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PHYSIOANATOMCAL ASPECT OF VAMANA-KARMA AUTHORS

Article · September 2019

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Siddharth K Roy
Krishna Ayurved medical college
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 Vol. 3, Issue-04 (2019), ISSN: 2456-8279 Siddharth K. Roy et al JIF: 1.021 IPIF:2.54

PHARMAAYURVED ONLINE RESEARCH JOURNAL FOR

PHARMACY, AYURVED AND ALLIED SCIENCES

http://www.pharmaayurved.in/

PHYSIOANATOMCAL ASPECT OF VAMANA-KARMA

AUTHORS
1. Siddharth K. Roy, Final Year PG Scholar, Department of Rachana Sharir, Parul Institute of
Ayurved, Parul University, Vadodara, Gujarat.
2. Abhijit Patil, Professor & HOD, Department of Rachana Sharir, Parul Institute of Ayurved - Limda
– Vadodara, Gujarat. Contact No.8758558617.
3. K. B. Roy, Professor, Dept. of Panchakarma, Parul Institute of Ayurved - Limda – Vadodara,
Gujarat.
Abstract:

Vamana karma is one of the panchakarma described in Ayurveda reference books with specific
chapters as one of shodhan (evacuation process of impurities in body) treatment. Elimination of
impurities from upper passage (i.e., mouth) is emesis (Vamana). Although all other evacuative
procedures (sodhan) are used for vitiation of dosas, yet emesis is specific procedure for expulsion of
vitiation of kapha or pitta+kapha with predominance of kapha2.
However, Vamana karma is an invasive procedure which needs more attention & care in pre &
post karma. Physio-anatomical aspect of Vamana karma is needed to be understood in view of large
numbers of abnormal complications & excessive application of Vamana affecting the physio-anatomical
conditions of body.
Anatomically the medicine for Vamana karma administered by oral route and passes through
oral cavity, pharynx, epiglottis, esophagus, stomach & duodenum (Upper Gastro-Intestinal Tract)
Medicines for Vamana stimulates the stomach and its physiological reaction to medicine is emesis
which is caused by stimulating the vomiting center in brain5.

For Corresponds:
Key Words: Vamana karma,
Name of Author: Dr. Siddharth K. Vomiting, CTZ, Panchakarma
Roy
Email: siddroy22@gmail.com

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 Vol. 3, Issue-04 (2019), ISSN: 2456-8279 Siddharth K. Roy et al JIF: 1.021 IPIF:2.54

INTRODUCTION:
Vamana karma is one of the panchakarma described in Ayurveda reference books with specific
chapters as one of shodhan (evacuation process of impurities in body) treatment. Elimination of impurities
from upper passage (i.e., mouth) is emesis (Vamana). Although all other evacuative procedures (sodhan)
are used for vitiation of dosas, yet emesis is specific procedure for expulsion of vitiation of kapha or
pitta+kapha with predominance of kapha1.
However, Vamana karma is invasive procedures which needs more attention & care in pre & post
karma. Physio-anatomical aspect of Vamana karma is needed to be understood in view of large numbers of
abnormal complications & excessive application of Vamana affecting the physio-anatomical conditions of
body6.
Anatomically the medicine for Vamana karma administered by oral route and passes through oral
cavity, pharynx, epiglottis, esophagus, stomach & duodenum (Upper Gastro-Intestinal Tract) Medicines for
Vamana stimulate the stomach and its physiological reaction to medicine is emesis which is caused by
stimulating the vomiting Centre in brain5.
Vomiting starts in the stomach or Upper GIT, when it is full with contents to be distended and
ready to expelled afterwards. Here udiran and Excitation of Pitta dosha cause to aggravate vega and
reflexes from gastric expulsion. This excited stage stimulations on both sympathetic & para sympathetic
(i.e. vagus efferent neurons) leading upward movements affecting the Hridaya (heart) as well5.
Anatomical aspect of Vamana karma:
Structures in role of Vamana (therapeutic emesis):
1. Oral cavity
2. Pharynx
3. Epiglottis
4. Oesophagus
5. Stomach (Gastric mucosa)
6. Duodenum (Partial involvement)5

Physiological aspect of Therapeutic Emesis: -

Vomiting reflex has 3 stages: -
1) Nausea – Feeling of nausea after taking the Vamana Medicine.
2) Retching occurs as a result of activation of spasmodic contraction of diaphragm, Intercostal muscle
combined with closure of epiglottis.
3) Act of Emesis
Sensory signals that initiate vomiting originate mainly from pharynx, oesophagus, stomach, and upper
portion of small intestines- vegal and sympathetic afferent nerve fibres vomiting centre5.
Physiological actions during vomiting;
Three groups of muscles are responsible for vomiting
(1) Stomach wall smooth muscle
(2) Diaphragm
(3) External oblique muscle of abdomen
The whole process of vamana requires the proper junction at gastro-oesophageal which is physiological
anti reflux-barrier. And thus, the smooth muscles of stomach wall, lower part of oesophagus & crus part of
diaphragm make this barrier. These structures work to exert a radial pressure over this barrier, during the

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vamana process this anti reflux process have to be lowered in order to expulse from stomach to oesophagus
to oral cavity.

Neural Pathways
 Both pathways (peripheral &central) lead to the vomiting centre, a network of neurons located in
the region of the brain known as the nucleus tractus solitarius (NTS), which ultimately coordinates
the physical manifestation of vomiting.
 Stimulation for vomiting further lead to autonomic motor reactions which send motor impulses to
the cranial nerves 5th, 7th , 9th , 10th , 12th& then towards the GIT.
 Also, spinal nerves involved to retch the abdominal muscles & diaphragm muscle to final produce
the emesis.

DISCUSSION: -
 Due to the gunas (i.e. Properties) of Vamana dravayas, they get absorbed sublingually and travel to
whole body without going through the process of digestion. Then they separate aggravated sticking
doshas and bring them back to central lumen or gastro-intestinal tract. Since these herbs (vamana
dravyas) are composed of air and fire element, they expel doshas from upper part of the body through
mouth with action of vomiting2.
 The properties of Vamana dravyas are – Ushna , TIkshna , Sukshama, Vyavayi , Vikasi & saratva ;
which stimulates the Udan vayu to go upward direction3.
 Udan vayu has the primary role in initiating and completing the process of Vamana itself.
 Vomiting center receives stimulation from 4 major areas5: -
(1) GI tract – Gastrointestinal Tract – irritation of mucosa of upper git is strong
stimulation for vomiting, irritation of duodenum provides strongest stimulus.
(2) Ctz - Chemoreceptor trigger zone;
Location – 4th ventricle (outside Blood Brain Barrier- BBB)

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Chemoreceptor cell initiate vomiting when they are electronically stimulated by certain circulating
chemicals and drugs (i.e. morphine, amorphine, digitalis derivatives etc.)
Clinicalanatomy- destruction of this area inhibits vomiting but doesn’t inhibit vomiting due to
irrigative stimulation of upper git
(3) Vestibular apparatus
(4) Higher cerebral cortex (smell, taste, memory, pain, fear)

Vomiting center5
 Location – situated bilaterally in medulla oblongata near tractus solitaries.
The sensory impulses from the irritated part of git or other organs are transmitted to vomiting center
through vagus and sympathetic nerve fibres
The motor impulses causing act of vomiting are transmitted from vomiting centre through
5th,7th,9th,10th,12thcranial nerves to upper part of Gi tract and through spinal nerves to diaphragm and
abdominal muscle.

CONCLUSION; -
 The complications due to hina (Hypo effect), ati (Hyper effect) and mithya (Adverse effect) yoga of
vamanakarma were described in Ayurveda which directly implicate that these complications occur
in GItract, respiratory system and cardiovascular system. (i.e. excessive emesis causing metabolic
alkalosis, hyper ventilation, tachycardia, dehydration etc….) so these can be also led to sudden
death. However, vomiting centre lies in medulla next to respiratory and cardiovascular centre6.
 Physical & mental stress caused by act of vamana damages secondary to mucosa of stomach wall &
oesophagus as well which is an actual result of marked increase in ACTH secretion by the anterior
pituitary gland and simultaneously increases in Adreno-cortical secretion of cortisol5.
 Decoction used for vamana karma also causing the damage to mucosal layer of stomach wall as
well. This physio-anatomical aspect of vamana karma is illustrated the modern view of act of
therapeutic vomiting as cortisol resolves the inflammation of stomach wall.
 The knowledge of physio-anatomical aspect of Vamana karma is required to lower and to manage
the complications of Vamana karma (hina, mithya & ati)

REFERENCES:

1. Shastri A, editor,(14th ed.). sushrut samhita ofsushrut; chikitsha sthan; vamanvirechan

sadhyaupadrava chapter 33,Verse 8 Varanasi: Chaukhamba
Sanskrit sansthan 2003; p 142-143
2. Sushruta . Sushruta Samhita, Chikitsa Sthana, Vaman Virechana Vyapat Chikitsa Adhyaya,
33/4. 2nd ed. Varanasi: Krishandas Academy; 1985. Hindi commentary by Shastri Shambhunath
Pandey; p. 448.
3. Agnivesha . Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Tasyashitiya Adhyaya, 6/19-
20. 18th ed. Varanasi: Choukhamba Bharti Academy; 1992. Hindi commentary by Shri Pandit
Kashi Nath Shashtri;
4. Vagbhata . Ashtanga Hridayam, Sutra Sthana, 18/60. 3rd ed. Varansi: Choukhamba Sanskrit Series;
1962. Hindi commentary by Kaviraj Shri Atridev Gupt; p. 161.

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 Vol. 3, Issue-04 (2019), ISSN: 2456-8279 Siddharth K. Roy et al JIF: 1.021 IPIF:2.54

5. Kasper, fauci ,hauser , Harrison’s Principles of Internal Medicine, 19th ed., Macgrew Hill education,
p. 258
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665106/

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