Vamana is one of the least understood of Ayurveda’s five elimination therapies. Most people associate emesis or vomiting with nausea and sickness and are repulsed by it. As some of my patient’s have said, “Just the thought of vomiting makes me vomit!” However, the emesis procedure used in vamana is quite smooth and painless, with little or no nausea, retching or discomfort.
This procedure for discharging excess kapha and kaphic ama was designed to be accomplished with great ease. When the body is properly prepared and the treatment correctly administered, vamana is effortless, and effectively removes toxins from the kapha zone.
The herbs used to produce the emetic effect provide the main keys to successful vamana. These herbs, such as yashti madhu (licorice) and madan phal (Randia Dymotorum) stimulate the action of agni and vayu bhuta. They are hot, strong and penetrating. Their action permeates the fine channels in the kapha zone and stirs up and liquefies the ama.
Just as fire always moves upward, the heating action of these herbs creates an upward motion which lifts ama out of kapha’s seat in the stomach.
Vamana is not for everyone. It is usually administered only for kapha-related disorders or ama. These include: all lung problems, bronchial asthma, allergies, chronic colds, rhinitis, diabetes melli-tus (prameha), arteriosclerosis, rheumatic diseases, arthritis and some chronic skin disorders like eczema, psoriasis and leukoderma. It is also beneficial for some viral disorders, like Herpes Zoster.
Vamana therapy is contraindicated for people who are emaciated or very weak, the elderly who are frail, young children and pregnant women. People with tuberculosis, pleurisy, collapsed lung, hepatitis, degenerative or cirrhotic diseases of the liver, severe heart disease and problems with blood pressure should also not undertake vamana therapy. For these people, as well as those with a severe vata imbalance, vamana may be too challenging a procedure.
Before describing the specific procedure of vamana therapy, I would like to share some experiences in my clinical practice of vamana’s, effectiveness. A man came to me with a severe skin disorder. He was covered with eruptions, oozing red patches that constantly itched. The doctors he had consulted were baffled by his condition, since it appeared to have some of the characteristics of both eczema and psoriasis. The medicines prescribed for him had a short-term, palliative effect, but the symptoms always returned. He consulted a homeopath whose treatments created some improvement, but after three months, his condition became highly aggravated and could not be controlled by any means.
When he came to my clinic, he was so miserable that he confessed he could not go on any longer. His symptoms indicated to me that he suffered from a crisis of ama toxicity. I explained Panchakarma to him and took him through the preparatory procedures. After three days of snehana and swedana, the reddish color of the skin decreased, the itching diminished and the oozing stopped. On the seventh day of the pre-procedures, even before undergoing the primary cleansing treatments, his symptoms had already abated by about eighty-five percent. We were both pleasantly surprised. After completing the shodhana karmas and the post-treatment procedures, his skin returned to normal.
Another related situation occurred in the first few years of my practice. A concerned family brought me a twenty-four year old woman with chronic allergic bronchial asthma. She had been taking steroids and using a bronchodilator for many years. Every month or two she would have an attack that required hospitalization in order to manage her symptoms. She had not been able to find anything that would bring her condition under control, and had become depressed and suicidal.
When she arrived for treatment, I found that she had been experiencing poor digestion and elimination since childhood. On my suggestion, she underwent several series of Panchakarma treatments, with an emphasis on vamana, nasya and basti. After ten months, her episodes ceased. I began tapering off her use of the steroids and bronchodilator, and after another series of treatments, she was totally free of her dependency on them. She has since married, had a baby and been leading a normal life. She learned to follow a healthy diet and lifestyle, and occasionally takes some herbs to keep her digestive agni strong and to ensure the elimination of toxins.
Proper Preparation for Vamana
To prepare for vamana, snehana and swedana (oleation and heating) is administered for seven days, after which time the patient should show signs of complete internal and external oleation. Previously we mentioned that the Ayurvedic physician confirms this by looking for a soft, shiny and slightly oily quality to the patient’s skin. He also examines the feces for a similar shiny, oily quality, as well as for increased quantity. When the dhatus get fully lubricated, the excess oil and ghee become evident through the oily smell emanating from the body and the feces. At this point, the patient is ready and vamana can be planned for early the next morning, during the kapha period.
The night before vamana is administered, the patient takes food which stimulates kapha — sweet, heavy, cool, sticky, slimy and oily foods, including yogurt, milk, bananas and urad dal (black lentil soup). They increase the volume in the stomach, and this provides the impetus for kapha-assoc’vixecX toxins to be expelled, as the stomach cannot hold the increased quantity.
Just before going to bed, the patient is given an herb to stimulate stomach secretions which further increase the volume of its contents. This herb, called vacha, has been used by Ayurveda for thousands of years for this purpose. Its energy is hot and causes the ama in the stomach to thin out. Because heat rises, vacha works in an upward direction, supporting emesis.
Patients receive small doses of less than one gram. After taking vacha, (Acoromus Calamus) they consume no additional food or liquid until the vamana procedure is administered. The patient is advised to refrain from most activity the evening prior to treatment and to retire early since excess activity draws away the doshic concentration from the stomach. Meditation always helps produce a calm, settled state of mind and body.
When he awakens, the patient urinates and defecates as usual, but refrains from eating and drinking. An empty stomach stimulates secretions from the surrounding tissues and encourages them to enter the stomach. The patient then receives light snehana and swedana to increase body temperature and insure that the tissues are expanded and the body’s microfine channels are dilated. Most people are unfamiliar with vamana therapy, so it is essential that the Ayurvedic physician remain with the patient to provide both technical expertise and support, as well as reassurance. As a word of caution, this is an extremely delicate procedure and should only be performed by an Ayurvedic physician specially trained in Panchakarma therapy.
Administration of Vamana
Vamana is always given early in the morning, when jala bhuta dominates the external environment and kapha dosha dominates the body’s internal environment. Normal doshic activity causes maximum watery and mucous secretions to accumulate in the kapha zone during this time, bringing kaphic toxins out of the dhatus and into the hollow spaces of the stomach. Early morning, when the greatest amount of kaphic ama is available for elimination, offers the optimum time for this process.
The procedure begins by giving the patient approximately 300 milliliters (1 1/2 cups) of a thin, sweet-tasting porridge made from wheat and milk. This promotes watery secretions, and again increases the volume of the stomach’s contents. The porridge is pleasant and soothing to the taste, and reduces the patient’s anxiety about the treatment.
After he eats the porridge, the patient receives an emesis-stimulating herb which contains a strong influence of agni and vayu bhuta. Such herbs have astringent and bitter tastes which help draw moisture and impurities into the stomach from the surrounding tissues. Classical Ayurvedic texts mention 355 such emetic substances. The fruit of the madan tree, called madan phal, is commonly used. The fruit’s dried powder is soaked in honey overnight and made into a paste. Approximately one-half teaspoon of this pleasant-tasting paste is given to the patient to lick.
To insure that the emesis is as effortless and comfortable as possible, the patient receives a large quantity of warm licorice tea, prepared as a cold infusion the night before. Licorice, or yashti madhu (Glycyrrhiza Glabbra), provides an excellent medium for moving sticky, heavy, oily impurities out from the tissues. It belongs to a class of herbs which are not converted into bodily tissue and which stimulate secretions without being absorbed into the tissues. It moves through the body, collecting substances which do not belong to the dhatus and is then excreted. Licorice begins building volume rapidly so that the patient suddenly experiences his stomach emptying smoothly, in bouts without retching. If a patient is averse to licorice, sugarcane juice or a saline solution is used.
The patient is asked to drink as much licorice tea as possible during vamana to fill the stomach completely (as much as four liters or one gallon). This helps to liquefy the contents, which facilitates their removal. Within a few minutes, the patient feels hot, his stomach churns and he begins to feel the urge to vomit. Salivary secretions fill his mouth and he spontaneously starts vomiting. The patient is encouraged to allow his stomach to empty without resisting. Vomiting comes in bouts and usually occurs smoothly, without strain. A properly prepared patient will not feel sick or uncomfortable. Vomiting is a natural reflex like defecating or sneezing, and the body does not have to exert itself unduly.
Within an hour, the entire procedure is usually finished. The substances used to induce vomiting work for thirty to forty minutes and then their effect naturally subsides. Because of the wheat porridge and licorice tea, the initial taste of the vomitus will be sweet and not unpleasant. The patient should continue vomiting until there is a bitter, sour or burning taste in the mouth. This indicates that the stomach is empty and the contents of the small intestine are now being discharged.
At this point, the urge to vomit automatically stops and the procedure ends. If some of the licorice tea has entered the small intestine, it will come out with the next few bowel movements. The patient should be told that it is not uncommon to have two or three loose bowel movements during the next twelve hours .
When the vomiting stops, the patient should rest and avoid stress as well as any physical or sexual activity for the remainder of the day. He should also abstain from food and liquids for four to five hours, after which time he can take some thin rice water. Vamana temporarily exhausts the digestive agni, so after treatment the patient needs food which is easily digestible and which will allow the digestive power to rebuild slowly.
Heart rate and blood pressure rise naturally during vamana. These should be monitored during the course of the treatment in cases where caution is necessary. The physician measures and compares the amounts of porridge and licorice tea that are ingested, as well as the vomitus that is expelled. A patient may commonly ingest three liters (about three quarts) and vomit out four liters (about four quarts). The difference represents the ama and excess kapha which have been eliminated from the body. The physician carefully observes the vomitus for color, consistency and odor, which gives him detailed information on the treatment’s effectiveness.
Vamana benefits all kapha disorders. It leaves the patient feeling light and aware. His senses function with greater clarity and precision. Patients who have suffered with nasal or bronchial congestion notice that their breathing becomes much freer and easier. With proper post-vamana follow-up, patients will also find that their digestion is greatly improved.
The body naturally wants to eliminate the toxicity which impairs its functioning, and vamana is a natural procedure to eliminate kapha-related impurities. With good preparation and administration, vamana is as effortless and as easy and spontaneous as yawning or sneezing. It uses the body’s innate mechanisms for disposing of damaging substances. As a result, the patient gains immediate relief from the symptoms produced by toxins associated with kapha.