Vamana (वमनम्) - Revision history

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Mode of action of vamana karma

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Vamana karma is one of the panchakarma procedure wherein there is controlled therapeutic emesis or vomiting. Vamana translates to act of vomiting, ejecting or emesis. Thus, it is a type of shodhana karma (detoxification process) in Chikitsa or treatment aspect where the doshas which are morbid are eliminated from stomach through vomiting. vamana karma is a frontline treatment protocol in the treatment of various kapha dosha related disorders. Vamana karma along with other panchakarma therapies are amongst the most known and widely used procedures not just for treatment purposes but for prevention of diseases as well and are considered as rejuvenating therapies commonly.

DEFINITION

तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम् (char. kalp.1.4)

When the morbid doshas in the body are eliminated through oral route in a controlled manner by vomiting, the procedure is known as vamana karma.

(shar. purv.4.8)

The procedure wherein undigested pitta dosha and kapha dosha are forcibly made to travel towards oral route and by there are expelled by the action of vomiting is vamana karma.

DERIVATION

(vachaspatyam)

The word “vamana” in Sanskrit is made from root word “vam” which means to eject. Suffix “lyut” is added.

Vama and lyut pratyaya together makes word vamana.

Meaning, to vomit, to expel,to move or movement.

VAMANA VIDHI (PROCEDURE)

The whole vamana therapy is divided in 3 sections,

PURVA KARMA (pre procedure/before procedure)

PRADHANA KARMA (main procedure)

PASCHAT KARMA (after procedure)

PURVA KARMA (before procedure)

It mainly includes the procedure which is supposed to done before vamana karma.

1. Collection of materials- though a very basic karma or part of process it is essential to keep the ingredients and materials required for the therapy ready beforehand.

Materials like weighing scale, measuring flask, medicines for management of any complications, dravya or drugs to be used for vamana karma etc.

2. Assessment of patient – there is consideration of few aspects in patient or individual before vamana karma. Whether the individual is vamya(indicated for vamana) or avamya(contraindicated for vamana). Ashta vidha pariksha or 8 factors of examination (bowel,bladder etc). dosha and bala(strength) of patient.

3. Dosage – according to acharya charaka the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in one hand’s fist. (char. kalp.1.14). there is also one another pramana or measurement mentioned by commentators of ashtanga hrudaya, that the dosage should be considered according to individual’s strength and the disease affected, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely if koshta or digestive ability of individual is mrudu(weak) then the matra(dose) of drug or dravya is alpa(small) if koshta is madhyama(medium) then matra(dose) is also madhyama(medium) if koshta is krura(strong) then matra(dose) will be uttama(high). (asht. hrud. sutr.18.14)

4. Diet before vamana karma- diet starts from the day of snehapana (oral administration of ghee or oil). Individual is advised to take food which are liquid in consistency, ushna (hot) in potency and which is abhishyandi (heavy and slimy, eg;curd), should not be unctuous and should be clean.(asht.sutr.16.25).

Patients who are old, very young, have low strength or are weak, and are afraid of vamana karma, to them Yusha(water in which various pulses have been boiled), sugarcane juice, milk, meat soup etc should be given.

Pachana karma (improving digestion) is an essential purva karma to avoid complications.

5. Snehana and swedana(fomentation) - oral administration of Sneha (ghee or oil) is given for a period of 3-7 days according to the condition, disease of the individual in increasing order according to the digestive ability of the individual.

Later, on the day of completion of snehapana, abhyanga (oil massage) is done for 2-3 days followed by swedana(fomentation) until the day of vamana karma. (char. kalp.1.14)

Every pre procedure plays an important role in the whole vamana karma, thus, in a nutshell with snehapana, there is aggravation of the doshas in the body and when abhyanga and swedana is done these doshas are moved from the affecting area to stomach, then with the help of vamana dravya these doshas are expelled out from the body through controlled vomiting.

6. Manasaupchara(counselling) – individual or patient must be well acknowledged about the procedure beforehand. To keep the patient in good mental health, patient is required to have a good sleep, overhead bath, worn clean clothes, worshiping god, brahmin, Vaidya(physician). Thus, a happy and calm atmosphere must be created.

PRADHAN KARMA

1. Vamana dravya (emetic drug) is administered which is based on the above assessment and differs with everyone. The patient is made to sit on a comfortable and relaxed chair. Just before administration of vamana dravya milk, curd, decoction of yashtimadhu (glychirhyza glabra) etc is given to elderly and very young patients, boiled pulses soup(yavagu) mixed with ghee is also given.

2. Patient must swallow vamana drug at once to avoid initial nausea.

3. After administration of drug, patient must be kept under constant observation. A large vessel must be kept ready to collect the vomitus.

4. Once the bouts of vomiting start, forehead and chest of patient must be held by nurse. Back of the patient’s is gently massaged to comfort the patient.

5. Each Vega (bout) should be observed, counted and assessed by sound, colour, taste, consistency, odour etc.

6. There are few parameters addressed by acharyas to assess the vitiation of doshas, and effects after procedure.

{| class="wikitable"
|SHUDDHI(PURIFICATION)
|PRAVARA (high)
|MADHYAMA (medium)
|AVARA (low)
|-
|VAIGIKI (number)
|8 vega(bout)
|6 vega(bout)
|4 vega(bout)
|-
|MANIKI (measurement)
|2 prastha
|1.1/2 prastha
|1 prastha
|-
|ANTIKI (end effect/product)
|Pitta(bile)
|pitta
|pitta
|}

1 prastha = 640 gm(approx.)

7. There are certain features stated by acharyas to assess whether the procedure has been done appropriately and if the doshas have been eradicated completely, which are samyak yoga(appropriate), ayoga(insufficient) and atiyoga(excess) lakshanas(symptoms) which are seen in patient or an individual. Following each feature are mentioned below in the tabular form,

(char. siddh.1.15-17)

{| class="wikitable"
|SAMYAK YOGA(APPROPRIATE)
|AYOGA(INSUFFICIENT)
|ATIYOGA(EXCESS)
|-
|On time vega(bout) initiation
|No initiation of vega (bout)
|Excessive thirst
|-
|Kapha dosha, pitta dosha, vata dosha elimination sequence
|Skin eruptions
|Delusions
|-
|Vega’s(bout) stop by itself
|Excess salivation
|Giddiness
|-
|purification of bodily channels
|Itching all over body
|Vitiation of vata dosha and its related disorders
|-
|Feeling of lightness
|Heaviness of body
|Excessive Weakness
|-
|Cleanliness of the sensory organs
|Improper cleansing of channels
|Loss of sleep or insomnia
|-
|
|rashes
|
|}

8. Individual is further observed for any kind of complications. Distension of abdomen, cutting like pain in anal region, cardiac spasms or ache, excessive discharge of any kind, blood discharge, rigidity and spasms etc. these complications can arise if the vamana karma is done inappropriately. Further treatment is given immediately in any such case. (char. sidd.6.29)

PASCHAT KARMA

It includes few dietic and behavioural restrictions and advises after the vamana karma.

1. After appropriate vamana karma patient is made to wash mouth clean with warm water and must rest in a room which is not very well ventilated or where there is not direct air

2. Dhumapana or inhalation of medicated smoke wherein the dravya or drugs are decided based on the condition of the patient. Dhumapana is essential procedure to eliminate the kapha doshas which are adhered to bodily channels locally. (sush. chik.33.11)

3. There are certain behavioural instructions stated to avoid further complications. Patient should avoid sitting or standing in one position for too long, long walks must be avoided, speaking loudly, anger, grief, exposure to excessive cold, sunlight, winds etc. excessive sexual intercourse, sleeping during daytime, staying awake late at night are few restrictions to be avoided after vamana karma.

4. Samsarjana krama meaning diet after vamana karma (rehabilitation diet) must be given upto seven days depending on the level of shuddhi(purification) that is avara(high), madhyama(medium) or hina(low) shuddhi starting from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.

5. On the first day or as a first meal, “manda” is specifically made with red variety of rice which is gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquidy in nature and helps the weak digestive ability which is present after the vamana karma.

6. For next three consecutive meals “vilepi” which is again a kind of gruel, made with red type of rice. This is semisolid in consistency.

7. After this,” odana” which is a well cooked rice made with red rice along with mudga yusha(soup from green gram)

8.

FIT AND UNFIT/ VAMANA ARHA AND ANARHA

MODERN VIEW

IMPORTANCE

ELIGIBILITY CRITERIA

← Older revision		Revision as of 10:38, 10 January 2022
Line 110:		Line 110:

	== References ==		== References ==
		+	<references />
		+	[[Category:Ayurveda]]

@@ Line 89: / Line 89: @@
 # '''Dhumapanam:''' Dhumapana (धूमपानम्) or inhalation of medicated smoke wherein the dravya or herbs to be smoked are decided based on the health of the patient. Dhumapana is essential procedure to eliminate the remnant kapha dosha which is adhered to bodily channels locally even after vamana.<ref>Sushruta Samhita (Chikitsasthanam Adhyaya 33 Sutram 11)</ref>
 # There are certain behavioral instructions stated to avoid further complications.  Patient should avoid sitting or standing in one position for too long, long walks must be avoided, speaking loudly, anger, grief, exposure to excessive cold, sunlight, winds etc.  sexual indulgence, sleeping during daytime, staying awake late at night are few restrictions to be avoided after vamana karma.
-# '''Samsarjana krama''':  (संसर्जन क्रमम्) It refers to the specific diet plan after vamana karma (rehabilitation diet) which is given from aat least 3 to 7 days depending on the grade of shuddhi (purification) happened by vamana. It is to be started from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.
+# '''Samsarjana krama''':  (संसर्जन क्रमम्) It refers to the specific diet plan after vamana karma (rehabilitation diet) which is given for at least 3 to 7 days depending on the grade of shuddhi (purification) happened by vamana. It is to be started from the same day (evening) of the procedure or on the next day morning if there is any vitiation of doshas observed and remaining doshas are yet to be eradicated.
-# On the first day or as a first meal, “manda” (मण्डम्) is ideally made with red variety of rice which is a gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquid in nature and helps the weak digestive state which is present after the vamana karma.
+# On the first day or as a first meal, “manda” (मण्डम्) is given. It is ideally made with red variety of rice which is a gruel like food preparation which is given for three consecutive meals. This kind of preparation is liquid in nature and helps the weak digestive state which is present after the vamana karma.
 # For the next 1 or 2  consecutive meals “vilepi” (विलेपी) which is again a kind of gruel, made with red type of rice is given. This is semisolid in consistency.
-# After this,” odana” (ओदनम्) which is a well cooked rice made with red rice along with mudga yusha (मुद्ग यूषम्  soup from green gram) is given for next one or three meals. Warm water is consumed during samsarjana krama.
+# After this,” odanam” (ओदनम्) which is a well cooked rice made with red rice along with mudga yusha (मुद्ग यूषम्  soup from green gram) is given for next one or three meals.
 # For the next one or three meals meat soup is given or for vegetarians simple regular diet is started. Later, the patient is expected to have a normal diet.
 In this way gradual shift in diet from rice water to normal diet helps one to regain his digestive strength which is significantly hampered in the process of vamana. Thus if one follows all the diet and other guidelines carefully can recover from illness and also prevent adverse effects of the therapy.

@@ Line 10: / Line 10: @@
 == Etymology ==
-(vachaspatyam)
+The word “vamana” in Sanskrit is made from root word “vam” which means to eject. Suffix “lyut” is added. <blockquote>वमन न० वम ल्युट् ।१ मर्दने २ छर्दने मेदि०) (Vachaspatyam)<ref>Vachaspatyam Pg 4847</ref></blockquote>Vama and lyut pratyaya together makes word vamana.
 Meaning, to vomit, to expel, to move or movement.
 == Indications for Vamana Karma ==
@@ Line 105: / Line 97: @@
 == Mode of action of vamana karma ==
-Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principal present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.<ref>Principles and practice of panchakarma, Dr. Vasant C. Patil , Chaukhamba publications 5<sup>th</sup> edition chap 11<sup>th</sup> pg 340-345</ref>
+Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principle present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.<ref>Principles and practice of panchakarma, Dr. Vasant C. Patil , Chaukhamba publications 5<sup>th</sup> edition chap 11<sup>th</sup> pg 340-345</ref>
 In a nutshell, vomiting in modern view is a cascade of events which leads to expulsion of upper gastrointestinal contents.
 == Therapeutic considerations ==
-Vamana is advised even prophylactically in Vasant rutu where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in chaitra month of hindu calendar which is mid-March to mid-April.   (char. Sutr.10.46)
+Vamana is advised even prophylactically in Vasant [[Rutucharya (ऋतुचर्या)|rutucharya]] where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in Chaitra month of hindu calendar which is mid-March to mid-April.<ref>Charaka Samhita (Sutrasthanam Adhyaya 10 Sutra 46)</ref>
-Dashavidha(10 fold examination parameters) and astha vidha pareeksha (8 fold examination parameters)  alongside modern clinical parameters, like respiratory system examination, Gastrointestinal Tract examination, Cardiovascular examination etc. also B.P, temperature, pulse etc before and during vamana karma.
+Assessment of the patient before Vamana includes Dashavidha (10 fold examination parameters) and astha vidha pareeksha (8 fold examination parameters)  alongside other clinical examinations like respiratory system examination, Gastrointestinal Tract examination, Cardiovascular examination etc. Blood Pressure, temperature, pulse and other vitals are also checked before, during and after vaamana karma. In certain traditions of vaidys or at institute level, routine blood check up, ECG etc are also done before the patient is posted for vamana.
 Vamana is contraindicated in vata dosha related diseases but there can be certain exceptions also, in such cases mild vamana is indicated.
 == References ==

@@ Line 27: / Line 27: @@
 Indications for any panchakarma are mainly based on the dominance of dosha in a particular disorder and the site at which dosha provokes.  Thus, to mention few, indications for vamana karma are,
-(To/beEdited)Acute fever, diarrhoea, bleeding disorders, tuberculosis, different types of skin disorders, diabetes, tumours, cough, asthma, obesity, heart diseases, epilepsy, piles, anaemia etc. (asht. sutr.27) (char. sidd.2.10) (sush.chik. 33.18)
+* Nava jwara(Acute fever),
 == Contraindications for Vamana Karma ==
 Vamana is mainly not considered in Vata dosha predominant diseases, where body is highly emaciated, in very weak and very old individuals. Thus, to mention few,
-In infant, very old, weak, tired, hungry, excessive thirst, exhausted from lifting weights, pregnancy, suffering from anxiety, worm infestations, bleeding disorders having pathology in upper half of body etc.
+* Ati baala (In infant),
 == Vamana Procedure ==
@@ Line 82: / Line 105: @@
 == Mode of action of vamana karma ==
-Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principle present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. (NeedsCitation) From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.
+Vamana karma is not just a gastric lavage, or a pathological vomiting, it is a complete systemic cleansing of morbid Kapha dosha having widespread advantages. When vamana drug is given orally, the active principal present in the drug reaches the cell where it forces the cell to release the toxins back in the stomach. From there on the vomiting occurs. This process occurs due to the irritant action of the drugs, which leads to mild inflammation at the site of action. This in turn leads to increased permeability in the capillaries which will allow the absorption as well as excretion of the substances. The vamana drug are given in full stomach when the pyloric end of stomach is closed allowing all the activities of the vamana dravya to remain in stomach itself. At the end of process bile is seen in vomitus due to flux of antiperistalsis set during the process, which means that the pyloric valve is open, and the procedure is completed or the morbid kapha dosha has been completely expelled out.<ref>Principles and practice of panchakarma, Dr. Vasant C. Patil , Chaukhamba publications 5<sup>th</sup> edition chap 11<sup>th</sup> pg 340-345</ref>
-In a nut shell, vomiting in modern view is a cascade of events which leads to expulsion of upper gastrointestinal contents.
+In a nutshell, vomiting in modern view is a cascade of events which leads to expulsion of upper gastrointestinal contents.
 == Therapeutic considerations ==
-Vamana is advised even prophylactically in Vasant [[Rutucharya (ऋतुचर्या)|rutucharya]] where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in chaitra month of hindu calendar which is mid-March to mid-April.   (char. Sutr.10.46)
+Vamana is advised even prophylactically in Vasant rutu where kapha dosha is seen in prakopa awastha (exaggerated). Mainly in chaitra month of hindu calendar which is mid-March to mid-April.   (char. Sutr.10.46)
 Dashavidha(10 fold examination parameters) and astha vidha pareeksha (8 fold examination parameters)  alongside modern clinical parameters, like respiratory system examination, Gastrointestinal Tract examination, Cardiovascular examination etc. also B.P, temperature, pulse etc before and during vamana karma.
@@ Line 94: / Line 117: @@
 Vamana is contraindicated in vata dosha related diseases but there can be certain exceptions also, in such cases mild vamana is indicated.
 == References ==

@@ Line 6: / Line 6: @@
 Acharya Charaka has defined the process of vamana as follows,<blockquote>तत्र दोषहरणमूर्ध्वभागं वमनसञ्ज्ञकम् (Char. Samh 1.4)<ref>Charaka Samhita (Kalpasthanam Adhyaya 1 Sutram 4)</ref></blockquote>
 Meaning: When the morbid doshas in the body are eliminated through oral route in a controlled manner by vomiting, the procedure is known as vamana karma.
 Acharya Sharangadhara in his treatise Sharangadhara Samhita described that, the procedure wherein undigested pitta dosha and kapha dosha (both) are forcibly made to travel towards oral route and by there are expelled out through vomit is called as vamana karma.(shar. purv.4.8)
@@ Line 33: / Line 32: @@
 It mainly includes the procedure which is supposed to done before vamana karma.
-# '''Collection of material''': Though a very basic karma or part of process it is essential to keep the ingredients and materials required for the therapy ready beforehand. Includes oil for abhyanga, medicines used to induce vomiting, medicines required for dhumapana (therapeutic smoking post vamana) etc
+# '''Collection of material''': Though a very basic karma or part of process it is essential to keep the ingredients and materials required for the therapy ready beforehand. Includes oil for abhyanga, medicines used to induce vomiting, medicines required for dhumapana (therapeutic smoking post vamana) etc. A [[Vaidya (वैद्यः)|vaidya]] may ask patient to buy from the store or the material will be made available by the Vaidya only.
-# Materials like weighing scale, measuring flask, medicines for management of any complications, dravya or drugs to be used for vamana karma etc.
+# '''Assessment of patient:''' there is consideration of few aspects in patient or individual before vamana karma. Whether the individual is vamya (indicated for vamana) or avamya (contraindicated for vamana) will be assessed by a vaudya. Ashta vidha pariksha or 8 fold examination of the patient will be conducted. [[Doshas (दोषाः)|Dosha]] and [[Balam (बलम्)|balam]] (strength) of patient will be critically analyzed and on that basis the entire vamana procedure would be planned.
-# Assessment of patient – there is consideration of few aspects in patient or individual before vamana karma. Whether the individual is vamya(indicated for vamana) or avamya(contraindicated for vamana). Ashta vidha pariksha or 8 factors of examination (bowel,bladder etc). dosha and bala(strength) of patient.
+# '''Pachana karma:''' Pachana refers to kindling digestive fire enhancing the digestive strength of the patient. Pachana is done with the help of some oral medications. This procedure prepares body to accept, digest and metabolise the oily or fatty substances which will be given before vamana. This is essential because the body is not used to accept large amount of ghee or oil orally in routine. And ghee or oil given in this stage without pachanam might cause digestive trouble or throw out the the substance as it is.
-# Dosage – according to acharya charaka the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in one hand’s fist. (char. kalp.1.14). there is also one another pramana or measurement mentioned by commentators of ashtanga hrudaya, that the dosage should be considered according to individual’s strength and the disease affected, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely if koshta or digestive ability of individual is mrudu(weak) then the matra(dose) of drug or dravya is alpa(small) if koshta is madhyama(medium) then matra(dose) is also madhyama(medium) if koshta is krura(strong) then matra(dose) will be uttama(high). (asht. hrud. sutr.18.14)
+# '''Snehapanam''': This is the most important part of purvakarma or pre procedure of vamana. Mostly a medicated ghee is given for oral consumption to a patient before starting vamana. The procedure takes minimum 3 to maximum 7 days before vamana. A Vaidya assesses the patient daily during this procedure and decides whether the snehapana should be continued by the patient on next day or to be kept on hold or to be stopped. Also a vaidya tells the dosage of medicated ghee to be taken on next day after assessment on previous day in certain cases.  The entire procedure requires careful monitoring and strict compliance to the dos and donts advised to patient. Medicated ghee and its dosage is decided according to the condition, disease of the individual an dususlaly the ghee is administered in increasing order starting from the minimal dose at the beginning.
-# Diet before vamana karma- diet starts from the day of snehapana (oral administration of ghee or oil). Individual is advised to take food which are liquid in consistency, ushna (hot) in potency and which is abhishyandi (heavy and slimy, eg;curd), should not be unctuous and should be clean.(asht.sutr.16.25).
+# '''Abhyanga and swedana:'''  Later, on the day of completion of snehapanam, [[Abhyanga (अभ्यङ्गम् )|abhyanga]] (oil massage) followed by swedanam (steam bath or fomentation) is done for 2-3 days until the day of vamana karma.<ref name=":0">Charaka Samhita (Kalpasthanam Adhyaya 1 Sutram 14)</ref>
-# Patients who are old, very young, have low strength or are weak, and are afraid of vamana karma, to them Yusha(water in which various pulses have been boiled), sugarcane juice, milk, meat soup  etc should be given.
+# '''Diet before Vamana karma:''' Diet starts from the day of snehapana (oral administration of ghee or oil) which is the chief part of pre vamana procedure. Diet differs during snehapanam and just a day before vamana procedure. During snehapanam, a patient is advised to take food only when the consumed ghee is fully digested, stomach feels light, appetite is felt. On that time easy to digest, light, simple, regular diet is to be taken. However the diet on day prior to vamana is designed specifically to aid the vamana procedure. Individual is advised to take foods which are liquid in consistency, ushna (hot) in potency and which is abhishyandi (heavy and slimy, eg; curd), should not be unctuous and should be clean.<ref>Ashtanaga Hrudayam (Sutrasthanam Adhyaya 16 Sutram 25)</ref>
-# Pachana karma (improving digestion) is an essential purva karma to avoid complications.
+# '''Water''': Patient is advised to take only warm water from the start to end of the vamana procedure.
-# Snehana and swedana(fomentation) - oral administration of Sneha (ghee or oil) is given for a period of 3-7 days according to the condition, disease of the individual in increasing order according to the digestive ability of the individual.
+# Every pre procedure plays an important role in the whole vamana karma. In a nutshell with snehapana, there is aggravation and dislocation of the vitiated doshas in the body and when abhyanga and swedana is done these doshas are moved from the distant body parts to stomach, then with the help of vamana dravya these doshas are expelled out from the body through controlled vomiting.
-# Later, on the day of completion of snehapana, abhyanga (oil massage) is done for 2-3 days followed by swedana(fomentation) until the day of vamana karma. (char. kalp.1.14)
+# Individual or patient is well acknowledged about the procedure beforehand. To keep the patient in good mental health, patient is required to have a good sleep, overhead bath, worn clean clothes, worshiping deities. Thus, a positive, happy and calm atmosphere is necessary.
 === Pradhana Karma ===
+'''Dosage of Vamana medicine:''' Dosage of the medicine used for vamana varies depending on various factors related to the patient and disease. Thus even when a standard dosage for vamana drug is mentioned it is  advised to be measured by that individual patient's hand. Acharya Charaka,  advises the dose of vamaka dravya (emetic drug) should be as much as patient can hold the drug in his hand’s fist.<ref name=":0" />  The commentators of Ashtanga Hrudayam of Vagbhata have specified the parameters on the basis of which the dosage is to be decided. They have advised to decide dosage on the basis of individual’s strength, the disease severity, and more importantly with respect to koshta (digestive ability). Koshta is one another unique and wide concept, but precisely it indicate capacity of the individual to hold the waste products of digestion inside the body.<ref>Ashtanga Hrudayam (Sutrasthanam Adhyaya 18 Sutram 14)</ref> Along with the vamana dravya, a patient might be given suitable liquids like sugarcane juice or milk or some decoction in large amount to drink so as to facilitate easy induction of vomiting and removal of accumulated doshas through that.
 Vamana dravya (emetic drug) is administered which is based on the above assessment and differs with everyone. The patient is made to sit on a comfortable and relaxed chair. Just before administration of vamana dravya milk, curd, decoction of yashtimadhu (glychirhyza glabra) etc is given to elderly and very young patients, boiled pulses soup(yavagu) mixed with ghee is also given.