Role of Sadyo Vamana in dental abscess (danta arbuda).

Sadyo Vamana is a type of purificatory measure mentioned in Ayurveda, which to expel the pus and morbid factors present in a dental abscess without opening it. However, Sadyo Vamana's role in fever and pus filled dental abscess has not been reported so far. I report a case of dental abscess with fever. A 24-year-old male patient with a pus filled dental abscess. His fever and dental abscess didn't respond to antibiotic and analgesic treatment for 10 days. The patient was given Sadyo Vamana (instant therapeutic emesis) to expel the accumulated pus in dental abscess without opening it. The patient got complete relief from fever and dental abscess after Sadyo Vamana. The patient not gave internal medication.

INTRODUCTION

Sadyo Vamana is the instant therapeutic emesis (purificatory procedure) conducted with out abhyantara Snehapana (internal oleation) and Sweda (sudation) in aggravated kapha conditions. It is indicated in conditions of arbuda (abscess) and nava jwara (acute fever). Sadyo Vamana is indicated in diseases of the oral cavity and throat where vitiated kapha (one of the fundamental humor) is the main doṣa.[1] Sadyo Vamana is used for instant expulsion of pus and other morbid factors accumulated in dental abscess without opening it. This article discusses a case of pus filled dental abscess with fever. Pus in the dental abscess and fever are manifested due to vitiation of kapha. Occurrence and relapse of such type of abscess is avoidable by proper administration of Sadyo Vamana, evaluating its role in abscess and in fever, understanding its mode of action and reporting such an event.

In Ayurveda, dental abscess is described as danta arbuda under the heading of danta vyadhi (dental diseases). The main symptom of danta arbuda is foul smell from the mouth, pain and swelling. Vamana (therapeutic emesis) is the best purificatory measure for urdhva jatrugata rogas (diseases of head and neck, throat) and in arbuda as the root because lies in the urdhwajatru bhaga (above the clavicle) and Instant therapeutic emesis conducted to prevent further progress.

CASE REPORT

A 24-year-old, unmarried male was presented with pus filled dental abscess inside the left cheek, severe, persistent, throbbing toothache and sensitivity to the pressure of chewing orbiting, fever, swelling in cheek, foul-smell from mouth, tender, swollen lymph nodes under the jaw and neck since 15 days. He was on antibiotic and analgesic for 10 days before being presented, but there was no relief either in fever or in dental abscess. The patient was given SadyoVamana. External oleation and sudation given locally prior to administration of emetic drug to facilitate proper expulsion of morbid factors as mentioned in Table 1.

Table 1

Procedure of Vamana

Informed consent was obtained from the patient for documenting and publication.

Routine hematology (hemoglobin, total count, differential count and erythrocyte sedimentation rate [ESR] investigations were normal. ESR was high.

Pathya: The patient was advised to eat only light, hot and easily digestible food.

Apathya: The patient was advised not to take head bath, and was advised to avoid drinking cold water and eating curds, cold food.

DISCUSSION

After Vamana, swelling, pain, fever, foul smell from mouth completely disappeared due to the elimination of vikrita kapha, pitta through oral route. Patient was not given internal medicines.

Mode of action

This may be an example for administering Vamana in abscess and associated fever. The present case shows that such resistant cases to antibiotics and analgesics are possible to be treated with Ayurvedic purificatory measures and the physicians need to use their intellect in understanding the indications of Vamana in a broader way, thus extending its applicability.

Criteria of selection of Vamana drugs: For abhyanga pūrvakarma of Vamana, Tila taila (gingelly oil) is used due to tridoṣa shāmaka properties. Due to sūkshma (minute), srotogāmi properties it reaches the minutest channels. Mukhābhyaṅga (facial massage) increases the blood circulation and helps in mobilization of the doṣas from the site of morbidity to the site of elimination.[2] Sveda karma causes liquefication of the accumulated doṣas (especially solidified kapha), helps to drain out the doṣas due to srotomukha viśodhana. This procedure of sweating also helps in the elimination of doṣas from the affected part into the amaśaya from where it is removed by Vamana.[3]

Madanaphala has tikta, kaṣāya rasa, laghu, rūksha, uṣṇa and tīkṣṇa guṇa, vyavāyī, vikasi, kaṭu vipāka, ushṇavīrya, kaphashāmaka, shothahara, srotośodhana, vatānulomana, lekhana (scraping), kaphanissaraka, shleshmahara, anti-inflammatory, antibacterial, antiviral and immunostimulatory properties.[4-6]

Vacha has laghu, a tīkṣṇaguna, kaṭu, tikta rasa, pittavardhaka, kaphavātashāmaka, srotoshodhana, lekhana, shothahara, vatānulomana, kaphanissaraka, antibacterial, anti-inflammatory and immunomodulatory properties.[7] Saindhavalavaṇam by virtue of laghu guṇapacifies the kapha, by mṛidu guṇa, it pacifies pitta and Vata. In larger doses (4-8 drachms), it is emetic.[8] Yastimadhu has tridoṣahara, vamanopaga properties. Madhu has lekhana (scraping), tridoṣahara, vamanopaga properties.[910] Thus, Vamana is selected for Shodhana (expelling the morbid factors in abscess) as the above mentioned drugs help to remove the pathology and promotes immunity.

Mode of action of Vamana

In pūrvakarma of Vamana: Abhyaṅga (oleation) and Sveda (sudation) causes mṛudutva of doṣas, vilayana (liquefaction) of accumulated doṣas, increase the local blood supply and liquefies the mucous, makes the drug absorption faster due to vasodilatation of blood vessels and increased permeability, brings the vitiated doṣas from shākhā to koshta.[11]

In Pradhāna karma: The drugs given orally enter the amāśaya (stomach), spreads to mouth, throat and remove the morbid doṣas to make srotośuddhi, and expel them through the nearest outgoing path of the body. Most of the ingredients in Vamana have kaṭu, tiktarasa, laghu, rūkṣa, tīkṣṇaguna, uṣṇavīrya, kaṭuvipāka, vatānulomana, shothahara and by srotoshodhana properties promote the expulsion of vitiated kapha and pitta from the abscess. The anti-inflammatory properties of the ingredients reduce the inflammation in the mouth, vedanasthapana and srotoshodhana properties help to provide symptomatic relief in pain and to purify the morbid factors. The antibacterial activity arrests secondary infection and prevents recurrence of the disease. Vamana shows shothahara action, sampraprtivighātana and eliminates the root cause by virtue of laghu, rūkṣaguṇa, kaṭuvipāka, tridoṣaśāmaka, lekhanakāri, bhedana and sūkshmamārgānusāri properties. Madhu directly acts on the vikriṛta kapha besides being a vehicle for the auṣdha dravya.[1112]

The drugs used in Vamana get absorbed into the oral mucosa and helps in removal of the doṣas. Thus, Vamana is the effective Shodhana procedure to eliminate the saṅga caused by vitiated kapha, pitta dosha and the rogādhiṣṭhāna is mouth, which is an ūrdhvajatru anga and danta arbuda is ūrdhvajatrugata vikāra. Vamana showed instant result in this case of dental abscess, which may be due to the elimination of vikriṛta kapha, pitta. Patient showed no recurrence of symptoms, pain after completion of treatment. This may be due to the local pathology, vitiation of doṣa.[1112]

Paśchātkarma (post-operativeprocedure): After 45 min of Vamana, Dhūmapana (medicated smoking) is given to remove the residual vitiated kapha to avoid reoccurrence after Vamana. These procedures clear the oral cavity and throat by removing the Kapha Doṣa.[13]

Such reports show the importance of the usage of the purificatory measures at Out Patient level in different types of abscesses to prevent further progress into sepsis, involving surrounding areas and creating complications. Complete expulsion of pus can be facilitated without opening the abscess, minimizing the pain. This procedure can be practiced in all types of benign tumors to prevent further progress into malignant tumors, to prevent the occurrence of tumors in persons with family history, to minimize the side-effects of chemotherapy, radiation and stress in malignancies.[1617]