25 years.

SEX: - Among the 22 patients of this study 72.72% patients were females and 27.27% patients

were males.

RELIGION: - Among 22 patients of these series maximum 68.18% of patients were belonged

to the Hindu community, 18.18% from Christian religion and 13.63% from Muslim.This shows

geographical predominance of Hindus in and around UDUPI area. The details are elaborated in

the Table No46. and Graph No.3

MARITAL STATUS: Out of 22 patients of Āmavāta studied in this work. Maximum 90.90% of

patients were married. And 9.09% were unmarried.

EDUCATION: Out of 22 patients of Āmavāta studied in this work, maximum 45.45% were

studied upto matric, 27.27% of the patients were graduates, 22.72% studied up to primary

Discussion


198

school, And 4.54% were uneducated. But from the above said data no definite conclusion can be

drawn regarding education with disease Table No.48 and Graph No.5

SOCIO-ECONOMIC STATUS: Out of 22 patients of Āmavāta studied in this work, 36.36% of

the patients belonged to upper middle class, 27.27% belonged to middle class, 13.63% belonged

to both lower middle class and poor, and 4.54% belonged to rich class.

OCCUPATION: Out of 22 patients of Āmavāta studied in this work, it was observed that

maximum number of patients were house wife i.e. 40.09%. 9.09 % were nurses, students and

employees, and 4.54% were teachers and business people. As in the study more of the house

wives were observed who can be considered under manual labour category, they have a more of

physical work which may provoke Vata dosha. Table No.50 and Graph No.7

DESHA: Out of 22 patients of Āmavāta studied in this work 72.72% of the patients belonged to

anupa desha, 22.27% belonged to jangala desha and 4.54% belonged to sadharana desha. The

Anupa Desha which is having predominance of Kapha dosha, this shows the relation of Anupa

desha one among the factor influencing in the disease. The details are shown in the Table No.51

and Graph No.8

CHRONICITY OF DISEASE: Out of 22 patients of Āmavāta studied in this work maximum

patients were suffering from the disease less than 1 year i.e. 13.63% and 31.81% suffered since

more than 2 years. And 54.54 % were suffering the disease since 1 to 2 years.

ADDICTION: Out of 22 patients of Āmavāta studied in this work, 95.45% were addicted to

coffe/tea. And 4.54% were addicted to tobacco

DIET:

Out of 22 patients of Āmavāta studied in this work 86.36% were of mixed diet and 13.63%

vegitarians.The diet plays an important role in causing the disease.The ahara which are Guru,

Abhisyandi etc which may provoke both Kapha kara and Ama. This favors the Amavata Nidana.

The details are shown in the Table No.54 and Graph No. 11

SLEEP PATTERN:

Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed sleep and

18.18% had sound sleep. The disturbed sleep was due to pain .The details are shown in the Table

No.55 and Graph No.12

Discussion


199

PRAKRITI: Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 36.36%

were Vāta pittaja prakrithi and remaining 18.18% were kapha pittaja prakrithi. Involvement of

Kapha as a part of body constituents is observed. Table No.56 and Graph No.13

SATVA: In this study Maximum of 81.81% of the patients were of madhyama satva, 18.18%

were avara satva.

SATMYA: Maximum of 36.36 %were of amla rasa satmya, and 27.27% were madhura rasa

satmya 22.72 % were katu rasa satmya and 13.63% were lavana rasa satmya.It is very difficult to

conclude the relationship between Satmya and Amavata.The details are shown in the Table

No.58 and Graph No.15

SAMHANANA: Maximum of 72.72% of the patients were of madhyama samhanana, 18.18%

were avara, 9.09% were pravara.The details are shown in the Table No.59 and Graph No.16

SARATAHA:

Maximum of 59.09 % patients were twak Sāra, and 9.09% of rakta Sāra and 31.81 % māmsa

Sāra .

AHARA - AHYAVAHARANA SHAKTI: Out of 22 patients Maximum of 86.36% patients

were having madhyama abhyvarana śakti and 13.63% were having avara abhyvarana śakti.This

data suggests the relation of Ama and Ahara Abhyavaharana Shakti. Details are given in the

Table No.61 and Graph No.18

AHARA - JARANA SHAKTI: Jarana Shakti of 22 patients revealed that

Maximum of 86.36% patients had madhyama jaraṇa shakti, 13.63% had avara jaraṇa shakti

The jarana shakthi plays an important role in formation of Ama. The same is shown in the Table

No. 62 and Graph No.19

VYAYAMA SHAKTI: Out of 22 patients taken for this study, Maximum of 72.72% patients

had madhyama vyāyāma shakti and the remaining 31.81 % had avara vyayama shakti. From

above said data it may be noticed like due to the disease nature the patients functional ability

reduced and and therefore Vyayama Shakti also. The same is given in the Table No.63 and

Graph No20

VAYA: It is observed that maximum of 86.36% of the patients taken for this study belongs to

madhya vaya, 13.63% belongs to vrudha.

Discussion


200

INCIDENCE OF KOSHTA: - Out of 22 patients taken for this study it is observed that

maximum of 81.81% of the patients had madhyama koṣta and 18.18% had mridhu koṣta. As

shown in the Table No.65 and Graph No.22

EFFECT OF THE THERAPY

Observation of Pachana and Deepana: Vadavanala choorna 5gm is used with hot water thrice

daily till the Nirama lakshanas observed in the patients.It has Pachana-Deepana effect and its

vata kapha hara quality helps in attaining nirama avasta easily.During the Pachana Deepana there

was no much improvement in the symptoms of the Amavata like shoola, shotha etc.

Observation of Snehapana:- Snehapana was started with the Moorchitha Ghrita & the dose was

25ml (Hrasiyasi Matra). On the basis of the time taken to digest first day of Sneha, a subsequent

dose of Ghrita was planned. The Sneha was given in Arohana Matra till patients has developed

Samyak Snigdha Lakshanas or upto maximum of seven days, whichever is earlier. The average

days of Samyak Snigda Lakshnas was observed in patients were three days. However a

maximum of five days is also noted. Mean of the total amount of the ghrita to attain the samyaka

Snigdha Lakshans were 335 ml . Minimum dose of 125ml at the maximum doses of 600ml was

also noted. The mean time taken for digestion of sneha on first day was 390min and the time

duration was increasing day by day the 5th day mean time taken was 523min.All the patients

were shown features of the Samyak Snigdha lakshna. None of the patients were shown

complications like that of Sneha Vibhrama. During the snehapana with Moochitha Ghrita there

was marked reduction in the Pain, Tenderness, Stiffness, Swelling was observed. There was

improvement in the agni. Maximum Samyak snigdha lakshanas were seen on 4th day.

Observation of Swedana Karma: - After attaining of Samyak Snigdha lakshana one day gap

was given during which Abhyanga was done with saindavadi taila followed by Bashpa sweda.

In this study after the Swedana, 100% patients manifested with Sheetoparama,

Shooloparama,Stamba nigraha, Sweda pradurabhava lakshanas.. But Lagutva, Mardavata,

Gourava nigraha was noted in 91.3% patients.During the rest day patients were advised to take

minimum of 2 liters of curds with rice,idlli,vada and ample amount of Sweets for the purpose of

Kaphothkleshana. As curds is the best abhishyandi and does Kaphothkleshana quickly, it has

been selected.

Discussion


201

Observation of Vamana Karma: On the day of Vamana after performing Abhyanga with

saindavadi taila followed by Bashpa sweda in the early morning between 6.15 Am to 6.45Am in

accordance with sunrise Vamana karma was administered. Madanphalapippali (3-

5gms),Saindhava Lavana(5gms),Vacha choorna(2-4gms) with sufficient quantity of Madhu was

used and it was mixed and made in to kalka form or Madanaphala Ksheerapaka in which Madana

phala powder(4-6gms) is boiled in 8 parts of milk (50ml) with the addition of 32 parts of

water(200ml). The boiling is continued till the water gets evaporated and milk alone is

left(ksheeravashesha i.e 50ml) was selected according to the Group. Madanaphala kalka can be

rolled into small pills for easy consumption. For akanthapaana, Ksheera was used, Yastimadhu

phanta was used as Vamanopaga dravya.. Vital data like B.P, Pulse Temperature, and

respiratory rate were noted at regular intervals.

Symptoms after Administration of Vamaka yoga: The Table No. reveaels that maximum

number of patients 100% (22) attained Hrillasa followed 95.25% showed sweating

(swedapravartanam) ,81.81% had Kukshi Adhmana, 50% had Nisteeva,31.81% had Daha, Lala

srava,27.27% showed Madhura asyata, Nasa srava,22.72% had Romaharsha, 18.18 % presented

with Akshi srava and Udgara, 9.09% individuals exhibited Kasa and Shirogaurava. The

symptoms explained above in sequential manner did not occur in each Vamana; hence it is

difficult to assess the perfect sequence in each time.

Expulsion of first Vega: In the present study, after the administration of Vamaka Yoga, a gap of

8-10minutes was given for its action. An average time of 9.52 minutes was noted for the

expulsion of first Vega. Here minimum of 3 minutes and maximum of 20 minutes was observed

for the expulsion of first Vega. As shown in Table No.72

In each of the Vega the change in the colour and nature of the expelled materials was observed.

Duration of total procedure:

In this study average time taken to finish the Vamanakarma was 43.28 min (Table No 76 .) in all

22 patients. So the concept “Muhurtham anukamkshayet” this is the time duration to end with

Pittanta Vamana. So here it gives the clear meaning that one has to finish the whole procedure

within 45 Minutes. In the study all patients was ended up with pittanta Vamana within one

muhurtha.

Discussion


202

Distribution of patients according to Vaigiki Shuddhi:

Out of 22 patients of this study, maximum 68.18% patients exhibited Madyama vega 31.81%

patients shown Pravara vega. As shown in Table No.78 . But the Vaigiki shuddhi is not reliable

to predict anything about the result. It only helps us to come to a conclusion about shuddi and

plan the Samsarjana karma accordingly.

Antiki Symptoms:

Whatever the amount that is ingested most of it will be thrown out of the body, hence 100% of

the patients exhibited lightness in the abdomen after vamana karma. Pittanta Vamana is

important feature as per Antiki shuddi is considered. All the patients ended up with Pittanta

Vamana.Due to appearance of Pitta 100% patient’s experienced bitter taste in the mouth and

burning sensation in the throat. Pungent taste was exhibited by 59.09% of patients.

Increased in freshness was seen in 95.45% patients. 86.36% patients showed lightness in the

head, and sides. 100% of the patients showed spontaneous cessation of the vomiting. (Swayam

cha Avasthanam) It was noted that when the patients were properly advised with Snehana,

Swedana and Kaphothkleshakara Ahara Vamana will be much easier and Pittanta takes place

faster. Vamana removes Kapha from the channels in the head region may bring the feeling of

lightness of the head. As Vamana is clearing all the channel pathways throughout the body, so

lightness in chest, lightness in sides, appearance of clear and tasteless belching were observed as

these are subjective criteria it is not possible to score in percentage.

Manki Shuddhi:

In the present study average value of total ingested material in 22 patients was 4469.523ml and

total expelled amount was 4740.95ml, that means the amount of 271.427 ml was in excess

(average), it was found that the mean quantity of difference between input and output was

indicates the quatity of doshas expelled during Vamana. If the expulsion of the viscous matter

showed an increase then there better chances to getting relief in the diseases afterwards.

Discussion


203

Laingiki Suddhi :

The laingiki shudhi is assessed in three stages.During Vamana,After vamana And After

samsarjana.krama. During vamana 100% patients had shown kale pravruthi, swayam cha

avashanam, yathakrama kapha pitta vata dosh harana.Where as 90.9 % patients shown anathi

mahathi vyadha ,After vamana 90.9% showed Kanta shudhi, Kapha samsrava, 77.2% exhibited

Hrudaya shudhi, Sroto shuddhi, 68.1% exhibited Parshva shudhi features.These Laingiki

lakshanas are much important to conclude the Samyak Vamana.

Changes observed in Blood pressure: The blood pressure initially raised during the process and

again came down. In all 22 patients in the beginning mean B.P was 126.2/80.5 mm of Hg which

got raised up to 142.6/94.6 mm of Hg during the procedure and came down to 122.2/84 mm of

Hg at the end of the procedure. This mechanism can be explained as follows- Normally,

whenever a change (for example, increased activity or a strong emotion) causes a transient

increase in blood pressure. Any type of mental and physical activities increases the arterial

pressure.In cardiovascular physiology, the baroreceptor reflex is one of the body's homeostatic

mechanisms for maintaining blood pressure. It provides a negative feedback loop in which an

elevated blood pressure reflexively causes blood pressure to decrease; similarly, decreased blood

pressure depresses the baroreflex, causing blood pressure to rise.These specialized neurons

(baroreceptors) in the aortic arch, carotid sinuses, and elsewhere to monitor changes in blood

pressure and relay them to the brainstem. When blood pressure rises, the carotid and aortic

sinuses are distended, resulting in stretch and therefore activation of the baroreceptors. The end

result of baroreceptor activation is inhibition of the sympathetic nervous system and activation of

the parasympathetic nervous system. Sympathetic inhibition leads to a drop in peripheral

resistance, while parasympathetic activation leads to a depressed heart rate and contractility. The

combined effects will dramatically decrease blood pressure.

There might be slight increase in initial B P than normal in all patients due to anxiety before

leading to vamana.After acclimatizing with vamana process and with negative feed back

mechanisms it almost returned to normal after the procedure.

Changes in pulse: Pulse also showed the same changes, average pulse recorded before

commencement to the process was 80.4/min, which elevated up to 106.7/min and then again

came down to 82.4/min. This increment was due to activation of autonomous nervous system,

Discussion


204

which stimulates the heart for more cardiac output to fulfill the need of increased blood flow in

the visceral region and the muscles helping the process.

Samsarjana Krama: After the completion of the Vamana Samsarjana was advised to the

patients and instructed them to follow it strictly. Looking in to the Vaigiki shuddhi and strength

of the patients Samsarjana Karma was planned. So maximum patients 68.18% were advised with

5 days of Samsarjana karma, where as 31.81% advised with 7 days of Samsarjana Krama. Table

No. 83.

EFFECT OF THERAPY:

Effect on Cardinal signs and symptoms:-

The administration of Vamana karma showed the following results,

Effect on Sandhi Shoola:-

In Group A there was significant reduction in the sandhi śūla .The improvement was of 3.22%

during AT1 and during AT5 the improvement was 58.05%.The therapy shows statistically

significant change at the level of P = <0.001, as shown in Table No.85a and Graph No.29.There

was significant reduction in the sandhi śūla in Group B .The improvement was of 16.68% during

AT1 and during AT4 the improvement was 59.99%. The change that occurred with the

treatment is greater than would be expected by chance; there is a statistically significant change

(P=<0.001)

Effect on Sandhishotha:-

In Group A there was significant reduction in the sandhi śotha i.e during AT1 the improvement

was seen at 17.22% , during AT5 55.15% of improvement is seen. There is a statistically

significant change at the level of P = <0.001. as shown in Table No 86a and Graph No.30.In

Group B there was significant reduction in the sandhi śotha i.e during AT1 the improvement was

seen at 3.95% , during AT5 56.00% of improvement is seen. The change that occurred with the

treatment is greater than would be expected by chance; there is a statistically significant change

(P = <0.001).So comparatively Group B shows better result.

Effect on Stabdhata:-

There was significant reduction in the stabdatha i.e during AT1 the improvement was seen at

5.26% , during AT5 57.90of improvement is seen. The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant change (P = 1.000)

Discussion


205

in Group a.There was significant reduction in the stabdata i.e. 20.85% of improvement is seen

during AT2, 41.65% during AT4, 58.34% of improvement is seen during AT6 The change that

occurred with the treatment is greater than would be expected by chance; there is a statistically

significant change (P = <0.001) IN Group B. So comparatively Group B shows better result.

Effect on Tenderness:


33.36%, AT5 77.80% of improvement is observed. The change that occurred with the treatment

is greater than would be expected by chance; there is a statistically significant change (P =

<0.001) in Group A. There was a significant reduction in the tenderness is observed. During AT2

15.39%, AT3 26.90%, AT5 73.05% of improvement is observed. The change that occurred with

the treatment is greater than would be expected by chance; there is a statistically significant

change (P = <0.001) in Group B. So comparatively Group A shows better result.

Effect on General Symptoms:-

• The symptoms like Jwara, trushna after the AT5 score became zero in all parameters

respectively. The percentage of improvement was 100%

• Aruchi had mean initial score 2.364 unit before treatment, after samsarjana krama it was

0.182 unit. This data shows 88.37% of improvement in Group A. Aruchi had mean initial

score 1.545 unit before treatment, after samsarjana krama it was 0.364 unit. This data

shows 88.37% of improvement in Group B.

• Alasya, Shareera gaurava features have the mean initial scores 1.818 and 2.091 units

each respectively. After AT5 the score reduced to 0.273 and 68.42 units respectively. The

percentages of improvement were 68.42% and 78.05% respectively in Group A. Alasya,

Shareera gaurava features have the mean initial scores 1.636 units each. After AT5 the

score reduced to 0.636 units. The percentages of improvement were 78.05% in Group B .

• In Group A the feature Sadana had the initial score of 1.909 units before treatment

which reduced to 0.364 units after treatment. The percentage of improvement was

79.99% . The feature Sadana had the initial score of 1.727 units before treatment which

reduced to 0.545 units after treatment. The percentage of improvement was 79.99% in

Group B

Discussion


206

• In patients treated with Vamana karma the Angamarda showed average improvement as

the initial score was 2.364 which reduced to 0.273 units after AT4 showing 81.63% of

improvement in Group A. In patients treated with Vamana karma the Angamarda showed

average improvement as the initial score was 2.091 which reduced to 0.364 units after

AT4 showing 81.63% of improvement in Group B.

• Malabadatha,praseka features have the mean initial scores 0.909 and 2.000 units each

respectively. After AT5 the score reduced to 0.090 and 0.273 units respectively. The

percentages of improvement were 92.85% and 84.20% respectively in Group A.

Malabadatha,praseka features have the mean initial scores 0.455 and 1.455units each

respectively. After AT5 the score reduced to 0.182 and 0.455 units respectively. The

percentages of improvement were 92.85% and 84.20% respectively in Group B.

• The symptoms like Anga shoonata,Kandu, Hrutgraha, Bahumootrata,Kukshi shoola,

Chardi, Bhrama, Antrakoojana was not recorded in any of 22 patients.

Effect on Total score of General symptoms:-



AT5 in Group A.





AT5 in Group B.



Effect on Clinical Parameters:-

Effect on the Range of joint Movements:


is a statistically significant change (P<0.001) There was a significant improvement is seen in the

range of joints movement AT1 showed 0.62% and AT5 showed 16.06% of improvement in

Discussion


207

Group A. There was a significant improvement is seen in the range of joints movement AT1

showed 1.18% and AT5 showed 17.75% of improvement in Group B. The change that occurred

with the treatment is greater than would be expected by chance; there is a statistically significant

change (P<0.001)

Effect on Hand grip power in mm of hg:

In Group A improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and

after AT5 31.72% The change that occurred with the treatment is greater than would be expected

by chance; there is a statistically significant change (P<0.001) In Group B improvement is seen

after AT2 is 9.82% statistically significant at p=0.100 and after AT4 19.66% The change that

occurred with the treatment is greater than would be expected by chance; there is a statistically

significant change (P<0.001)

Effect on Foot Pressure in kgs :-




chance; there is a statistically significant change (P<0.001) in Group A. There is significant

improvement is seen in the foot pressure after AT1 the improvement is seen at 1.51% which is

statistically significant at P= 0.192 and after AT4 the improvement was of 16.25%.The change

that occurred with the treatment is greater than would be expected by chance; there is a

statistically significant change (P<0.001) in Group B.

Effect on knuckle swelling which was measured using jewelers ring:-

The improvement is seen with only 1.45% after AT2 and 5.42% after AT5. The change that

occurred with the treatment is not great enough to exclude the possibility that the difference is

due to chance (P = <0.001) in Group A. The change that occurred with the treatment is not great

enough to exclude the possibility that the difference is due to chance (P = <0.001).The

improvement is seen with only 0.23% after AT1 and 3.43% after AT5 in Group B.

Effect on Circumference of limbs:-

• In the arm circumference of the patients 3% of the decrease was observed after AT3

which was again increased after AT5 (4.86%).So there is a statistically significant change

at the level of P = <0.001 in Group A. After AT5 6.04% of the improvement is seen, The

Discussion


208

change that occurred with the treatment is greater than would be expected by chance;

there is a statistically significant change (P = <0.001) in Group B.

• In the forearm circumference of the patients 5.38% of the decrease was observed after

AT3 which was again increased after AT5 (11.89%).So there is a statistically significant

change at the level of P = <0.001 in Group A. As the table shows after AT1 0.55% of the

improvement at P=0.167 and after AT5 4.95% of improvement is seen The change that

occurred with the treatment is greater than would be expected by chance; there is a

statistically significant change (P = <0.001) in Group B.

• In Group A the circumference of the thigh of the patients 3.80 % of the decrease in the

circumference was observed after AT3 which was again increased after AT5 (7.81%).

So there is a statistically significant change at the level of P <0.001. After AT2 only

0.35% of improvement is seen at P=0.082 and after AT5, 1.74% of the improvement is

seen .The change that occurred with the treatment is greater than would be expected by

chance; there is a statistically significant change (P = 0.006) in Group B.

• In the circumference of the calf of the patients 6.95 % of the decrease in the

circumference was observed after AT3 which was again increased after AT5 (12.35%).

So there is a statistically significant change at the level of P = <0.001 in Group A. After

AT2 only 3.09% of improvement is seen at P=0.100 and after AT5 7.15 % of

improvement is seen .The change that occurred with the treatment is greater than would

be expected by chance; there is a statistically significant change (P = <0.001) in Group B.

• The details of the same are given in the From above observations it is clear that the

patients of Amavata who are treated with Vamana karma shown good response to the

treatment with regards to cardinal symptoms of Amavata, general symptoms of Amavata,

clinical parameters, and overall effect of the medication. The improvement was marked

soon after the Abhyantara Snehapana and Swedana Then improvement was Satisfactory

after soon Vamana. But again there was good improvement noted after the Samsarjama

karma. Most of these improvements are found to be statistically significant as per the

paired‘t’ test.

Conclusion


209

CONCLUSION Conceptual study:

• Importance for Shodhana high lighted in all the classics in treating Amavata.

• Vamana is beneficial after the Vata is controlled by Basti etc.

• Indirect reference available for Vamana Karma in Amavata.

• Vamana should be given when Kapha predominance is seen.

Observations:

• Maximum patients (27.27%) were belonged to age group of 36-55 years.

• Physically strenuous (40.90%) work was found in maximum patients.

• Maximum patients (72.72%) were from Anupa desha.

Results:

• On an average on the 4th day patients (50.00%)attained samyak snigda lakshnas.

• 100% of the patients attained the Samyak Snigda lakshnas like Vatanulomana,

Deeptagni, snigda Varcha, Gatra snigdata,Adastath sneha darshana.

• Mean total of 335 ml Ghrita was required to attain the Samyak Snigda Lakshnas.

• Average time taken for the initiation of the first vega of Vamana was 9.52

minutes.

• Average time taken for the completion of vamana was 43.28 minutes whereas a

minimum of 25 minutes and maximum of 55 minutes was observed in this study.

• 100% patients possessed with Samyak yoga.

• All the patients ended with Pittantha Vamana

• There was significant reduction in the sandhi shoola(58.05%)in groupA

and(59.99%) in group B, Stabdhata(58.34%) in group A and (57.90) in group B

,Sandhishota(55.15%) in group A and (56.00) in group B,Tenderness (77.80% ) in

group A and (73.05%) in group B

• General symptoms of Amavata were decreased significantly by 80.05% in group

A and 68.56% in group B

Conclusion


210

• Range of joint Movements was improved significantly by 16.06 in group A and

17.75% in group B

• Hand grip power was improved significantly by 31.72% in group A and 19.66%

in group B

• Foot Pressure was improved significantly by 26.99% in group A and 24.85% in

group B

• knuckle swelling was improved significantly by 4.86% in group A and

3.43% in group B

After going through the available data’s, author is having the opinion of during

kaphothklista state, instead of going through upavasa or such measures, Vamana will

yield maximum benefits in the patients of Amavata. Further other Sodhana

procedures like Virechana, Kshara Vasti are employed at appropriate time and

condition of the patients complete cure from disease is a possibility.

Summary


211

SUMMARY The thesis entitled "Comparative study to evaluvate the effectiveness of Vamana

Karma by madhana phala kalka and madhana phala ksheerapaka in Amavata" comprises

of seven parts, viz. conceptual study, Conceptual Study of Vamana Karma and Amavata, Drug

Profile, Methodology, Clinical Study-Result, Discussion, Summary and Conclusion.

Chapter (1): Historical review deals with the historical aspect related of Vamana process,

etymology and definition of Vamana and indications-contraindications explained a glimpse on

utility of Vamana Karma in various conditions obtained from several texts.Vamana Karma was

studied under three major divisions as Purvakarma, Pradhanakarma and Pascata Karma. Vyapad

of vamana karma is briefly discussed. "Mechanism of Vamana" through Ayurvedic point and

also briefly a review on current physiology. Conceptual study of Amavata includes Etymology,

Definition, Nidana, Lakshana, Samprapti, Upadrava, Upashayaanupashaya, Pathyapathya and

Rheumatological Correlation to rheumatoid Arthritis.

Chapter (2): Explains the properties of drugs used for Deepana Pachana, Koshta pareeksha,

Snehapana, Sweda, Vamana , Dhumapana .

Chapter (3): The materials and methods adapted for the study are described here.

This chapter deals with the

• Protocol of the study Viz objective of the study.

• Inclusion and exclusion criteria of the patients.

• Intervention and criteria of assessment.

• Review of previous work done on Vamana karma and Amavata.

Chapter (4): The observation made on demographic incidence of age, sex, habits etc are

presented in the form of diagrams. The results of the clinical study are presented with statistical

analysis in the form of tables and brief narrations.

Chapter (5): Discussion, deals with the discussion of entire thesis. The conceptual part of

Vamana and its action on Amavata are explained. Clinical data is discussed in details. The result

obtained in clinical study, as well as Observations in it are discussed with relevant arguments.

Chapter (6): Conclusion, the conclusion of whole clinical study and Vamana is explained in this

chapter.

Chapter (7): Summary, summarized the whole thesis.

Bibliography


212

BIBLIOGRAPHY

1. The Atharvaveda, Sanskrita text with English Translation, Devi Chandra with

introductory remarks by M. C Joshi, Archeological Survey of India, New Delhi

Munisharma Manoharalal Publishers Pvt. Ltd. 1997 PP 939, pg 439,442

2. Agni Purana, Of Maharshi Veda Vyasa Edited by Acharya Baladeva Upadhyaya,

Chowkhamba publishers, Varanasi. Pp: 566 pg: 412

3. Manu Smriti edited with the Maniprabha hindi commentary by Pandit Haragovind

Sastri,Chowkamba Sanskrit Series,Varanasi.PP 716 , pg 283.

4. Agnivesa, Charaka Samhita, Acharya Jadavji Trikamji, Choukambha publication 2001

Varanasi. Pp 738, Page no: 20





















Bibliography


213







18. Susruta, Susruta Samhita, Acharya Jadavji Trikamji, Choukambha Orientalia 2005

Varanasi. Pp824, Page no: 182









23. The Kashyapa Samhita or Vriddha jivaka tantra by vrddha jivaka revised by vatsya

translation and commentary by Prof.P.V.Tewari,1996,Choukambha visvabharati

Varanasi. Pp- 792 Page.No-267

24. The Kashyapa Samhita or Vriddha jivaka tantra by vrddha jivaka revised by vatsya


Varanasi. Pp-792 Page.No-274

25. The Kashyapa samhita or Vrddha jivaka tantra by vrddha jivaka revised by vatsya



26. The Kashyapa samhita or Vrddha jivaka tantra by vrddha jivaka revised by vatsya



27. Vagbhatacharya, Ashtanga Sangraha, Pandit Kaviraj Tridev Gupta, Krishnadas Academy

1993, Varanasi.Pp 967 Page no:273

Bibliography


214


1993, Varanasi.Pp -967 Page no:567


1993, Varanasi.Pp-967 Page no:580

30. Vagbhatacharya, Ashtanga Hridaya, Pandit Bhishakacharya Hari Shastri Paradkar,

Chaukhambha Orientalia 2002, Varanasi.Pp956 Page no 262





33. Bhela Samhita, Teext with English translation commentator a critical notes byDr K Hh

Krsishnamurthy edited prof P v sharma Chaukamba Bharati Academy First academy

Varanasi.Pp 660 page no 485







36. Sri Chakrapanidatta, Cakradatta, Sri Jagadishprasad Tripati Bavarthasandipini,

Choukambha publication 1983, Varanasi. Pp672 Page no: 286

37. Harita; Harita Samhita; Ramavalamba Shastri 1985,Prachya Prakashan, Varanasi.Pp No:

456 Page No: 165

38. Sharangadhara, Sharangadhara Samhita, Parshuram Shastri Vidhyasagar,

Chaukhambha Orientalia. Pp:398 Page no: 36


Chaukhambha Orientalia . Pp:398 Page no: 304

40. Vanga sena vidhka grantha hindi commentary by Kaviraj sri saligramaji vaidya

samshodhan kartha sri vaidya sankaralala jain khemaraja sri Krishna das

prakashana,1996 Pp 1096 Page no:972

Bibliography


215

41. Sri Bhavamisra, Bavaprakasha, Vidyotini Hindi Commentary, Pandit Sri Brahma

Shankar Misra, Choukambha Sanskrit Sansthan 2003, Varanasi. Pp836, Page no 158

42. Yogaratnakara, Vidya prabha Commentary, Vaidya Sri Indra derva tripathi and

Dayashankara tripathi, Krishandas academy. Chaukhambha Sanskrit Sansthan 2004

Varanasi, Pp 894 Page.No:137


Varanasi. 2001,Pp 738, Page no: 132





46. Sharangadhara, Sharangadhara Samhita, Adamalla Gudarthadipika commentary, hindi

translation by Parshuram Shastri Chaukambha surabharati prakashan varnasi 2006 ,

pp398, pn 36

47. Susruta, Susruta Samhita, Acharya Jadavji Trikamji, Choukambha Sanskrit Sansthan

1998 Varanasi. Pp824, Page no:251



pp398, pn 36



pp398, pn 36

50. Agnivesha, charaka samhita, Acharya Jadavji trivikramji, Choukambha Publication 2001

Varanasi Pp: 738 Page No: 121


Varanasi Pp: 738 Page No:18





Bibliography


216



55. Vagbhatacharya, Ashtanga Sangraha, Vol 1 by Prof .K.R.Srikanta moorthy,Chaukamba

Orientalia Varanasi,6th edition 2002 Pp:631 Page.No:461












61. Vagbhatacharya, Ashtanga Sangraha, Vol 1 by Prof .K.R.Srikanta moorthy,Chaukamba

Orientalia Varanasi,6th edition 2002 Pp:631 Page.No:462









Varanasi Pp: 738 Page No: 410





Bibliography


217







71. Vagbhatacharya, Ashtanga Sangraha, Vol. 1st (Kha) CCRAS Publication, New Delhi,

Pp:659 Page No:153

72. Sushruta, Susruta samhita, Acharya Jadavji trivikramji, Choukambha Sanskrit sansthan

1977 Varanasi Pp:824











78. Agnivesha, Charaka Samhita, Kaviraja Sreebalayi Chandra SenaGupta, Choukambha

Publication 2001 Varanasi Pp: 3069 Page No: 2932

79. Hareeta, Hareeta samhita; Ramavalabha Shastri Prachya prakashan ,1985 Varanasi Pp456

Page No; 341




Varanasi. Pp 738, Page no: 518, 521



Bibliography


218











88. Agnivesha, Charaka Samhita, Acharya Jadavji Trivikramji, Choukambha Publication

2001 Varanasi Pp: 738 Page No: 579







92. Vagbhatacharya, Ashtanga Hridaya, Pandit Bhishkacharya Hari Shastri Pradkar,

Choukambha Oriantalia 200 Varanasi Pp 965 Page No: 910











Bibliography


219









102. Sri Chakrapanidatta, Chakradatta, Sri Cheppdu K Achuta Wariar Godartha Deepika

Vyakhaya S.T rediar & sons Quilon Pvt ltd 1999 Pp 553 Page No 380


1977 Varanasi Pp:824 Pg 484








2001 Varanasi Pp: 738 Page No: 624,625











Bibliography


220
















Choukambha Oriantalia 2002Varanasi Pp 965 Page No: 838







124. Bhavamishra, Bhavaprakssha, Vidyotini Hindi Commentary, Pandit shri Bramhashakar

Mishra, Chowkhamaba Sanskrit Samsthana 2003, Varanasi PP 836

125. Vanga sena Vidhka grantha Hindi commentary by kaviraj sri saligramaji vaidya

samshodhan Kartha sri Vaidya shankarlala jain Khemaraja Sri krishnadas Prakashana Pp

1096 Pg 371



Bibliography


221





















137. Sharangdhara , Sharangdhara Samhita ,Parashuram shastri Vidyasagar, krishnadas

Academy Pp:398 Page No: 306

138. Bela Smhita, K H Krishna Moorthy, Choukambha orientalia 2000Varanasi Pp 660 Page

No- 518







Bibliography


222






1977 Varanasi Pp:824 pg:511

145. Kalyanakarakam, of Ugradityachaya, edited with introduction, translation, notes, index

and dictionary by Vrdhamana Prashwanath Shastri, Published by Seth Govindaji Raji

Doshi, 1940, pp 748 pg 586




1977 Varanasi Pp:824 pg: 510








1977 Varanasi Pp: 824 pg:511



153. Sushruta, Susruta samhita, Acharya Jadavji trivikramji, Choukambha sanscrit sansthan






Bibliography


223



157. Sushruta, Susruta samhita, Acharya Jadavji trivikramji, Choukambha sanscrit sansthan




























Bibliography


224






1977 Varanasi Pp:824 pg.515







177. Vagbhatacharya, Ashtanga Sangraha, Vol. 1st (Ka) CCRAS Publication, New Delhi, Pp:

659 Page No: 322


Choukambha Oriantalia 200 Varanasi Pp 965 Page No:264

179. http://en.wikipedia.org. /wiki / vomiting








659 Page No: 327





Bibliography


225






659 Page No: 327

189. Sharangdhara, Sharangdhara Samhita ,Parashuram shastri Vidyasagar, krishnadas









659 Page No: 327












1993, Varanasi.Pp Page no:199



Bibliography


226


1977 Varanasi Pp: 824 pg: 516




659 Page No: 326

204. The Kashyapa samhita or Vridha jivaka tantra by Vridhajivaka revised by vatsya with

Sanscrit introduction by Neapal Rajaguru Pt Hemaraja Sarma with the vidyothini Hindi

commentary and Hindi translation of Sanskrit introduction by Ayrveda alankara

Sathyapala bhishagacharya prof. Gurukal kangarrai. Chaoukambha Sanskrit Publishers

and distribution of oriental cultural literature Varanasi Pp 364 Page No: 336



















Bibliography


227




Varanasi. Pp 738, Page no:705



217. Vagbhatacharya, Ashtanga sangraha Vol 2 by Kaviraja Trivdev Gupta 1993,

Krishnadas Acadamy,Pp 436 Page.No:151 218. Agnivesa, Charaka Samhita, Acharya Jadavji Trikamji, Choukambha publication 2001










223. www.pubmed.com

224. Madhavakara, Madhava Nidhana Part 1 with Madhukosh vyakhya by Vijayarakshita and

Srikantadatta, Vidyotini tika by Sri Sudarsana Sastri, Reprint 2004 Chaukamba sansrit

Bhavan Varanasi Pp-568,Page No:508

225. Madhavakara, Madhava Nidhana Part 1 with Madhukosh vyakhya by Vijayarakshita

and Srikantadatta, Vidyotini tika by Sri Sudarsana Sastri,Reprint 2004 Chaukamba sansrit


226. Vagbhatacharya, Ashtanga sangraha Vol 2 by Kaviraja Trivdev Gupta 1993,

Krishnadas Acadamy,Pp 436 Page.No:469 227. Madhavakara, Madhava Nidhana Part 1 with Madhukosh vyakhya by Vijayarakshita and



Bibliography


228


Chaukhambha Orientalia 2002, Varanasi.Pp956 Page no 216.



prakashana,1996 Pp 1096 Page no:399.







and Srikantadatta, Vidyotini tika by Sri Sudarsana Sastri, Reprint 2004 Chaukamba

sansrit Bhavan Varanasi Pp-568,Page No:511

233. Sri Bhavamisra, Bavaprakasha, Vidyotini Hindi Commentary,Part 2 Pandit Sri Brahma

Shankar Misra, Choukambha Sanskrit Sansthan 2000, Varanasi. Pp824, Page no 278



prakashana,1996 Pp 1096 Page no:399-400



236. Harita; Harita Samhita; Ramavalamba Shastri 1985,Prachya Prakashan, Varanasi.Pp

No: 456 Page No: 322









Bibliography


229







456 Page No: 325




244. Govinda das sen,Baishajya Ratnavali with Siddiprada hindi commentary by Prof

Siddhinandan Mishra 1st edition 2005 Pp :1196 Pp:596,614

245. Govinda das sen,Baishajya Ratnavali with Siddiprada hindi commentary by Prof

Siddhinandan Mishra 1st edition 2005 Pp :1196 Pp:614


456 Page No: 325


and Srikantadatta, Vidyotini tika by Sri Sudarsana Sastri,Reprint 2004 Chaukamba sansrit








250. API text book of medicine.7th edition 2006 Editor Siddharth.N.Shah.Pp-1533 Page.no-

1160-1164

251. Govinda das sen,Baishajya Ratnavali with Vidyotini hindi commentary by Prof

Ambikadatta shastri Choukambha Sanskrit Series Varanasi pp 891, pn 244.

Bibliography


230

252. Govinda das sen,Baishajya Ratnavali with Vidyotini hindi commentary by Prof

Ambikadatta shastri Choukambha Sanskrit Series Varanasi pp 891, pn 130.

253. Vcdvfvdfdxbdfnbgn

254. Sri Bhavamisra, Bavaprakasha, Vidyotini Hindi Commentary, Pandit Sr Brahma Shankar

Misra, Choukambha Sanskrit Sansthan 2003, Varana, Pp836, Page no 36


Varanasi pp 738, pn 655


Varanasi pp 738, pn 655

257. www.wikipedia.org/wiki/milk


Chaukhambha Orientalia 2006, Varanasi.Pp956 pn 735.

259. Lankapati Ravana , Arka prakasha hindi traslation by Indradev tripati, Krishnadas

achedamy publications, pp172, pn 39,42.

260. Sri Bhavamisra, Bavaprakasha Vol I, Vidyotini Hindi Commentary, Pandit Sri Brahma

Shankar Misra, Choukambha Sanskrit Sansthan 2003, Varanasi. Pp 959 pn 65

261. Mahendra bhogika ,Dhanvantari nighantu hindi commentary by Prof PV Sharma ,

Chaukambha orientalia varnasi pp 360 pn.

262. Kaiyyadeva, Kaiyadeva nighantu hindi commentary by Prof PV Sharma , Chaukambha

orientalia varnasi pp 696, pn 209

263. Narahari, Raja nighantu hindi commentary by Indradev tripathy Chaukambha krishnadas

achedamy varnasi pp 704, pn 164

264. Shri Shaligrama,Shaligrama nighantu Khemraj Krishnadas prakashan bombay 935,

pn129

265. Acharya Shodala ,Shodala nighantu hindi commentary by Prof PV Sharma, gackwad’s

oriental series Baroda pp 266pn 19.

266. Database on medicinal plants used in Ayurveda Vol 2 edition 2002 Pp:590 Page.No:380

45RESEARCH PROFORMA

DEPARTMENTOFPANCHAKARMA S.D.M COLLEGE OF AYURVEDA

KUTHPADY, UDUPI

COMPARITIVE STUDY TO EVALUVATE THE EFFECTIVENESS OF VAMANA BY MADHANA PHALA KALKA AND MADHANA PHALA KSHEERA PAKA IN AMAVATA. Guide:Dr. NIRANJAN.RAO. Co- Guide:Dr. SHREEKANTH.U

Researcher: Dr. RIYAS. K. A Name : Serial No : Age : Group (MPK/MPKP) Sex : M / F OPD No : Religion : H / M / C / O IPD No : Education : UE / P / M / MS / GR / PG DOA : Marital Status : UM / M / D / W DOD : Social Status : VP / P / LM / M / UM / R/VR Occupation : Physical strain/Mental strain Diagnosis : Desha : Anupa / Jangala / Sadarana Result : Postal Address : MAIN COMPLANTS:

SYMPTOMS Duration BT AT 1 AT 2 AT 3 AT 4 AT5 AT6 Jwara Stabdatha Aruchi Mala Bhaddatha Angamarda Sadana Alasya Hrutgraha Anaha Preseka Trushna Hasta-Pada Daha Bahumootrata Kukshi Shoola Chardi Bhrama Shareera Bhara Antrakoojana Kandu Anga shoonata

BT-Before treatment, AT1-After amapachana,

AT2-Aftrer Snehapana, AT3-Before vamana,

AT4-After vamana (evening), AT5-After samsarjana krama,

AT6-After follow up period.

HISTORY OF PRESENT ILLNESS: Onset: insidious / gradual / sudden

Sequence of joint involvement:

1……Since……2……Since……3……Since……4……Since……

5……Since……6……Since……7……Since……8……Since……

Course: Progressive / receding / relapsing / stationery

Aggravating factors:

Relieving factors:

Symmetry of joint involvement: 1 2 3 4 5 6

HISTORY OF PAST ILLNESS:

FAMILY HISTORY:

TREATMENT HISTORY: Drugs Dosage Duration Details NSAID’S STEROIDS DISEASE MAGNIFYING AGENTS OTHERS

PERSONAL HISTORY: Vyasana: Coffee/Tea…… Alcohol…… Cigarette…… Tobacco Chewing…… Others……

Duration: Since………Occational / Regular / Stopped / Reduced / Continued

Ahara: Veg / Mixed Samasana / Visamasana / Adyasana / Anasana Dominant Rasa - M / A / L / K / T / Ka Dominant Guna – R / S / U / Sh / G / L

Nature of work: Manual /Sedentary / Labour / Traveling / Walking / Studying / Sitting/Day/Night,

Strain-physical/mental

Vishrama: ……Hours Proper / Less / Excessive

Vyayama: No / Proper / Excessive / Irregular

Nidra: Sound / Disturbed/Delayed/ Night …… Day ……Difficulty in falling Asleep / Staying Asleep

Bowel: Frequency ……… Consistency ………… Colour

Micturition: ………Frequency………quantity………Colour

OBSTETRIC HISTORY: No. of delivery ……. Normal…… Surgical Intervention……

Abortions …… Miscarriages …… Last Delivery ……

Years Back……

GYNAECOLOGICAL HISTORY:

Menstrual cycle: …… Regular / Irregular / Menarche …… years

Bleeding ….. days Menorrhagia / Metrorrhagia / Dysmenorrhoea / Leucorrhoea

Menopause since……years

GENERAL EXAMINATION: DASHAVIDHA PARIKSHA

Pulse …… / min,reg/irregular Prakrutitah:V/P/K/VP/VK/PK/VPK B.P …… mm / Hg Vikrutitah: P / M / A Dosha : Dushya : Srotas : Udbavasthana : Sancharasthana : Vyakthasthana : Temperature……0F Satwatah: P / M / A Respiratory rate…… / min Saratah: P / M / A Nourishment: G / F / P Satmyatah: RASA SATMYA Built: Samhanatah: P / M / A Nails: Ahara Shaktitah: Abyavaharana: P / M / A Conjunctiva: JaranaShaktitah: P / M / A Sinuses: Vyayama Shaktitah: P / M / A Lymph nodes: Pramanatah: P / M / A Deformities: Height …… cms Contractures:SD/BD/DC/VD Weight …… Kgs Rh.Nodules: Y / N Vayataha; Bala / Madya / Vradha Others:

SYSTEMIC EXAMINATION:

CNS : CVS : RS : GUS : P/A : LOCOMOTOR SYSTEM ASSESSMENT CRITERIA-FUNCTIONAL TEST

BT 1 2 3 4 5 6 Joint Motion Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

Flexion Extension Abduction Adduction Lat. Rot.

Shoulder

Medi. Rot. Flexion Elbow Extension Supination Forearm Pronation Uln. Devi. Radi. Devi. Flexion

Wrist

Extension Flexion Extension Abduction Adduction Lat. Rot.

Hip

Medi. Rot Extension Knee Flexion Plant. Flex. Ankle

Dorsi. Flex. Inversion Foot Eversion

MCP1 Flexion Extension Abduction Adduction MCP2 Flexion Extension

Abduction Adduction MCP3 Flexion Extension MCP4 Flexion Extension Abduction Adduction MCP5 Flexion Extension Abduction Adduction PIP1 PIP2 PIP3 PIP4 DIP1 DIP2 DIP3 DIP4

Flexion TOE Extension

Spine Flexion Extension Lat. Bend.

Neck

Rotation

RING TEST BT 1 2 3 4 5 6 No. Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

1 2 3 4 5

BT 1 2 3 4 5 6 TEST Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

Grip Test Foot Pressure Gen. Functions

BT 1 2 3 4 5 6 Circumference (CMS) Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt LtArm Forearm Thigh Calf

INVESTIGATION:

Test BT AT HB% T.L.C D.C / N D.C / L D.C / E D.C / B D.C / M E.S.R RA Factor C-reactive protein

E.C.G ASO Titer JOINT EXAMINATION

Pain Swelling Stiffness Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 Rt

DIP Lt Rt

PIP Lt Rt

WRI Lt Rt

ELB Lt Rt

SH Lt Rt

DIP Lt Rt Lt PIP

Lt Rt

ANK Lt Rt

KN Lt Rt

HIP Lt Rt

TMJ Lt Rt

STC Lt Rt

ARC Lt SPINE C/T/L/S

TREATMENT SCHEDULE: POORVA KARMA: Administration of Deepana Pachana: vadavanala choorna with Ushna Jala Dose: 3/5gmsTDS for 3 days Koshta pariksha- Triphala kwatha - Dose.........ml Time- No.of malapravriti: .......... Koshta------------- SNEHAPANA VIDHI: Name of Sneha given- moorchitha gritha with Ushana jala as Anupaana SNEHAPANA DAY Date

Time Quantity Time of Snehajeernata

Tenderness Warmth Redness Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 Rt

DIP Lt Rt

PIP Lt Rt

WRI Lt Rt

ELB Lt Rt

SH Lt Rt

DIP Lt Rt Lt PIP

Lt Rt

ANK Lt Rt

KN Lt Rt

HIP Lt Rt

TMJ Lt Rt

STC Lt Rt

ARC Lt SPINE C/T/L/S

Sneha jeeryamana lakshanas LAKSHAN Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Shiroruk Bhrama Nishtiva Moorcha Saada Aruchi Klama Trishana Daha Snehaudgara Arati Sneha jeerna Lakshanas

LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Trishna Kshudha Udgarashudhi Shiralaghavata Vatanulomata Samyak snigdha lakshanas

LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Vatanulomata Agnideepti Snigdha asamhata varcha

Gatramardava Twaksnigdhata Snehodvega Klama Shaitya Angalaghava

VISHRAMA KALA: Sarvanga abhyanga with saindhavadi taila followed by bhashpa sweda. SAMYAK SWINNA LAKSHANAS

LAKSHNAS DAY1 DAY 2 Sheeta uparama Shoola uparama Stambha nigraha Gaurava nigraha Mardavata Sweda virathi/sheetaartitva

Vyadi haani Laghutava Sweda srava Agni deepti Twak prasada Bhakta shrudda Strotasam nirmalatva

Nidra hani Tandra hani Chetayedh Aashu Stabdha

Sandheen

PRADHANA KARMA: Administration of milk followed by madanaphala kalka/madanaphala ksheerapaka followed by milk upto stomachfull and later yastimadhu phanta(vamanopaga) Time of administration of Vamana Dravys-….......

OBSERVATION Liquid given

Time of administn

Quantity in ml

No of vegas Sharira

sambhandhi lakshana

Colour Consistency Temp BP/mmhg

Pulse/min

2]LAINGIKI Total input = ml Total output = ml Total vaanta dravya = ml Weight before vamana = kgs Weight immediately after vamana = kgs Weight in the evening before manda pana = kgs

Samyak Yoga Ati Yoga Ayoga Kale pravruthi Phenila vamana Vega apravarti Yathakarma.kapha,pitta,vata doshaharanam

Raktha,chandrikavata vamana Kevala.oushada pravruthi

Swayam avasthana Athyanta rakthasrava Jwara Hridaya suddhi Trusna Hridaya asuddhii Parsva suddhi Moha Srotoasuddhii Mrudha suddhi Murcha Vegavibandhaa Srotosuddhi Nidra haani Gurugatrat Indriya suddhi Bala haani Spota Laghuta Hritapida Kota Karshya Kanta pida Kandu Dourbalya Tamha pravesa Kaphaprasekha Kantasuddhi Brhama Kapha samsravha Pittati yoga Vata prakopa Daha

ANTHAKI

VEGAKI

MANAKI

LYNGIKI

OBSERVATION

OBSERVATION OF VITAL DATA

Time Pulse Blood Pressure Resp.Rate

PASCHAT KARMA

CONDITION OF THE PATIENT AFTER TREATMENT

COMPLETE REMISSION MAJOR IMPROVEMENT MINOR IMPROVEMENT No Improvement / PROGRESSION Signature of scholar: signature of guide:

No. of Annakalas Diet Regimen Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi

Peya Vilepi Akrita Yusha Krita Yusha

Assessment criteria: Changes in the subjective signs and symptoms will be assessed by scoring method. By using appropriate clinical tools objective signs are assessed A. Subjective criteria: 1. Pain in the joints: Symptom No 0 Mild (on motion o 1 Moderate (at rest) 2 Severe (wakes patient from sleep) 3 2. Morning stiffness (duration in hours): 0-5 min. 0 5 min. - 2 hrs. 1 2 - 8 hrs. 2 8 hrs. or more 3 3. Swelling in the joints: Absent 0 Mild 1 Moderate 2 Severe 3 4. Redness: Absent 0 Mild 1 Moderate 2 Severe 3 5. Warmth: Absent 0 Mild 1 Moderate 2 Severe 3 6. Tenderness in the joints: 0 No tenderness 1 Says tender 2 Patient winces 3 Winces and withdraws Not allowed to be touched 7. Alasya: Fully active 0 Mild laziness, slow initiative in work 1 Initiative in some works, absent in others 2 Absolute lack of initiative even though capacity for work exists 3 8. Dourbalya: No feeling of weakness 0 Slight weakness 1 Feeling of weakness but ability unimpaired 2 Ability to do duties affected 3

11. Malabaddhata/Vibandha (Constipation): Absent 0 Slight with one motion per day 1 Marked constipation with one motion after two days or more 2 12. Jwara ( in degree farhenheit ) No fever 0 Mild (990 F – 1010 F) 1 MODERATE ( 1010 F – 1030 F) 2 SEVERE ( > 1030 F) 3 13. Sadana - fatigue: No fatigue 0 Works full-time despite some fatigue 1 Patient must interrupt to rest 2 Fatigued at rest 3 14. Bahumootrata (frequency of micturition per 24 hours): Absent (less than 4 times/24 hrs) 0 Mild (upto 6 times/24 hrs) 1 Moderate (6-10 times/ 24 hrs) 2 Severe (> 10 times/ 24 hrs) 3 15. Chardi (frequency of bouts per 24 hours): Absent 0 Mild (upto 2 vegas/24 hrs) 1 Moderate (2-4 vegas/24 hrs) 2 Severe (4 vegas/24 hrs) 3

16. Angamarda :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 17. Aruchi :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 18. Gourava : No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 19. Bhrama : 0 No symptoms 1 Mild symptoms 2 Moderate symptoms 3 Severe symptoms 20. kukshishoola :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3

21. Hritgraha :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 22. Anaha

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 23. Praseka :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 23. Trishna :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 24. Hasta pada daha :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 25. Kandu :

No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 26. Moorcha :

Present / Absent 27. Apaka :

Present / Absent B. Functional assessment: The objective improvements are assessed as following methods.

1. Grip strength: The functional capacity of effected upper limb of the patient is assessed by compressing the inflated ordinary sphygmomanometer cuff which will be carried out under standard conditions both before and after treatment.

2. Foot pressure:

The functional capacity of lower limb of the patient is assessed by pressing a weighing machine under standard conditions both before and after the treatment

3. Range of joint movement :

Goniometer is used to see the range of movement of all effected joints both before and after the treatment.

4. General functional capacity:

• Complete ability to carry on all usual duties without handicap 1

• Adequate normal activity despite handicap of discomfort or limited joint movement 2 • Limited only to little or none of the usual occupation or self care 3 • Bedridden or confined to wheel chair, little or no self care 4

C. Investigations: To confirm the diagnosis and to assess the general condition following investigations are conducted before after the treatment

1. Hemoglobin percentage (Hb% using Sahli’s method) 2. Total Leukocyte count (TC using Neubauer’haemocytometer) 3. Differential Leukocyte count (DC using Neubauer’haemocytometer) 4. Erythrocyte sedimentation rate (ESR using Westergren’s method) 5. Rheumatoid arthritis factor (using immunoglobulin agglutination method) 6. Antistreptolycin o Titer

D. Disease activity degrees: On basis of criteria laid down by American rheumatism association (1967) the degree of disease activity was estimated for the diagnosis and therapeutic purpose. Details are as follows:

Grade 0 1 2 3 Morning stiffness 5 minutes or less 5 minutes to 2 hours 2 to 8 hours 8 hours or Fatigue None Works full time

despite some fatigue must interrupt work to rest

Fatigue at rest

Pain None only on movement At rest Wakes patient from sleep.

Patients estimation Fine Almost well Pretty good Pretty bad General function Full activity without

difficulty Most activities but with difficulty

Few activities cares for self

Little self care mainly chair and bed

Grip strength 200mm/Hg or more 195 to 120 mm/Hg 115 to 70 mm/Hg under 70mm/Hg Spread of joint Involvement

None 0to50 51to100 Over 100

Westergren ESR 0to20mm 20to35 35to50 above 50 Haemoglobin 12.5gms% 12.4to11gms% 10.9to9.5gms% Less than 9.5gms% Physicians estimate Inactive Minimal active moderately active severely active

E. Overall assessment of the treatment: The overall effect of the therapies assessed on the basis of criteria laid down by ARA (1967) was adopted. The results are classified as four groups as listed below. Grade I: Complete remission

• No systemic signs of rheumatoid activity. • No sign of inflammation. • No evidence of activity in any extra articular process, including nodules, tino-vaginitis and iritis. • No lasting impairment of joint mobility other than that associated with irreversible changes. • No elevation of erythrocyte sedimentation rate. • Articular deformity or extra articular involvement due to irreversible changes may be present.

Grade II: Major improvement • No systemic sign of rheumatoid activity, with the exception of an elevated sedimentation rate and vasomotor imbalance. • Major signs of inflammation resolved, such as heat, redness of joint structures. • No new rheumatoid process of intraarticular or extraarticular structures. • Minimum joint swelling may be present. • Impairment of joint mobility associated with minimum residual activity may be present. • Articular deformity or extra articular involvement due to irreversible changes may be present.

Grade III: minor improvement Any decrease in the signs of rheumatoid activity inadequate to fulfill the criteria of grade II.

• Diminution of systemic signs of rheumatoid activity. • Signs of joint inflammation only partially resolved. • No evidence of extension of rheumatoid activity into additional articular or extra articular structures. • Decreased but not minimum joint swelling present. • Impairment of joint mobility may be present. • Articular deformity or extraarticular involvement due to irreversible changes may be present.

Grade IV: Un improvement or progression

• Undiminished signs of rheumatoid activity, regardless of functional capacity. • Exacerbation of any previously involved joint or joints, or development of sites of rheumatoid activity. • Roentgenologic changes indicative of progression of the rheumatoid process, excepting hypertrophy changes. • In the presence of one or more of the aforesaid criteria, involvement in other features, including a normal or lowered ESR, not

significant. ************

Madhanaphala Madhanaphala Unripened

Madhanaphala Pippali Madhanaphala ripened

Saindhava Lavana Madhanaphala Choorna Honey Vacha Choorna

Madhuyesti Choorna Madhuyesti Phanta

Madhanaphala Kalka Madhanaphala Ksheerapaka

Pittantha Vamana

DEFORMITIES OF RHEUMATOID ARTHRITIS

Documents

Amavata vamana-pk