Changes

Followed by antiperistalsis movements - Electrical stimuli : (prabhava) by stimulating CTZ centers in brain

Followed by antiperistalsis movements - Electrical stimuli : (prabhava) by stimulating CTZ centers in brain

*Research work on comparative study of Vamana by two different methods:

'''Research work on comparative study of Vamana by two different methods:'''

A comparative clinical study on standardization of Vamana Vidhi by classical and traditional methods was carried out<ref>Ranjip Kumar Dass, Nilesh N. Bhatt, Anup B. Thakar,  Vagish Dutt Shukla. Ayu. 2012 Oct-Dec; 33(4): 517–522. doi:  10.4103/0974-8520.110531 </ref>.  Total 50 patients and healthy volunteers were selected irrespective of gender, religion, occupation, etc., from O.P.D. and I.P.D. of Panchakarma Department of Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar. The patients as well as healthy volunteers were randomly divided into following two groups: One group had performed Vamana by the classical methods according to Charaka and Sushruta Samhita.  Madanphala Pippali was taken in Antarnakha Mushti (making fist) Pramana by the patient's own hand. It was then added in Yashtimadhu Kwatha and kept for one night (previous night of Vamana Karma). In the morning time, it was stirred properly and filtered. Then it was given to the patient in lukewarm state mixing with honey and Saindhav Lavana (rock salt) upto Pittanta Vamana (till bile comes). Before that in early morning, Ghritayukta Yavagu was given to the patient after Abhyanga (massage) and Swedana (fomentation).

A comparative clinical study on standardization of Vamana Vidhi by classical and traditional methods was carried out<ref>Ranjip Kumar Dass, Nilesh N. Bhatt, Anup B. Thakar,  Vagish Dutt Shukla. Ayu. 2012 Oct-Dec; 33(4): 517–522. doi:  10.4103/0974-8520.110531 </ref>.  Total 50 patients and healthy volunteers were selected irrespective of gender, religion, occupation, etc., from O.P.D. and I.P.D. of Panchakarma Department of Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar. The patients as well as healthy volunteers were randomly divided into following two groups: One group had performed Vamana by the classical methods according to Charaka and Sushruta Samhita.  Madanphala Pippali was taken in Antarnakha Mushti (making fist) Pramana by the patient's own hand. It was then added in Yashtimadhu Kwatha and kept for one night (previous night of Vamana Karma). In the morning time, it was stirred properly and filtered. Then it was given to the patient in lukewarm state mixing with honey and Saindhav Lavana (rock salt) upto Pittanta Vamana (till bile comes). Before that in early morning, Ghritayukta Yavagu was given to the patient after Abhyanga (massage) and Swedana (fomentation).

   

   

From the above study it was observed that average no. of Vega and Upavega (i.e., 7.41 and 12.41) were found in by the classical method as compared to traditional methods (i.e., 6.91 and 8.77). Because Vega had come out easily from deeper part of the stomach with viscous matter in group A than the group B as the particles of Madanphal Pippali were present in Yashtimadhu Kashaya (decoction) till end, for which individual had felt more exertions earlier but got more relief later on. The average quantity of every Vega in traditional method was measured more as compared to classical method, as more Kshudra or Madhyama and Khandit Vega had come in this method may be due to less intake of Vamana Kashaya (probably due to more thickened solution). Maximum percentage (i.e., 68.2%) of Pravara Shuddhi was observed in group A as compared to group B (i.e., 59.1), whereas more percentage of Madhyama and Avara Shuddhi were seen in group B most probably due to earlier expulsion of Vamana Yoga with vomitus. As MSI of group B (i.e., 2.86) was lesser than group A (i.e., 4.91) more drug output (more Dosha Shuddhi) were there in group B as compared to group A. Furthermore, more mucous (i.e., Kapha like viscous matter) were expelled in group A than group B, whereas Pitta Darshan was seen easily with a lesser time in group B as compared to group A. The average time taken to complete the Vamana (vomiting) by the classical method (58.36 min) was lesser than the time taken for traditional method (64.91 min), may be due to quick expulsion of vitiated matter, as Madanaphala Pippali was properly diluted in the Vamana Kashaya or may be due to quick appearance of Antiki Lakshanas, which leads the procedure to an end point. Clinically more percentage of individuals had marked improvement in group A, whereas more percentage of individuals got moderate improvement in group B, most probably because of more Shuddhi obtained by the classical method than the traditional. As we know that Vamana Karma is a stressful work, which is done in early morning (i.e., Kaphaja Kala). Likewise, according to modern science the plasma cortisol level also rises in early hours of morning and in any stressful stimuli. So Plasma Cortisol level was tested just before and after Vamana Karma, where a rise in Cortisol level was observed in classical methods. By physical analysis of vomited material, acidic pH was found in earlier stage and alkaline pH was seen in last stage (i.e., when Accha Pitta comes). More value of Specific gravity was found in vomitus of classical method as compared to the vomitus of traditional method. By biochemical quantitative analysis of vomitus (i.e., Hexosamine Test); mucopolysaccharide content of vomitus was found more in group A (669.64 μg/ml) in comparison to group B (480.68 μg/ml), as more viscous matter was expelled during Vamana. From the present clinical study, it can be concluded that the method mentioned in the classics are very much beneficial from every point of view in comparison to the method which has been used traditionally as it is very easy, safe, less time-consuming, and clinically as well as statistically the most effective method.Madanphala Pippali, which was taken in Antarnakha Musti Pramana (By patient's own hand) in case of the classical method measured about average 13.51 g, which should be mixed in 4 l of Yastimadhu decoction for proper dilution. So this proportion can be taken as a standard ratio for Vamana Karma. In concern to Vaigiki Shuddhi, it indicates that more no. of Vega and Upavega come by the classical method as compared to the traditional methods. Measurements of drug inputs and drug outputs (i.e., vomitus) are necessary as Maniki Shuddhi may guide towards proper judgment regarding purification and provide some clues regarding the results obtained. By physical analysis of vomited material, “pH” of the vomitus can be used as an indicator to guide oneself towards “end point” (as Antiki Shuddhi). As acidic pH was found in earlier stage and alkaline pH was seen in last stage (i.e., when Accha Pitta comes), it may help to cease the Vamana at particular point. According to Laingiki Shuddhi, more Pravara Shuddhi is achieved in Vamana by the classical methods in comparison to traditional methods. However, all the Shuddhi have equal role in assessing the proportion of purification and predicting any type of result from it. Regarding the duration of Vamana, it can be said that the time taken to complete the Vamana by the classical method is lesser than the time taken for traditional method. Significant more reduction in FBS and lipid profile test (S. Cholesterol, HDL and S. Triglyceride level) by the classical method (despite of the consumption of a huge amount of Ghee during Snehapana) indicates that classical Vamana improves the internal homeostasis more easily in comparison to traditional method. By comparing the improvements in the symptoms obtained after Vamana with the purification done earlier, it can be said that more expulsion of vitiated matter might be there in the classical method in comparison to traditional methods.

From the above study it was observed that average no. of Vega and Upavega (i.e., 7.41 and 12.41) were found in by the classical method as compared to traditional methods (i.e., 6.91 and 8.77). Because Vega had come out easily from deeper part of the stomach with viscous matter in group A than the group B as the particles of Madanphal Pippali were present in Yashtimadhu Kashaya (decoction) till end, for which individual had felt more exertions earlier but got more relief later on. The average quantity of every Vega in traditional method was measured more as compared to classical method, as more Kshudra or Madhyama and Khandit Vega had come in this method may be due to less intake of Vamana Kashaya (probably due to more thickened solution). Maximum percentage (i.e., 68.2%) of Pravara Shuddhi was observed in group A as compared to group B (i.e., 59.1), whereas more percentage of Madhyama and Avara Shuddhi were seen in group B most probably due to earlier expulsion of Vamana Yoga with vomitus. As MSI of group B (i.e., 2.86) was lesser than group A (i.e., 4.91) more drug output (more Dosha Shuddhi) were there in group B as compared to group A. Furthermore, more mucous (i.e., Kapha like viscous matter) were expelled in group A than group B, whereas Pitta Darshan was seen easily with a lesser time in group B as compared to group A. The average time taken to complete the Vamana (vomiting) by the classical method (58.36 min) was lesser than the time taken for traditional method (64.91 min), may be due to quick expulsion of vitiated matter, as Madanaphala Pippali was properly diluted in the Vamana Kashaya or may be due to quick appearance of Antiki Lakshanas, which leads the procedure to an end point. Clinically more percentage of individuals had marked improvement in group A, whereas more percentage of individuals got moderate improvement in group B, most probably because of more Shuddhi obtained by the classical method than the traditional. As we know that Vamana Karma is a stressful work, which is done in early morning (i.e., Kaphaja Kala). Likewise, according to modern science the plasma cortisol level also rises in early hours of morning and in any stressful stimuli. So Plasma Cortisol level was tested just before and after Vamana Karma, where a rise in Cortisol level was observed in classical methods. By physical analysis of vomited material, acidic pH was found in earlier stage and alkaline pH was seen in last stage (i.e., when Accha Pitta comes). More value of Specific gravity was found in vomitus of classical method as compared to the vomitus of traditional method. By biochemical quantitative analysis of vomitus (i.e., Hexosamine Test); mucopolysaccharide content of vomitus was found more in group A (669.64 μg/ml) in comparison to group B (480.68 μg/ml), as more viscous matter was expelled during Vamana. From the present clinical study, it can be concluded that the method mentioned in the classics are very much beneficial from every point of view in comparison to the method which has been used traditionally as it is very easy, safe, less time-consuming, and clinically as well as statistically the most effective method.Madanphala Pippali, which was taken in Antarnakha Musti Pramana (By patient's own hand) in case of the classical method measured about average 13.51 g, which should be mixed in 4 l of Yastimadhu decoction for proper dilution. So this proportion can be taken as a standard ratio for Vamana Karma. In concern to Vaigiki Shuddhi, it indicates that more no. of Vega and Upavega come by the classical method as compared to the traditional methods. Measurements of drug inputs and drug outputs (i.e., vomitus) are necessary as Maniki Shuddhi may guide towards proper judgment regarding purification and provide some clues regarding the results obtained. By physical analysis of vomited material, “pH” of the vomitus can be used as an indicator to guide oneself towards “end point” (as Antiki Shuddhi). As acidic pH was found in earlier stage and alkaline pH was seen in last stage (i.e., when Accha Pitta comes), it may help to cease the Vamana at particular point. According to Laingiki Shuddhi, more Pravara Shuddhi is achieved in Vamana by the classical methods in comparison to traditional methods. However, all the Shuddhi have equal role in assessing the proportion of purification and predicting any type of result from it. Regarding the duration of Vamana, it can be said that the time taken to complete the Vamana by the classical method is lesser than the time taken for traditional method. Significant more reduction in FBS and lipid profile test (S. Cholesterol, HDL and S. Triglyceride level) by the classical method (despite of the consumption of a huge amount of Ghee during Snehapana) indicates that classical Vamana improves the internal homeostasis more easily in comparison to traditional method. By comparing the improvements in the symptoms obtained after Vamana with the purification done earlier, it can be said that more expulsion of vitiated matter might be there in the classical method in comparison to traditional methods.

 

Another study on vasantika vamana concluded that average quantity of Madanaphala, Ksheera, Yastimadhu Phanta and Lavanodaka can be 5.81 g, 1130.29 ml, 3202.9 and 2489.13 ml respectively. The study also depicted that laingiki and antiki criteria seem to be the better criteria for the assessment of Vamana.<ref>Bhatted S, Shukla V D, Thakar A, Bhatt N N. A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin. AYU [serial online] 2011 [cited 2019 Feb 20];32:181-6. Available from: http://www.ayujournal.org/text.asp?2011/32/2/181/92562</ref>

Another study on vasantika vamana concluded that average quantity of Madanaphala, Ksheera, Yastimadhu Phanta and Lavanodaka can be 5.81 g, 1130.29 ml, 3202.9 and 2489.13 ml respectively. The study also depicted that laingiki and antiki criteria seem to be the better criteria for the assessment of Vamana.<ref>Bhatted S, Shukla V D, Thakar A, Bhatt N N. A study on Vasantika Vamana (therapeutic emesis in spring season) - A preventive measure for diseases of Kapha origin. AYU [serial online] 2011 [cited 2019 Feb 20];32:181-6. Available from: http://www.ayujournal.org/text.asp?2011/32/2/181/92562</ref>