Physiological and biochemical changes with Vamana procedure.

Vamana Karma (therapeutic emesis) primarily a Samshodhana Karma (purification procedure) is one of the five Pradhana Karmas (chief procedures) of Panchakarma. It is mentioned in Ayurvedic texts that a person after Samyak Vamana (proper Vamana) experiences lightness of the body, Hrit (precordium), Kantha (throat/voice), and Shirah (head) and weakness. This procedure is effectively used in healthy and ailing persons for purification of body and extraction of Doshas (especially Kapha) in Ayurvedic system. It has been found worth to observe the physiological and biochemical changes during Vamana and after the procedure to understand the effect/safety margins of the procedure in healthy volunteers.

Introduction

Vamana and Virecana are mainly used for extraction of vitiated Doshas from the body.[1] If the Vamana procedure is adopted properly, lightness of the body, clarity of precordium (Hridya), throat (Kantha) and head (Shirah), happiness and weakness are the usual symptoms following Samyak Shuddhi (proper purification).[23]

It is also mentioned that the person undergoing Vamana never develops[4] Kasa (cough), Malavriddhi in Srotasas (accumulation of waste in body channels), Svarabheda (hoarsness of voice), Nidra (sleepiness), Tandra (drowsiness), Mukha Durgandhata (bad smell in mouth), Vishajanya Upadrava (complications of poisoning), Kapha Srava (excessive salivation or toxaemia), Grahani (malabsorption syndrome).

According to Ashtanga Hridaya, Samyak Shodhana results into[5] clarity of Buddhi (thought), strength of Indriyas (sense organs), stability of Dhatus (body tissues), improvement of Agni (appetite and digestive capacity), delay of ageing.

Considring these benefits, it is attempted to understand the physiological changes in apparently healthy volunteers during and after Vamana in terms of changes in blood pressure (BP), pulse, body temperature, respiration rate, appetite, bowel habit, heaviness of abdomen, sleep pattern and intestinal flora and the changes in biochemistry and immunological status of the body (if any). This study also evaluate the safety aspects of the procedure.

Materials and Methods

The present study is carried out at Ayurveda Central Research Institute, Delhi in collaboration with Department of Physiology, All India Institute of Medical Sciences (AIIMS) on 30 apparently healthy volunteers between the age group of 18 to 60 years.

Exclusion criteria

Patients of hypertension, diabetes, renal diseases, peptic ulcer, jaundice, acute infections, dehydration and any other chronic disease which is not suitable for Vamana Karma as detected by clinical history/investigations.

Age group: Lesser than 18 and above 60 years.

Patients with lactose intolerance.

Pregnant/lactating women.

Procedure adopted

Volunteer's written consent in Hindi was taken and information about the study was provided in information sheets on the day of registration. Physical examination along with physiological parameters were assessed before, during and after Vamana. Routine blood examinations like Total Leukocyte Count, Differential Leukocyte Count, Hemoglobin%, Blood Sugar, Kidney Function Tests, Liver Function Tests, etc. were done so as to exclude any underlying disease in the volunteers. The procedure of Vamana is as per the standard protocol prescribed in classics and adopted in earlier works.[6]

Observations

Changes in blood pressure

A rise in systolic BP has been observed in the volunteers during the procedure of Vamana. However, after completion of the procedure, systolic BP became normal. The systolic BP during Vamana ranged from 100 to 170 mmHg [Figure 1a]. A rise in diastolic BP has been observed during the procedure of Vamana. However, after completion of the procedure, diastolic BP became normal. The diastolic BP during Vamana ranged from 70 to 100 mmHg. The rise in systolic BP was more marked as compared to the rise in diastolic BP during Vamana procedure [Table 1, Figure 1b].

Figure 1a

The levels of systolic blood pressure before Vamana, during Vamana and after Vamana

Table 1

Change in blood pressure

Figure 1b

The level of diastolic blood pressure at before, during and after Vamana

Changes in pulse rate

It has been observed that the pulse rate increased during the Vamana procedure and was normal after the procedure. The pulse rate ranges from 65 to 106/min during the Vamana procedure [Table 2, Figure 2].

Table 2

Change in pulse rate

Figure 2

The levels of pulse rate before Vamana, during Vamana and after Vamana

Changes in body temperature

A mild rise in temperature was noticed during the Vamana procedure and was normal after the procedure. The temperature ranged from 98° to 99°F during the procedure [Table 3, Figure 3].

Table 3

Change in body temprature

Figure 3

The levels of body temperature before Vamana, during Vamana and after Vamana

Changes in respiration rate

A mild rise in respiration rate was noticed during the Vamana procedure and was normal after the procedure. The respiration rate ranged from 16 to 26 per min during the procedure [Table 4, Figure 4].

Table 4

Change in respiration rate

Figure 4

The levels of respiration rate before Vamana, during Vamana and after Vamana

Effect of Vamana on appetite

There was an improvement in appetite of the volunteers after Vamana. Before Vamana only 40% volunteers showed good appetite while after Vamana 73.3% of the volunteers showed good appetite. The volunteers with poor or irregular appetite reporated improvement in their appetite. The improvement in appetite was significant [Table 5].

Table 5

Effect of Vamana on appetite

Effect of Vamana on bowel habits

There was a marked improvement in the bowel habit of the volunteers after Vamana. Only 50% were having regular bowel habit with normal consistency before Vamana, but after Vamana 76.7% showed regular bowel habits with normal consistency. Volunteers with hard, loose consistency stool and irregular timings of bowel evacuation showed improvement in their symptoms. There was significant improvement in bowel habit [Table 6].

Table 6

Effect of vamana on bowel habits

Effect of Vamana on heaviness in abdomen after food

There was significant reduction in complaint of heaviness of abdomen after Vamana. Before Vamana 53.3% of the volunteers complained of heaviness of abdomen after food but after Vamana only 20% of the volunteers were having this complaint and rest of the 80% volunteers had no symptom of heaviness of abdomen [Table 7].

Table 7

Effect of Vamana on heaviness in abdomen after food

Effect of Vamana on sleep pattern

There was a mild improvement in duration of sleep in volunteers after Vamana, however, the gross sleep pattern among most of the volunteers remained unchanged [Table 8].

Table 8

Effect of Vamana on sleep pattern

Effect of Vamana on intestinal flora

Pus cells count of intestinal flora before Vamana and 15 days after Vamana: The pus cells in stool of healthy volunteers before Vamana were within normal range. There was no change after 15 days of Vamana [Table 9a].

Table 9a

Effect of Vamana on intestinal flora (pus cell count)

Bacteroids count of intestinal flora before Vamana and 15 days after Vamana: In two volunteers, the bacteroids were present in stools before Vamana (107 and 108) which were absent after 15 days of Vamana. The changes were statistically insignificant [Table 9b].

Table 9b

Effect of Vamana on intestinal flora (bacteroids)

E. coli count of intestinal flora before Vamana and 15 days after Vamana: The concentration of E. coli before Vamana ranged from 0 to 1011 in healthy volunteers. After Vamana a mild shift in count was noticed as the E. coli count decreased, though it remained within the normal limits. The changes were statistically insignificant [Table 9c].

Table 9c

Effect of Vamana on intestinal flora (E. coli)

Effect of Vamana on hematological parameters

Hematology before Vamana and after 5 min of Vamana: Erithrocyte Sedimentation Rate (ESR) decreased significantly after 5 min of Vamana. Total Leukocyte Count (TLC) increased significantly after 5 min of Vamana [Table 10a].

Table 10a

Effect of Vamana on hematological parameters (after 5 min)

Hematology before Vamana and after 15 days of Vamana: The hematological parameters were again assessed after 15 days of Vamana and the values were compared with the parameters assessed before Vamana. A significant decrease was observed in ESR after 15 days of Vamana [Table 10b].

Table 10b

Effect of Vamana on hematological parameters (after 15 days)

Effect of Vamana on lipid profile

Changes in lipid profile before Vamana and after 5 min of Vamana: Lipid profile was assessed at the day of registration (before Snehana and Svedana). The values were compared with the results of lipid profile obtained after 5 min of Vamana. Significant increase in High Density Lipoproteins (HDL) and significant decearse in Low Density Lipoproteins (LDL) was observed. Total cholesterol was noticed after 5 min of Vamana, though the decrease was statistically insignificant [Table 11a].

Table 11a

Effect of Vamana on lipid profile (after 5 min)

Lipid profile before Vamana and after 15 days of Vamana: Lipid profile was assessed at the day of registration. The values were compared with the results of lipid profile obtained after 15 days of Vamana. It was observed that, HDL, Very Low Density Lipoproteins (VLDL), and serum triglycerides insignificantaly increased. Statistically insignificant decrease in LDL and total cholesterol was noticed after 15 days of Vamana [Table 11b].

Table 11b

Effect of Vamana on lipid profile (after 15 days)

Effect of Vamana on electrolytes

Serum electrolytes before Vamana and after 5 min of Vamana: There was statistically insignificant fall in serum sodium and serum potassium levels after 5 min of Vamana. All the values of serum electrolytes before and after Vamana were within the normal range [Table 12a].

Table 12a

Effect of Vamana on serum electrolytes (after 5 min) (n=25)

As Upadrava, only one volunteer developed Bhrama (giddiness) and there was a fall in serum electrolyte level just after Vamana, and he was managed with Oral Rehydration Solution (ORS).

Serum electrolytes before Vamana and after 15 days of Vamana: Serum sodium and serum potassium level were assessed atthe day of registration and after 15 days of Vamana. The values were compared and it was observed that there was statistically insignificant fall in serum sodium and serum potassium levels. All the values of serum electrolytes before and after Vamana were within the normal range [Table 12b].

Table 12b

Effect of Vamana on serum electrolytes (after 15 days) (n=25)

Effect of Vamana on Liver Functional Test (LFT) and Renal Functional Test (RFT)

Liver Functional Test (LFT) and Renal Functional Test (RFT) before Vamana and after 5 min of Vamana: LFT and RFT were assessed before Vamana and after 5 min of Vamana. It was observed that Blood Urea Level (BUL) decreased significantly. Total serum protein and serum creatinine decreased insignificantly. Serum Glutamic Oxaloacetic Trasminase (SGOT), Serum Glutamic Pyruvic Trasminase (SGPT) were found to be increased significantly though all the values were within normal range. Serum bilirubin increased insignificantly [Table 13a].

Table 13a

Effect of Vamana on liver function test and renal function test (after 5 min)

LFT and RFT before Vamana and after 15 days of Vamana: LFT and RFT were assessed before Vamana and after 15 days of Vamana. It was observed that BUL, total serum protein and serum creatinine decreased insignificantly. SGPT, serum bilirubin were found to increase insignificantly. SGOT was found to increase significantly though all the values of above parameters were within the normal range [Table 13b].

Table 13b

Effect of Vamana on liver function test and renal function test (after 15 days)

Effect of Vamana on immunological status

Immunological status before Vamana and after 5 min of Vamana: Biochemical investigations were performed before Vamana and after 5 min of Vamana. It was observed that plasma histamine and plasma adrenaline decreased insignificantly. Plasma dopamine and plasma nor-adrenaline increased after 5 min of Vamana insignificantly [Table 14a].

Table 14a

Effect of Vamana on Immunological status (after 5 min)

Immunological status before Vamana and after 15 days of Vamana: Biochemical investigations were performed before Vamana and after 15 days of Vamana. It was observed that plasma histamine and plasma adrenaline decreased insignificantly. Plasma dopamine and plasma nor-adrenaline increased after 15 days of Vamana insignificantly [Table 14b].

Table 14b

Effect of Vamana on immunological status (after 15 days)

Effect of Vamana on IgE

There was insignificant increase in Immunoglobulin E (IgE) level when compared before Vamana with just after 5min Vamana and 15 days after Vamana [Table 15].

Table 15

Effect of Vamana on IgE

DISCUSSION

Panchakarma procedures are also recommended in healthy individuals in Ayurvedic classics. It is important to understand the physiolological, biochemical and immunological changes in the healthy volunteers. The present study was carried out on 30 apparently healthy volunteers, between the age group of 18 and 60 years to observe the changes during and after Vamana procedure.

Volunteers with lactose intolerance were excluded as milk was used in this study. Pregnant and lactating mothers were also excluded from the study because of physiological variations and specified Do's and Don'ts for them.

The physiological parameters were assessed before, during and after Vamana. Rise in systolic and diastolic BP, pulse rate, temperature and respiration rate were noticed during the Vamana procedure which may be attributed to the sympathetic system involvement caused by physiological stress.

There was an improvement in appetite (Agni) of the volunteers after Vamana. Volunteers with poor or irregular appetite showed improvement. Volunteers with hard, loose consistency of stool and irregular timings of bowel evacuation showed improvement in symptoms. Maximum volunteers developed regular bowel habit with normal consistency of stool after Vamana. Improvement in heaviness of abdomen after Vamana was also observed. This may be due to Shodhana of Kapha and Pitta and improvement of Agni. As the obstruction caused by Kapha and Pitta were reduced, Vata in Pakvashaya was also regularized resulting in regularized bowel habits. There was an improvement in duration of sleep in volunteers after Vamana.

The intestinal flora was studied before Vamana and 15 days after Vamana. The pus cells (0-2/hpf) and E. coli (104 -1011) were within the normal range before Vamana and 15 days after Vamana. In few volunteers, the bacteroids (107 -108) were present before Vamana and were absent after 15 days of Vamana. This indicates that the Vamana is a cleansing procedure which does not disturb intestinal flora as such.

ESR decreased significantly after 5 min, as well as, after 15 days of Vamana. TLC increased significantly after 5 min of Vamana. There was a fall in plasma electrolyte, BUL and serum creatinine levels but, all values are within physiological limits.

Significant fall in plasma adrenaline, plasma histamine and insignificant increase in plasma dopamine and plasma nor-adrenaline was observed in the volunteers after Vamana.

Conclusion

Thus, it can be concluded that, Vamana is a safe Panchakarma procedure if undertaken methodically. It is a cleansing process that improves appetite, regulates bowel habits and improves sleep pattern. It decreases LDL and serum cholesterol level as a part of its Kapha-Hara action. Mild elevations in BP (systolic and diastolic), pulse, temperature and respiration during the Vamana procedure may be attributed to sympathetic stimulation. Thus its use in hypertensive subject may be avoided. It improves appetite and regularizes bowel habits. It also gives some relief to the feeling of heaviness of abdomen after taking food. It shows a mild cleansing action on intestinal flora, however, the bacteroids and E. coli remain within normal limits after Vamana.