Chapter 18: Vamana Virechana Vidhi

- Emesis and Purgation Therapies This chapter explains in detail regarding Vamana and Virechana Panchakarma procedures. Who are best suited for these therapies, who are not, what are the signs to observe during the procedure, complications and treatments for such complications. It is the 18th Chapter of Ashtang Hridya Sutrasthana. It is called as Vamana Virechana Vidhi Adhyaya. कफे व यात ् वमनं संयोगे वा कफोलबणे त व

वरे चनं प ते

Vamana – Emesis should be administered for increase of Kapha either alone or in combination with other Doshas where Kapha is predominant. Virechana – purgation should be administered to treat increase of Pitta – alone or in combination with other Doshas where Pitta is predominant. 1

Persons suitable for Vamana procedure – Vamana Arha वशेषेण त ु वामये त ्

नव वरा तसाराधः प तास ृ ाजयि मणः

कु ठमेहाप च ि थ ल पद उ मादका सनः वास ु लासवीसप त यदोषो वरो गणः

Emesis should be administered to persons suffering from Navajwara – fever of recent origin Atisara – diarrhoea, dysentery Adha:pitta – Pitta imbalance in lower part of abdomen Pittasruk – Bleeding disorder due to Pitta imbalance Rajayakshma – Chronic Respiratory disorder Kushta – skin diseases Meha – diabetes, urinary tract disorders Apachi, Granthi – Goitre, tumour, fibroid Shleepada – Elephantiasis, Filariasis Unmada – Schizophrenia Kasa – cough, cold Shwasa – Chronic Respiratory tract disease, Asthma Hrullasa – nausea Visarpa – herpes Stanyadosha – vitiated breast milk Urdhvaroga – diseases affected neck and above region 1b-2b

Persons not suitable for Vamana Panchakarma – Vamana Anarha – Avamya अवा या ग भणी बालव ृ कृश थल ू

ः

ु धतो न यद ुः खतः

ो ग तदब ु लाः

स तवमथु ल हा त मर

मकोि ठनःउ व व ृ तवा व द तबि तहत वराः

मू ाघा युदर गु मी दव ु मो अ यि नरशसः उदावत मा ठ लापा व

वातरो गणः

ऋते वषगराजीण व

ा यवहारतः

Garbhini – The pregnant woman, Rooskha – persons who are dry –not undergone oleation therapy, Kshudhita – hungry, Nitya Dukhita – constantly grief-stricken, children, old persons, Krusha – the emaciated, Sthula – the obese, Hrudrogi – patient of heart disease, Kshata – the wounded, Durbala – weak, debilitated, who are having bouts of vomiting, Pleeha – enlargement of spleen, Timira – blindness, Krimikoshta – intestinal parasites, upward movement of vata and Asra- blood, Soon after administration of Vamana, who have loss of speech, dysuria, Udara – ascites, interstinal obstruction, tumor of the abdomen, who faced difficulties during Vamana therapy, who have strong digestive activity, Arsha – hemorrhoids Urdhva Vata – upward movement of air – reverse peristalisis, Giddiness / Dizziness – enlargement of the prostate, Parshva vata – pain in the flanks and diseases caused by vata; Person suffering from poisoning, indigestion and who have consumed incompatible foods. 3b-6 स तवमथोः पूव

ाये णाम वरो अ प च

धूमा तैः कम भव याः, सवरे व वजी णनः Those persons enumerated earlier to praskta vamathu and persons who are suffering from recent fevers are generally to be rejected for therapies ending with dhuma, and those suffering from indigestion from all therapies.

Virechyah – persons suitable for purgation therapy:वरे कसा या गु माश व फोट य गकामलाः

जीण वरोदरगर छ

ल हहल मकाः

व धि त मरं काचः

य दः प वाशय यथाः

यो नशु ा यरोगाः को ठगाः कृमयो वाता मू वगं र तं मू ाघातः शकृ

णाः हः

वा या च कु ठमेहा याः

Diseases requiring purgation therapy areGulma – Tumors of the abdomen, Arsha – Piles, Visphota- blisters, Vyanga – discolored patch on face, Kamala – Jaundice, Liver disease Jeernajwara - Chronic fever, Udara – ascites, interstinal obstruction Poisoning, Chronic poisoning Chardi – Vomiting Pleeha – Disease of the spleen, Splenomegaly, Haleemaka – advanced jaundice, Vidradhi – Abscess Timira – blindness, Kacha, Syanda – Cataract pain in the large intestine, Diseases of male and femal urogenital system wounds/ Ulcers, Vatasra – Gout, Urdhwarakta – bleeding disorders of upper parts of the body (such as nasal bleeding) Diseases of blood vitiation, Mutraghata – Dysuria Shakrut graham – constipation Those persons who are Suitable for emesis therapy- enumerated in earlier verses commencing with “ those suffering from Kustha” are curable- to be treated with purgation therapy. 8-10a Those diseases are Kushta – skin diseases Meha – diabetes, urinary tract disorders Apachi, Granthi – Goitre, tumour, fibroid Shleepada – Elephantiasis, Filariasis Unmada – Schizophrenia Kasa – cough, cold Shwasa – Chronic Respiratory tract disease, Asthma Hrullasa – nausea Visarpa – herpes Stanyadosha – vitiated breast milk Urdhvaroga – diseases affected neck and above region

Contra indication for Virechana – Avirechya – Virechana Anarhaन तु रे या नव वर अ पा

यधोग प ता

तपा व तसा रणः

सश या था पत ू रको ठा दि न धशो षणः Navajwara – fever of recent origin Alpa Agni – poor digestive activity, Adhoga Raktapitta – bleeding disease of lower part of the body (such as bleeding per rectum wounds, Ulcers of the rectum Atisara – diarrhoea, dysentery Sashalya – foreign bodies; Who have been administered decoction enema, Krurakoshta – Persons who naturally have hard bowel movement, Atisnigdha – who have undergone excess of Oleation treatment Shosha – emaciated 10b-11

Vamana Vidhi- Procedure of emesis therapy:अथ साधारणे काले ि न ध ि व नं यथा व ध वोव यमुि

ल टकफं म

यमाष तला द भः

नर नमीषि

न धं वा पेयया पीतस पषम ्

नशां सु तं सुजीणा नं पूवा ने कृतम गलम ्

व ृ बालाबल ल बभी न ् रोगानुरोधतः आक ठं पा यता म यं

ीर म ुरसं रसम ्

यथा वकार व हतां मधुसै धवसंयुताम ् को ठं वभ य भेष यमा ां म मद ाि व

े

भूच

ा भमि

ाका नलानलाः

ताम ्

ऋषयः सौष ध ाम भूतस घा च पा तु वः १६

रसायन मवष णामामराणा मवाम ृतम ्

सध ु ेवो तमनागानां भैष य मदम तु ते १७

ॐ नमो भगवते भैष यगुरवे वैडूय भराजाय

तथागतायाहते स य स बु ाय त यथा

ॐ भैष ये भैष ये महाभैष ये समु गते

वाहा

ा गमुखं पायये त ्

Next, during temperate seasons, after administering oleation and sweating therapy properly, on the day previous to the day of emesis, The patient is made sure that he has slept well the previous night. Patient is made sure that his previous food is well digested In the morning of the previous day to Vamana, at first, Auspicious rituals are carried out.

Next, Kapha Dosha is excited in the patient by administering peya (drink) / thin gruel prepared from fish, Masha (black gram) ,Tila (Sesame) etc. added with little quantity of fats, in morning. On the day of Vamana, again, it is made sure that the patient’s previous food has got digested and he had slept well. He is either maintained on empty stomach or a little quantity of ghee is given. The Aged, children, the debilitated, VIPs and cowards, should be made to drink wine, milk, sugarcane juice or meat juice added with honey and Saindhava salt, appropriate to the disease, to their maximum capacity. Afterwards, determining the nature the nature of his bowels (Intestines – Koshta), the emetic drug is administered sanctifying it with the following hymn“Let Brahma, Daksa, Ashvinis, Rudra, Indra, the Earth, Moon, Sun, Air, Fire, Sages, comity of herbs, and of living beings protect you; let this medicine be to you like Rasayana for the Sages, Nector for gods and Sudha for the good serpents; Om, Salutations to the medicine.” Uttering these hymns, he should drink the medicine, facing east. 12-18a Note: The medicine given for Vamana depends on the disease. It usually contains Madanaphala (Randia spinosa), Licorice etc. Various combinations of Vamana drugs are discussed in a later chapter.

Vamana Vidhi – Procedure of Vamana पीतो मह ु ू तमनप ु ालये त ् त मनाः जात

लास से क

छ ये ततः

अ गु ल यां अनाय तो नालेन म ृद ुना अथवा

गालता व जन ् वे गान ् अ व ृ तान ् वतयन ् वतयन ् व ृ तां च जानुतु यासने ि थतः

उभे पा व ललाटं च वमत चा य धारयेत ् पीडये तथा ना भ ं पु टं च

तलोमतः

After consuming the medicine, he should await for one Muhurta – 48 minutes for the commencement of vomiting, with keen intent. With the appearance of oppression in the chest and salivation he should try to vomit If the bouts are not coming up easily, he should tickle his throat either with his fingers or a soft tube without injuring the throat, Sitting on a seat of the height of one knee, the bouts of vomiting should be held supported by another person. His umbilical region and back should be massaged in upward direction. 18-21a कफे ती नो णकटुकैः प ते

वाद ु हमै र त

वमेत ् ि न धा ललवणैः संस ृ टे म ता कफे

In case of increase of Kapha, vomiting should be induced with drugs having properties like penetrating, hot and Pungent (Teekshna, Ushna, Katu); In case of Pitta with drugs of sweet and cold properties and In case of association of Vata with Kapha, with drugs of Unctuous, sour and salt properties. (Snigdha Amla Lavana) 21b-22a प त य दशनं या

छे दो वा ले मणो भवेत ् २२

Vomiting should be allowed till the appearance- coming out of Pitta or complete expelling of Kapha. 22b ह नवे गः कणाधा ी स ाथः लवणोदकैः वमे पुनः पुनः If bouts are insufficient, they should be induced again and again by drinking water boiled with Kana, Dhatri, Siddhartha and salt. (long pepper, Amla, White mustard and black salt) त

वेगानाम वतनम ्

विृ तः स वब धा वा केवल यौषध य वा

अयोग तेन न ठ वक डूकोठ वरादयः

Less bouts – Ayoga - Non – commencement of bouts, bouts coming on with hindrance or elimination of the medicine only- are the features of Ayoga- inadequate bouts; from it arise, excess of expectoration, itching, appearance of skin rashes, fever etc. 23b-24 Proper bouts – Samyak Yoga न वब धं मनः

वत ते कफ प ता नलाः

सादः

वा

यं चाव थानं च

मात ्

वयं भवेत ्

वैपर यमयोगानां न चा तमहती यथा स यक् योगे Kapha, Pitta and vata coming out in successive order, without any hindrance, calmness of the mind and cessation of vomit bouts on its own, absence of features of inadequate bouts and feeling of not too much of discomfort are the features of samyagyoga- proper bout.25a अ तयोगे त ु फेनच

व मतं

र तवत ्

ामता दाहः क ठशोष तमो

मः

घोरा वायु आमया म ृ यु जीवशो णत नगमनात ् In Atiyoga- excess bouts the vomited materials will be frothy, with glistering particles and blood;

The patient will experience weakness, burning sensation, dryness of the throat, giddiness, powerful disease of vata origin and even death due to discharge of life supporting blood. 25b-26

Care after vomiting therapy - Vamanottara Upacharaस य योगेन व मतं धूम य या यतमं

णात ् आ वा य पायये त ्

नेहाचारमथा दशे त ् २७

After the patient had proper bouts of vomiting, he should be comforted with encouraging words, made to inhale any one kinds of smoke (Dhuma)- mild, medium, or strong, and then allowed to follow the regimen of after-care of oleation therapy. 27 ततः सायः

भाते वा

ु वान ् नातः सुखा बुना

भु जानो र तशा य नं भजे पेय ा दकं

मम ्

Then, either in the evening or next morning, after feeling hungry, after bath with warm water, he can eat mass prepared with red rice or if he not feeling hungry he should adhere to the following regimen of Peya (Thin gruel) etc. 28 This regimen is called as Samsarjana Karma.

Samsarjana – Peyadi Ahara Karma- Regimen of liquid Diet पेयां वलेपीमकृतं कृ तं च यूषं रसं

ीनुभयं तथैकम ्

मेण सेवेत नरो अ नकालान ् धानम यावरशु शु ः

Persons who have had the maximum, medium and minimum purificatory therapies, should consume Peya- thin Gruel, Vilepi- thick Gruel, Akruta Yusa- soup not processed with fat, salt, sours etc. Krutayusa- Soup processed with fat, salt and Sours and Rasa- meat juice- in Successive order, for three, two and one Annakala- time of meal respectively. 29 Note: Eating periods = Anna Kala. Each day has two anna kala. – morning and evening. If the maximum vomiting bouts were observed (Ati Yoga), Then, the patient should take Peya, Vilepi, Akruta Yusha, Kruta Yusha and Mamsarasa – three eating periods (Annakala) each. The patient will not have any food except these. Likewise, for the medium vomiting bouts, the number of eating periods Is two each and for lesser bouts (Heena Yoga), the number of eating periods (Anna kala) is one each.

Benefits of Samsarjana Karma – यथा अणुरि नः त ृणगोमया यैः स धु यमाणो भव त

महान ् ि थरः सवपच तथैव शु

मेण

य पेया द भर तरि नः

Just as a spark of fire after being fed by grass, powder of dry cow dung etc, gets augmented gradually and becomes great, steady, and capable of burning everything, similarly, the internal digestion fire, by the Samsarjana regimen, in the patient who has undergone Vamana karma, gains strength. 30

Vega Samkhya- Mana- Number of Bouts and quantity:जघ यम य वरे तु वेगा च वार इ टा वमने षड टौ दशैव ते

व गुणा वरे के

थ तथा

याद वचतुगुण च ३१

For Vamana, Heenayoga – Minimum bouts – 4 bouts Madhyama vega – Moderate – 6 bouts Atiyoga – Maximum bouts – 8 bouts For Virechana – Heenayoga – 10 bouts of purgation or half prastha of purgated material (384 grams) Madhyamayoga – 20 bouts – 1 prastha of material (768 grams) Atiyoga – 30 bouts. – 2 prastha (1,536 grams). 31 प तावसानं वमनं वरे काद , कफा तं च वरे कमाहुः

व ान ् सा व कानपनीय वे गान ् मेयं वरे के, वमने तु पीतम ्

Vomiting therapy is allowed till the expulsions of pitta or half of purgations Purgation therapy is allowed till Kapha comes out; Measurement to be done after rejecting 2 – 3 bouts, containing faeces in case of Vamana and after rejecting the medicine- emetic Drug in case of Vamana. 32

Virechana Vidhi- Purgation therapy procedure अथैनं वा मतं भूयः ले मकाले गते

नेह वेदोपपा दतम ्

ा वा को ठं संयि वरे चयेत ् ३३

After Vamana therapy, patient is given Samsarjana regimen. After that, he is again given Snehana and Swedana treatment. After that, in the morning, after Kapha time has lapsed (after around 9 – 10 am,) Virechana drug should be given. should be given the Purgation medicine. The kind and quantity of purgation medicine should be determining the nature of his Kostha (alimentary tract, bowels). 33

बहु प तो म ृद ुः को ठः भत ू मा तः ू रः कृ

ीराण प व र यते ात ् यामा दकैरा प

A person with Mrudukoshta (soft intestines), even milk will induce purgation. For a person with Krurakoshta, (hard bowels, intestines), even Trivrit (a purgative herb) might cause purgation with great difficulty. 34 कषायमधुरैः प ते वरे कः, कटुकैः कफे ि न धो णलवणैवायौ

For Pitta disease, Kashaya – astringent and Madhura – sweet drugs should be used for purgation. For Kapha disease, Katu (pungent) herbs should be given for purgation. For Vata, drugs with Snigdha – unctuous, oily, Ushna (hot) and Lavana (salt) taste b given to induce purgation. 35 अ व ृ तौ तु पाययेत ्

उ णा बु, वेदयेद य पा णतापेन चोदरम ् If bouts of purgation do not commence, he should drink hot water and his abdomen should be fomented with warmed with palms of the hand. 36a उ थाने अ पे दने ति म भु

वा अ ये युः पुनः पबेत ्

अ ढ नेहको ठ तु पबेद ू व दशाहतः

भूयो अ युप कृततनुः

यौ गकं स यगालो य

नेह वेदै वरे चनम ्

मर पूवम त मम ्

If, on the day of consuming the purgative drug, the patient responds poorly, he should be allowed to take his food on that day and the purgative drugs administered again on the next day; Persons who have unstable and unlubricated alimentary tract, should consume the purgative drugs after ten days – during which Snehana and sweating therapies should be done because the body which has been well prepared with Snehana and sweating therapies, will be able to have purgation properly; then the purgative drug should be administered after considering all aspects and remembering the procedures described earlier . 36b-38a

Vishama Yogah – Abnormal bouts:तकु

अशु

च

लेशः ले म प तयोः ३८

क डू वदाहः प टकाः पीनसो वात व

हः

अयोगल णम ्

योगो वैप र ये यथो दतान ् ३९ व प तकफवातेषु नःसत ृ ेषु

मा

वे त ्

नः ले म प तमुदकं वे तं कृ णं सलो हतम ् ४०

मांस धावनत ु यं वा मेदः ख दाभमेव वा

गुद नःसरणं त ृ णा मो ने

वेशनम ् ४१

भवि त अ त व र त य तथा अ तवमनामयाः Ayoga – lesser quantity of purgation Discomfort in the region of the heart and abdomen, Aruchi – anorexia, Too much of Kapha and Pitta increase in the intestines (because they are not properly thrown out of the body) or expulsion of Doshas coming out through the mouth, Kandu – itching, Vidaha – burning sensation, Pitika – eruption on the skin, Peenasa – rhinitis, Vata Vidgraha – blocking of flatus and constipation are the features of Ayoga- inadequate bout of purgation therapy; opposite of these are the features of proper bouts; In case of Atiyoga – excess bouts After the elimination of faeces, Pitta, Kapha and vata in Succeeding order, there will be elimination of watery material which does not contain Kapha or Pitta, which is white, black or slightly red in color, resembling the water in which meat has been washed or resembling a piece of fat; prolapse of the rectum, thirst, giddiness Sunken eyes and diseases caused by excess of vomitingwill appear. 40-42 स यि व र तमेनं च वमनो तेन योजये त ् धूमव यन व धना ततो व मतवा नव

मेणा ना न भु जानो भजे त ् कृ तभोजनम ्

The person who has undergone proper purgation therapy, should administered all other therapies, except inhalation of smoke, which are described under emesis therapy; afterwards he should stick to the regimen of diet, in the same way as of emesis therapy and then resume his normal food. 4243 म दवि नमसंशु म ामं दोशद ुबलम ् अ

टजीण ल गं च ल घये पीतभे षजम ्

नेह वे दौषदो

लेशस गै र त च बा यते

On the day of consuming the purgation, If the patient has weak digestion strength (Mandagni), coated feeling in the gut, and if the digestion symptoms of previous food are not seen, the he should be made to fast. By this fasting he will not be harmed by the discomfort caused by the obstruction of Doshas, aggravated by oleation, Sweating therapies. 44-45a

संशोधना

व ाव नेहयोजनल घनै ः

या यि नम दतां त मा

मं पेया दमाचरे त ्

The digestive activity becomes weak by purification therapies, blood letting, oleation and fasting; hence the regimen of Peya- thin Gruel etc. should be followed. 45b-46a ुता य प त ले माणं म यपं वातपैि तकम ्

पेयां न ् पायये तेषां तपणा द मो हतः

Peya should not be given when only little quantities of Pitta and Kapha are expelled out, to the person is Addicted to wine, and in whom Vata and Pitta are Predominant; for them regimen of Tarpana etc. – nourishing therapy are suitable. 46b-47a अप वं वमनं दोषान ् प यमानं वरे चनम ् नहरे वमन यातः पाकं न

तपालयेत ्

Vamana (Emesis) brings out Doshas which are not cooked (processed by heat) Whereas Virechana (purgation) brings out the Doshas which have undergone Paka (cookingprocess by heat); hence in case of emesis – the physician need not await Doshapaka (cooking of the Doshas). 47 द ुबलो बहुदोष च दोषपाकेन यः

वयम ्

व र यते भेदनीयैभ यै तुमुपपादये त ्

Person who is weak, who has great amount of increased Doshas develops purgation on his own – without consuming purgative Drug; he should be treated with foods which are purgative. 48. द ुबलः शो धतः पूवम पदोषाः कृशो नरः

अप र ातको ठ च पबे म ृ व पमषौधम ्

वरं तदसकृ पीतम यथा संशयावहम ्

हरे बहूं चलान ् दोषान पान पान ् पुनः पुनः द ुबल य म ृद ु वैर पान ् संशयमे तुतान ् Persons who are weak, who have undergone purification therapy previously, who have little amount of imbalanced Doshas, who are emaciated and whose nature of the alimentary tract is not known should be given mild purgative drug in a small dose; It is better given in small doses often; Large dose given once creates doubt of death; The drug in small and repeated doses will eliminate the circulating Doshas little by little; in a weak person, little quantity of Doshas should only be mitigated by mild drugs, they need not be expelled out by purification therapies . 49b-51 लेशयि त चरं ते ह ह युवनम न ताः

Doshas which are more in quantity trouble the person greatly and even kill him, if not expelled out- by purification therapies. म दाि नं संधु

ू रको ठं च सा ारलवणैघ ृतैः

ताि नं विजतकफवातं च शोधयेत ्

Person who have weak digestion strength, Krura koshta – hard bowels (hard natured alimentary tract), should be administered ghee processed with Kshara and Lavana (Alkalis and salts), to Augment his digestive capacity and Vanquish Kapha and Vata; afterwards he should be given purification therapies. 52 बहू नल ू रको ठ यायामशी लनाम ्

द ता नीनां च भेष यम वरे चै व जीय त ये यो बि तं पुरा द या ततः ि न धं वरे चनम ् शकृि न

य वा कि चती णा भः फलव त भः

व ृ तं ह मलं ि न धो वरे को नहरे सख ु म्

In persons who are Rooksha (dry), who have great increase of Vata, who have hard natured Alimentary tract (Krura koshta), who do exercise regularly and who have strong digestion strength, the purgative drug gets digested without producing purgation; for them, an enema should be given first and then purgative drug which is Snigdha – (unctuous, oily) should be given ; or the faeces should be removed first by using a strong rectal suppository made from fruits; the Doshas thus initiated in their movement, the purgative drug expels them easily. 53-55 वषा भघात प टकाकु ठशोफ वस पणः

कामलापा डुमेहात ना ति न धान ् वशोधयेत ्

सवान ् नेह वरे कै च,

ै तु

नेहभा वतान ्

Persons who are suffering from poison , Abhighata (Trauma), Pitika(skin eruption), Kushta – skin diseases, Shopha (inflammation), Visarpa- herpes, Kamala (Jaundice), Anaemia and Diabetes, should be given the purgative therapy without too much of Snehana (oleation. Mild oleation itself is sufficient for them. All of them should be given fatty purgatives; those who have had oleation earlier should be given dry- non- fatty purgatives. 56 कमणां वमनाद नां पुन र य तरे अ तरे

नेह वे दौ यु जीत, नेहम ते बलाय च

Note: Virechana is of two types. Snigdha Virechana and Rooksha Virechana. Snigdha Virechana- done by fatty purgative, such as a castor oil. Or the fatty material is mixed with herbs. Such as Castor oil mixed with Haritaki. Rooksha Virechana – wherein dry purgative herb alone is given. For example, Trivrit Lehyam.

मलो ह दे हाद ु

ले य

नेह वे दै तथोि

यते वाससो तथा

ल टः शो यते शोधनैमलः

Doshas getting loosened from the body by oleation and Sweating therapies are expelled out by purification therapies just like the dirt from the cloth – by washing. 58 नेह वे दावन य य कुयात ् संशोधनं तु यः

दा

शु कं इवानामे शर रं त य द यते

The body of the person who resorts to purification therapies without undergoing oleation and Sweating habitually, gets broken just like a log of dry wood while being bent.

Shodhana Phala- benefits of Purification therapies:बु

सादं बल मि

याणां धातुि थर वं

वलन य द ि तं

चरा च पाकं वयसः करो त संशोधनं स यगुपा यमानम ्

Clarity of the mind, strength of the sense organs, stability of the tissues, keenness of digestive power and slow ageing occur from purification therapies, properly undertaken. 60

Thus ends the chapter- Vamana Virechana Vidhi- The eighteenth in Sutrasthana of Astangahrdaya Samhita.