J. Res. Educ. Indian Med.

, 2013; XIX (1-2) 37-43 ISSN 0970-7700

AN OBSERVATIONAL STUDY ON VAMANA KARMA DONE WITH

MADANAPHALA PIPPALI CHOORNA YOGA AND
MADANAPHALA PIPPALI SHEETHA KASHAYA YOGA
POOJA B.A,1 SANTOSHKUMAR BHATTED2 AND SHALINI C.ELI3
Dept. of Panchakarma,1,2 National Institute of Ayurveda, Jaipur - 302002 Rajasthan (India)
Dept. of Panchakarma,3 Govt. Ayurveda Medical College, Bangalore - 560009, Karnataka (India)

Abstract: Context: Vamana karma (therapeutic emesis) is considered as best for the elimination
of morbid Kapha dosha among all the Panchakarmas. Though many drugs are mentioned under
Vamaka dravyas, the drug Madanaphala (Randia spinosa) is most commonly utilized because of
its easy utility and safe property. There are 133 formulations of Madanaphala mentioned in
classics but only few formulations are in practice. Hence, in this trial Madanaphala pippali choorna
yoga (powder) and Madanaphala pippali sheetha kashaya yoga (decoction) has been selected for
Vamana karma (therapeutic emesis) to see their comparative effects. Materials and Methods: Study
is carried out in 30 patients (2 groups of 15 each). The observations on time taken for the initiation
of first bout and completion of Vamana procedure, Vegiki shuddhi (number of bouts), Maniki
shuddhi (quantity of expelled morbid factors), Antiki shuddhi (appearance of Pitta), Lainghiki
shuddhi (appearance of procedural benefits), were made. Results: Both the groups showed the
same efficacy. Earlier initiation, completion of Vamana procedure and easier oral administration of
drug was observed in Madanaphala pippali sheetha kashaya yoga.

Keywords: Vamana karma, Madanaphala pippali choorna yoga, Madanaphala pippali

sheetha kashaya yoga, Panchakarma, Randia spinosa, Acorus calamus.

Introduction Among the various drugs available for

Ayurveda aims at Swastyasya swastya
rakshana (maintenance of health in healthy) and
Aturasya vikara prashamana (prevention of
disease). 1 Panchakarma, one of the major
treatment modality of Ayurveda operates to fulfill
these objectives. Vamana karma (therapeutic
emesis) is the first and foremost among the
Panchakarma therapeutic regimens, which
eliminates the morbid Kapha dosha through the
oral route.2
Whole of the section known as
Madanaphala kalpa in Kalpasthana of Charaka
Samhita is denoted formulations to induce
Vamana (therapeutic emesis) and Virechana
(therapeutic purgation), where in out of 600
formulations mentioned in this section, 355 are
meant, only for Vamana karma. This shows the
importance of Vamana karma.
Vamana (therapeutic emesis), the drug
Madanaphala (Randia spinosa) is considered
best, mainly because of its Anapayikatwa guna
(safe property).3
Charaka has mentioned 133 Madanaphala
yogas (preparations of Randia spinosa) for
Vamana karma,4 but now a days very few, say
about 2 to 3 formulations are in clinical practice.
Hence, it is the need of time to evaluate
different formulations for their induction and
adoption in day to day practice.
In this study Madanaphala pippali
choorna yoga (powder form) and Madanaphala
pippali s h e e t h a kashaya yoga 5 (decoction
form) has been selected to evaluate their effect
on induction of Vamana on clinical variables like
Vegas (bouts), benefits and comfort to the patient
including safety profile.

1. Ph.D. Scholar 2. Associate Professor and Head 3. Professor and Head

38 Pooja B.A., Santoshkumar Bhatted and Shalini C. Eli

Aims and Objectives 4. Maniki shuddhi (quantity of expelled

1. To evaluate the efficacy of Vamana morbid factors).
karma with Madanaphala pippali 5. Antiki shuddhi (appearance of Pitta).
choorna yoga. 6. Lainghiki shuddhi (appearance of
2. To evaluate the efficacy of Vamana procedural benefits).
karma with Madanaphala pippali
seetha kashaya yoga. Sample size and grouping
3. To compare Madanaphala pippali 30 patients irrespective of their sex, religion,
choorna yoga and Madanaphala pippali race, socio-economic status, education were
sheetha kashaya yoga on induction of selected.
Vamana and safety of these drugs. They were randomly allocated into following
two groups.
Materials and Methods
Research design Group A
A randomized comparative study. 15 patients received Vamana karma with
Source of data Madanaphala pippali choorna yoga.
30 patients indicated (Yogya) and fit for
Vamana karma were selected from out-patient Group B
and in-patient department of National Institute 15 patients received Vamana karma with
of Ayurveda, Jaipur. Madanaphala pippali sheetha kashaya
yoga.
Inclusion criteria
a. Patients between the age group of 20 to Methodology
60 years. Vamana vidhi (therapeutic emesis
b. Patients who were fit for Vamana procedure as per classical Ayurveda).
karma.
Definition
Exclusion criteria For expulsion of morbid doshas through
a. Patients below 20 years and above 60 the oral route using the emetic drugs.
years.
b. Patients suffering from any other Poorva karma
systemic disorders like hypertension, (Preparation prior to Vamana procedure)
diabetes mellitus and cardiac diseases. Pachana deepana (digestives and
c. Patients who were unfit (Ayogya) for appetizers) with Chitrakadi vati 1 tid was advised
Vamana karma. till Nirama lakshana (devoid of features of Ama)
and good appetite were observed.
Laboratory investigations Snehapana (internal oleation) with
Routine hematological, urine investigations Moorchita ghrita (medicated ghee) was started
and ECG was done before the procedure. with 30ml according to the patient Koshta
(nature of bowel) and Agni (digestive fire).
Criteria of assessment The dose of Snehapana was decided and
1. Time taken for the initiation of administered in the increasing order till the
first bout of Vamana. attainment of Samyak snigdha lakshana.
2. Time taken for the completion of the Sarvanga taila abhyanga (whole body oil
Vamana karma. massage) was carried out with Moorchita tila
3. Vegiki shuddhi (number of bouts). taila for two days.
 An Observational Study on Vamana Karma 39

Kapha utkleshakara ahara (diet aggravating prepared was brought to luke warm status before
Kapha) was administered on the previous day of oral intake by the patient.
Vamana karma.
Pradhana karma
Source of Madanaphala (Main therapeutic Vamana procedure)
Fresh Madanaphala was collected from Group A
Shimoga District of Karnataka State (India). Patient was asked to sit comfortably in a
knee height chair and vitals were recorded.
Pradhana karma (Main Vamana procedure) Patient was made to take full stomach
(Preparation of formulation) (Akanta pana) of milk and then the prescribed
The drug collected from the same batch dose of Madanaphala pippali choorna yoga was
was used in both the groups. Freshly prepared administered.
powder was utilized in the preparation. Signs of Sweda pradurbava (sweating),
Romaharsha (horrification), Kukshi admana
Madanaphala pippali choorna yoga (distension of abdomen), Hrillasa (nausea),
Ingredients Praseka (salivation),6 the time of initiation of Vega
(1) Madanaphala pippali (Randia spinosa) (of Vamana) and nature of vomitus were
powder - 6G. recorded. Yastimadhu phanta (Glycirrazhia
(2) Vacha (Acorus calamus Linn) glabra decoction) was administered to further
powder - 3G. continue the procedure.
(3) Saindhava lavana (Rock salt) - 1G. During each Vamana bout, patient was
(4) Madhu (Honey) Q.S. assisted to bow-forward properly to facilitate
expelling the vomitus without much discomfort.
Madanaphala pippali sheetha kashaya yoga Gentle massage over the back was made
Madanaphala pippali (seeds of Randia in upward direction, patient’s forehead was hold
spinosa) 6 grams were dipped in 200ml of firmly and gentle pressure was given over the
Yastimadhu kashaya (Glycirazzhia glabra abdomen. Warm water was used for washing
decoction) in previous night of Vamana. Next hands.
morning Honey and Saindhava lavana (Rock Finger tickling of palate region was
salt) was added. Madanaphala pippali were advised when initiation of Vega was less than
crushed and entire Kashaya (decoction) thus expectations. Procedure was continued till
the appearance of Pittanta lakshanas like
Table 1. Showing the Pradhana karma of Vamana
appearance of Pitta (including bile), Katu-tikta
Group A Group B asyata (bitter taste in mouth) and Kantha daha
1. Akantapana Ksheera Ksheera (burning sensation in throat).
Luke warm Saindhava jala (rock salt
Madanaphala pippali Madanaphala pippali
2. Vamaka yoga water) was administered at the end. During each
choorna yoga sheetha kashaya yoga
step of the procedure, concerned vitals were
3. Symptoms after
Observed Observed recorded.
Vamaka yoga
4. Vamanopaga Yastimadhu phanta Yastimadhu phanta
dravya Saindhava jala Saindhava jala Group B
The procedure remains the same as of
Kapha; Pitta Kaph; pitta
nirharana in an order; nirharana in an order; group A except medicine - Madanaphala pippali
5. Samyak sheetha kashaya yoga. It was observed that
Laghuta and shuddhi laghuta and shuddhi
lakshanas
in hrit. parshva and of hrit; parshva and Madanaphala pippali sheetha kashaya yoga was
kanta kanta easier for the intake than Choorna yoga.
40 Pooja B.A., Santoshkumar Bhatted and Shalini C. Eli

Paschat karma Table 2. Different observations of Vamana karma

(Therapeutic regimens after Vamana Sr. Group Group
procedure) No. Observations
A B
Patient was assisted to wash face, hands, Average drugs quantity for Vamana karma (ml)
legs and made to lie down comfortably,followed - Ksheera 1600.12 1598.61
by Dhumapana (medicated fumes inhalation) and 1.
- Yastimadhu phanta 3400.34 3492.45
Kavala (gargling) with hot water.7 - Lavanodaka 2342.12 2245.34
Further the patient was advised to avoid Symptoms observed after administration of
day sleep, exposure of cold and also scorching Vamaka yoga (in average percentage)
sunlight. 2. Sveda pradurbhava 66 73
Romaharsha 26 20
Samsarjana krama Kukshi adhmana 86 80
Hrillasa 93 80.66
(Diet after procedure)
Time taken for the
An appropriate diet was advised depending 3. initiation of 1st bout 15.7 11.8
on the type of Shuddhi (purification) achieved. (average in minutes)
The above procedure was conducted Time taken for the
between December, 2009 to May, 2010. 4. completion of procedure 50.2 48.5
(average in minutes)

Observations Vegiki shuddhi

5 (Number of bouts) 6.13 5.6
Among 30 patients, 56.66% (maximum) (average in numbers)
were in the age group of 26-35 years, 82.46% Upavegas
6. 5.8 5
were females, 76.66% were Hindus, 80% patients (average in numbers)
were from Urban population, 70% patients were Maniki shuddhi
Graduate, 73.33% were from middle class, 7. (average quantity of 268 206.3
expelled morbid factors) ml
60.33% patients were married, 60% patients were
Antiki shuddhi
taking mixed diet, 63.33% patients were having 8. 80 74
(appearance of Pitta ) %
Madhyama koshta, 65% patients were having
Vishamagni and 60% patients were having The average time taken for the initiation of
Kapha pitta prakriti. first Vamana bout was 15.7 minutes in group A
Table 2 shows that the average quantity where as in group B it was 11.8 minutes. The
of Ksheera (milk) used, was about 1600ml in average time taken for the completion of the
group A and 1599ml in group B, quantity of procedure was 50.2 and 48.5 minutes in
Yastimadhu phanta was 3400ml and 3492ml in group A and B respectively.
group A and B respectively. Average number of Vega (Vanmana bouts)
Whereas Lavanodaka quantity was in group A was 6.13 and where-as in group B
2342 ml in group A and 2245 ml in group B. it was 5.6 only.
After the administration of Vamaka yoga, Sveda The average number of Upavega was 5.8
pradurbhava was observed in 66% of patients in and 5 in group A and B respectively.
group A and 73 % of patients in group B. Average difference of quantity between
26% of the patients in group A and 20% output and input was 268 ml in group A and
of patients in group B had Romaharsha. Kukshi 206.3 ml in group B.
adhmana was noticed in 86% of patients in group In Antiki shuddhi 80% patients had
A and 80% in group B. Pittanta in group A whereas in group B it was
93% patients of group A reported 74%.
Hrillasa while comparitively less number of Table 3 shows that most of the Langhiki
patients (80.66%) from group B had it. shuddhi symptoms appeared in both the groups.
 An Observational Study on Vamana Karma 41

Table 3. Langhiki shuddhi (appearance of benefits) Table 6. Vyapadas (complications) of Vamana karma
Symptoms Group A* Group B* Group A Group B
Symptoms
Kramat doshanirharana (%) (%)
52.63 49.52
(elimination of dosha in order) Adhmana
20.00 26.66
Hridhaya shuddhi (distension of abdomen)
60.00 58.72
(clearness in chest) Shirashoola
26.66 13.33
Parshva shuddhi (headache)
65.32 63.12
(clearness in flanks) Udarashoola
20.00 33.33
Kanta and murdha shuddhi (abdominal pain)
68.12 65.00
(clearness in throat and head) Raktachandrika darshana
13.33 06.66
Indriya prasada (appearance of blood)
69.34 67.32
(freshness in sensory organs) Atisaara
20.00 40.00
Laghutva (lightness) 82.32 80.34 (watery / loose stools)

*= Percentage of patients

Table 4 reveals that the mean blood
pressure in initial stage was 122/80, whereas
during and after the Vamana karma it remained
elevated to 130/90 mm of Hg. The mean pulse
rate in initial, during and after the Vamana karma
was 77.2, 84.8 and 76.4 respectively.
Table 4. B.P. and Pulse during Vamana karma *1
Vitals BP *2 Pulse *3
Initial 122/80 77.2
During the procedure 130/90 84.8
After the procedure 130/90 76.4
*1 = Variation in Both Groups *2 = (mean in mm of Hg)
*3 = (mean in minutes)
Table 5. Average Samsarjana krama in days
Group Average
Group A 5.08 days
Group B 5.00 days
Table 5 shows that the average number of
days required for Samsarjana krama were 5.08
and 5 days in group A and group B respectively.
Table 6 shows that 20% and 26.66% of
patients in group A and B had Adhmana. 26.66%
of patients in group A and 13.33% in group B
were having Shirashoola (headache).
Udarashoola was observed in 20% of the
patients in group A and 33.33% patients in
group B. In group A. Raktachandrikadarshana
was observed in 13.33% patients of group A
and in 6.66% of patients in group B.
Atisara was observed in 20% patients in
group A and 40 % in group B.
Discussion
Vamana karma is one of the main
Panchakarma procedure indicated for
management of disorders resulting from vitiated
Kapha dosha. The Shodhana (purificatory
measure) is contraindicated in Samavasta
(features associated with Ama), hence,
Niramikarana is essential as the first step. This
was achieved by administering Deepana and
Pachana drugs.
Snehana (oleation) and Svedana (sudation)
are the important steps prior to Shodhana.
Abhyantara snehana (internal oleation) does Vata
shamana (of alleviated Vata), Mrudukarana of
deha (smoothens the body) and Mala, thus
removes the Sangha (obstruction).
Whereas Abhyanga (massage) and
Svedana (sudation) does the Vilayana
(liquefaction) of doshas and brings them from
Shakha to Kosta, thus helps in expelling out the
doshas.
To conduct Vamana, Kaphadosha should
be in Utklishtavastha (aggravated state). To
maintain that state of Kapha and to produce
more Utklesha, Kaphotkleshakara aahara
(diet aggravating Kapha) is advised.
In morning Kapha dosha has more
dominance hence, it is important to perform
Vamana karma in the morning.
42 Pooja B.A., Santoshkumar Bhatted and Shalini C. Eli
In the main procedure Ksheera (milk)
was used till full stomach. That facilitates the
Vamana procedure. The average quantity of milk
used was 1600.12 ml in group A and 1598.61 ml
in group B (Table 2).
Considering the facts of palatability and
easy oral administration, 133 preparation of
Madanaphala are mentioned in Ayurveda classics,
but in present time only few preparations are
used in clinical practice.
Hence, in this clinical trial effort has been
made to see the efficacy of Sheetakashaya yoga
in Vamana karma. The assessment of the Vamana
karma is done based on Vaigiki, Maniki, Laingiki
and Antiki lakshanas. As the Laingiki lakshanas
are indicative of Samyakyoga or Ayoga of
Vamana, Antiki shuddhi helps to complition the
Vamana procedure, where as Maniki and Vaigiki
lakshanas help to assess Pravara, Madhyama or
Avara shuddhi. All this helps in planning the
Samsarjana krama.
Quantity of Yastimadhu phanta utilized
for the Vamana karma was 3400.34 ml and
3492.45 ml in group A and B. The quantity of
Lavanodaka utilised/required was 2342.12 ml in
group A and 2245.34 ml in group B (Table 2).
In most of the patients symptoms like
Sveda pradurbava (sweating), Kukshi adhmana
(distension of abdomen), Hrillasa (nausea),
Praseka (salivation) were observed after the
administration of Vamaka yoga (Table 2), this
shows the typical Vamaka action of trial
drug.
In patients from group B, the initiation of
Vamana vega was observed earlier than the
group A. In group B, Yastimadhu kashaya and
Vamaka yoga were used in kashaya form. This
might have helped for faster action of drug in
comparison to the choorna yoga in group A.
In group B Vamana karma procedure
was also completed earlier than group A
(Table 2).
As initiation of Vamana vega was
earlier and Vamaka aushada (formulation) also
came out earlier in group B, hence Vamana
karma was completed earlier in Kashaya
group.
Comparatively the total number of Vegas
and Maniki shuddhi were more in group A than
group B. It showed that both the groups had
Madhyama shuddhi.
Majority of the patients had Pittanta
vamana in both the groups (Table 2).
In both the groups, most of the Lainghiki
shuddhi lakshanas appeared. Lainghiki shuddhi
lakshanas appeared more in group A than group B
(Table 3).
However, this suggests the proper Vamana
karma occurred in both the groups.
There was a slight variation in blood
pressure and pulse rate before, during and after
the Vamana procedure (Table 4). As such, this
difference had no significance.
The average number of days of Samsarjana
krama were 5.2 and 5.08 in group A and B
respectively (Table 5). This is because, the
majority of the patients had only Madhyama
Shuddhi.
26.66% of patients in group A and
13.33% in group B were having Shirashoola
(headache) (Table 6). This could be because of
Kapha and Pitta utklesha in Koshtha.
The 20% and 26.66% patients in group A
and B had Adhmana. Udarashoola was
observed in 20% patients in group A and 33.33%
patients in group B, it might be due to the
irritant nature of Vamakayoga particularly due
to Madanaphala-pippali and Vacha (Acorus
calamus Linn). Raktachandrika darshana has
been observed in 13.33% patients in group A and
6.66% in group B. It could be due to the excessive
exertion and irritation in the throat for inducing
Vamana vega and the patient might have been
suffering with gastritis.
Atisara was observed in 20% patients in
group A and 40% in group B. This could be
because of the excessive use of Yastimadhu
phanta which is known for its Mridu rechana
(mild purgative) property.8
The main aim was to compare the two
Madanaphala pippali yogas to see their
efficacy and safety in Vamana karma. It
was observed that both Yogas showed all
most similar effects.
 An Observational Study on Vamana Karma
Conclusion
1. Vamana karma, is one of the five
Panchakarma procedures indicated for 1.
the expulsion of morbid Kapha dosha.
2. Among the various Vamaka formulations
2.
of Madana phala, only few Yogas are
in clinical practice. Hence, one such
classical yoga in the form of Sheetha
3.
kashaya was studied to see efficacy of
this Vamaka yoga to perform Vamana.
3. Both the Yogas showed almost same 4.
efficacy. But administration of drug is
easier in Kashaya form.
4. In Kashaya group initiation of the first 5.
Vega and completion of the
procedure was earlier than the Choorna
yoga group. 6.
5. The average Vegiki, Maniki, Antiki and
Lainghiki lakshanas were significant in
group A as compared to group B. 7.
6. Madhyama shuddhi was observed in
both the groups with average five days
of Samsarjana krama. 8.
7. In both the groups minor complications
were observed in two patients only.
Address for Correspondance: Dr. Pooja B.A. Ph.D scholar, Department of Panchakarma, National Institute of
Ayurveda, Jaipur-302002 Rajasthan (India) Email: drpoojaba@gmail.com (82-1333786434 JREIM -2012-04-01)
43
References
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Sutrasthana 30/26
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Kalpasthana 1/4
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Kalpasthana 1/13
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Sutrasthana 4/4
Agnivesha, Charaka Samhita ,Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Kalpasthana 1/14 and 20
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Sutrasthana 15/11
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Sutrasthana 15/14
Agnivesha. Charaka Samhita, Chaukamba
Sanskritha samsthana Varanasi; reprint: 2004.
Sutrasthana 1/84