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COMPARATIVE STUDY TO EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY MADHANAPHALA KALKA AND MADHANA
PHALA KSHEERAPAKA IN AMAVATA
BY
Dr. RIYAS K.A. B.A.M.S
Dissertation submitted to the Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka.
In partial fulfillment of the regulations for the degree of
AYURVEDA VACHASPATI
DOCTOR OF MEDICINE (Ayu) In
PANCHAKARMA
GUIDE:
Dr.NIRANJAN RAO. M D (Ayu) G.A.U Professor
Department of Panchakarma
CO-GUIDE:
Dr.SHREEKANTH. U M.D (Ayu) G.A.U Professor, Former Dean, H.O.D
Department of Panchakarma
DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA
S. D. M. COLLEGE OF AYURVEDA, UDUPI 2010 – 2011
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation thesis entitled “COMPARATIVE STUDY TO
EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY
MADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA IN
AMAVATA” is a bonafide and genuine research work carried out by me under the
guidance Dr. Niranjan Rao M.D (Ayu) G.A.U. Professor, Dept of Panchakarma, Co-
Guide Dr. Shreekanth U. M.D.(Ayu) G.A.U, Professor, Former Dean & Head, Dept of
Panchakarma, S.D.M.C.A, Udupi.
Date: Signature of the Candidate
Place: Udupi Dr. Riyas K.A.
Department of Panchakarma
S.D.M.C.A.,Udupi
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “COMPARATIVE STUDY TO
EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY
MADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA IN
AMAVATA” is a bonafide research work done by Riyas.K.A” in partial
fulfillment of the requirement for the degree of Doctor of Medicine in Ayurveda,
under my guidance Dr.Niranjan Rao M.D. (Ayu) GAU.
Date: Signature of the Guide
Place: Udupi. Dr Niranjan Rao M.D (Ayu) GAU Professor Department of Post graduate Studies in Panchakarma S.D.M.C.A. Udupi
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “COMPARATIVE STUDY TO
EVALUVATE THE EFFECTIVENESS OF VAMANA KARMA BY
MADHANAPHALA KALKA AND MADHANAPHALA KSHEERAPAKA IN
AMAVATA” is a bonafide research work done by Riyas.K.A under the guidance
of Dr.Niranjan Rao. M.D. (Ayu) G.A.U, Professor and Co- Guide Dr Shreekanth.U.
M.D (Ayu) G.A.U, professor, Former Dean, H.O.D, Department of panchakarma.
Signature of H.O.D Signature of Principal
Dr. Shreekanth U, M.D. (Ayu) Dr.U.N Prasad, M.D. (Ayu)
Professor, Former Dean & HOD Principal
Dept of Panchakarma SDMCA,Udupi
Date: Date:
Place: Udupi Place: Udupi
COPYRIGHT
Declaration by the Candidate
I hereby declare that the Rajiv Gandhi University of health Sciences,
Bangalore, Karnataka shall have the rights to preserve, use and
disseminate this dissertation in print or electronic format for academic /
research purpose.
Date: Signature of the Candidate
Place: Udupi Dr. Riyas.K.A
© Rajiv Gandhi University of Health Sciences, Karnataka
Acknowledgements
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and
Madhanaphala Ksheerapaka in Amavata I
ACKNOWLEDGEMENTS
On the occasion of the successful completion of this assigned dissertation work, it is with
deep sense of gratitude to the almighty for providing me smooth and successful completion of
this dissertation. I express my gratitude to my esteemed parents Mr. K.S Aliyar and Mrs.
Suhara.P.A for taking pain to bring up me to this position. I am highly obliged for their
blessings, support and sacrifice.
I most sincerely convey my thanks and gratitude to my Guide Dr.Niranjan Rao M.D. (Ayu),
Professor, and my Co-Guide Dr.Shreekanth U. M.D. (Ayu), Professor, Former Dean, H.O.D.
Department of Panchakarama, Dr.Rajalaxmi. M.D. (Ayu), Assistant Professor, Dr.Padmakiran. M.D.
(Ayu), Lecturer, for their valuable guidance, timely remarks, and helpful suggestions throughout
study.
I wish to express my sincere thanks to Principal Dr.U.N.Prasad, & Dean of P.G. Studies
Dr.Govinda Raju.
I acknowledge my sincere gratitude to my friends Dr Rahul, Dr Girija, Dr Greeshma,
Dr Prakash, Dr Nishanth for their needful help and support. I also take pleasure to thank
Dr Manu K.N. for their valuable help.
I express my sincere whole hearted thanks to my beloved seniors, Dr.Vinay kumar,
Dr.Prajwal, Dr.Sandeep, Dr.Prashanth, Dr.Avinash, for their assistance in the work, which
helped me to conduct the work smoothly. I thank my juniors Dr varun, Dr Raksha,
Dr Vignesh, Dr vishwanath, Dr shankar for their kind co-operation during the completion of this
thesis work.
I would like to thank all Library staffs for their timely help. I whole heartedly express my
thanks to all the Panchakarma hospital staffs mainly Mr.Ravi, Mr Monthu D’silva, Mr.Jayaram
and Mr.Sherif, also to all my patients who participated in this work, and Mr. Sachin Samruddi,
Udupi for their assistance in DTP.
Date:
Place: UDUPI DR. RIYAS K.A.
Abbreviations
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
II
ABBREVIATIONS OF REFERENCES
1.Cha. : Charaka Samhita
2. Su. : Sushruta Samhita
3. A.S. : Ashtanga Sangraha
4. A.Hr. : Ashtanga Hridaya
5. B.P. : Bhava Prakasha
6. M.N. : Madava nidana
7. Sha. : Sharangadhara Samhita.
8. B.S : Bhela Samhita
9. H.S. : Harita Samhita
10. Ka. : Kashyapa Samhita
11. Van. : Vangasena
12. Y.R. : Yogaratnakara
13. G.D. : GadaNigraha
14. Bhai.Rat : Bhaishajya Ratnavali
15. Nig.A. : Nighantu Adarsha
16. Su. : Sutra Sthana
17. Ni. : Nidana Sthana
18. Vi. : Vimana Sthana
19. Chi. : Chikitsa Sthana
20.K : Kalpa Sthana
21. Si. : Siddhi Stana
22. Pu. : PurvaKhanda
23. M : Madyama Khanda
24. U : UttarKhanda
Abbreviations
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
III
25. Nig. : Nighantu
26. AT1 : After deepana & Paachana
27. AT2 : After Sneha paana
28. AT3 : After swedana karma
29. AT4 : After Virechana
30. AT5 : After samsarjana krama
31. AT6 : After the follow up period
32. BT : Before treatment
33. Cm : Centimetres
34. d : Difference
35.DC : Differential Count
36. ESR : Erythrocyte Sedimentation Rate
37. CRP : C Reactive Protein
38. RA Factor : Rheumatoid factor
39.Hb : Hemoglobin
40. No. : Number
41. SD : Standard Deviation
42. SEM : Standard Error Mean
43. TC : Total Count
44. Yrs. : Years
45. MPK : Madanaphala kalka
46. MPKs : Madanaphala Ksheerapaka
Abstract
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
IV
ABSTRACT Amavata is a pain predominant joint disorder which if not managed in time may prove
crippling. Rheumatoid Arthritis is a disorder where in a lot of similarity is seen with Amavata.
Joints are precious jewels of our body and maintaining their health is like acquiring a great
treasure. The mechanical properties of these joints are related with their adequate construction.
Any slightest change in the interior constitution of these joints, hampers the disciplines of
movement. Often the joints get exploded due to wide range of causative factors during different
phases of one’s life. Amongst the derangements of joints Amavata is commonest disease.
The figures of prevalence vary substantially ranging from 0.3% to 2.1% of the population.
Indian data suggests the prevalence to be around 0.65% to 0.75% of the population. 1% to 3% of
women may develop Rheumatoid Arthritis in their life time. Around twice as many women as
men are affected. The incidence and prevalence of Rheumatoid Arthritis generally rising with
increasing age until about 70 years and then declines. About 60% of Rheumatoid Arthritis
patients are unable to work 10 years after the onset of their disease. Estimation of life span
shortening in Rheumatoid Arthritis varies from 5 to 10 years. Family history is an important risk
factor. First degree relatives prevalence rate is 2 to 3%.Amavata is a vyadhi having
Bahudoshawastha, where kapha, vata, pitta dosha are predominantly involved. Its udbhavasthana
is amashaya, vyakthastana is sandi. Vamana karma is considered as an ideal treatment for morbid
kapha, its associated condition and in kapha sthanagata doshas. In Amavata mainly kapha sthana
like sandi is affected. Langhana is considered as the prime line of treatment for amavata.
Vamana is considered under shodana variety of langhana by charaka. Here an attempt is made to
evaluate the efficacy of vamana karma in Amavata.
OBJECTIVE OF THE STUDY :
To evaluate the action of vamana karma in patients of Amavata.
Abstract
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
V
STUDY DESIGN :
It is a comparative clinical study with pre-test and post-test design where in minimum of
22 patients diagnosed as Amavata of either sex will be selected. All the patients falling in the
inclusion criteria shall be subjected to Vamana karma. Patients were subjected to deepana
pachana with vadavanala choorna 5gms with hot water before food thrice daily till amapachana.
After proper amapachna arohana snehapana with moorchitha gritha was administered till
obtaining samyak snigda lakshans(3-7days). After that they were subjected to abhyanga with
saindhavadi taila followed by bashpa sweda for two days. On the previous day of Vamana
Kaphothkleshakara diet was prescribed. Vamana was induced with Madanphala Yoga. After
Vamana Haridra dhumapana was done and proper assessments were taken. Patients were
subjected to Samsarjana krama based on their shudhi lakshanas. The assessment criteria were
noted before, during and after Samsarjana krama
RESULTS:-
• The average time taken for Samyak Snigdata was 4 days.
• The average time taken for completion of vamana karma was 43.28 minutes.
• All patients had Samyak Vamana Yoga
• 80.05% in group A and 68.56% in group B improvement seen in general symptoms of
Amavata.
Key Words: Amavata, Vamana Karma, Bahudoshawastha, Madanaphala kalka(MPK),
Madanaphala Ksheerapaka(MPKs).
TABLE OF CONTENTS
CONTENTS PAGE NO. ACKNOWLEDGEMENT I ABBERAVITIONS II-III ABSTRACT IV-V LIST OF TABLES VI-XI LIST OF FIGURES/GRAPHS XII-XIII INTRODUCTION 1 - 2 OBJECTIVES 3 PART 1 CONCEPTUAL STUDY 4 - 66 PART 2 DRUG REVIEW 67 - 87 PART 3 METHODOLOGY 88 - 102
PART 4 OBSERVATIONS AND EFFECT OF THERAPIES 103 - 195
PART 5 DISCUSSION 196 - 208 PART 6 CONCLUSION 209 - 210 PART 7 SUMMARY 211 BIBLIOGRAPHY 212 - 230 ANNEXURE
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
VI
LIST OF TABLES
SR.NO. NAME OF TABLE PAGE NO.
1 Indications of Vamana 12 2 Contraindications of Vamana 14 3 Causes behind avoiding Vamana in Avamya: 16 4 Utility of Vamana karma 17 5 Vamaka Aushadhi 23
6 Vamana Kalpa according to Caraka 23
7 Koshtha sthiti and Dose 25 8 Dosage of emitics according to Sharangadhara 25 9 According to Bhela the dosage 25 10 Sneha Prakarsha Kala 27 11 Anupanas of Sneha 28 12 Observation of Sneha Jeeryamana and Jeerna Lakshana 29 13 Samyak Snigdha Lakshanas 29 14 Asnigda Lakshanas 30 15 Atisnigda Lakshanas 30 16 Samyaka Yoga Lakhanas of Vamana 37 17 Atiyoga Lakshnas of Vamana 38 18 Ayoga Lakshanas of Vamana 38 19 Observation of shuddi lakshana 39 20 Manaki Pariksha 41
21 Laingiki criteria 41
22 Appearance of Pitta 42 23 Dhumapana with respect to doshas 44 24 Peyadi Krama 46 25 Peyadi Kalpana 46
26 Tarpanadi Krama 48
27 Rasadi samsarjana krama 49 28 Vamana vyapath 51 29 Ayoga of vamana and Upadrava in certain condition 53 30 Vamana vyapath 58 31 Lakshanas of ama 69
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
VII
32 Samanya and Pravridha Lakshanas of Ama 79
33 Classification of Lakshanas 80 34 Classification based on Dosha Bheda 82 35 Prognosis based on Doshasthiti 83 36 Triphala Kashaya 103 37 Vadavanala churna 104 38 Murchita Ghrita 105 39 Rasapancaka of saindhavadi taila 105 40 Drugs for Swedana 107 41 Rasa Panchaka of Madana phala 109
42 Yashti Madhu 112
43 Drug used for Dhumapana 114
44 Age group 125
45 Sex 125
46 Religion 126
47 Marital status 126
48 Education 127
49 Socio economic status 127
50 Occupation 128
51 Desha 128
52 Chronicity of disease 129
53 Addiction 129
54 Diet 130
55 Sleep pattern 130
56 Prakrithi 131
57 Satva 131
58 Rasa satmya 132
59 Samhanana 132
60 Sāra 133
61 Abhyavarana śakti 133
62 Jarana shakti 134
63 Vyayama shakti 134
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
VIII
64 Vaya 135
65 Koṣta 135
66 Day of attainment of Samyak Snigda Lakshnas 136
67 Samyak Snigdha Lakshanas observed on last day of Snehapana 136
68 Average amount of Ghrita required 137
69 Average Time Taken for Digestion of Sneha 137
70 Appearance of Samyak Snigdha Lakshana 138
71 Samyak Swinna Lakshana 139
72 Time taken to expel first Vega 139
73 Symptoms after Administration of Vamaka yoga 139
74 Changes observed in Blood pressure 140
75 Changes observed in the Pulse rate 141
76 Time taken to complete the process of Vamana 142
77 Average value of Vega observed 142
78 Vaigiki Shuddhi 142
79 Laingiki Shuddhi 143
80 Antiki signs & symptoms 143
81 Quantitative study showing the drug Input viz drug Output 144
82 Samyak and Asamyak Yoga (Laingiki shuddhi) 145
83 Samsarjana Krama 145
84 Changes in the weight due to Vamana karma 145
85a Effect on Sandhi sula Group A 146
85b Paired T test on Sandhi sula Group A 146
86a Effect on Sandhi shotha Group A 147
86b Paired T test on Sandhi shotha Group A 148
87a Effect of the therapy on Stabdhata Group A 149
87b Paired T test on Stabdhata Group A 149
88a Effect of the therapy on Tenderness Group A 150
88b Paired T test on Tenderness Group A 150
89a Effect on the Range of joint Movements Group A 151
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
IX
89b Paired T test on Range of joint Movements Group A 152
90a Effect of the therapy on hand grip power Group A 153
90b Paired T test on hand grip power Group A 153
91a Effect of the therapy on foot pressure Group A 154
91b Paired T test on foot pressure Group A 154
92a Effect of the therapy on knuckle swelling Group A 155
92b Paired T test on knuckle swelling Group A 156
93a Effect of the therapy on circumference of arms Group A 157
93b Paired T test on circumference of arms Group A 157
94a Effect of the therapy on circumference of forearms Group A 158
94b Paired T test on circumference of forearms Group A 158
95a Effect of the therapy on circumference of thighs Group A 159
95b Paired T test on circumference of thighs Group A 160
96a Effect of the therapy on circumference of calf Group A 161
96b Paired T test on circumference of calf Group A 161
97 Effect on general symptoms Group A 162
98a Effect on Total score of General symptoms Group A 163
98b Paired T test on General symptoms Group A 163
99a Effect on Sandhi Sula Group B 164
99b Paired T test on Sandhi Sula Group B 165
100a Effect on Sandhi shotha Group B 166
100b Paired T test on Sandhi shotha Group B 166
101a Effect of the therapy on Stabdhata Group B 167
101b Paired T test on Stabdhata Group B 167
102a Effect of the therapy on Tenderness Group B 168
102b Paired T test on Tenderness Group B 169
103a Effect on the Range of joint Movements Group B 170
103b Paired T test on Range of joint Movements Group B 170
104a Effect of the therapy on hand grip power Group B 171
104b Paired T test on hand grip power Group B 172
105a Effect of the therapy on foot pressure Group B 173
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
X
105b Paired T test on foot pressure Group B 173
106a Effect of the therapy on knuckle swelling Group B 174
106b Paired T test on knuckle swelling Group B 175
107a Effect of the therapy on circumference of arms Group B 176
107b Paired T test on circumference of arms Group B 176
108a Effect of the therapy on circumference of forearms Group B 177
108b Paired T test on circumference of forearms Group B 177
109a Effect of the therapy on circumference of thighs Group B 178
109b Paired T test on circumference of thighs Group B 179
110a Effect of the therapy on circumference of calf Group B 180
110b Paired T test on circumference of calf Group B 180
111 Effect on general symptoms Group B 181
112a Effect on Total score of General symptoms Group B 182
112b Paired T test on General symptoms Group B 182
113 Effect on Sandhi sula Group B 183
114 Comparative effect on Sandhi Sula 184
115 Comparative effect on Sandhi shotha 184
116 Comparative effect of the therapy on Stabdhata 185
117 Comparative effect of the therapy on Tenderness 185
118 Comparative effect on the Range of joint Movements 186
119 Comparative effect of the therapy on hand grip power 186
120 Comparative effect of the therapy on foot pressure 187
121 Comparative effect of the therapy on knuckle swelling 187
122 Comparative effect of the therapy on circumference of arms 188
123 Comparative effect of the therapy on circumference of forearms. 188
124 Comparative effect of the therapy on circumference of thighs 189
125 Comparative effect of the therapy on circumference of calf 189
126 Comparative effect on Aruchi 190
127 Comparative effect on malabhadhatha 190
128 Comparative effect on Angamarda 191
List of Tables
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
XI
129 Comparative effect on sadhana 191
130 Comparative effect on Alasya 192
131 Comparative effect on Anaha 192
132 Comparative effect on Trushna 193
133 Comparative effect on Hasta pada daha 193
134 Comparative effect on Jwara 194
135 Comparative effect on Shareera gaurava 194
List of Graphs
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
XII
LIST OF FIGURES / GRAPHS
SR.NO. NAME OF FIGURES / GRAPHS: PAGE NO. 1. Age 125 2. Sex 125 3. Religion 126 4. Marital Status 126 5. Education 127 6. Socio-Economic Status 127 7. Occupation 128 8. Desha 128 9. Chronicity of Disease 129 10. Addiction 129 11. Diet 130 12. Sleep Pattern 130 13. Prakriti 131 14. Satva 131 15. Satmya 132 16. Samhanana 132 17. Sara 133 18. Ahara-Abhyavaharana Shakti 133 19. Ahara- Jarana Shakti 134 20. Vyayama Shakti 134 21. Vaya 135
22. Koshta 135
23. Day of attainment of Samyak Snigda Lakshnas 136
24. Time Taken for Digestion of Sneha 137
25. Appearance of Samyak Snigdha Lakshana day wise 138
26. Changes observed in Blood pressure during Vamana 140 27. Changes observed in the Pulse during the Vamana 141 28. Samsarjana Krama 145 29. Effect on Sandhi Shoola 147 30. Effect on Sandhi shotha 148 31. Effect on Stabdhata 150 32. Effect on Tenderness 151
List of Graphs
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
XIII
33. Effect on the Range of joint Movements 152 34. Effect on Hand grip power in mm of 154 35. Effect on Foot Pressure in kgs 155 36. Effect on knuckle swelling 156 37. Effect on Circumference of Arms 158 38. Effect on Circumference of Forearms 159 39. Effect on Circumference of Thighs 160 40. Effect on Circumference of Calf 162 41. Effect on general symptoms 163 42. Total effect on general symptoms 164 43. Effect on Sandhi Shoola 165
44. Effect on Sandhi shotha 167
45. Effect on Stabdhata 168
46. Effect on Tenderness 169
47. Effect on the Range of joint Movements 171
48. Effect on Hand grip power in mm of 172
49. Effect on Foot Pressure in kgs 174
50. Effect on knuckle swelling 175
51. Effect on Circumference of Arms 177
52. Effect on Circumference of Forearms 178
53. Effect on Circumference of Thighs 179
54. Effect on Circumference of Calf 181
55. Effect on general symptoms 182
56. Total effect on general symptoms 183
Introduction
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
1
INTRODUCTION
The interaction and exchange between Loka and Purusha continues in a natural way as
the man breaths air, drinks water and consume food articles available in nature. As long as this
interaction is wholesome the man is in optimum health, when there is any set back in this
harmonious relationship the disease state ensues. Here, Ayurveda should be accepted as clinical
methodology rather than a set of fundamental principle to determine life pattern for maximum
health, vitality and harmony. The changing life style of human being by means of dietic and
behaviour pattern plays a major role in the manifestation of several disorders. Thus, this type of
pattern may also lead to the development of the disease Amavata.
The disease rheumatoid arthritis can be presented as very similar to Amavata. The disease
R.A. is chronic in nature and affects mostly the middle aged group. It is one of the common
debilitating disease by the virtue of its chronicity and implications. The onset of disease is
frequent during 4th and 5th decade of life with 80% of patients developing the disease between
35 - 50 years of age. Community prevalence study shows that female are more sufferers than
male and the ratio of occurrence between them is 3:1. It is also noted that frequency is often
associated with remission of the disease in last trimester with subsequent relapses after delivery.
The spectrum of disease that results due to Ama ranges from acute conditions like
Visuchika, Alsaka, Vilambika etc. to the chronic disorders like Amavata, Grahani and Amatisara
etc. In Amavata, Vata as a Dosha and Ama are chief pathogenic factors. They are contradictory
in nature and thus possesses difficulty in planning the line of treatment. It is mostly the disease of
Madhyama Roga Marga and having Chirkari Swabhava. Sometime it can also be manifested as
the acute case. Due to their similar mode of presentation, the disease rheumatoid arthritis can be
broadly grouped under the heading Amavata. The treatment proper is also not unidirectional, for
e.g: the antagonistic treatment of Kapha and Vāta must be carried out simultaneously,
gambiradhātu (asthi),uttānadhatu (rasa),makes the treatment more a puzzle.
Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required in
āmavāta Vamana is one such śodhana procedure fulfilling the above criteria.(Ch.Su. 16/20.)
Caraka has said that the dosas controlled by Samśamana are having the possibility of
reoccurrence while such a prospect is absent when it is managed by Samśodhana.
Introduction
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
2
Only one treatment protocol will not help to curtail the disease. The author opines that a full
planned course of śodhana measures like vamana, virecana, basti along with the use of other
external and internal treatments will help over a period of time to curb this grave disease.
The conceptual study includes three separate chapters. The historical aspect of the disease
Amavata is elaborated in the chapter on historical review. Nidana panchaka as well as treatment
of this disease is made clear in the second chapter. Madhana phala kalka and Madhana phala
ksheera paka is used for Vamana karma. Here in kapha utklishta avastha vamana is the best
treatment considered rather than other Samshodana therapies.
The details of the present research work that include material and methods, observation,
results and statistical analysis all are methodically presented in chapter entitled clinical study.
General symptoms of Amavata were decreased significantly by 80.05% in group A(madanaphala
kalka) and 68.56% in group B (madanaphala ksheerapaka). The conclusion drawn from this clinical study is listed in the final chapter summary and
conclusion.
Objectives
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
3
OBJECTIVE OF THE STUDY
To evaluate the action of vamana karma in patients of Amavata.
Conceptual Study
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
4
CONCEPTUAL STUDY Historical aspects of Vamana
Veda Kala:
Ayurveda is based on the fulcrum of Atharva Veda and is considered as its Upaveda.
Vamana was popular in Vedic period. Atharvaveda has advised to perform Vamana Karma with
Madana Phala (Randia dumatorum) in treatment of poisoning. Further, in the snake bite
poisoning, the use of Katutumbi (Lagenariasiceraria) and Dhamargava (Luffa acutangula) for
Vamana has been eluded.
Atharva Veda1 :
One of the prominent Sutra belonging to Atharvaveda i.e. Kaushika Sutra states that
emetic drug should be prescribed in case of persons injured by poisoned arrow. While referring
to the treatment of Poisoning in Visha chikitsa it has been mentioned that Madanaphala should
be used for Vamana.
Vinaya Pitaka is one of the important and popular literatures of Buddha period. In this
treatise, abundant references of Shodhana are available. Physician of Buddha named Jivaka,
performed Vamana therapy where ever necessary.
Purana Kala :
Garuda Purana :
In Garuda Purana Vamana Karma has been advised to combat all types of Kustha. Vamana
Dravya such as Dhamargava (Luffa acutangula), Madanaphala (Randia dumatorum), Indrayava
(seeds of Holarrhena antidysentrica) have been mentioned in Garuda Purana.
Agni Purana2 :
In Agni Purana, it has been quoted that Vamana is of great importance in the patients suffering
from Adhoga Raktapitta. A recipe for Vamana Karma in the form of Kwatha and Kalka of
Vamaka and Vamanopaga drugs have been mentioned. Vamana Therapy is considered as one of
the best line of treatment for disorders of Kapha.
Manu Smriti3 :
Vamana karma is explained and snana is advised after the completion of the therapy.
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Vamana In Ayurvedic Literature
There are some chapters in the Ayurvedic classics which mainly deals with either the
process of Vamana or the drug used for it. These chapters are the main source material for
Vamana Karma. Therefore only such references found in the Ayurvedic texts, which are relating
to either process or drugs used in Vamana Karma in general are being mentioned here.
Charaka Samhita
Charaka Samhita is the most important classic of Kayachikitsa. Few chapters of Sutra
Sthana, Kalpa Sthana, and Siddhi Sthana describe Vamana Karma in general, the details of
which are as follows -
A) Sutra Sthana
In first chapter of Sutra Sthana named "Dirghanjivaniya Adhyaya",4 some emetic roots
and fruits are mentioned and in the second chapter named "Apamargatanduliya Adhyaya"5 some
important emetic drugs are quoted. In the fourth chapter entitled "Shad Virechana Shatasritiya
Adhyaya"6, after mentioning the number of preparation which can be obtained from the major
Vamana drugs, the Vamanopaga Dravyas are stated. Besides these, in fifteenth chapter under the
heading "Upakalpaniya Adhyaya"7, describes broadly about different aspects of Vamana. It
enlights the information about the collection of equipment required (Sambhara Sangraha),
Process of Vamana, Dose of Madana Phala, Lakshanas produced due to Ayoga and Atiyoga of
Vamana, complications produced due to fault of physician, drugs, nurse and Patient, Dhumapana
to be done after completing the Vamana process and Samsarjana Krama with its importance.
Further in the 20th chapter the use of Vamana Karma in the Nanatmaja disorders of Kapha has
been emphasized8.
B) Vimana Sthana
In the eighth chapter of Vimana Sthana named "Rogabhisakjitiya Vimanadhyaya",9
various Vamana and Vamanopaga Dravyas are mentioned under the heading of Vamana Dravya
Kalpa Sangraha".
C) Kalpa Sthana
In Kalpa Sthana, first six chapters are devoted to describe emetic drugs. First Chapter
entitled "Madanphala Kalpa Adhyaya"10 has explicated the intricate pharmacological action of
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emetic drugs. Same chapter discuss the different Kalpana of Madanphala to be administered in
different stages of the diseases and to the patients having different body constitution. Next five
chapters are also fully devoted to discuss the Kalpana of Vamana drugs they are Jeemoothaka
Kalpa, Ikshvagu Kalpa, Dhamargava Kalpa, Vatsaka Kalpa and Krithavedhana Kalpa11,12,13,14,15
respectively.
D) Siddhi Sthana
Some verses of the first chapter entitled "Kalpana Siddhi"16 are related to Kaphakara and
Utkleshakara diet, Samsarjana Krama and its importance to increase Agni. In the same chapter
Pradhana, Madhyama and Hina Shuddhi Lakshanas are mentioned along with the Lakshanas
produced due to Ayoga, Atiyoga and Samyakyoga. Indications and contraindications are
discussed in detail in second chapter named as "Panchakarma Siddhi Adhyaya."17 Sixth Chapter
entitled "Vamana Virechana Vyapad"18 deals with Vyapad manifested due to Ayoga and Atiyoga
along with its treatment.
In addition to these references, use of Vamana while describing the treatment of
different disease in chikitsa Sthana been dealt with at length taking into consideration the stages
of that particular disease and the strength of the patients and Dosha.
Sushruta Samhita
Vamana has been dealt in detail in Sushruta Samhita. Lots of references are available in
Sutra Sthana, Kalpa Sthana and Chikitsa Sthana.
A) Sutra Sthana
Forty first chapter of Sutra Sthana named "Dravya Vishesha Vijnaniya
Adhyaya"19 describe the upward direction of emetic drugs. While fortieth chapter entitled
"Vamana Dravya Vikalpaniya Adhyaya"20 is devoted to describe Kalpanas of emetic drugs and
Kalpanas, particularly pertaining to Madana phala which is considered as one of the best emetic
drug.
B) Chikitsa Sthana
Chikitsa Sthana, thirty first chapter mentions some emetic drugs. Thirty third chapter of
Chikitsa Sthana under the heading "Vamana Virechana Sadya Upadrava"21 deals with Vamana
process, in which pharmacological action of emetic drugs is given. The same chapter also
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describes Vamana process, Kaphakara diet, Ayoga, Atiyoga and Samyakyoga of Vamana and
Dhumapana to be taken after Vamana. Along with these aspects indications, contraindications
and Shodhana measures which are to be done after Vamana have also been stated. Vamana
Vyapad has been dealt along with Virechana Vyapad, in thirty-fourth chapter "Vamana
Virechana Vyapad".22 Thirty ninth chapter entitled "Aturaupadrava Chikitsa Adhyaya"23
mentions the Samsarjana Krama to be followed after Vamana. In addition to these, various
scattered references are also available in Sushruta Samhita.
Kashyapa Samhita
Description of Vamana is given in detail in Siddhi Sthana and Khila Sthana.
A) Siddhi Sthana
The third chapter of Siddhi Sthana named as "Vamana Virechana Adhyaya"24 deals with
the process of Vamana, Hina, Madhyama and Uttama Shuddhi, regimen to be followed after
Vamana, importance of Vamana in Balaroga, Shuddhi lakshanas and Vyapad of Vamana. Its
seventh chapter explains indications and contra-indications of Vamana25.
B) Khila Sthana
In Khila Sthana "Samshuddhi Vishesiniya Adhyaya"26 mentions the Vamana process in
detail along with Samsarjana Krama.
Astanga Sangraha
Vriddha Vagbhata has mentioned one chapter in Sutra Sthana and two chapters in Kalpa
Sthana mainly for Vamana Karma.
A) Sutra Sthana
Twenty seventh chapter of Sutra Sthana entitled as "Vamana Virechana Vidhi
Adhyaya"27 gives details of Vamana process, properties of emetic drugs along with their
pharmacological actions. Apart from these aspects indication, contraindication and process of
Vamana are fully described along with Shuddhi Lakshanas in the same chapter.
B) Kalpa Sthana
In Kalpa Sthana, first chapter named "Vamana Kalpa Adhyaya"28 mentions Madanphala, as
one of the best emetic drug. In this chapter depending upon, Dosha, Dushya etc. different
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Kalpanas are discussed. Another chapter of Kalpa Sthana entitled "Vamana Virechana Vyapad
Siddhi Adhyaya"29 is fully devoted to the Vyapad..
Astanga Hridaya
Three chapters of this text describe fully different aspects of Vamana.
A) Sutra Sthana
Eighteenth Chapter of Sutra Sthana, states the process of Vamana, while the chapter of Kalpa
Sthana named as "Vamana Kalpa Adhyaya"30 gives the information about the Kalpas of emetic
drugs. Vyapad are described in third chapter, under the heading of "Vamana Virechana Vyapad
Adhyaya"31.
Bhela Samhita
A) Kalpa Sthana
It has narrated the Kalpanas of Madana Phala (Randia dumatorum), Ikshvagu
(Langenaria Siceraria), Dhamargava (Luffa acutangula) and Kutaja (Holarrhena antidysentrica)
in Kalpa Sthana33.
B) Siddhi Sthana
Siddhi Sthana provides two chapters to describe Vamana. The first chapter of Siddhi
Sthana mentions idea regarding the diet to be taken on the previous day of Vamana, dose of
decoction, expulsion of Kapha, Pitta, Vata and Rakta respectively and Lakshanas produced by
Ayoga and Samyakyoga34. Vyapad are mentioned in the fourth chapter of Siddhi Sthana entitled
"Vamana Virechana Siddhi"35.
Chakradatta
In this text, only one chapter is devoted for the description of Vamana Karma. The sixty-
ninth chapter named "Atha vamanadhikar"36 deals with the preparation of patient and process of
Vamana. Different Vamana Dravyas and their Kwatha are mentioned along with Lakshanas
produced due to Atiyoga, Ayoga and Samyakyoga, Samsarjana Krama, indication and
contraindication are also described. It is mentioned that Prastha in Shodhana chikitsa should be
considered as thirteen and half Palas.
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Harita Samhita
No Separate chapter is devoted for the description of Vamana in Harita Samhita available
now a days. However Vamana is advised as line of treatment at many places in different
disorders37.
Sharngadhara Samhita
A) Purvakhanda
Definition of Vamana is given in the fourth chapter of Purvakhanda38.
B) Uttarkhanda
In the third chapter of Uttarkhanda39, Vamana Karma has been described in detail. The
process of Vamana for children, emaciated (Krisha), aged (Vriddha) and delicate (Sukumara)
person is mentioned. In this chapter the indications, contraindication, doses of Kalka and Kwatha
are stated; management of Vyapad caused by Atiyoga and Ayoga, prescribed diet to be taken,
diet to be restricted are also mentioned in this chapter of Uttara Khanda.
Vangasena
One separate chapter entitled "Vamana Adhikara Adhyaya"40 has been devoted in
Vangasena. In this chapter indication, contraindications, proper season for Vamana, preparation
of patient, process of Vamana, some emetic decoction and symptoms produced due to over and
under administration of Vamana are dealt with. The use of Nasya along with Dhumapana has
particularly been mentioned to remove the Doshas after Vamana.
Bhavaprakasha
A) Purvakhanda
Sixth chapter named "Mishraka Prakarana Adhyaya" in Purvakhanda deals with the
definition, proper season for Vamana, indications, Contraindications, preparation of patient and
importance of Kapha Utkleshakara diet, madhu and saindhava in the emetic preparation, Hina,
Madhyama and Uttama Shuddhi lakshanas; over and under administration of Vamana and its
treatment are also described. In addition the specific diets which are to be given and not to be
given after Vamana have also been explained in this chapter41.
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Yogaratnakara:
A) Poorvardha
It has explained about vamana kala, Indication, contraindication, doshanusara karma, brief
description of vamana42
Definition
iÉ§É SÉãwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉxÉÇ¥ÉMüqÉç || (Ca Ka 1/4)43
Charaka defined Vamana as a process in which waste products or Toxins (Dosha) are
eliminated through upper channels i.e. mouth.
uÉqÉlÉÇ vsÉãwqÉWûUÉhÉÉqÉç ||
qÉSlÉTüsÉÇ uÉqÉlÉ AÉxjÉÉmÉlÉ AlÉÑuÉÉxÉlÉ EmÉrÉÉåÌaÉlÉÉqÉç || (Cha su 25/40)44
As per as expulsion of Shleshma is concerned Vamana is the Agroushadha &
Madanaphala is best drug to produce Vamana.
AmÉYuÉÇ uÉqÉlÉÇ SÉãwÉÇ mÉcrÉqÉÉlÉÇ ÌuÉUãcÉlÉqÉç|
ÌlÉWïûUã²qÉlÉxrÉÉiÉ: mÉÉMüÇ lÉ mÉëÌiÉmÉÉsÉrÉãiÉç || (Cha Ka 12/62)45
Vamana is one such procedure which expels the Apakva Dravyas therefore one should
complete the procedure before the drug attains Paka Avastha.
AmÉYuÉ ÌmɨÉvsÉãwqÉÉhÉÉÇ oÉsÉÉSÕkuÉïÇ lÉrÉããiÉÑ rÉiÉç |
uÉqÉlÉÇ iÉÌ® ÌuÉ¥ÉãrÉÇ qÉSlÉxrÉTüsÉÇ rÉjÉÉ || ( Sha.sam.p 4/ 8)46
Vamana is a process in which Apakva Dravyas are removed forcefully through upper
channels by the act of vomiting.
The above mentioned definitions conclude following aspects:-
a) Route of Expulsion- ‘Urdhva’- refers to Mouth
b) Way of Expulsion-‘Balaat’-Prabhava suchaka – Forceful Expulsion
c) Dosha Expelled – Kapha / Kapha-Pitta
d) Phase of the Dosha- Apakva Avastha- Its of 2 types
1)Pitta Apakva avastha
2)Kapha Apakva avastha
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Pitta Apakva avastha47- Apakva of pitta refers to Vidagdha avastha where pitta attains Amli
Bhava & such pitta leads to symptoms like Tikta-Amlodgara leading to Vidagdhajeerna &
Vamana is the Vyadhi pratyanika chikitsa in case of Vidagdhaajeerna.Even in case of Amlapitta
the Ushna & Amlaguna of pitta is increased because of Vidagdha Avastha (Ma.ni.II/51.1).
Kapha Apakva avastha- Mainly refers to Kaphotklishta Avastha. Features like Hrulasa, Praseka,
Gaurava Hrutpida etc & Utklishta Kapha is the essential fator in case of Vamana.
e) Fate of the Drug48: According to adamalla Apakva specifies to fate of the drug. The drug
produceses Vamana by its vyavaee vikasi & Prabhava nature atlast before it gets digested it will
be expelled out. So Muhurta is the Kalaavadhi for vamana, if delayed it may lead to
complications.
f) Phase of Dosha & Anna49: As per the gudarthadipika commentary vamana helps to expel the
Apakwapitta, Apakwa kapha & Apakwa anna.
Synonyms For Vamana :
Samsodhana. Sodhana, Virecana, Vireka, Chardi, Chardana, Vami, Ullekhana, Lekhana.
Vamana Guna:
“uÉqÉlÉÇ iÉÑ xÉuÉÉãïmÉ¢üqÉãprÉÈ vsÉãwqÉÍhÉ mÉëkÉÉlÉiÉqÉÇ qÉlrÉliÉã ÍpÉwÉeÉÈ ||” (Cha.su 20/19)
Vamana karma is the first measure amongst Panchakarma, has been considered as the
best line of treatment for the Kaphaja disorders.
“vÉUÏUeÉÉlÉÉÇ SÉãwÉÉhÉÉÇ ¢üqÉãhÉ mÉUqÉÉæwÉkÉqÉç|
uÉÎxiÉÌuÉïUãMüÉã uÉqÉlÉÇ iÉjÉÉ iÉæsÉÇ bÉ×iÉÇ qÉkÉÑ||” (A.Hr.Su 1/14)
Vagbhata also repeated that Vamana is the most ideal treatment for morbid Kapha.
Sushruta asserts that just like the flower, fruit and branches which are destroyed at once as soon
as the mother tree is rooted out, the disease originated due to excessive Kapha are subdued after
the elimination of Kapha through the process of Vamana.
VAMANA KARMA – ONE AMONG CHATUSH PRAKARA SAMSHUDHI
Charaka explains that Vamana is Shodana procedure under the heading of “Chatush
Prakara Samshudhi”50. This procedure is capable to expel the Shareeragatha Doshas.
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While differentiating the major procedure from the minor procedures Chakrapani clearly
elaborate Vamana etc procedures capable to do.
1. Bahudosha Nirharana51
2. Bahu iti Kartavyata51
Bahudosha Nirharana: Indication of the Vamana clearly shows the procedure having
definite impact on Kapha and associated Kapha conditions so Acharyas are explaining the
conditions like Utkristha Kapha, Pitta Samsristha Kapha, Pitta- sthanagata Kapha, Pitta, Vata
condition etc.
Bahu iti Kartavyata: Here Chakrapaani may be keeping the meaning that benefit of the
Vamana in different aspect that is Vamana is Shodhana, Shamana, at the same time it is
Rasayana also.
INDICATIONS OF VAMANA:
Vamana is indicated in cases of Bahudoshavasta e.g-Prameha, Kusta etc.
In case of morbid aggravated kapha in their own seat.e.g kasa,swasa etc
In case of kapha combined with pitta
In case of kaphastanagata vata and pitta.
In general it is indicated in disease where we need shodana.e.eg-unmada,apasmara.etc
In disease where prathimargahara shodana told e.g-adhoga raktapitta.
In kaphapradhana vyadhis.
INDICATIONS OF VAMANA: 52,53,54,55,56,57
Table No: 1
Diseases Cha SU A.H A.S SHA.S V.Se
Pinasa + + + - + -
Kustha + - + + + +
Nava Jwara + + + + + +
Rajayaksma + + + + - -
Kasa + + + + + +
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Swasa + + + + + +
Galaganda + - - + - -
Galagraha + - - - - -
Slipada + + + + + +
Prameha + - + + + +
Mandagni + + - + + -
Viruddajeerna + + - + + -
Visuchika + - - + - -
Alasaka + - - + - -
Vishapeeta + + + + +
Adoga raktapitta + + + + - -
Murcha + + + + - -
Hrullasa + + + + + +
Aruchi + + + + + -
Avipaka + - - + - -
Apachi + - - + - -
Granthi - - - + - -
Apasmara - + + + - -
Unmada - + + + - -
Atisara + + + + + -
Pandu + - - + - -
Mukhapaka + + - + - -
Stanyadusti + + + + + -
Arbuda - - + + + -
Vidarika - + + -
Medoroga - + + + + -
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Hridroga - + - - + -
Visarpa - + + + + -
Chitta Vibhrama - + - - - -
Vidradhi - + - - - -
Kantapaka - + - - - -
Karma srava - + - - - -
Adhi jihwika - + - - - -
Galasundhika - + - - + -
Kaphadikya + + - + + -
Pittaja roga - - - - - +
Asroja roga - - - - - +
Urdwajatru
roga
- - - - - +
CONTRAINDICATIONS OF VAMANA:58,59,60,61,62,63
Here maily diseases like Hrdgraha, Udavarta etc seen.
Some individuals who are emaciated weak,aged,
The disease involving marma sthana.
Disease having similar gati to that of vamana.e.g-urdvaga raktapitta.
Table No:2
Diseases Cha SU A.H A.S SHA.S V.Se
kshataksheena + + + + + +
Ati Sthula + + + + + +
Ati Krsa + + + + + +
Ati Baala + + + + + +
Ati Vriddha + + + + + +
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Sukumara + - - + - -
Kshyama + - - - - -
Durbala + + + + - -
Sranta + + - + - -
Ksudhita + + + + + -
Pipasita + + + + - -
Karmahata + - - - -
Bharavahaka + - - + - -
Upavasita + - - + - -
Maithuna
Prasakta + - - + - -
Adhyayanakala + - - + - -
Garbhini + + + + + +
Vyayama
prasaktha + - - + - -
Chinta
prasakta + - - + - -
Samvrita kosta + + + +
Duschardana + + + + +
Krimi kosta + + + + +
Urdvaga
raktapitta + + + + + -
Urdva vata + + + + -
Asthapita + + + + + -
Anuvasita + + + + - -
Hrdroga + + + + - -
Udavartha + + + + + -
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Mutraghata + + + + - -
Pliha roga + + + + - -
Gulma + - + + + +
Udara + + + + + +
Ashteela + + + + - -
Timira + + + + + +
Shankaka + + - + - -
Siraha shoola + - - + - -
Arsha - - + + - +
Parshva shoola - - + + - -
Navamaya - - - - - +
Pandu - - - - - +
Abhigata - - - - - +
Atirooksha - - - - - +
Ardhita - - - - - +
Akshepaka - - - - - +
CAUSES BEHIND AVOIDING VAMANA IN AVAMYA: 64
Table No: 3
Sr.
No. Avamya Causes for Contra-indication
1. Ksataksina Due to excess strain profuse haemorrhge may
occur.
2. Ksheena, Atisthula, Krisha, Bala, Vriddha, Durbala
Unable to tolerate the procedure, may lead danger
to their lives or cause death.
3. Shranta, Pipasita, Kshudita, Similar afflictions.
4. Persons broken by constant labour, load lifting and
way-faring, weakened by constant fasting, sexual
Vayu gets aggravataed, haemorrhage or Injury to
lungs.
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indulgence, study, exercise and worry
5.
Garbhini
Complications of pregnancy, abortion of immature
fetus and incidence of severe diseases.
6.
Sukumara
Due to strain in his heart severe haemorrhage may
take place through upper and lower routs.
7.
Samvrita koshta
Morbid doshas get stimulated but not eliminated,
accumulate in the alimentary tract and causes
internally acute spreading affections, stasis,
dullness, fainting or even death.
8. Urdhwaga Raktapitta, Prasakta Chardha It may provoke Udana Vata and take away the life
or cause profuse bleeding.
9 Urdhva-Vata, Anuvasita, Asthapita Increase in Upward movement of Vata
10 Hrdroga Will lead to cardiac arrest.
11 Udavarta Aggravation of condition which may quickly
cause death
12 Mutraghata Manifestation of colic pain or more of acute
origin.
13 Timira There will be further vitiation of the condition
14 Shira shoola Leads to excessive aggravation of pain.
UTILITY OF VAMANA KARMA IN VARIOUS CONDITIONS :
Table No: 4
Disease Explanations
Jwara When Uthklishta Dosha is seen.65
In Pakwa (purana) jwara66.
Raktha pitta Vamana can be given in Adhogatha Rakthapitta67.
Gulma In Kaphaja gulma.68
Prameha In case of Kaphaja Meha.69
Atisara When morbid Kapha is there.70
Prameha Pitaka When Medas is involved.71
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Kushta Every 15 days Vamana is advised72 in kaphaja stage.73
Rajayakshma Tikshna Vamana after considering strength ,doshas74.
Unmada Kaphaja Unmada.75
Apsmara Vamana advised in Kaphaja stage.76
In shvayathu Vamana is advised.77
Udara Kaphaja Udara Vamana advised.78
In Jalodara.79
Arshas Kaphaja arshas80.
Grahani When Ama is seen,pittaja & kaphaja grahani.81
Pandu Tikshna Vamana can be done
In case of Mrithbhakshna janya Pandu.82
Swasa When swasa associated with Kasa, Chardi,
Hrithgraha83.
Kasa In kaphaja, pittaja kasa84
Chardi Vamana is advised in vitiated condition of Kapha.85
Visarpa In Kaphaja,pittajaVisrpa Ullekhana is advised.86
Trishna Kaphaja trishna.87
Visha
In Kaphaja type of Keeta visha88
In 2nd Visha vega of Rajeemanta 89
In third Visha vega of Mandaleena90
Darveekara in4th vega91
Vrischeeka92
Lutha visha93, Gara visha94, Akhu visha.95
Madatyaya Kaphaja madatyaya – Ulekhana96
In vruna chikitsa One among 36 upakrama 97
Udavartha In case of Udavarta due to Chardi Nigraha98
Mutra krichra In Kaphaja type99
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Hridroga In Kaphaja type of Hridroga100
Peenasa In kaphaja type where uthklishta kapha is seen.101
Mukha roga
Paridhara102
Rohini103
Upakusha 104
Arochaka In Kaphaja verity105
Swara bedha In Kaphaja type.106
Avarana In Kaphavritha Vata.,Annavritha Vata107
Vata Rakta Kaphavrita vata mild Vamana is advised108
Yoni roga Acc to dosha vamana given.109
Pratyadmana Vamana advised 110
Vidradhi Kaphaja verity111
Apachi Industa Apachi 112
Glaganda Kaphaja Galaganda113
Shotha Acc to involvement of doshas.114
Nasa roga Kaphaja Prathisyaya,115 Nava Prathishyaya116
Kaphaja Pinasa.117
Karna roga Karna paka,118 Karnapali roga,119 Karna nada120
Shiro roga Kaphaja type121
Kukshi shula Vamana advised122
Datri Sleshma dusta datri123
Vata Vyadi
In Gridrasi124
In Arditha125
In Pakshaghata- mild vamnana126
Arumshika If not controled by other means.127
Kukunaka Vamana advised.128
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Pakshma kantaka Vamana advised 129
Yauvana pidaka Vamana advised 130
Mukha dushika Vamana advised 131
Importance of Vamana Karma
Panchakarma therapy in Ayurveda has attracted the attention of the people world wide as
it is a unique type of treatment of various chronic, auto immune, hormonal, degenerative
disorders etc. where other sorts of treatments have no satisfactory answer as well equally
beneficial for the promotion and preservation of health. Acharya Charaka has highlighted, the
role of Panchakarma therapy by stating that the disease treated by Shodhana will never recur
whereas those treatment with Shamana therapy may recur in due course of time. In addition if
the Shamana drugs are administered after taking the proper course of Shodhana then it provides
additional relief and thus helps in eradicating the diseases completely. Vamana Karma is first
measure amongst Panchakarma and has been considered as the best line of treatment for the
Kapha disorders. Following points show the importance of Vamana amongst the other measures
of Panchakarma.
• The first act is emesis, which is performed immediately after birth, for elimination of
Garbhodaka. Charaka, Sushruta and Vagbhata have advised to use the mixture of Ghrita
and Rock salt for this purpose
• Acharyas mentioned the upper part of body as a Kapha Sthana. This portion contains
major vital parts of body like lungs, brain, pituitary gland, eyes, thyroid gland etc. In the
diseases of the Urdhvabhaga (Kapha Sthana) which are related to above organs, Vamana
Karma is the main treatment.
• It has been mentioned that Virechana therapy should be preceded by Vamana Karma;
otherwise the prevailing Kapha Dosha by involving Graham may produce complications.
Vamana procedure
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Generally any measure of Shodhana therapy cannot be under taken directly without
preparing the patient. Vamana is somewhat strainful process to the patient and may cause
complications also (if not performed properly). Therefore it is necessary that all the aspects
should be taken into consideration before performing this Karma. Shodhana therapy is generally
applied mostly in chronic diseases where vitiated Doshas are at their higher level & where
Shamana drugs may not have significant role. In this situation we have to take care at every step
of treatment and procedure. Some processes should be done before treatment as Poorvakarma
and some are after treatment as "paschat Karma. Following points require consideration in this
regard.
Purvakarma
A. Sambhara Sangraha
B. Selection and examination of the patient
C. Snehana and Svedana
D. Dietic regimen before Vamana Karma
E. Manasopachara
A. Sambhara Sangraha
It is necessary to collect all the required equipment; drugs, articles etc. well in advance,
so that Vamana Karma may be performed safely and if any complication arises during the
therapy, then it can be treated immediately. Patient should always be hospitalized for Vamana
Karma.
Upakalpaneeyam:132
Acharya Caraka in Upakalpaneeya chapter is explaining about the collection of necessary
equipments before going for the Pancha karma chikitsa for the purpose of smooth and easy
practice. Following points has to be incorporate before going for the Vamana karma.
Vamana room:
In Upakalpaneeya context treatment room is also explained. It should be constructed according
to Vasthu shastra. Gangadhara also elaborate this point on his commentary.
• Dridham: the room should be constricted firmly.
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• Nivatham Pravathamekadesham: the room should not be affected with much air. So the
outlet of air should be only through one way.
• Sukha pravicharam: the room should be spacious that one can carry out the activities
comfortably.
• Anupapatyakam: it should be away from other building i.e. it has to be placed in a
comfortable area devoid of any disturbances.
• Dhuma athapa rajasam Anabhigamneeyam: it should be protected from external dust, air,
light and disturbing sound.
Equipments:
• Vamana Peedam: Caraka explains Vamana Peetha should have the height of knee joint
(janu thulya samam). It must have arms and capable to relax the patient when they are
debilitated.(Asamkeernam).
• Equipments like vessels for the collection of vomitus. For storage of drug, etc has to be
made available.
Drugs:
• Drugs used for Vamana, Akanthapana, and Vamanopaga. Drugs for the management of
complication are also made available priory.
• Stalk of eranta or Kamalanala for the purpose of induction of Vamana.
Foods:
• It necessary that diet articles starting from Pachan Deepana to Smasrjana Karma has to be
collected priory.
Other rooms: Also Caraka suggesting that to attach a Shouchalaya and Mahanasa (toilet and
kitchen) to treatment room. Which are the primary things for the conduction of the procedure.
Present day: For the present day practice of Vamana it is better to incorporate assessment of
vital data, so it is better to keep Sphygmomanometer and Stethoscope. For the purpose of
induction of Vamana can be taken the help of Red rubber catheter.
Dravyas for Akantapaana: 133
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Arunadatta comments that administration of Akantapana should be based on the assessment of
the diseases. Further says, patients who are having fear for Vamana, less strength, increased age,
very young age etc has to be administered Akanthapana of Yusha, Ikshurasa, Ksheera,
Mamsarasa, Madhya, Tushodaka, Yavaagu, Manda.
Medicines for Vamana karma:
1.Vamaka Aushadhi 2.Vamanopaga Aoushadhi
Vamaka Aushadhi:134
Table No.5
Caraka narrate above-mentioned vamaka Aushadhies. Based on these six drugs Caraka has
explained 355 formulations in Kalpa stahna. It can be administered in different forms like
Kashayas, Ksheera, Ghritha, Phanita, and Churna etc.
Table No. 6 Vamana Kalpa according to Caraka:
Type of
Formulation
Madana
Phala Jeemutaka Ikshwaku Dhamargav Kutaja
Krita
Vedhana
Kashaya 9 19 9 20 9 22
Matra 8 8 8 - - -
Ksheera 4 6 8 4 - 4
Ghrita 1 1 1 1 - 1
Phanita 1 - - - - -
Churna 1 - - - 5 -
Ghreya 1 - 1 - - 1
Varti 6 - - - - 6
Madana phala (Catunaregum spinosa)
Jeemuthaka (Luffa echinata)
Ishwaku (Lagenarea leucantha)
Dhamargava (Luffa aegyptioca)
Kutaja (Holarrhena antidysentrica)
Krita vedana (Luffa acutangula)
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Leha 20 - 5 10 - 8
Modaka 20 - - - - -
Utkarika 20 - - - - -
Shadava 10 - - - - -
Sashkuli 16 - - - - -
Apupa 16 - - - - -
Suramanda - 1 1 1 - 1
Swarasa - 4 - - - -
Dadhimastu - - 1 - - -
Takra - - 1 - - -
Palala - - 1 - - -
Taila - - 1 - - -
Vardhamana - - 6 - - -
Mandha - - 1 - - -
Mamsarasa - - 1 - - 7
Pallava - - - 9 - -
Sakridrasa - - - 12 - -
Kalka - - - 1 - -
Anna - - - 1 - -
Salila - - - - 3 -
Krisara - - - - 1 -
Picha - - - - - 10
Ikshurasa - - - - - 1
Total 133 39 45 60 18 60
Dosage:
For Madanaphala churna Caraka explained, as “Antarnakha Musthi”135 i.e. when the
medicine is kept inside the fist and firmly closed and the nail should not expose out. This much
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has to be considered as the dose. It can be considered or standardized as 5 gms.While explaining
the dosage for Madanaphala Kashaya, Caraka explains that Samshodhana dosage has to be fixed
“ Pratipurusha Apekshitavyani ”136 so Acharya indirectly objects the pre fixed dose for
Shodhana. Chakrapani comments on it as disease, status of Agni and Strength of the patient has
to be assessed before deciding the dosage of Vamana drugs. Chanranandana used to incorporate
status of the kostha before deciding the dosage which is given as follows,
Table No.7 Koshtha sthiti and Dose:
Kostha sthithi Dosage
Mridu kostha Lesser dosage
Madhyama kostha Medium
Krura kostha High dosage
Table No.8 Dosage of emitics according to Sharangadhara:137
Table No.9 According to Bhela the dosage is as follows:138
Individual status Dosage
Young age, Good strength, affected by poison, Skin disorder, Shwasa Uttama
Disease in moderate stage with moderate strength Madhyama
Disease having involvement of minimum morbidity of doshas and lesser
strength Avara
VAMANOPAGA AUSHADHI:139
Vamanopaga drugs are supportive drugs which helps in easy vomiting by generating the
Vegas Vamanopaga drugs explained are Yasthimadhu, Karbudara, Nipa, Vidula, Bimbi,
Formulation Utama matra Madhyama matra Kaniyasi matra
Kwatha 9 Prastha 6 Prastha 3 Prastha
Kalka Avaleha Churna
3Pala
2 Pala
1Pala
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Shanapupshi, Sadapushpi and Pratyakpushpi. Chakrapani advocate to administer Vamana drugs,
then go for the Vamanopaga drugs till the Antiki features appear.
DEEPANA AND PACHANA:
Pachana and Deepana is the prime step before the practise of any Shodhana. Aacharya
Vagbhata is giving the warning that practise of Shodana in presence of Ama will destroy body
just like extracting the juice from an unripened fruit.
Sharangdhara explains Deepana is the process of Augmentation of Agni where as Pachana
will helps in the digestion of Ama140. Pachana has to be done till the Niarma lakshnas are
obtaind. Augmented Agni has to be tested by digestive power (Agnim Jarana Shaktya ).
B. Selection and Examination of the patient
Charaka States that, the difference in the variation of humeral discordance, drug, place, time,
strength, body, food homologation, mind, constitution and age are so minute that they baffle the
understanding of even those whose intellect is clear and broad. Patient should be examined
thoroughly. First of all it should be decided that the patient is fit for Vamana Karma or not
indicated as a Vamya or Avamya by Acharyas. The patient should be examined by Ashtavidha
and Dashavidha Pariksha141 followed by abdomen examination, respiratory system examination,
cardiovascular system examination, central nervous system examination and special examination
of disease for which Vamana is being done. Pulse, blood pressure, temperature and respiratory
rate are also to be monitored as Vital Data. The tests like; pathological, E.C.G. etc. should be
used for excluding the disease where Vamana is contraindicated. If the patient is not examined
fully and some points are missed in relation of the patients then complications may occur during
or after performing the Vamana Karma.
SNEHANA AND SWEDANA:
Snehana and Swedana are the purvakarma, which is a mandatory step before going for the
Vamana and Virechana.It will be harm full for the body if one who practice “Shodhana therapy”
without theses Poorva karma. Caraka compared this with just bending a piece of dry wooden rod.
Abhyantara Snehapana:
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According to Chakrapani, Snehana should be considered as Snehapana and Abhyanga.142
Snehapana should be administered till Samyak Snigdha Lakshanas are obtained. The aim of
Abhyantara Snehapana therapy is to prepare the body for Shodhana Karma i.e. the Doshas
situated in Shakha are to be brought down to Kostha, so that they can be easily expelled out.
Charaka gives simile that as content from a container smeared with oil, easily separate without
any effort; similarly Doshas are easily expelled out from the Snigdha body.
Sneha Prakarsha kala:
Shodhananga Snehapana is a process of administering Doshotkleshana within a speceific
number of days. Acharya Caraka mentioned that 3,5,7 days are required for attain ‘Samyak
Snigdha Lakshanas’ in Mridu, Madhyama, and Krura Kostha respectively.143
But Dalhana is quoting an anonymus reference for the prakarasha kala that is as follows:
Table No.10 Sneha Prakarsha Kala:144
Bhoja opines that person having Kaphaja Pittaja and Vataja Prakriti needs 3, 5and
7days Snehapana respectively. On the other hand Vagbhata emphasizes that Shodhananga
Snehapana should be continued till Samyak Sningdha Lakshanas are obtained irrespective of any
time limit.If Shodhananga Snehapana continued more than 7 days Sneha becomes Satmya and
fail to produce Doshotklesha. Chakrapani opines that if the dose of Sneha administered less then
it will fail to produce desired effect in 7days.In such cases is there should be a small gap after the
7th day.
Snehapana - Methodology:
Mridikostha Madhyama kostha Krura kostha
Mrudutama-1day
Mrudutara-2days
Marudu-3days
Madhyatama-4days
Madyatara-5days
Madhyama-6days
Kruratama-9days
Kruratara- 8days
Krura-7days
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A) Matra Anusara Snehapana- Arohana Snehapana:145
b) Pravicharana Sneha- Sadhya Sneha146
Matra Anuasara Sneha pana is not as such mentioned in anywhere in Samhitas. Acharya Charaka
describes, three doses of Snehapana i.e. Maximum (Pradhana), Moderate (Madhyama) and
Minimum (Hrasva). Moderate dose has been prescribed .for Shodhana therapy because it
conducts to oleation with ease. Sushruta mentions Madhyama matra which is digested in twelve
hours (Ardha Divas). Vagbhata has same opinion. This Madhyama Matra may be given on the
last day of Snehapana because Sushruta mentions that, the first dose should be adjusted as per
Agni otherwise it creates many complications. Vagbhata described Hrasiyasi matra (Test dose)
which is digested with in the time limit of Hrasva matra. Increasing dose schedule of Snehapana
is not described in any of Bhrihatatrayi. In Kalyankara (6th A.D.)145, it was clearly mentioned
that Sodhnartha Abhyantara Snehapana is to be given in increasing dose only. The Vangasena
(9th A.D.) also recognizes Vardhmana matra. This Vardhmana Krama is practically used for
Snehapana.
Rules of Snehapana: Sneha should be taken in early morning hours when the diet taken on the
previous night will be completely digested and there should not be sensation of appetite. Acahrya
Sushrutha elobarate the exact time of Snehapana in the morning hours as “ Udaya Giri Shikhara
Samsthithe Praptha Kanaka Nikara Peeta Lohite”147 that is during the day break when golden
yellow red colour appears on the sky. Caraka explaining that when Sneha taken in the early
morning hours it is capable to produce Uthklesha in the body.
Anupana:
Anupana should be given along with sneha. It helps in easy digestion and proper assimilation and
instant diffusion of the sneha taken. A specific Anupana mentioned in the Samhitas are,
Table No.11 Anupanas of Sneha:148,149
SNEHA ANUPANA For all Sneha except Tuvaraka and Bhallataka taila
Ushnodaka
Taila Yusha Vasa and Majja Manda For bhallataka and tuvaraka taila Sheeta jala
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Table No.12 Observation of Sneha Jeeryamana and Jeerna Lakshana:
Sneha Jeeryamana
Lakshana150
Sneha Jeerna Lakshana151
Shiroruja Shirorujadi Jeeryamana Lakshana prashamana
Bhrama Vatanulomana
Nisthiva Swasthyata
Murcha Kshuta
Sada Trishna
Arati Udgara shuddhi
Klama, Trishna, Daha Laghuta
Observation of Snigdha, Asnigdha, Atisnigdha Lakshanas:
The knowledge of Asnigdha, Atisnigdha and Samyak Snigdha Lakshans is a basic tool
for the assessment of Snehana they are as follows,
Table No.13 Samyak Snigdha Lakshanas: 152,153,154,155
Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S
Vatanulomana + - + + Vit Shaithilya - + - -
Deepta agni + - + + Glani - + - +
Snigdha varcha + - + + Angha laghava - + - +
Asamhatha
Varcha + - + + Adhastat sneha
darshana - + - -
Angha Mardava + - + + Snehodwega - + - +
Snigdha anga + - + + Vimalendriya - - - +
Snigdha twak - + - -
Table No.14 Asnigda Lakshanas:156,157,158,159
Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S
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Grathitha
purisha + + - - Uro vidaha _ + - -
Ruksha
purisha + + - - Daurbalya _ + - -
Agnimandya + + - - Dur varna - + - -
Vayu
pratiloma + + - - Krichrat anna
Pachana _ + - -
Khara gatra + _ - - Susnigdha
Lakshana Viparyaya
_ _ + +
Ruksha Gatra
+ - - -
Table No.15 Atisnigda Lakshanas: 160,161,162,163
Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S Lakshana Ch.
Sa. Su.
Sa. Ah.
Hr. Sh.S
Pandutha + - - - Guda srava - + + -
Gaurava + - - - Ghrana srava - + -
Jadya + - - - Guda daha + + - +
Avipakwa
Purisha + + - - Bhakta dwesha - + - +
Tandra + - - - Pravahika - + - +
Aruchi + + - - Purishaati
pravritti - + - -
Utklesha + - - - Purishaati
pravritti - + - -
Mukha srava + + + +
Benefits of Snehana:
Caraka explains “Snehoanilam Hanti Mrudumkaroti Deha
Malanam Vinihanti Sangam”164 the concept is explained as follows
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1) Snehoanilam Hanti: This directly refers to Vatashamaka property of Sneha. As sneha is
having exactly opposite Gunas to tha of Vata Dosha, Sneha insist the proper functioning
of Vata and this can be clearly observed through the occurance of Vatanulomana as the
very first Samyak Snigdha Symptom. Vitiated Vata Dosha will be coming back to
normalcy and most of the derangement sets right. To bring the morbid Doshas which
were situated in the Shakhas to the Kostha, Vata nigraha is one of the modality
mentioned by Caraka.
2) Mrudukaroti Deham: Snigdha and Mrudu are important property of Sneha Dravyas. In
the definition of Snigdha Sushruta says ‘Sneha Mardavakrit’ mardava means softness
which can be clearly assessed by Gatra Mardava.
3) Malanam Vinihanti Sangam: To cut out the Srotorodha is again the prime importance
regarding the Shodhanartha Snehapana, Malasnga generally occurs due to Rukshata in
the Koshtha, Sneha over come this Rukshata by Snigdha property and Sanga sets right.
Bahya Snehana and Swedana:
Charaka says after the Sneha pana one-day gap should be given during which, he will be
subjected to Snehana and Swedana. Chakrapani says Snehana and Swedana should be done two
or threee days ie; on the day Snehapana is completed. On the rest day and on which is to be
administerd. Caraka states that Swedana helps in Draveekarana (liquifaction) of Doshas, which
stuck up in various srotas in the body. Dalhana mentions that Doshas which are lodged in the
Shakha are made to move towards the Kostha by means of Snehana and Svedana. Vagbhata
mentions that the waste products are removed from the body by Snehana and Svedana in the
same way, as the dirt of cloth is removed with the help of soap and hot water. Sweda has the vital
role in carriying of the vamana karma. It functions as follows,
1) Srotasu abhi Vileeyate- it helps to dissolve the Shleshma, which is in the Grathita form
step the srotas firmly.
2) Khani Mardavamayati: It makes the srotas soften which vata can flow through in
Anuloma gati.
3) Shleshmaha Vishyandhati: it increases the secreation of vitiated Shleshma through the
Srotas.
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Dietetic Regimen
It can be categorized into following 3 groups.
A. Diet during the days of Snehapana
Snehapana is done during the time of Sunrise. During Snehapana, patients are advised to
have the diet of Drava (liquid), Ushna(hot), Anabhisyandi properties in appropriate
quantity165. The food must not have too unctuous material mixed in it. Also it should not
contain the articles having the property to provoke any other dosha. Rice soup or ganji
will be more preferable for the diet.
Patient should be advised to consume ushnambu whenever needed.Chandranandana is having the
opinion that due to Kaphotklesha ‘Dosha Prachyavana’ is going to happen. Parameshwara make
it more clear that ‘Kapham Swasthanath Sanchalathi’ i.e, movement of Kapha from its sites.
B. Diet for previous day of Vamana for Utkleshana
Food articles described by different texts:
♦ The meat of the animals of Gramya, Anupa & Audaka origin
♦ The articles made of milk
♦ Sesame, Black gram, Curds, Milk, Jaggery, Fishes, Mutton soup etc.
♦ Above articles + Sali rice
Dalhana comments over the word 'Sambhojayet" as the meal containing both Pathya and
Apathya together (Samasana)
Thus it should have the properties like heavy, liquid and ability to produce secretions
(Abhisyandi).
Purpose
Arunadatta mentioned that this diet helps doshas, which are provoked due to proper
snehana & svedana to move towards Kostha due to their similar nature with latter.
This diet also has the property to excite Kapha dosha (Kaphotklesa)166 and to minimize
the pain & produces the vomiting with much less efforts.
Dalhana advised to inspect the dosas which are flowing freely after losing bonds with the
channels & arrange the meals accordingly. He further mentioned that dosas which have
already become provoked, if associated with new ones excited by this type of diet, they
will produce "Samyak Yoga" otherwise "Ayoga" will occur.
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Gangadhara strokes a brilliant string by stating that "This type of diet is served so that
Kapha should neither turn desiccated nor become dense or solidified". Thus to maintain
the liquified stage of the humors, achieved by Snehana & Svedana during Poorvakarma,
this diet should be provided.
Diet just proceeding to Vamana karma:
Generally on the day of Vamana, patient should be in empty stomach. Acharya Vagbhata
suggests that one has to go for the administration of “Nirannam Ishad Snigdha Yavagu”.
Arunadatta comments as “Nirannam Akruthaharam”167 unprocessed gruel and “Athurvashadwa
Kinchitth Snigdham” at the time of administration physician has to be added little amount of
Ghrita in it. This may even consider for Akanthapana.
Manasopachara
Purpose
Vamana is the process which depends much more upon the mental strength of the patient.
It progresses fluently when the patient will be satisfied regarding several doubts in one's
mind about the process and prepared mentally for the same.
This process can be divided in three sections.
A. Counseling before Vamana
In the present days, there is misimpression about the process of Vamana. Patient already
has a lot of wrong information received from other people. So mental counseling by
physician keeps much more importance.
Before Vamana, patient must be instructed about Snehapana, Svedana, Dietary regimen,
administration of Vamana and Vamanopaga drugs by Physician.
He should be informed about the whole procedure and proper understanding of each step
& its benefits which will encourage him.
B. Preparation of patient before Vamana
Charaka advised to carry out the process under auspicious Constellation, Day, Karana,
and Muhurta. He also says that before Vamana, "Svastivacana"168 should be performed
by Brahmins.169 Patient should be sanctified by holy blessings. For the purpose, he should
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worship the deity, Fire. Patient should be allowed to have a full bath, anoint his body
with several essences, wear a garland.
Charaka also advocated vaidya to create an atmosphere by displaying Homa, Mangala,
Prayascitta, Bali etc. for well being of patient before Vamana.
C. During Vamana
During Vamana process, patient is advised to concentrate on Vamana process, by keeping
Kama, Krodha, Lobha, and Irsya etc. factors aside.
Parmeswara, commentator of A.H. provided a reason behind all the auspicious proceedings
as "Vyapad bahulatvat" that means Vamana has a plenty of complications with it.
PRADHANA KARMA
The whole procedure, which is performed from the period of oral administration of
Vamana drugs up to the completion of Vamanavega, may be taken as Pradhana karma, this is
described as follows,
a.Administration of Vamana Yoga:
Time of administration of Vamana Yoga:
Acharya Vagbhata is advising to conduct Vamanakarma in “Poorvahnna”. Arunadatta
commented that “Poorvahnna” is “Pratha Kala”170 i.e. morning hours. Further Parameswara
specifying the time by stating “ Poorvahnne Sleshma Vruddhi Kale Prathama Yama eva”. So the
first Yama of the day it is prone to Sleshma Vruddhi is to be considered as ideal time for
Vamanakarma.
Preparatory procedures:
On the day of Vamana, after performing the Snehana and Swedana successfully, patient has
to take full bath and wear clean cloth anoit the body with a garland. The patient is asked to seat
in a comfortable chair. Patient should be covered with a clean cloth.
A big sized round vessel should be kept in front of the patient for the collection of vomitus.
It should not be placed neither too down nor too up. Acharya Caraka is advocated to keep some
Paricharaka to assist the physician during the procedure. Paricharaka is having the following
works171
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1) Lalata pratigrahe: Holding at the forehead, when patient will bow down to expel the
vomitus, which help to relax one’s over streached neck muscles.
2) Parsvopagrahane: The muscles at the side of the chest wich mainly originating from the
back region and help to keep the body straight.
3) Prushtonamardane: Doing the gentle massage in the opposite direction over the
muscles of spine, which is again the process to relax the same muscles.
4) Nabhi prapidana: this will induce pressure over the abdominal muscles and diaphragm
so the upward movement will be facilitated.
So the Paricharaka should be friend or any intimate to the patient. Before starting the procedure
physician has to make sure that all the necessary equipments and medicines need for the
procedure is kept ready.
b. Examination of vital data
Pulse, blood pressure, respiration & temperature should be recorded prior to
administration of Vamana drugs. An ECG reports of patient before the procedure will help to
avoid any cardiac manifestations. It is advised to record pulse & blood pressure at regular
intervals during Vamana.
c. Administration of Vamaka drugs
For Akhanta pana ksheera, yavagu, ikshurasa, mamsa rasa etc can be used.
Caraka says the akhanta pana dravyas must be in the state of nirranna,naathisnigdha.Then one
has to go for the administration of madhana phala choorana in Antarnakha
mustipramana,whichis processed in the yastimadhu etc kashayas.Shushrutha says one may go for
ksheera ,ikshurasa,dadhi,takra for akhantapana in case of krisha,vridha,bala followed by
administration of vamaka yoga.
Arunadatta advised the ksheera, ikshurasa isgiven bhavana with vamaka drugs and administered.
Importance of adding Madhu and Saindhava lavana in vamaka yoga172:-
Caaka in kalpa sthana says “Sarveshu tu’ i.e in all vamaka yogas one has to add madhu and
lavana.It is added for the kapha vilayana and kapha chedana purpose.It facilitate the liquification
and separation of adhesion of kapha.Further he says the honey should not be heated as it is
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viruddha173 but it may be added to the heated vamaka yoga.Because as the honey is vomited out
in apakwa stage along with the medicine before its digestion during vamana.It also helps in
elimination of morbid doshas.
Administration of Vamanopaga:-174
Caraka explains that Bhavana of Kwatha of Vamanopaga drugs such as Yasthimadhu,
Karbudara, Nipa, Vidula,Bimbi etc should be given to Madanaphalapippali, and this processed
poweder of Madanapippali should be given along with Saindhava Lavana, Madhu and Phanita.
Yashtimadhu Phanta is commonly practiced as Vamanopaga.
d. Observation During Vamana Karma
After the administration of Vamana drug, physician has to observe the whole process
carefully. In the beginning the physician should continue to apply his warmed palm to the face
and back. Caraka opeins “Peethavantham thu Khaluenam Muhurtham Anukamkshet”175
According to Dalhana “Muhurtham Ghatika Dwayam” This can be taken approximately as 45
minutes. So Patient should be kept in this position for one Muhrtha or till he gets the Vega of
Vamana, which ever is earlier.
Action of medicine:
Appearance of sweat on the fore head of the patient indicates that Doshas are liquefying in
srotas and Romaharsha (horipulation) shows that doshas were sarted moving towards Koshtha.
When Doshas reaches the koshtha there will be Kukshi Adhmana (distension of abdomen). Then
Hridayopamarda, Praseka and Hrillasa giving the signal that Doshas are in Urdhwa Gathi and
ready to eliminate.
The oncoming urge may be excited by tickling the throat with two well-manicured
fingers or with the stalk of Eranda (Stalk of Eranda). When the salivation appears patient is
asked to bend forward. Thereafter the paricharakas assistant should hold the forehead and chest
of the patient. Caraka suggests that Nabhi region of the patient should be pressed and back of the
patient massaged in Pratiloma direction. The patient should be instructed to open his mouth on
the feeling of vomiting. Forceful uninterrupted expulsion has to be counted, as Vegas and
upavegas are those, which occur in between the Vegas.176
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Vruddha Vagbhata advises that patient should not bow too down too more or lesser
extent.177 It may lead to complication Hemadri explains extreme stretch deposition of neck create
pain in back and chest region. Extreme forward bending causes Headache and abdominal
discomfort, extreme tilting on lateral sides produces pain in the side of chest, abdominal region
heart and upward region.
During the procedure Vamanopaga can be administered repeatedly till the appearance of
pittanta Vamana. If Heena Vega (Under bouts) happence then it is adviced to give Kalka of
Pippali, Amalaki and Sarshapa or Ushnodaka mixed with Saindhava Lavana178. Kashyapa says
one should not give any rest in between the Vegas.
Table No. 16 Samyaka Yoga Lakhanas of Vamana179,180,181,182,183
Lakshana Ch. Sa Su. Sa As.Hr. As.Sa. Sh.S
Kale Pravrutti + - + - -
Elimination of Kapha Pitta and Vata respectively
+ + + - -
Svayam Avasthana + + + - -
Hridaya Shuddi + + + - +
Parsva Shuddi + - - - -
Murdha Shuddi + + - - +
Srotas Shuddi + - - - +
Indriya Shuddi + - - - -
Laghuta + + - + +
Karsya + - + + -
Daurbalya + - - + -
Kantha shuddhi - + - + +
Kapha samsrava - + - - -
Anati mahati vyatha + - + + -
Jatha Kala kshudha, Pipasa - - - - -
Jathagnita - - - - +
Ashebairasyavada - - - - -
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Ashya shuddhi - - - + -
Table No. 17 Atiyoga Lakshnas of Vamana184,185,186,187,188
Lakshana Ch. Su. As.Hr As.Sa. Sh.S
Phenila Vamana + - + - -
Rakta Candrikayukta + - + - +
Trisha + - + + +
Moha + + + + -
Murcha + + - + -
Vata Prakopa + - + + -
Nidra hani + - - + -
Bala hani + - + + -
Hrid pida - + - - -
Kantha pida - + + - +
Tamah Pravesha - - + - -
Brama - - + - -
Pittati yoga - + - - -
Daha - + + - -
Udgaradhikya - - - + +
Hikka - - - + +
Hanustambha - - - + +
Mrityu - - + - -
Table No. 18 Ayoga Lakshanas of Vamana189,190,191,192,193
Lakshana Ch. Su As.hr As.Sa. Sh.S
Apravritti + - - + -
Only Aushadha Pravrutti + - + + -
Vega Vibandha + - + + -
Hridaya Avishuddhi + + + + -
Srotas Avishuddhi + - - - -
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Guru Gatrata + - - + -
Sphota + - - + -
Kandu + + + + +
Kapha Praseka + + + + +
Jvara - + + + -
Kota + - + + +
ASSESSMENT OF VAMANA:
To assess the quantity and nature of the doshas and to assess the effect achieved after
Sasmshodhana Chakrapani is giving some parameters - Aantiki, Vaigiki, Maniki and Laingiki
criteria.194
Chakrapani quotes 4 criteria at first but later on counts Antiki shuddhi under the Laingiki.
Dalhana elucidate195 three criteria viz Laingiki, Vaigiki and Maniki not explained Antiki criteria.
Separately. At last both of them clearly conclude that laingiki shudhi is the most acceptable one
to practice the effect of Shodhana.
OBSERVATION OF SHUDDI LAKSHANA:
As classified by Chakrapani the assessment of samyak shudhi is studied under 4 headings
viz. Antiki, Maniki, Vaigiki and Laingiki196.
Table No 19
Vamana AVARA
SUDDHI
MADHYAMA
SUDDHI
PRAVARA
SUDDHI
Vaigiki 4 Vega 6 Vega 8 Vega
Maniki 1 prastha 1 ½ Prastha 2 prastha
Antiki Pittanta Pittanta Pittanta
Laingiki SIGNS OF SYMPTOMS OF SAMYAK VAMANA
Vaigiki criteria:
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Caraka describes three types of shuddhi naming them as Heena, Madhyama and Pravara
shuddhi.when 4, 6 and 8 Vegas come respectively.197
Kashyapa is quoting an anonymous reference according to that Shuddhi can be called as
Kaniyasi producing 2-3 Vegas, Madhyama having 4-5 Vegas and uttama having 6-7 Vegas.
Counting of Vega and Upavega:
The Commentator Indu define the Vegas as “Sukhadagataha Pratigraha prapto
Vegaucchyate”198 pratigraha means a bowl in which Vega is collected. The bout collected in a
bowl after an effort less expulsion is termed as Vega. Where as Upavega is nearer to Vega,
which can be explained, lesser in every aspect of Vega.
Dalhana199 is having the opinion that some times patient may not exhibit proper Antiki
feature even though many number of bouts, hence there are lacuna for considering this
measurement criteria as authoritative.
Importance of Assessment of Vegas:
Assessment of Vamana Vega carefully gives idea about Heena, Madhyama or Pravara
shuddhi and helps in planning the Samsarjana krama. It helps to identify change in colour,
consistency occurring after each vega to know about the movement of Dosha during Vamana
karma. Caraka mention to continue the procedure till Pitta comes. At that time he does not
emphasis on the quantity of Doshas expelled or number of Vegas occurred.
Maniki:
The criterion to assess the Doshas, which is expelled out, is called Maniki. While
explaining Heena, Madhyama and Pravara Shuddhi, Caraka explained the quantity obtained will
be 1,1 & 1/2, 2 Prasthas respectively. Chakrapani considered them under the term Maniki
Pariksha. So Maniki pariksha is the quantitative analysis of the morbid Kapha and Pitta, which is
expelled out. Aachary Caraka explained that “Vamane tu pitam”200 so, the difference between
input and output has to be considered here.
According to Dalhana the measurement of the vomitus varies form person to person.
Since Samhanana of the body depends on Deergha, Hrasva, Sthula, Krisha constitution the
amount of Dosha resides in the body is also going to vary. Hence Maniki is not an authoritative
criteria.201
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Maniki Pariksha highlights the quantitative analysis of the vomitus that is quantity of
Kapha or Pitta that is to be expelled out. The word Prastha indicates some quantity; hence one
can deal with Maniki criteria by considering the volume and also by weight. According to
Chakrapani
1 prastha = 13 1/2 pala (54 tola)
1tola = 12gms, So 54 tola = 648 ml
Table No. 20 Manaki Pariksha
Heena shudhi 648ml
Madhyama shushi 972 ml
Pravara shudhi 1296ml
Importance of Assessment of Maniki criteria: This criteria helps to guide us in
differentiating 3 types of Shuddhi i.e Heena Madhyaama and Pravara. And also helps to decide
the quantity of the Doshas expelled out. Finaly helps physician to judge directly the quantity of
Kapha and Pitta vomited during Vamana. The difference between input and out put can be
measured.
Laingiki:
The signs and symptoms featured in Samyak lakshana can be considered under Laingiki
criteria. Atiyoga, Ayoga, Samyak yoga, Lakshanas of Vamana has to be analyzed to predict this
criterion.
Table No. 21 Laingiki criteria can be classified as follows, 202
During Vamana After Vamana After Samsarjana
Kalepravritti Hridaya shrotoshudhi, indriya shudhi, Parshwashudhi, murdhwa shudhi
Swasthata
Yatakrama kapha pita vata dosha hara Laghuta, karshya, dourbalya Swaravishudhi
Swayamcha avasthana Kantha shudhi Laghhava
Anati mahati vyatha Kapha samsrava stithi Kostha tanutvam
Dalhana comments that Laingiki is the most acceptable criteria to assess the Vamana then that
of Maniki and Vaigiki.
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Anthiki:
End point of Vamana karma is termed as Anthiki. Charaka adviced to continue Vamana till
pitta appears.
Vruddha Vagbahta elaborated Antiki criteria. Giving following points,203
• Kapha Chedana: Complete removal of the morbid Kapha.
• Kevala Aushadha Pravritti: After the removal of the Kapha the medicine is going to expel
out
• Pittasya Darshanam va: Appearance of Pitta in the vomitus.
Indu comments that, all these above mentioned facts depend on strength of the patient and
strength of the disease. Parameshwara comments that “Peetabham jalam Drushyate” a yellow
coloured fluid is going to appear in the vomitus is the Pittanta.
"Pitta" is a Dravya, which has specific characteristics and functions. When one describes
'Pittanta,' Pitta appears with certain and shows some symptoms.
Table. No. 22 "Appearance of Pitta" can be perceived by all the Pramanas.
Pramanas "Appearance of Pitta"
Colour A greenish yellow
Taste Bitter or pungent taste (sour taste also)
Smell Usually have a metallic smell.
Symptoms It produces certain symptoms while coming
through Amashaya like burning sensation in
the chest or throat or eyes.
Acharya Kashypa in the context of Amlapitta- giving a slimile that when fresh milk will
be turned to curds when it is poured to a vessel containing curd in the same way morbid Pitta is
also going to spread in the body204. By considering this contaminating nature of Pitta
(Ashrayashrayee Sambandha with a Rakta) it has to be eliminated properly so in Vamana karma
expulsion of morbid Pitta is a mandatory step to attain maximum purity.
Conclusion
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When one goes through all the textual references regarding these criteria, there is a debate over
the point that which criteria must be followed for assessment. But, if studied critically, all these
four criteria have to be used by Vaidya while following the process.
Charaka when explained the process of Vamana in Kalpa Sthana, has mentioned to
continue the procedure till Pitta comes out. So Vaidya has to concentrates on Pittanta
Criteria while directing the process. At that time he does not emphasize on the quantity of
Doshas expelled or number of Vegas occurred.
After completion of process when time comes to set "The sequence for Samsarjana" one
review the quantity of dosas expelled (Maniki Pariksha) and counts the number of Vegas
(Vaigiki Pariksha) expelled. Decision over the nature of Shuddhi is taken and Samsarjana
Krama is set upon.
After completion of "Samsarjana Krama" when one has to-decide the 'treatment regimen'.
Now Vaidya considers all the 3 parameters, correlate them with the proportion and
placement or dosas, observe the symptoms and set the treatment regimen.
Paschath karma
When Vamana Karma is finished, patient should be looked after carefully till one would
not be subjected to the normal diet. Till then patient is kept on special dietetic and behavioral
restrictions which are considered as "Paschat Karma". This may be classified under three
divisions.
A. Dhumapana
Charaka stated that after Samyak Vamana, patient is advised to wash mouth, hands &
feet, then to rest for a Muhurta.205
Afterwards one is advocated to inhale the smoke from any one of the three types of
smoke i.e. Snaihika (unctuous), Vairecanika (errhine) or Upasamaniya (palliative), which
will be suitable for him.
Dalhana provides the reason behind it as smoke will help to separate Kapha which is
stuck to srotasas. Dalhana also categorized the three types of Dhumapana according to
Prakrti of the patient as:
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Table No. 23 Types of Dhumapana with respect to doshas206
Prakrti Type of smoke
Vata Snaihika
Kapha Pitta Prakrti and utklista dosa Vairecanika
Samadosa Prakrti Upasamaniya
Swastha Prayogika
"Pariharya Vishaya" (Dietetic and Behavioral Restrictions) after Vamana207
Behavioral Restrictions
Loud speeches, sitting in one position for long duration, standing in one position for long
duration, long walks should be avoided.
Exposure to excessive cold or heat or dew, exposure directly to flowing winds, long
journey, and sleeplessness in the nights, sleeps during day time, to retain strong urge or
provocation of the urges.
Dietetic Behavior
Virudha diets, diet during Ajeerna State, Apathya diet, meals at wrong times, Pramita diets,
excessive diet, less diet, heavy diet, Vishama diet should be averted.
Samsarjana Krama
Purpose
1. Due to Dosha elimination from the body after Samshodhana Karma, Agni becomes
weakened. So to restore the strength of Agni and Prana, Peyadi Samsarjana Krama
should be followed208
2. Vamana process mainly takes place in 'Amashaya'. Amashaya is the site of both Pitta &
Kapha. More correctly, it is the site of Kledaka Kapha & Pachaka Pitta. Vamana
removes the vitiated matter mixed with Kledaka Kapha & Pacaka Pitta.
3. Samana Vayu is the prime factor which controls the movements of this whole region. In
this whole process, drug is accepted in Kostha by Samana Vayu.
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But 'Virya & Prabhava of the Vamaka medicine' activate Udana Vayu & instead of
further progression of digestion of food, it is dragged backwards & expelled through mouth.
Thus, during Vamana process, the functions of Samana Vayu are hampered and it is propelled in
the reverse direction. All the three factors which regulate the functions of Agni are "interfered in
this arduous process. So, to normalize them Samsarjana Krama is planned. Hence, Samsarjana
Krama achieves normalization of the edifice of digestion i.e. Samana Vayu, Pacaka Pitta &
Kledaka Kapha.
4. Yogindranatha Sen mentions that during Vamana process doshas become 'Dravibhuta'
(Liquify), so that they can be expelled out easily through Vega.
By evaluating the number of Vega during Vamana, one can understand the proportion of Doshas
which are liquefied. During Vamana if Vegas are produced in more number, it indicates that
dosas in the body are in more with Drava guna. One can easily understand that if liquid
property is increased in excessive quantity & enter the Amashaya, more and more weakening of
Agni will happen. Thus during the Uttama Vaigiki Shuddhi, Agni will use more time to return to
normal position, so maximum days (7 days) are attributed to it.
Hence, the Samsarjana Krama is arranged in proportion to Shuddhi done during Vamana.
5. Vigorous Sodhana done by Vamana causes, weakness, loss of weight, freeness of
Sandhibandha, decrease in the Agni and emptiness in the respective ashayas due to
expulsion of Kapha, Pitta, Vata and Mala. Due to this reason patient cannot tolerate any
type of treatment or diet, other than the prescribed for purpose. So "Samsarjana Krama"
should be planned.
6. Haranacandra pointed a very empirical point that this mitigation of Agni lasts up to
maximum one week. So it should be lifted by light diet sequentially.
Commencement of Samsarjana Sequence
When Samyak Shuddhi occurs, Samsarjana Krama may be started on that day only. If a
little vitiation (Ashuddhi) is remained inside, Samsarjana Krama can be initiated from the next
day.
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Course of Samsarjana
The Samsarjana Krama to be planned, is based on the type of purification done by
vomiting i.e. for Avara Shuddhi, Madhyama Shuddhi and Hina Shuddhi, it is of 3 days, 5 days &
7 days respectively. 209
Samsarjana Krama according to the Strength210
Sushruta mentioned that Samsarjana sequence can be followed by keeping an eye over the
strength of the patient. He says as 3 types of bala exist, Samsarjana Course should also be
adopted accordingly. For the individuals having good strength, three Annakala are advocated,
two Annakala for the individuals of Medium Strength & the individuals with lesser strength only
one Annakala is advised. Dalhana mentions that here bala can be judged by one's "Upashaya".
Divisions of Samsarjana Krama
Charaka classified Samsarjana Krama into two divisions as
(A) Peyadi Samsarjana Krama
(B) Tarpanadi Krama
A. Peyadi Samsarjana Krama
Generally, in all the patients after Vamana process (Samshodhana Karma), the "Peyadi
Sequence" is advised as diet regimen as follows:
Table No. 24 Peyadi Krama208
Days Annakala Pravara Suddhi Madhyama Suddhi Avara Suddhi
I day 1 morning 2 evening
Peya
Peya
Peya
II day 1 morning 2 evening
Peya Peya
Peya Vilepi
Vilepi
KrtakrtYusa
III Day 1 morning
2 evening
Vilepi
Vilepi
Vilepi
Akrta Yusa
Krtakrt
Mamsarasa
Normal diet
IV 1 morning 2 evening
Vilepi Akrta Yusa
Krta Yusa Akrta Mansarasa
- -
Vday 1 morning Krta Yusa Krta mamsarasa -
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2 evening Krta Yusa Normal diet -
VI day 1 morning 2 evening
Akrta Mamsarasa Akrta
Mamsarasa - -
-
VII day 1 morning 2 evening
Krta Mamsarasa Normal diet - -
- -
Role of Maniki Shuddhi in the planning of Samsarjana Krama
Sushruta also suggested performing the Samsarjana Krama after considering quantity of dosas
expelled during Vamana. When dosas are expelled in one Prastha quantity, serve Yavagu which
is made from the rice in a lesser quantity. If dosas in Madhyama or Uttama quantity are
eliminated, then two and three Annakala are followed respectively211.
He further provided the recipe to make the Peya, Vilepi, Yusha and Audana.
Table No. 25 Peyadi Kalpana
Kalpana Kalpana mixed with controlled diet Properties Peya yavagu Rice in a lesser quantity with more water.
Vilepi
Used1/4th Audana+Velepi (Well boiled)
Apicchila
Asiddha Yusa
Mudgayusa + ½ Audana
Without unctuous Material
+ Without salt. Siddha Yusa Siddha Yusa +3/4th Audana Hrudya + tasty Mamsarasa Mamsarasa of Lava, Ena, Harin
etc.animals + Audana Full diet
B. Tarpanadi Krama
In the following patients, Charaka advised to follow "Tarpanadi Sequence" as' Samsarjana
Krama'.
1. The patients with increased Kapha and Pitta
2. When Kapha & Pitta are eliminated in a smaller quantity during Samsodhana.
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3. in the alcoholic patients.
4. The patients having Vata-Pitta Prakrti.
This is preferred against 'Peyadi Sarnsarjana Course' as it may produce 'Abhisyanda' again in the
srotasas (channels) of Vishodhita' (well purified) body. 212
Nature of Tarpanadi Krama
According to Chakrapani, 'Swaccha Tarpana' can be served instead of Peya and "Ghana Tarpana"
instead of "Vilepi". Jejjata says due to similarities, (i.e. Samana Jatiyatvat) Mudga Yusha &
Mamsa rasa can be given as Tarpana. But commentators of Vagbhata mentioned the diet regime
clearly pertaining to 'Annakala'.213
Table No. 26 Tarpanadi Krama
I II III
Arunadatta (A.D. on A.H. 18/40)
Laja + Saktu Jirna Sali +Audana Mamsarasa +Audana
Parameswara (A.H. 18/40) Laja + Saktu Yusa + Anna Bhojana Mamsarasa +Anna
Role of various types of tastes while preparing Peyadi or Tarpanadi recipe
During "Annasamsarjana Sequence", there are chances of excitation of doshas due to augmented
Agni. So to prevent such increase, dosas are fought by arranging "Taste of the recipe" in such a
series that the chances of increase will be lessened. It is elaborated by "Dalhana" and Chakrapani
as.
Table No. 27 Rasadi samsarjana krama214
Reason Probable effect of Dosa Taste Used
Susruta Caraka
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1. Augmented Agni 1. To pacify Vata Pitta & to
balance Agni 2. To pacify Vata situated in
pakwasaya
Sweet & Bitter Sweet, Sour
pleasant to heart,
unctuous
2. Taste opposite to
previous one 1. To pacify Vata & Kapha 2. To increase Agni Bala 3. To augment Agni in the
Upper site
Unctuous Sour, Salty
Pungent Sour & Salty
3. Increased Pitta due to
previous Taste 1. To pacify Pitta & Vata Sweet, Sour, Salty Sweet & bitter
Here unctuous & dry properties should be used alternatively in appropriate manner.
Chakrapani says that these properties can be planned through the means of Taste. When the taste
having unctuous property is applied, then the taste having dry property can be planned and the
same pattern is followed further. Unctuous & dry properties are mentioned here as symbolic ones
only. One can arrange heavy & light properties & further more in the same manner.
Benefits
1. Helps to regularize the body which is weakened due to purificatory process (Prakrti
Bhojanartham).
2. To provide strength to the debilitated humors
3. By arranging such plan, the diet comprised of all the tastes can be served through 12 meals
Vyapad (Complications)
"Vyapad" are the symptoms which are produced other than Samyak Lakshanas, causing harm to
the patient and increasing the symptoms of the disease.
Charaka explained them as Adhmana (distension of abdomen), Parikartika (gripping
pain), Srava (excessive discharge), Hridgraha (Cardiac spasm), Gatragraha (spasm of
limbs), Jivadanam (discharge of blood), Vibhramsha (improper action of medication),
Stambha (rigidity), Upadrava (Serious afflictions), and Klamah (Exhaustion). These are
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considered to be the 10 complications due to Ayoga orAtiyoga of the Vamana, due to the
defects of attendant, the medication, the physician or the patient215
Sushruta mentioned 15 complications, Out of which Adhmana, Jivadanam,
Hrdayopasaranam, Parikartika, Parisrava, Angagraha, Vibandha are common.
Savasesausadhatvam Jirnausadhatvam, Hina dosha, apahritatva and movement of the
humors in opposite direction are different in Sushruta which are included in the causes of
complication by Charaka.216
Vriddha Vagbhata explained 12 complications having some different afflictions like
Grathitatva, Gaurava, Doshotklesa, Dhatu Srava etc217.
Factors
Four elements that influence the occurrence of complaints during process of Vamana are
Helper (Nurse), Medicine, Physician & Patient himself
Before initiating any one of the processes in Panchakarma, Charaka warned
Physician to keep an eye on the aspects like Dosha, Oushadha
(Medicine), Desha (Place), Kala (Ritu, time), Satmya, Agni, Satva,
Vayah (Age) and bala (Strength of the patient). If one failed to judge
any of this objects, it will lead to Vyapad (Complications) as a result.
Types
While describing Vyapad or complications, Charaka categorized them into two broad
divisions.
A. Ayoga
B. Atiyoga
That means, whenever any complication will arise, it will be due to either Ayoga or
Atiyoga of the process influenced by other factors. Ten Complications explained in Siddhi
Sthana, may be divided into these two broad categories. But Chakrapani ruled out the law of
inclusion under *nese two, by a remark in which he says, "it is not mandatory that these
symptoms should be produced after Ayoga or Atiyoga of Vamana but they may be produced as
an 'Upadrava' of the act. Later on, he blended them in two divisions i.e. Ayoga & Atiyoga as,
Table No. 28 Vamana vyapath218
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Ayoga Atiyoga
Adhmana Parikartika
Srava Jivadanam
Hrdgraha Vibhramsa (Gudabhramsa
&vSanjnabhramsa)
Angagraha
Kandvadi Vibhramsa
Upadrava
Klama
Mithyayoga
While reasoning to exclude mithyayoga from the complications of Vamana, Chakrapani
analyzed whole concept brilliantly. He explains, "Though Ayoga, Atiyoga and Mithyayoga are
described accordingly everywhere in the texts, but in the case of Vamana & Virechana there is
no need to consider Mithyayoga as a separate entity. In these processes, expulsion occurs in four
different ways as
1. Atipravrtti - Excessive expulsion.
2. Asamyak Pravrtti - Expulsion by improper way.
3. Apravrtti - Cessation of process of expulsion.
4. Alpapravrtti - Expulsion in a lesser quantity.
Here, last 3 are covered under an umbrella of "Ayoga". As an "Asamyak Pravrtti" means
expulsion through opposite route, it indicates that expulsion of vitiated matter is not in a
quantity, which is expected. So it must be considered under the term of 'Ayoga" and not
"Mithyayoga"
In the verse Su Chi 34/22, which divides fifteen complications of 'Vireka' into Atiyoga,
Duryoga and Ayoga, Dalhana expresses the views as here Vireka includes both Vamana &
Virechana. He further mentions Jejjafa who nominated the form 'Vipaka' to 'complications'
meaning which ends producing misfortunes
(Vishama Paka Anishtam Phaia) can be called as 'Vipaka'.
It is again divided into 3 factors viz. Atiyoga, Duryoga & Ayoga.
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A. Atiyoga means excessive Vamana.
B. Duryoga means wrongly medicated (Duryojanam) or wrongly administered
(Dushprayoga, Mithyaprayoga).
He further divided this into 3 categories as
Vaidya Duryoga (wrong medication by physician) causing Vamana, Mithyaprayoga,
Virechana Mithyaprayoga, Parikartika.
Atura Duryoga (Wrong response by patient) producing Hridaya Upasaranam, Vibandha.
Ubhaya Duryoga (wrongly treated & wrongly responded) causing Pravatika, Vatashula.
C. Ayogaja: Administered in lesser quantity
Ayoga
Vriddha Vagbhata explains, Ayoga means
Apravrtti - the ingested material doesn't come out absolutely.
The medicine which is administered, that is coming out alone.
Vibandha - the vomitus coming out in small bouts slowly
Factors initiating ayoga219
1. Status of Bowel : Krura & Bahudosa
2. Medicine : Quality- Dry (Ruksha), insubstantial(Alpagunam)
State- Decrepit (Anavam or Jirnam)
Quantity- Inadequate (Alpam)
3. Status of individual : Not properly oleated (snigdha) & sweated (Swinna)
4. Status of appetite : Increased appetite (Diptagni), but medicine-
Ruksa & Jirna.
5. Dosha sthiti : 1. Dosha with in less excited (Utklista) condition.
2. If dosas are in large quantity and accumulated
in Kostha having medicine with less potency
and with less appetite.
Symptoms
They can be divided into 3 groups:
A. Classically explained as 'Ayoga'
B. Described in ten complications produced as "Upadrava'
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C. Emerged after influenced by certain condition
Table No. 29 Ayoga of vamana
Group A Group B Group C
Cessation of Vega, Adhmana Srava Hrdgraha Vibhramsa, Sotha,
Expulsion of Medicine only, Angagraha Kandvadi HikkaTamasah darsana,
Vegavibandha, Hrdya Vibhramsa Upadrva Klama Pindika udvestana, Kandu,
Asuddhi, Srotoguruta, Uruh Sada, Vivarnata,
Gurugatrata, Sphota, Kotha, Gauravam Utklesa, Hrdaya
Kandu, Kaphapraseka,Jvara Asudhi Vyadhi Vrdhi, Trsna
(Sita), Sopha, Pratisyaya Parsvasula, Chardi, Murcha,
Lomaharsa, Alasya, Sula Parvabheda, Hrllasa, Arati
Udgara Avisuddhi,
Ten Vyapadas explained by Charaka
1. Adhmana
(A) Patient : Less appetite, misperistalis
(B) Medicine : Less in a dose
(C) Physician : Has excess of morbidity, dehydrated
(D) Pathogenesis : Will rouse the morbid humors and obstruct
the body channels.
(E) Signs and symptoms : Great distension of abdomen, pain in back,
sides of the chest and head, serious
obstruction to breath, faces, urine and flatus
(F) Treatment : (1) Induction, (2) Sudation, (3) Suppository
and similar treatment, (4) evacuative and
unctuous enemata and ail treatment
curative of disorders of misperistalsis
(Udavarta).
2. Parikartika
(A) Patient : HardBowelled
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(B) Medicine : Strong
(C) Physician : Patient suffers from Ama morbidity,in a
person who is emaciated soft bowelled,
exhausted and is poor of vitiaily
(D) Pathogenesis : Reaches the rectum and eliminates
morbid matter along with chime
(E) Signs and Symptoms : Causes acute colic and gripping pain
accompanied with slimy and bloody discharge,
(F) Treatment : Langhana, pachana, Rookshoshna bhojana
a. Patients with Chyme morbidity starvation
Digestive medication, diet should be dry, hot and light articles
And in conditions of emaciation measures of roborant therapy
Medications prepared with drugs of sweet group are recommended.
b. if even after the digestion of Ama there is obstnation medication with acid and alkali,
Light diet.
3. Srava
(A) Patient : Stools with abnormal excessive
morbidity.
(B) Medicine : In a small dose.
(C) Physician : With excessive morbidity
(D) Pathogenesis : Rouses the humours
(E) Signs and symptoms : Causes frequent and scanty elimination
and gives rise to the pruritus, edema,
dermatitis, heaviness of the body,
impairment of gastric fire, nausea,
stiffness, anorexia anaemia.
(F) Treatment : Either treated with sedative drugs with
emetics of giving oneself oleation. Again one should
be administered a strong purgative and perfectly
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cleansed, may be given powders, medicated wines
prepared with suitable medications.
4. Hridgraha
(A) Patient : Suppression of urge in after taking the
emetic drug.
(B) Medicine : -
(C) Physician : -
(D) Pathogenesis : Vata and other humors getting provoked
and reaching the heart, causing severe
cardiac spasm.
(E) Signs and Symptoms : The person becomes, causing severe
cardiac spasm and pain in the sides of the
chest. He gets depressed. There is dribbling
from the mouth, agitation of the eyes, one
bites the tongue, fails unconscious and
gushes one's teeth.
(F) Treatment : If condition is serious (fainting) due to
excesss of Pitta, emesis should be given
prepared with drugs of sweet group. If it is
due to Kapha, drugs of pungent group can
be used,. Thereafter the residual morbidity
should be digested away by digestive
medications. Then one's body and vitality
should be systematically
Also, if the person while vomiting excessively, is by Vata, he should be given unctuous acid and
salt articles due to Pitta and Kapha-dry, pungent and bitter articles sh
5. Angagraha
(A) Patient : Suppression of the urges by a person who
has taken the purificatory dose
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(B) Medicine : ---
(C) Physician : ---
(D) Pathogenesis : Owing to obstruction of Vata by Kapha or
owing to purification done in excess. The
provoked Vata seizes the limbs
(E) Signs and Symptoms : Causes the stiffness, tremor, pricking pain.
Asthenia, cramps and churning
(F) Treatment : Oleation, sudation, and ail similar other
measures curative of Vata should be carried
out.
6. Discharge of live blood
(A) Patient : Soft bowelled
(B) Medicine : Strong medication
(C) Physician : Soft bowelled + Slight morbidity
(D) Pathogenesis : After elimination the morbid matter and
churning the system excessively.
(E) Signs and Symptoms : Causes the discharge of the live blood.
(F) Treatment : Measures curative of Pitta of treatment
behetical.in the cover action of purificatory
procedures. Give fresh blood of a live deer,
cow, buffalo or goat. May be given blood
churned with,sacrificial gross in the form of
an enema.
7. Vibhramsa
Prolapse of Rectum : (Gudabhramsa)
It should be replaced after constricting it with astringent medication.
Unconsciousness: (Sanjnabhramsa) Soothing songs and words should be uttered.
Symptoms due to agitation: (Laksanbhramsa)
If the purgative dose ceases to act immediately after elimination of faecal matter or the
emetic does is immediately vomited out, it causes only the agitation of the morbid humor but
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does not eliminate it. Provoked humors cause pruritis and other diseases. This called condition of
wrongful action as medication in accordance with pathological features.
8. Stambha
(A) Patient : Undergone oleation procedures
(B) Medicine : An Unctuous portion
(C) Physician : -----
(D) Pathogenesis : It gets covered up by the morbid matjer
which is in softened condition and will be
unable to expel the morbid matter from its
habitat. It even obstructs those that have
been dislodged from their habitats.
(E) Sign and symptoms : Causes scanty and frequent elimination
accompanied with acute obstruction of
Vata. Stambha (rigidity) and pain in the
rectum.
(F) Treatment : Strong enemata or purgation preceded by
lightening and digestive measures.
9. Upadrava
(A) Patient : Lacking in unctuous property, debilitated
(B) Medicine : Ununctuous purgative medication
(C) Physician : ---
(D) Pathogenesis : Will provoke the Vata quickly and give rise
to severe complications.
(E) Signs and symptoms : Causes rigidity and severe pain in all limbs
and fainting.
(F) Treatment : Oleation sudation, similar measures
(treatment curative of Vata)
10. Klamah
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(A) Patient : Undergone the oleation procedure and soft
bowelled
(B) Medicine : Mild Medication
(C) Physician : ---
(D) Pathogenesis : Rouses up the Kapha and Pitta and
obstructs Vata.
(E) Signs and Symptoms : Heaviness, exhaustion.
(F) Treatment : Vamana, Langhana (lightening), Pacana
(Digestive remedies), Should be given
unctuous and strong purigicatpry measures
Vyapad
Table No. 30 Vamana vyapath according to different classics
Symptms/Samhita Caraka Susruta Vagbhata Bhela Kasyapa
Adhman + + - - -
Parikartikas + + + + +
Sarva + - - - -
Hrdgraha + - - - -
Gatragraha + - + + +
Jivadanam + + - + +
Vibhramsa + - - - -
Stambha + - - - -
Upadrava + - - - -
Kalma + - - - -
Ausadasya
Pratikula Parvatti + - - - -
Savasesausadhatva - + - - -
Jimaushadatva - + - - -
Hina dosaprtasya + - - -
Vatasula - + - - -
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Ayoga - + - - -
Atiyoga + - - - -
Pravahika - - - - -
Hrdayopasaranam - + - - -
Parisravah - + + - -
Vibandha - + - + +
Angamarda - + - - -
Paka - + - - -
Grathitatva - - + - -
Gaurava - - + - -
Dosatklesha - - + - -
Bhrsadhmana - - + - -
Sarvadhatusravana - - - + -
Gudaparisrava - - - + -
Pratisyaya - - - + -
Vamanasamprapti
Vamaka drugs possessing the properties like Usna, Tiksna, Suksma, Vyavayi,Vikasi
And with their ‘Swavirya’
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Move to ‘Hrdaya’
From there, through various “Dhamanis”
Lead to micro and macro channels in the body
Act over the vitiated complexes in the body
(i) With Agneya Property’-liquefy the complexes
(ii) With ‘Tiksana property’- Break them don into several particles
Liquified matter then glindes thorugh various unctuous or
Smooth channels to towards Kosha
Enter ‘Amasaya’ and then stimulated by ‘Udana Vaya’
Having the dominance of ‘Agni’ and ‘Vayu’ elements in the constitution
Along with self disposition (Prabhava)
Move in upward direction towards oral cavity
Expelled to outside through it
Vamana (Ca Ka1/5)
Flow chart 6
Vamana – Mode of Action
Properties of Vamana Drugs
Vamana Drug is a main tool for inducing the Vamana. Apart from the Vamana drugs
Vamanopaga Gana has also been described. Drugs included in Vamanopaga Gana help in
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enhancing the process of Vamana. These Vamana drugs have following characteristics for
producing Vamana.
Bhauthika Constitution:
All the Vamana drugs have dominance of Agni and Vayu mahabhuta.
Guna220,221: According to Charaka, Vamana Drug must have properties to reach at the site of the
Doshas and cause Sampraptivighatana. These gunas are Ushna, Tikshna, Sukshma, Vyavayi and
Vikasi. Apart from these Gunas, Sushruta mentioned Saratva Guna instead of Vyavayi. The role
of each Guna in producing the vomiting and thus relieving the Dosha is being discussed as here
under.
a)Ushna
Ushna is Agneya, which produces Dahana, Pachana and Sveriana Ushna drugs pfay
important role in the process of Visyandaha of the Dosha Sanghata responsible for the disease
Chakrapani comment that Vishyandayati means "Vilinam Kurvanti" According to Apte (1965),
Viiinam means to dissolve or to liquefy. Dalhana opines that Ushna drugs are capable to
dominate the Saumya drugs due to their Ushanata. In this way due to Ushna property, the drugs
used in Vamana Karma, liquefy the Dosha Sanghata.
b)Tikshna
Daha, Paka and Srava are produced by Tikshna. Tikshna acts for Vicchindana.
Chakrapani mentions that Vicchindanti is nothing but the breaking down of the morbid matter
into the small possible Particles. Dalhana explains that because of Tikshna property waste
Products (Dosha) oozes out immediately. Tikshna is also Agneya. It Produces Shodhana,
Pachana, Chedana and Sravana of Doshas in their Places.
c) Sukshma
The drugs can pass through minute srotas due to Sukshma Guna. Vayu, Akasha and Agni
Mahabhuta are dominant in its Bhauthika constitution. Due to Sukshma Guna, Vamana drugs
enter Sthula andAnu Srotas. Sharngadhara has mentioned the same. Dalhana is also of the same
opinion. Vamana drugs after breaking the Dosha Sanghata by its Ushna and Tikshna properties,
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due to their Anu-Pravanabhava brings, the Dosha into the Kostha. To enter the minute srotasas is
due to its anutva and to bring the Doshas from there to koshta is due to pravantva bhava.
d) Vyavayi
Vyavayi drugs are supposed to act directly on the body. It is generally considered that as
soon as these types of drugs are ingested, their action starts before digestion. Due to this
property, the Vamana drugs get absorbed and then act quickly. Dalhana mentions that due to
Vyavayi guna, Vamana drugs spread into the body without changing its form. Charaka attributes
Vyavayi Guna to Visha and Madva. Chakrapani comments, Vyavayi means spread out in whole
body in the Visha Chikitsa Adhyaya. In Madatyaya Chikitsa Sarva Vyapakatva is Mentioned for
Vyavayi Guna. So, on the basis of the above references, It can be said that, due to Vyavayi
property Vamana drugs spread out in whole body and starts the action of Ushna, Tikshna and
Sukshma gunas before its Pachana, like Visha and Madya.
e) Vikasi
The drugs, which are having Vikasi Guna, produce Saithilya in sandhi and especially in
Ojus. It has been mentioned in Sushruta Samhita that Vikasi are those which loosen
(Vimokshayet) the Dhatu Bandhana. Dalhana explains that Vamana drugs due to Vikasi property
also pervade through whole body without digestion like that of Vyavayi. Further he mentions
that loosening of Dhatu Bandhana means Dhatu Saithilya.
f) Saratva
Saratva Guna for Vamana is mentioned by Sushruta. Dalhana opines that due to Saratva
Guna Anulomana is possible. Gayi another expounder is of. the opinion that Saratva is Visarana
i.e. sliding, spreading. It is possible that due to Saratva Guna, malas which are brought towards
the Kostha from Shakha may be evacuated. Thus removal of Dosha may be enhanced.
g) Virya
Mostly all the Vamana drugs should have Ushna Virya. Due to Ushna virya, the Vamaka
Dravyas are Dahana, Svedana, and particularly pachana in nature; hence they are first brought to
Hridaya and further circulated through Dhamani to Sthula and Anu Srotas of the body. Thus
Ushna Virya helps the Vamana drugs in their circulation all over the body and also in breaking
up the Dosha Sanghata.
h)Vipaka
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Due to Vyavayi Guna, Vamana drugs get absorbed without their digestion so Vipaka
seems not to play any role in Vamana Karma.
i )Prabhava
Charaka clearly mentions that the main action of Vamana is due to its Prabhava. Charaka
said "Urdhva Bhaga Prabhavat Aushadhasya Urdhvam Utkshipyate". Elaborating Prabhava of
Vamana drugs, Chakrapani mentions that due to dominance of Agni and Vayu Mahabhuta in
their Panchabhautika constitution, there is a tendency of Urdhva Gati of Vamana drugs. It is
initiated by Udana Vayu. However Chakrapani emphatically mentions that it is the Prabhava of
Vamana drugs, which have important role in Urdhva Gati.
Role of Udana Vayu in Urdhva Gati
Charaka has mentioned the word, 'Udana Pranunno’,Chakrapani comments that Vamana
drugs are set in motion in upward direction (Urdhva Gati) by Udana Vayu. Astanga Sangraha
also has the same view.
SITE OF ACTIONS:222
Dhamani:
Caraka used the word “Dhamani” through which Vamana drugs spreads throughout the
body. Definition of Dhamani by Caraka is “Dhamanath Dhamanyah” that means Dhamana is
what which pulsates. Thus it is a structure resembling to artery. Chakrapani also comments that it
provide nourishment to the paramanus. So in the Vamana process, Dhamani is the medium
through which the Vamana drugs act in cellular levels.
Amashaya:
Since Amashaya is the site of both Kapha as well as Pitta it is significant in Vamana.
From the Shakas doshas reaching the Amashaya and is the site of production of Ama. So it has to
be expelled out. Removal of Doshas from its production site is appreciated by the Acharyas.
Hridaya:
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The drugs due to their so Virya reach to Hridaya from there it spread to all over the body
by aiming the dosha complex in micro level by a short period of time. So the word Hrudya
narrated here can be considerd in terms of both vital as well as chief organ i.e. heart and brain
Due to the property Ushna, Tikshna, Sukshma, Vyavayi, Vikashi and so virya (potency)
emetic drug reaches the heart and able to penetrate macro and micro srotas which are connected
to Dhamanies. It will then try to breakdown the complexes of accumulated doshas, which is
adhering to srotas. Due to Agneya and Tikshna nature it is going to liquefy as well extricate the
doshas. Then this liquefied and fragmented doshas are lead eloquently to Amashaya, flowing
through micro srotas without adhering to them. Caraka is giving a simile for better understanding
that water floats through the pot layered by unctuous material without sticking to the same.
Thereafter by the action of ‘Urdwabhaga prabhava’ of emetic drugs as well as with the action of
Udana Vayu the process Vamana taking place.
PHYSIOLOGY OF VOMITING 223
Vomiting is the forceful expulsion of contents of the stomach and often, the proximal small
intestine. It is a manifestation of a large number of conditions, many of which are not primary
disorders of the gastrointestinal tract. Regardless of cause, vomiting can have serious
consequences, including acid-base derangements, volume and electrolyte depletion, malnutrition
and aspiration pneumonia
The Act of Vomiting
Vomiting is usually experienced as the finale in a series of three events, which everyone reading
this has experienced:
Nausea is an unpleasant and difficult to describe psychic experience in humans and
probably animals. Physiologically, nausea is typically associated with decreased gastric
motility and increased tone in the small intestine. Additionally, there is often reverse
peristalsis in the proximal small intestine.
Retching ("dry heaves") refers to spasmodic respiratory movements conducted with a
closed glottis. While this is occurring, the antrum of the stomach contracts and the fundus
and cardia relax.
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Emesis or vomition is when gastric and often small intestinal contents are propelled up
to and out of the mouth. It results from a highly coordinated series of events that could be
described as the following series of steps
o A deep breath is taken, the glottis is closed and the larynx is raised to open the
upper esophageal sphincter. Also, the soft palate is elevated to close off the
posterior nares.
o The diaphragm is contracted sharply downward to create negative pressure in the
thorax, which facilitates opening of the esophagus and distal esophageal
sphincter.
o Simultaneously with downward movement of the diaphragm, the muscles of the
abdominal walls are vigorously contracted, squeezing the stomach and thus
elevating intragastric pressure. With the pylorus closed and the esophagus
relatively open, the route of exit is clear.
Figure No.1
Control of Vomition
The complex, almost sterotypical set of activities that culminate in vomiting suggest that control
is central. Within the brainstem are two anatomically and functionally distinct units that control
vomiting:
Bilateral vomition centers in the reticular formation of the medulla integrate signals from a
large number of outlying sources and their excitement is ultimately what triggers vomition.
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Electric stimulation of these centers induces vomiting, while destruction of the vomition centers
renders animals very resistant to emetic drugs. The vomition centers receive afferent signals
from at least four major sources:
• The chemoreceptor trigger zone.
• Visceral afferents from the gastrointestinal tract (vagus or sympathetic nerves) - these
signals inform the brain of such conditions as gastrointestinal distention (a very potent
stimulus for vomition) and mucosal irritation.
• Visceral afferents from outside the gastrointestinal tract - this includes signals from
bile ducts, peritoneum, heart and a variety of other organs. These inputs to the vomition
center help explain how, for example, a stone in the common bile duct can result in
vomiting.
• Afferents from extra medullary centers in the brain - it is clear that certain psychic
stimuli (odors, fear), vestibular disturbances (motion sickness) and cerebral trauma can
result in vomition.
The chemoreceptor trigger zone is a bilateral set of centers in the brainstem lying under the
floor of the fourth ventricle. Electrical stimulation of these centers does not induce vomiting, but
application of emetic drugs does - if and only if the vomition centers are intact. The
chemoreceptor trigger zones function as emetic chemoreceptors for the vomition centers -
chemical abnormalities in the body (e.g. emetic drugs, uremia, hypoxia and diabetic
ketoacidosis) are sensed by these centers, which then send excitatory signs to the vomition
centers. Many of the antiemetic drugs act at the level of the chemoreceptor trigger zone. To
summarize, two basic sets of pathways - one neural and one humoral - lead to activation of
centers in the brain that initiate and control vomition.
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AMAVATA The disease Amavata is named after the involvement of pathological factors -Ama and
Vata. These two are the central phenomenon of the disease.
Vyutpatti of Amavata
AmamCha VatamChaAmavatam M.N.25/2, madhukosa
The word Amavata comprises of two meaningful terms Ama and Vata which form the
pathogenic basis of the disease.
Amena Sahito Vata Amavata M.N.25/2, madhukosa
This derivation highlights the propulsion of Ama by Vata to produce Amavata.
Amo Apaaka Hetuh Vataha Swanaama Khyaata Rogavisheshaha” shabdakalapadruma
That which is the result of improper digestion is Ama and with Vata the disease is
popularly known as Amavata.
Definition
Yugapath Kupithavantaha Trikasandhi Praveshakau
Stabdham Cha Kuruthe Gatramamavathaha Sa Uchyate M.N 25/5 madhukosa
Amavata is a condition where Stabdhata of the body occurs due to lodging of vitiated
Ama and Vata in the Trika Sandhi.
Ama
The first of the pathological factors of Amavata, Ama is the root cause of all Vikaras
more so in Amavata and it prompts a detailed study as discussed below.
Etymology
1. "Am+Nich": 'Am' Dhathu with 'Nich' Pratyaya constitutes the word Ama.
2. Amyate Gamyate Pakadyartham Iti Amah.
⇒ The substance which goes into the process of digestion is Ama.
3. Amyate Ishath Pachyathe.
⇒ It means substance which is incompletely digested or uncooked is Ama.
4. Amyate Peedyate Srotas Samooho Anena Iti Ama.
⇒ Substance which harms a group of Srotas is Ama. This etymology of Ama is
nearer to the disease Amavata.
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Definition of Ama
In Samhitas various definitions of Ama are available. Some of them are:
Due to hypo-functioning of Ushma (Agni), the first Dhatu - the Rasa is not properly
formed; instead the Annarasa undergoes Fermentation or putrefaction (Dushta) and remains in
Amashaya. It is this state of Rasa which is spoken of as Ama. AH.SU.13\25
Three different opinions about Ama are compiled by Vijaya Rakshita. First view is about
the improperly digested food and the second describes the accumulation of Malas in the different
parts of the body. According to the third view, the first stage of Dosha Dushti is
Ama.MA.NI.25\1-4
Etiology of Ama224
The causative factors of Ama are described detailed in Charaka Samhita.
Aharaja Hetu :
Abhojana (not taking food), Atibhojana (excessive consumption of food) Ajeerna Bhojana
(taking food before the previous food gets digested), Asatmya Bhojana (taking unwholesome
food), Viruddha Bhojana (simultaneous consumption of food having antagonistic properties).
Dwishta Bhojana ((unpalatable), Ashuchi Ahaara (unclean food), Rooksha, Sheeta, Shushka,
Vishtambhi, Vidahi Bhojana.
Viharaja Hetu :
Improper administration of Samshodhana and Snehana, Vega Vidharana, Prajaagara and
Dukhashayya (sleeping on uneven mattress) can also initiate production of Ama.
Manasika Hetu:
Food consumed by a person in the state of Bhaya, Krodha, and Shoka also leads to Ama Utpatti.
Anya Hetu:
Desha, Kaala, Rutuvaishamya,Vyaadhikarshana are mentioned as the causative factors for Ama.
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Lakshanas of ama
The following explains the generalized symptoms with their etiopathogenesis of manifestation
which may be later modified by individual Doshas to show its specific presentations.
Table showing Lakshanas of ama225
Table - 31
Symptoms Etiopathogenesis
Srotodushti Picchila and Snigdha Guna of Ama
Balabramsha Mandagni causing lack of nutrients
Gourava Snigdha, Picchila, Guru Gunas of Ama
Aiasya Snigdha, Picchila, Guru Gunas of Ama
Malasanga Disturbance to Vata by Srotorodha
Anila moodhata Disturbance to Vata by Srotorodha
Apakti The qualities of Ama in turn leads to
Agnimandya forming a vicious cycle
Nishteeva Madagni causing Kaphotklesha
Aruchi As a result of Ajeerna
Klama . Due to Dhatvagnimandya
Above said symptoms are the general symptoms produced by Ama. Further, when this
Ama comes in contact with Dosha, Dushya and Mala it is termed as Sama Dosha, Sama Dushya
and Sama Mala
Concept of ama
In other words, Ama reflects the products of deranged homeostatic mechanisms in the
body. This clogs the controlling centers and pathways of normal physiologic functions marking
the beginning of pathogenesis in the form of sammurcchana of Nidana, Dosha and Dushya.
Hence, the total body homeostasis is the augmented effect of non-defective functioning of
the multiple organizations called Srotases. Each Srotas has a feeding point, a target point, a
controlling center (Srotomula) and a pathway (Srotas) and its function is appropriate
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transformation of the input raw material in to a finished product with elimination of the waste
product, effected by the transformative principle Agni.
Levels of existence of ama226
As mentioned above, the Ama exists at three levels in the body.
a) Ama at Jatharagni level
Amashaya is the substratum of Jatharagni, when the vitiated Agni acts upon the Ahara, it
fails to completely transform Ahara into nourishing moieties. The resulting Ahara Rasa is a
mixture of formed and unformed elements called Ama, which is thrown out of the Amashaya
through the Urdhwamarga by the Chardi (vomiting) and through the Adhomarga (Athisara), or it
may get displaced into the Grahani to remain stagnant. Due to prolonged stagnation, it may
assume the properties of Visha. Further Ama may associate with the Doshas, Dhatus and Malas
after getting absorbed from Amashaya and manifest symptoms related with each of them.
Dietetic indiscretions and emotional stresses may between them impair the functioning of
the neurohumoral mechanisms responsible for ensuring proper secretion of the digestive juices,
the disturbances of the pH in the gastro-intestinal environment and more often sluggish and
sometime hyper-motility of the stomach and intestine, thus leading to Shuktata or Shuktapaka
where food will be Avipakva, Asamyukta, Bahupicchila and Durgandha, due to fermentation and
putrefaction of the carbohydrate, fat and protein components. Thus causes the toxic state -
Visharupatvam.
This pathogenesis may cause the following metabolic disturbances
1) Toxic states
a) Intermediate toxic byproducts of metabolism
b) Superadded microbial action
2) Malnutritional states
a) Intermediate toxic by products of metabolism: It is clear from the texts that Sama Ahara
Rasa induces the production of various deranged metabolites like
1. Sama Dosha: In Avasthapaka, there will be Udeerana of
the Doshas i.e. Madhura Avasthapaka - Kapha (Amashaya), Amla Avasthapaka - Pitta
(Pittashaya) and Katu Avasthapaka-Vata (Pakvashaya)
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But, due to Apakva Ahara produced by Mandagni, there will be Udeerana of Dushita
Dosha called as Samadosha. Further in Nishthapaka, due to affliction of Rasa and Rakta Dhatu,
there will be further increase of vitiated Kapha and Pitta in the form of Mala thus contributing to
Sama Dosha.
Bhutagni and Dhatvagni Mandya : Jatharagnimandya will lead to Bhutagni and
Dhatvagni Mandya also. Jatharagni is the Poshaka to the different Agni of the body, but
Bhutagni and Dhatvagni can even get vitiated independently i.e. irrespective of
Jatharagnimandya.
Sama Dhatu : With affliction of both Avastha and Nishthapaka, the Dhatu Poshaka Rasa
produced is Vikruta. Thus, with production of Sama Rasa Dhatu, succeeding Dhatu will also get
vitiated producing Dhatu Pradoshaja Vikara. Sama Dhatu Utpatti is due to Bhutagni and
Dhatvagni Mandya but it can even be independent of Jatharagni status.
II. Sama Mala : The word Mala includes 2 entities.
a. Mala of Ahara Rasa i.e. Pureesha, Mutra and Sweda and also the other Dhatugata
Malas
b. Dushita Dosha and Dhatu are also called Mala
2. Superadded microbial action: Toxins in the intestines in the present days are greatly
attributed to the action of different microbes, thus leading to different manifestations like:
i) Infective gastro-enteritis
ii) Toxic gastro-enteritis
iii) Botulism
Intestinal flora in the human body exists in the state of symbiosis; these can be very well
compared with Sahaja Krimi. Chakrapanidatta explains them as the one which exists within the
body without causing diseases. Intestinal flora breaks the complex molecule which are not
broken by the body, metabolises them into simple molecules by 2 kinds of actions. They are
Fermentation and Putrefaction.
Putrefaction is similar to fermentation but it specifically refers to conversion of protein
substances to smaller molecules with the liberation of various gases viz. Indol, Skatole, Phenol,
Hydrogen sulphate and Ammonia that are characteristically pungent in odour. Fermentation is
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related to the Carbohydrate and fat metabolism by the microbes. Microbe's metabolism releases
few of the waste products vital for the body like Vit. Bgroups.
Among these microbes, there are some in borderline populations which under
circumstances become parasitic. There are other groups of virulent organisms which invade body
through food and drinks, producing abnormalities in the body, e.g.: Salmonella, Staphylococcus,
B. botulinus, B.typhosus and coma bacillus of Kochs. Hence, the normal food metabolism also
includes the metabolism by Intestinal flora (Sahaja Krimi).
Hence, different microbial infections occur in the body when it is made susceptible by
predisposing factors like metabolic abnormalities, emotional stress, overstrain and other
Agnimandyakara and Amotpattikara Nidana.
Malnutritional states
In chronic disorders, due to Agnimandya or Amotpatti, there will be predominant manifestation
of Dhatukshaya as it is told in Vatavyadhi context that the Avarana will cause Rasadi Dhatu
Kshaya. Depending on the speed of manifestation, disease can be
Acute
Sub-acute and Chronic
Acute conditions include Visuchika, Jwara, Atisara, Pravahika and so on. Sub-acute and chronic
conditions include Grahani Dosha, Udara roga, Pandu, Amavata, Prameha and so on.
a)Dhatvagni level
• The Ama at Dhatvagni level occurs due to vitiated Dhatvagni first as a result of a direct
influence from Jatharagni as the Dhatvagnis are derivatives of Jatharagni and Jatharagni
hyperfunction or hypofunction results in respective derangements of Dhatvagnis too
• Secondly, as a result of Dhatvagni malfunction independent of Jatharagni. The
hypofunction of Dhatvagni leads to morbid increase of the Dhatu involved and
hyperfunction leads to its morbid decrease. The Ama hence formed gets associated with
these morbid Dhatus to form Sama Dhatus resulting in manifestation of symptoms
explained under Dhatupradoshaja Vikara .
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b) Bhutagni level
The Ama at the Bhutagni level occurs as a result of Bhutagnimandya, the mechanism of
formation is similar to that mentioned under Dhatvagni level. The symptoms produced are
Shosha, Vrana, Vidradhi and similar diseases.
1. Ama as a result of Malasanchaya:
The Malas (waste products) produced at various levels in the body, when accumulates
beyond tolerable limits also constitutes Ama. The Mutra and Pureesha are the Malas of Ahara,
Kapha that of Rasa, Pitta of Rakta, Vasa and Khamala of Mamsa, Sweda of Medas, Loma, Asthi
and Tvacha Sneha and Akshi Vit of Majja
The excessive accumulation of these Malas (Mala Sanchaya) therefore gets to be called
Ama as they are harmful to the normal physiology of the body. The Shukra is the essence
of all Dhatus and it does not have any Malas.
Production of Ama independent of influence of Agni - as a result of Dosha Anyonya
Sammurcchana
Strangely, the Doshas exist in the body in equilibrium of mutually paradoxical Gunas of
Doshas; this equilibrium is inherent and compatible with the normal bodily functions. This has
been called as "Sahajasatmya"
An interesting feature of this concept is its close resemblance to the concept of auto
immunity in the modern parlance. The Major Histocompatibility Complex determined by Human
Leukocyte Antigens marks the surface proteins of all the cells of the body. This helps the T cells
(responsible for Cell mediated immunity) to recognize the self antigens from the non-self. When
this mechanism fails, the immune system starts secreting antibodies against body's self proteins
producing crippling and fatal diseases. They are called Auto immune diseases and Rheumatic
Fever is one among them
Nidana224
Identifying the causative factors and understanding the role of these causative factors in
the manifestation of the disease is utmost important to make a proper diagnosis, to predict
prognosis and to plan treatment.
Invariably two factors are responsible for the manifestation of the disease Amavata. As
the name indicates, Ama and Vata are those two factors. The Anjana Nidana author opines Ama
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and Vata get vitiated due to their own respective causes to promote disease. Hence, individual
etiological factors responsible for the vitiation of Vata and those etiological factors which
produce Ama may also be considered as etiological factors of Amavata.
Madhavakara has explained following Nidanas for Amavata
1. Viruddha Ahara (incompatible diet)
2. Viruddha Cheshta (Erroneous habit)
3. Mandagni (diminished digestive fire)
4. Nischalata (Sedentary habits)
5. Vyayama soon after Snigdha Ahara
Besides this, Harita opines consuming Guru Ahara, Kanda Shaka (tubers) in excess and
indulging in excessive Vyavaya is the Nidana of Amavata.
To sum up, the causative factors of Amavata can briefly be classified in to two.
1) Viruddha Ahara- unwholesome diet
2) Viruddha Cheshta- erroneous habit
Viruddha itself is the root cause of the disease Amavata. The factors which cause Dosha
Utklesha (vitiation) but do not have the capacity to eliminate those Doshas out of the body are
considered as Viruddha.
Charaka has elaborately mentioned regarding Viruddha Ahara and categorized these into
18 types.They are Desa (Habitat) Viruddha, Kala (season) Viruddjia, Agni (digestive power)
Viruddha, Matra (dose) Viruddha, Satmya (compatibility) Viruddha, Dosha Viruddha, Samskara
(processing) Viruddha, Veerya (potency) Viruddha, Koshta (bowels) Viruddha, Parihara
(proscription) Viruddha, Avastha (state of health) Viruddha, Krama (order) Viruddha, Upachara
(prescription) Viruddha, Paka (cooking) Viruddha, Samyoga (combination) Viruddha, Hrit
(palatability) Viruddha, Sampath (quality) Viruddha, Vidhi (rules of intake) Viruddha.
Viruddha Cheshta includes a wide variety of causative factors. They are consumption of
Snigdha Ahara and doing Vyayama immediately, Sheetoshna Vyatyasa (alternative use of Sheeta
and Ushna), use of Sheetodaka at once during Bhaya Shrama and so on, Vega Vidharana
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(suppression of natural urges), Vega Udeerana (provoking of natural urges), Diva Swapna (day
sleep), Ratri Jagarana (night vigil), Sahasa (act beyond capacity).
The causative factors of a disease operate in varied patterns in the body to cause the
disease. This depends upon the extent to which the environment is made favorable for the
interaction of Nidana, Dosha and Dushya.
The capacity of the body to resist this interaption is called Vyadhikshamatva/ Vyadhi
Pratyaneeka Bala. This Bala differs from person to person. That is why inspite of exposure to
Nidanas, some develop severe disease with negligible exposure while some people do not.
Samprapti227
The pathology of a disease involves various complex and sequential mechanisms. This
has to be unraveled for the proper understanding of the disease and then to plan successful
treatment. Mechanisms of the disease process are best understood by means of Samprapti of the
disease.
Madhavakara has explained the Samprapti of Amavata as follows. In the presence of
Mandagni, if one is exposed to Nidana then Ama is formed in the Amashaya along with vitiation
of Vata Dosha. This Ama circulates in the body propelled by the vitiated Vata exhibiting an
affinity to get lodged in the Shleshma Sthana i.e. Sandhi. Further, this circulating Ama in the
Dhamanis interact with the normally present Vata Pitta and Kapha Dosha giving rise to
variegated color to the virulent Ama. It becomes qualitatively heavy and viscous, facilitating
Sroto Abhishyandana and Srotorodha.
Alteration in the Srotas endures Sthana Samshraya leading to the manifestation of
symptoms like Hrutgourava, Dourbalya, Sandhi Shotha and Shoola etc.
Amavata is basically caused by the Viruddha Ahara as well as Cheshta. More over this
phenomenon of Viruddha Ahara may not be similar in every patient rather it is individual
specific. This etiology of Viruddha Ahara is said to be in connection with the establishment of
the disease. On exposure to Viruddha Ahara it may cause morbidity of Dosha, impair the
functioning of the Jataragni or else it may lead to the formation of more virulent Amavisha.
Similar to virudhahara, virudha cheshta also has got an important role. Chestas like
sedentary habits or doing tidious work or exercises just after having heavy or fatty meals affects
the proper digestion and metabolism This will accelerate the formation of ama visha in the body.
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Dosha Dushti :
Consumption of Viruddha Ahara precipitates morbidity of Doshas. Due to the deleterious
effect of the Viruddha Ahara, any Dosha may get vitiated or else any combination of the two
Doshas or all the three together. These vitiated Doshas in turn afflicting the specific Dushya
manifests as illness, pertaining to Amavata. By the deleterious effect of the Viruddha Ahara,
there occurs the morbidity of the Vata Dosha. The clinical manifestations like Anaha, Antrakuja,
Vibandha, Sandhi Sula, Sandhi Jadyata etc are suggestive of vitiation of Vata Dosha at different
levels.
Chesta
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Agni Mandya and Amotpatti
Intake of Viruddha Ahara has detrimental effect on the functioning ofthe Jataragni. As
mentioned byAcharya Charaka, intake of Viruddha Ahara leads to Agnimandya which in turn
generates the virulent Ama in the body. Invariable involvement of Ama is characteristic of the
disease Amavata. Both Koshtagata as well as Shareeragata Ama are the hallmarks of the
pathogenesis of Amavata. Reduction in the Abhyavaharana Shakti andJal-ana Shakti, symptoms
like Praseka, Aruchi, Apakti, Malasanga and similar other symptoms are indicative of
Koshtagata Ama. Shareeragourava, Alasya, Klama, Sandhi Shotha, Staimitya are the other
common clinical features of Amavata suggestive of Shareeragata Ama. Moreover, the symptom
complex of Amavata is more indicative of combined effect of Ama as well as morbid Vata and is
popularly known as Samavata state. Progressive involvement of the joints in the form of severe
pain and swelling, worsening of the symptoms by the application of the oil, more severity of the
symptoms at the time of sunrise, as well as on appearance of the clouds in the sky, all are the
typical features indicative of Samavata state in the disease Amavata.
Similar to virudhahara, virudha cheshta also has got an important part in the
pathogenesis.
The Ama and morbid Vata, from Amashaya circulates in the whole body. The properties
of the Samavata being similar to that of the Kapha Dosha, Ama and morbid Vayu exhibits an
affinity to get lodged in the Kapha Sthana, more particularly tend to get localized in the joint.
With in the joint, these two pathological factors undergo a pathological union with the naturally
present Doshas in the joints. It is said that by the interaction with the Doshas in the joint the Ama
and morbid Vata acquires further virulence and then manifests as Amavata. Here, the interaction
with in the joint causes the generation of Amavisha.
Perpetuation of the illness for a long duration destroying the joints is analogous to the
effect of Garavisha in the body. Progressive damage that occurs for long is very characteristic of
Garavisha.. Thus relating this to the causation of the illness, indulgence of Viruddha Ahara
ultimately culminates in the generation of Amavisha. This Amavisha gradually causes
destruction of the body. Later, during the course of the disease, permanent destruction of the
joints results in the Anga Sankocha, Jadyata, Anga Vaikalya etc, totally incapacitating the
patients and restricting him to the bed. Viruddha produces some alteration in the humoral activity
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of the body and results in the production of Ama. This Ama is antagonistic to the bodily tissues
(Dhatu Virodhi). Effect of this may be rapid or gradual.
Dhatu Dushti
Deleterious effect of the Viruddha Ahara is not restricted to the Dosha and Agni; rather it
badly influences the Dhatu even. This nature of the Viruddha Ahara is described as
Dhatupratyanika effect. It is worth mentioning here that the Viruddha Ahara is considered as an
etiology of Majjavaha Sroto Dushti and the Mula of the Majjavaha Srotas being Asthi and
Sandhi, this implies the detrimental effect of the Viruddha Ahara on the Asthi and Sandhi
wherein the disease Amavata manifests. The symptoms like Sandhi Shotha, Sandhi Shoola,
Bhedanavat Shoola in Asthi and Parva Pradesha, Mamsa Kshaya, Sandhi Sankocha etc. are
suggestive of Dhatu Dushti in the disease Amavata.
Samprapti Ghataka
Dosha : Tridosha-Vata kapha predominant
Dhatu : Rasa, Mamsa, Asthi, Majja
Upadhatu : Snayu, Sandhi
Srotas : Annavaha, Rasavaha, Asthivaha, Majjavaha,
Udakavaha, Purishavaha, Mutravaha
Srotodushti : Sanga, Vimargagamana
Udbhavasthana : Amashaya, Pakvashaya
Adhishtana : Sarvashareera
Vyakta Sthana : Sarva Shareera more particularly Sandhi
Avayava : Sandhi
Vyadhisvabhava : Chirakari
Roga Marga : Madhyama
Poorva Roopa228,229,230
The Poorva Roopa of Amavata is not explained in the Samhitas, we can consider few of
the Samanya Arnavata Lakshanas as its Poorva Roopa.
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In Amavata before the onset of disease, Ama is formed. The symptoms produced when
Ama only gets involved with Vata before getting lodged in the Shleshma Sthana, can be
considered as Poorva Roopa. The Samanya Lakshanas of Amavata though not very disease
specific to Amavata, likeAgnimandya, Aruchi, Angamarda and Gourava can be considered as
Poorva Roopa.
Roopa
Specific signs and symptoms of a disease when manifested conspicuously are considered
as Roopa or Lakshana of a disease.
Roopa is one of the key tool in arriving at the diagnosis.
Of course this is also helpful in assessing the Sadhyasadhyata and to plan the treatment.
The Lakshanas of Amavata have been explained in length in the classics.
Based on the stages of the disease the lakshanas are broadly classified into
Samanyalakshanas and Pravridha lakshanas.
Samanya and Pravridha Lakshanas of Ama231,232,233,234
Table No– 32
Samanyalakshanas Pravridha lakshanas
Angamarda Sandhi Soolam
Aruchi Sopham
Trishna Agnidourbalyam
Alasyam Prasekam
Gowravam Aruchi
Jwaram Gowravam
Apakam Utsahahani Soonathanganam Vairasyam
- Daham
- Bahumootrata
- Kukshi soolam
- Nidrviparyayam
- Trit
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- Chardi
- Bhramam
- Moorcha
- Hritgraham
- Vitbandham
- Jadhyam
- Antrakoojam
- Anaham
On keen observation and assessment of Lakshanas, they can be broadly classified into 3
categories.
1. Lakshana specific to involvement of Sandhi.
2. Lakshana specific to involvement of Ama.
3. Lakshanas produced as a consequence of the disease
process. They are elaborated below:
Classification of Lakshanas
Table No.-33
Lakshana specific to Lakshana specific to Lakshanas produced
involvement of Sandhi involvement of Ama as a consequence of the
disease process
Sandhi Shoola Chardi Nidraviparyaya
Sandhi Shotha Arochaka Bhrama
Shunata Anganam Aruchi Murcha
Sashabdha Sandhi Anaha
Gatrasthabdhata Angamarda
Jadyata Alasya
Sandhi Vikunchana
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Sankocha
Kanja
Though in this disease is Vata predominant, involvement of Ama is invariable. Hence, we
see Sama Vata Lakshanas in the patients of Amavata. This might be the reason for not
mentioning the disease Amavata separately byCharaka.
Doshanubandha Lakshanas
Vatanubandha : Sasularn
Pittanubandha : Sadaha, Saraga
Kaphanubandha : Stimitata, Guru, Kandu
According to Rasaratnasamuchaya, the lakshanas of Amavata are
Persistent pain the Katee pradesha (Katyam vyadha bhavennithyam), swelling in Sandhis
(sandhishu swayadhur bhaveth), inability to rise even from sitting position
(Uthanepyasamarthathwam) are the features of the disease.
Bheda
For a better understanding, the disease Amavata can be broadly classified into two
categories, the first, on the basis of clinical manifestation and the second, on the basis of
prognosis, with sub classification existing in each category. The details are as follows;
1. Based on clinical manifestations it is divided into:
a. Dosha Bhedena
In Amavata, the Pradhana Dosha is invariably Vafa. Due to some supportive factors other
two Doshas also get involved; accordingly, we can observe the symptoms. Madhavakara has
explained seven type of Amavata on the basis of Dosha Pradhanyata. They are as follows:
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Classification based on Dosha Bheda 235
Table No. - 34
Dosha Symptoms Guna
Vataja Shoola Sheeta ,Chala
Pittaja Raga, Daha Teekshna, Ushna
Kaphaja Sthaimitya, Guruta, Kandu Picchila, Sthira, Sheeta
Vatapittaja Shoola ,Raga, Daha Sheeta, Chala,Teekshna, Ushna
Vatakapha Shoola,Sthaimitya,Guruta, Sheeta,Chala, Picchila,
Kandu Sthira, Sheeta
Pittakapha Raga,Daha,Shoola, Teekshna, Ushna,Sheeta,
Sthaimitya,Guruta, Chala,Picchila, Sthira,
Kandu Sheeta
Sannipatika All the above All the above
c) Avastha Bhedena
Based on the different stages of the disease, Madhavakara has broadly classified Amavata
into two varieties they are,
1. Samanya
2. Pravruddha
The symptomatology of this has been discussed in Roopa Table No. 2.
d) Lakshana Bhedena
Acharya Harita's classification of Amavata has been unique. According to him, Amavata is
of four types.236
1) Vishtambhi : This type of Amavata presents with Shareera
Guruta, Adhmana, and Basti Shoola.
2) Gulmi Amavata : Amavata having Jatara garjana, Gulmavat
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peeda and Kati jadata is called as Gulmi.
3) Snehi : Here Gaatra snigdhata, Jadhya, Mandagni
and excretion of Vijala and Snigdha ama are characteristic.
4) Pakva ama : This variety of Amavata presents with
excretion of Shyava vijala pitta and Pakva ama along with
Shrama and Klama.
d) Based on prognosis237,238
Based on the general principle of Sadhyasadhyata, Amavata can be of two types.
1. Naveena: If the duration of disease is not more than one year, it is called Naveena Amavata
which is Sadhya.
2. Purana: If the duration of Amavata is more than one year, it is called Purana Amavata which
is difficult tatreat.
Prognosis based on Doshasthiti 239
Table No. -35
Dosha sthiti Prognosis
Ekadoshaja Dwidoshaja
Tridoshaja Sadhya Yapya Krichrasadhyam
Classical Management of Amavata240
The treatment of amavata was first described by Bhavamishra. The lisease has got two
stages namely ama stage and nirama stage. In the initial stage treatment is given to subside the
ama which is the causative factor of the disease. When ama has been subsided treatment is done
to alleviate Vata. Prophylactic treatment also should be done inorder to check the recurrence of
the disease. The line of treatment described by acharyas may be as follows.
1. Langhana
2. Swedana
3. Administration of deepana drugs which are having thikta and katu rasas
4. Virechana
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5. Sneha pana
6. Vasti
Treatment Principle
1. Langhana
In Amavata, ama is the primary cause of the disease. Agnimandya is responsible for the
formation of ama and vataprakopa. According to Ayurvedic authorities Langhana is one of the
best therapies for eliminating ama. By ama pachana the passages of vayu can be cleared, ie.the
vitiated vata come to normal stage.But as long as ama remains, the disease will not subside. So
ama must be eliminated first and then only other medicines for vata to be used.
Upavasa is recommended in Amavata. Amavata is caused by ama which is the result of
hypofunctioning of the digestive and metabolic enzymes. In such a condition, the body cannot
digest even light meals. If ingestions of food is not restricted the angimandya will continue and
the disease gets aggravated. Hence langhana in the form of Upavasa is the best treatment for
amapachana in amavata.
If the patient is weak complete fasting should be avoided and light food prepared with
deepana, pachana drugs should be given.
The samyaklanghita lakshanas are mentioned as follows.
Proper excretion of flatus, urine and faeces, lightness of the body, feeling of purity in
heart, purity in mouth and throat disappearance of drowsiness and exertion, appearance of sweet
taste for food, simultaneous hunger and thirst and contentment.
Yogaratnakara also explains in the case of ama vyadhi’s one may go for the
samshodana,in the form of vamana. It is also considered as shodana variety of langhana by
charaka.241
2. Swedana
Among the several types of swedanas mentioned in Ayurvedic classics, Ushma sweda, Tapa
sweda and Upanaha sweda are recommended inAmavata.
When the swollen joint is fomented the srotorodha is minimized and therby relieves pain
and inflammation. The fomentation relieves the local congestion and the redness is relieved, the
patient is able to move the joint with least trouble. Rooksha sweda which is usually carried out
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by valuka potali is recommended in this specific type of disease. Other ushna dravyas such as
kulatha could also be used for this purpose.
The principle underlying the use of valuka potali is that the arna along with vayu plays an
important role in the initial stage of the disease and creates unbearable pain in the joints. The
ama is guru-snigdha and sthira in nature and hence that type of fomentation which is exactly
antagonistic in nature is advised in this condition. It has been observed that by application of
sneha the symptoms will get aggravated. Sneha vivarjitha upanaha sweda also is recommended
in amavata by Bhavamishra.
Sweda karma is contra indicated in persons belonging to Pitha prakriti. In such a person
instead of direct swedana anagni sweda is recommended. The patient is asked to wear wollen
clothes, blankets etc. the same type of swedana can be given by keeping the patient in a closed
room where direct exposure to heat is, avoided. The drugs having the quality of ushna, rooksha
etc. are selected and made in to a paste, and to be applied in the inflamed parts. The lepas
commonly used in Amavata are Jadamaydi lepam, kottam chukkadi lepam and Ellumnisadi
lepam,
3. Administration of deepana drugs which are having both thikta and katu rasas Drugs having
katu, thikta rasas are used in Amavata. Amapachana is the important therapeutic measure
administered in this disease. Medicines having katuthikta rasas have both deepana and pachana
property; The selection of these two rasas is most significant. Ama is guru, pichila, snigdha and
sthira. pridhvi and jala are abundant in it. Tikta rasa is laghu and rooksha in nature and the
mahabhutas present in it is akasha and vayu.
Katu rasa contain Agni and Vayu in abundance. It is ushna veerya in nature and having deepana,
pachana and vataghna properties Thikta and katu rasa act antagonistically and hence medicines
having thikta and katu rasas are very useful for deepana and pachana.
The above mentioned therapies langhana, swedana, and administration of deepana
pachana drugs are helpful in the ama stage of the disease. In the nirama stage virechana,
snehapana and vasti are mentioned.
4. Virechana
Due to fasting, swedana and shamana chikihtsa the doshas attain nirama stage and reach koshta
and from there they are to be eliminated.
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Here virechana is done for the elimination of both pitha and kapha and for the anulomana of
vayu. Complete eradication of doshas by virechana will prevent the tendency to recur the disease
again and again.
Eranda thaila is the drug of choice for virechana in amavata. It has got the pachana, virechana
and vataghna property. According to Susruta it is deepana also. Hence it is considered as an
unchallangable drug of this disease.
This purgative should not be given in the initial stage of the disease because in that stage
the doshas are sama and are leena.in the dhatus. After attaining nirama stage and bringing the
doshas to pakwasaya, they should be thrown out gradually.
5. Snehapana
When the doshas became nirama kevala vatahara treatment is indicated. In kevala vata
sneha is the prime remedy.
Charaka says sneha pacifies vitiated vata, gives mridutwa for body and removes the
obstruction of malas. In amavata sneha medicated with deepana and pachana drugs are found to
be most effective.Both external and internal application of sneha is necessary in amavata.
External application such as abhyanga and moordha taila is indicated in this disease. For internal
use hriswa matra type of snehapana is suitable as the patients are weak due to the disease. Here
the sneha gives brimhanatwa to the patient. It also gives vata shamana, agni deepthi and koshta
shudhi to the patient. Bhavamishra suggests repeated administration of sneha in amavata
patients.
Pathya:- Harita explains that the pathya told in jwara roga should also be considered in amavata as in both
the disease involvement of rasavaha srotas is there.242All the ahara vihara which are Vata Kapha
hara, 0Amapachaka, Agnivardaka are useful.Yava ,kulatha, shyamaka, kodrava, rakthashali,
vastuka, shigru, karavaellaka, patola, ardraka, lashuna, ushnajala, takra, jangala
mamsa.Panchakola siddha jala,katu tikta phala, gokshura,varuna,arishtaka, purana
shali,sauveera, punarnava, lavamamsa processed in takrakulatha yusha ,jeerna
Madhya.balataka.243,244
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Apathyas:- The ahara vihara which cause agnimandya, abhishyandana, all the nidanas which are Vata and
Kapha kara in nature is apathya to amavata. Dadhi,matsya,guda,ksheera, mahapistaka, dushta
jala, virudhashana, satmya, vishamashana, guru adhishyandaahara,vegadharana, jagarana,
nischeshtata,Dwidala danya, goulya, taila, sheetala jala snana, ushna drava.245,246
Sapeksha nidana
Sapeksha nidana is the comparison of diseases having look alike feature.Amavata is a painful
joint disorder which has to be differentiated from other painful joint diseases like,
1. VATA RAKTA:247
In this disease as the name suggest involvement of rakta plays important role in causing
disease. Main feature of the disease is, it affects classically the big toe with some skin
manifestation. Pain will be like akoovisha
2. SANDHIGATA VATA:248
Here swelling occurs like air filled bladder in touch and pain during contraction and
extension of limb.
3. KROSHTUKA SHEERSHA:249
It is mainly due to vata and shonitha.It effect only knee joint. Pain is severe and the shape of
joint is shrigala mastakavath.( head of a jackal)
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Rheumatoid arthritis250
Rheumatoid arthritis is an autoimmune chronic inflammatory disorder. Autoimmune
diseases are illnesses that occur when the body tissues are mistakenly attacked by it’s own
immune system. RA is characterized by an inflammation of the synovial joints leading to joint
and periarticular tissue destruction as well as a wide variety of extraarticular features. Patients
with autoimmune diseases have antibodies in their blood that target their own body tissues,
where they can be associated with inflammation. Because it can affect multiple other organs of
the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called
rheumatoid disease. While rheumatoid arthritis is a chronic illness, meaning it can last for years,
patients may experience long periods without symptoms. Typically, however, rheumatoid
arthritis is a progressive illness that has the potential to cause joint destruction and functional
disability.
Etymology of RA
According to collinns dictionary-Rheumatism is derived from the word – “Rheumatimos” a
Greek word designating ‘mucous’, an evil humor which flows from brain to the joints and other
portion of the body, producing pain(Hollander) -
• The term “Rheum” also means stiffness.
• The term Arthritis derived from – a Greek word “arthros” means joint. Arthritis means
inflammation of the joint.
Definition of RA
• RA is a chronic, multisystem disease of unknown etiology. Although there are a variety
of systemic manifestations, the characteristic feature of RA is persistent inflammatory
synovitis, usually involving peripheral joints in a symmetric distribution. The potential of
the synovial inflammation to cause cartilage destruction is the hallmark of the disease.
• RA is a systemic connective tissue disorder which affects predominantly the synovial
joints. Hence the term ‘rheumatoid arthritis’.
• RA is the most common form of chronic inflammatory joint disease. In its typical form
RA is a symmetrical, destructive and deforming. Poly arthritis affecting small and large
synovial joints with associated systemic disturbance, a variety of exra–articular features
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and the presence of circulating antiglobulin antibodies (rheumatoid factors).
Characteristically the course of the disease is prolonged with exacerbations and
remissions forms are not uncommon.
• RA is a systemic inflammatory disorder of a chronic nature that is characterized primarily
by the pattern of involvement of synovial joint. The inflammatory process may involve
soft tissue and may extend into bone. By virtue of inflammation that are involved in
rheumatoid process, systemic involvement of a generalized inflammatory nature affecting
different organs and structures may also be seen.
• Rheumatoid disease is an inflammatory condition in which immunological mechanisms
probably play an important role. Arthritis is its principal manifestation. (Chamberlain)
• RA is a systemic condition which produces intra-articular and periarticular inflammation.
Although the principal symptoms relate to the joints it is now regarded as a disease of
mesenchymal connective tissue which affects many organs-skeletal tissues including
bones, muscles, tendons, fescia, synovia, and bursae.
Historical review:
Regarding the disease Rheumatoid arthritis –
Hippocrates: Introduced the disease in the field of medicine.
Aretus: Give the clinical description of Rheumatoid arthritis.
Galen: Coined the word ‘Rheumatism’.
Pavlow: Distinguished acute arthritis from gout.
CLASSIFICATION OF RA
According to modern medicine – RA can be classified into three types.
1. Juvenile RA – (in children)
2. Adult RA
3. Psoriatic and atypical RA
Further on the basis of various features and factors – RA can be classified as
(1) According to chronicity – 2 type
(i) Type 1 – The less common form, lasts a few months at most and leaves no permanent
disability.
(ii) Type 2 – It is chronic and lasts for years, sometime for life.
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(2) According to ARA criteria – 4 type
(i) Possible RA – presence of 2 criteria for 3 wks.
(ii) Probable RA – 3 or 4 criteria for at least 6 wks.
(iii) Definite RA – 5 or 6 criteria for at least 6 wks.
(iv) Classical RA – 7 or more criteria.
(3) According to Pattern of onset249
(i) Acute RA or Explosive – (10%)
• Very rapid with severe symmetrical polyarticular involvement.
• Many patients with this type of onset do surprisingly well in long.
(ii) Palindromic RA
• Repeated attacks of acute self limiting synovitis affecting a variable number of joints.
• Inflammation develops over a few hours accompanied by erythema and swelling of affected
joints, resolves within 32-48 hours leaving no residual features.
• It is usually identified by presence of RF in blood.
(iii) Insidious RA – (70%)
• Cases of RA develop insidiously over weeks or months with gradually increasing joint
involvement. Progression is from predominantly peripheral small joint disease to the
involvement of the more proximal joints including the knee and hips.
(iv) Systemic RA
• It is usually seen in middle aged man.
• No articular features dominate, i.e. fever, myalgia, weight loss, anemia, pleural effusion and
vasculitis lesion may occur.
• RF usually present with high titer.
(4) According to number of joints involved
(i) Mono – articular RA
(ii) Oligo – articular RA
(iii) Poly – articular RA
(5) According to Radiological changes
(i) Erosive RA
(ii) Non-Erosive RA
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(6) According to RA factor
(i) Sero – positive RA
(ii) Sero – Negative RA
(7) According to presence of rheumatoid nodules
(i) Nodular RA
(ii) Non Nodular RA
Clinical pattern of different types of RA
(i) Palindromic – Attack of 24-98 hrs, 50% progress to pattern.
(ii) Transient – self limiting less than 12 months, not permanent.
(iii) Remitting – Remission after 3-5 years minimal residual damage.
(iv) Persistent – Relapsing and remitting case with variable disability.
(v) Chronic and progressive – heads to severe deformity and disability.
Abnormality in RA-Synovial joint
• When the synovial becomes inflamed in RA – the protein content of Synovial fluid increases.
• The concentration of hyaluronic acid (3.5. gm) and its molecular wt. are reduced.
• Fluid viscosity decreases.
PATHOLOGICAL CHANGES IN JOINTS IN RA:
• In RA synovium becomes inflamed causing warmth, redness, swelling and pain.
• As the disease progress the inflamed synovial invades and damages the cartilage and bone of
the joint.
• The destruction of ligaments and tendons by proliferation margins of inflamed synovial
referred to as pannus.
• surrounding muscles, ligaments and tendons become weakened, and unable to work normally.
• RA also can cause more generalized bone loss that may lead to osteoporosis.(Fragile bones
those are prone to fracture.)
AETIOLOGY OF RHEUMATOID ARTHRITIS:
The cause of RA is still unknown, even though infectious agents such as viruses, bacteria, and
fungi have long been suspected; none has been proven as the cause. The cause of rheumatoid
arthritis is a very active area of worldwide research. Some scientists believe that the tendency to
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develop rheumatoid arthritis may be genetically inherited. It is suspected that certain infections
or factors in the environment might trigger the immune system to attack the body's own tissues,
resulting in inflammation in various organs of the body such as the lungs or eyes.However
following are some of the speculations in this respect according to modern medical science.
• The disease is triggered by T-lymphocyte activation in genetically predisposed individuals with
defined HLA class-II halotypes. HLA-DRI is more important in Indians
• RA might be a manifestation of the response to an infectious agent like mycoplasma, Epstein
Barr virus, cytomegalovirus, rubella virus in a genetically susceptible host.
• A persistent infection of articular structure or retention of microbial products in the synovial
tissues generates a chronic inflammatory response.
• The microorganism or response to the microorganism might induce an immune response to
components of the joint by altering its integrity and revealing antigenic peptides (Harisson)
• The sensitization of self antigens could be a consequence of enzymatic or free radical damage
to proteins such as IgG or type-II collagen, the development of anti-idio type antibodies or a
defect in glycostation of IgG.
• Molecular mimicry - The infecting microorganism might prime the host to cross reactive
determinants expressed within the joint. There is recent evidence of similarity between products
of certain gram negative bacteria and HLA-DR molecule.
• Super antigen driven disorder-super antigens are proteins produced by a number of
microorganisms like staphylococci, streptococci and M. arthritis. They have capacity to bind
HLA-DR molecular and particular VB segments of heterodimeric T cell receptor and stimulate
specific T cells expressing the VB gene products (H P I M).
• Risk factors for the development of RA include obesity, smoking, high red meat consumption,
a previous blood transfusion and an adverse pregnancy outcome (Symmons DP Looking back:
rheumatoid arthritis--etiology, occurrence and mortality/Pubmed 16306475).
• Over work and psychological stress cause first attacks as well as relapses.
• Endocrine factors play a part in 20-25% cases which occur within a year of menopause (Savil
1988).
• Of all the potential environmental triggers, the only one clearly associated with the
development of RA is cigarette smoking.
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Pathogenesis of Rheumatoid arthritis:
There are three important factors in the pathogenesis of the RA.
1. Initiation of Disease: HLA-DR4 cell binds with the antigen. This may occur in 4 ways i.e.,
HLA-DR4 binds an endogenous peptide, HLA-DR4 binds an exogenous peptide, HLA-DR4
presents itself as an antigen and QKRRA and exogenous antigen share structural homology
(molecular mimicry). Once this binding occurs the main function of DR4 is to present the
antigen to CD4+ T cells. CD4 cells recognize the peptide antigen initiate the host response.
2. Autoimmune reaction within the synovial membrane: As the result of host response
appearance of CD4+ T cells is seen in the joint. There will be subsequent activation of the
endothelial cells of synovial capillaries. This process results in the transmigration and attachment
of inflammatory cells like neutrophils and macrophages. Neutrophils release reactive free
radicals and lysosomal enzymes. Activated macrophages release prostaglandins, cytokines and
chemokines such as IL-1, IL-6, TNF-_, and IFN-_. Whole of this leads to the activation of B
cells with antibody production, which results in the appearance of immune complexes in sera,
synovial fluid and synovial membrane.
3. Mediators of joint damage: As described above sensitized T cells, activated _cells,
macrophages, neutrophils, synoviocytes in the inflamed synovium leads to the release of the
cytokines and lysosomal enzymes like IL-1, IL-2, IL-3, IL-4, IL-6, IFN_, GM-CSF, TGF_, TNF-
_, TNF-_14. These will stimulate the cells of the pannus to produce collagenase and other neutral
proteases, and also activate chondrocytes in situ, stimulating them to produce proteolytic
enzymes that can degrade cartilage. These also cause the activation of osteoclasts, leading to
further bone demineralization
STAGES OF RHEUMATOID ARTHRITIS:
From the clinical point of view a rheumatoid arthritis can be divided into three stages:
1) Potentially reversible soft-tissue proliferations: In this stage .the disease is limited to the
synovium. There occurs synovial hypertrophy and effusion. No destructive changes can be seen
on X-Rays.
2) Controllable but irreversible soft –tissue destruction and early cartilage erosion:
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X-rays shows a reduction in the joint space, but the outline of the articular surfaces is
maintained.
3) Irreversible soft-tissue and bony changes: The pannus ultimately destroys the articular
cartilage and erodes the subchondral bone. The joint becomes ankylosed usually in a deformed
position (fibrous ankylosis).It may be subluxated or dislocate.
Joints affected in rheumatoid arthritis:
Common : MCP joints of hand
: PIP joints of fingers
: Wrists, knees, elbows, ankles
Less Common : Hip joint
: Temporo-mandibular joint
Uncommon : Atlanta-axial joint
: Facet joints of cervical spine
Deformities in Rheumatoid arthritis:
Hand : Ulnar drift of the hand
: Boutonniere deformity
: Swan-neck deformity
Elbow : Flexion deformity
: Early-flexion deformity
Late-Triple _ (Flexion, Posterior, and external rotation.) subluxation
Ankle : Equinus derformity
Foot : Hallux valgus, Hammer toe.
Pathology and pathologenesis of Rheumatoid Arthritis:
The earliest change is swelling and congestion of the synovial membrane and the underlying
connective tissues, which become infiltrated with lymphocytes espially (CD4T cells), plasma
cells and macrophages. Effusion of the synovial fluid into the joint space takes place during
active phase of the disease. Hypertrophy of the synovial membrane occurs with the formation of
lymphoid follicles resembling an immunologically active lymph node. The inflammatory
granulation tissue (pannus) is formed, spreading over and under the articular cartilage which is
progressively eroded and destroyed. Later, fibrous adhesions may from between the layers of
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pannus across the joint space and fibrous or bony ankylosis may occur. Muscles adjacent to the
inflamed joints atrophy and there may be focal infiltration with lymphocyte.Subcutaneous
nodules have a characterstic histological appearance. There is a central area of fibres, fibrinous
exudates and cellular debris, surrounded by a palisade of radially arranged proliferating
mononuclear cells. The nodules have a loose capsule of fibrous tissue. Similar granulomatous
lesions may occur in pleura, lung, pericardium and sclera. Lymph nodes germinal centre
numerous plasma cells in the sinuses.Immunofluorecene shows that plasma cells in the synovium
and lymph nodes synthesis rheumatoid factors.
PRODROMAL SYMPTOMS OF RA:
Symptoms like fatigue, weakness, anorexia, joint stiffness, vague arthralgia and myalgia are
seen as prodromal of rheumatoid arthritis.
Clinical Manifestation :
Presentation of the disease may vary from person to person. Amavata may present with the
predominance of the Samanya Lakshanas. The disease process may start with invovlement of the
joints where the Khavaigunya takes place. The disease may be presented with all the Pravruddha
Amavata Lakshanas depending upon the degree of Doshic vitiation.
There are 7 types of presentation of RA. They are as follows,
1. Classical: Pain, stiffness and swelling of small joints of hands and wrists. Symptoms fluctuate
in severity from day to day.
2. Palindromic: Intermittent episodes of pain, swelling and redness, usually single joint
followed by rapid return to normal after several days.
3. Systemic: Weight loss, pleurisy and pericarditis but minimal joint involvement.
4. Polymyalgic: Pain and stiffness in shoulders and hip with subsequent synovitis.
5. Monoarthitic: Single joint involvement usually knee.
6. Acute onset: Sudden overnight onset with stiffness and pain.
7. Lymphadenopathy: generalized As the rheumatoid arthritis advances, tendon sheath and
joint destruction results in joint instability and deformities. The flexion deformities of small
joints of hand & feet, the elbow and knee are characteristic deformities of RA. Ulnar deviation
of the fingers is usually associated with anterior subluxation of metacarpophalangel joints. Other
finger deformities like hyperextension of the proximal interphalengeal joint with fixed flexion at
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distal interphalengeal joints, i.e. swan neck deformity; fixed flexion of the proximal
interphalangeal joint and extension of terminal interphalangeal joint, i.e. button whole deformity;
and a Z deformity of thumb, lead to greater loss of hand function. Tenosynovitis and bursitis are
also common features of RA as tendon sheath and bursae are lined with synovium.
As RA is a systemic disorder it produces
1. Skin: Palmar erythema, psoriasis.
2. Subcutaneous nodules: Rheumatoid nodules develop in 20 to 30% of persons with RA.
Common locations include olecrenon bursa, proximal ulna, occurring over bony prominences at
site of pressure or function.
3. Systemic features: Fever, weight loss, fatigue, susceptibility to infection.
4. Haematological: Anaemia, thrombocytosis, eosinophilia.
5. Lymphatic: Splenomegaly, Fetty’s syndrome.
6. Myositis: Muscle wasting around inflamed joint.
7. Ocular: Episcleritis, Scleritis, Keratoconjunctivitis sicca.
8. Vasulitis: Purpuric rashes, pyoderma gangrenosum.
9. Cardiac: Pericarditis, myocarditis, endocarditis
10. Pulmonary: Pleuresy, pleural effusion, fibrosing alveolitis.
11. Neurological: Neuropathy, cervical nerve root compression, muscle wasting.
12. Amyloidosis
Remissions, exacerbations are the hallmarks of the disease. In a small percentage however, the
disease progresses relentlessly to joint destruction and crippling.
DIFFERENTIAL DIAGNOSIS:
Rheumatoid Arthritis differentiated from other diseases having similar features like Joint
Pain on the basis of presenting Signs and Symptoms & biochemical investigations. These
diseases are as follows:
1. Gout :
In pathological investigation high serum uric acid level is present. Response to
administration of Colchicine is found in this condition.
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2. Osteoarthiritis :
Radiological appearance differs, absence of subcutaneous nodules and R.A. factor. In typical
case, Heberdon’s nodes appear in relationship to DIP joints and ESR usually within normal
limits.
3. Polymyalgia Rheumatica :
In this condition ESR is very high and peripheral joint signs are minimal. (Onset of
Rheumatoid Arthritis in elderly mimic Polymyalgia Rheumatica)
4. Polyarthritis Nodosa :
May resemble Rheumatoid Arthritis, but radiological changes are minimal. Severe systemic
symptoms and necrotising vasculitis at early stage of polyarthritis may be present, but joint
erosions and typical Rheumatoid Arthritis deformity are rare in later stage.
5. Systemic Lupus Erythematosis :
It is characterized by the presence of numerous autoantibodies, circulating immune
complexes and widespread immunologically determined tissue damage. Chronic inflammatory
arthritis and tenosynovitis may lead to deformities and contractures, but erosive changes are very
uncommon.
6. Rheumatic Fever :
First, attacks are usually under 15 years of age in 70% of case. It is characterized by flitting
type of joint pain and sustained fever. Spindling of finger joint is rare. Myocarditis, endocarditis
and nodules on the different histological picture are present. Some other diseases are as follows
from which we have to differentiate the disease Rheumatoid Arthritis.
• Acute Suppurative Arthritis
• Tuberculous Arthritis
• Reiters Syndrome
• Hypertrophic Osteoarthropathy
• Chronic Arthropathy
• Sarcoid Arthritis
• Scleroderma
• Myeloma
• Arthritis with Erythema Nodosum
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• Spondylitis
• Psoriatic Arthritis
INVESTIGATION
Immunological assay:
No tests are specific to RA, but rheumatoid factors (RF) are found in the two-thirds of RA
patients. 5% of healthy individuals also have RF positive. Thus the presence of RF is more of
prognostic value than diagnostic value. Patients with higher RF titers found to have more severe
and progressive RA with extra-articular manifestations.
Blood picture:
Normochromic, normocytic aneamia is commonly found in RA patients. White blood cell
count may be normal or mild leukocytosis may be present.
ESR:
Erythrocyte sedimentation rate is increased in all most all the patients of active RA. In few
patients ESR level may be elevated even after the diseases activity subsides due to the raised
globulin levels.
Anti nuclear antibodies (ANA):
ANA positive increases the likely hood of auto-immune disease. Chief utility of this test is to
exclude the diagnosis of SLE when the test is negative.
C-reactive protein and ceruloplasmin:
The C-reactive protein and ceruloplasmin levels are elevated in inflammatory conditions and
gradually such elevations correlate with disease activity and the likely hood of progressive joint
damage. The findings can be useful as a simple index of the disease activity and treatment status.
Synovial Fluid Analysis:
Synovial fluid analysis confirms the presence of inflammatory arthritis. The synovial fluid is
turbid, with reduced viscosity, increased protein content, and a slightly decreased or normal
glucose concentration. The white cell count varies between 5 and 50,000/uL and
polymorphonuclear leukocytes predominate in the RA.
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Radiographic Evaluation:
Arthroscopy, Roentgenograms, Arthrographs, ultrasound, CT Scan, MRI, 99m TC
biophophonate bone scanning etc. are useful to establish the extent of local pathology in joints.
Roentgenograms:
Roentgenogram of the affected joint in early stages is not helpful in diagnosis. There may be
no changes during first few weeks of the disease manifestation. Evidence of soft tissue swelling
and joint effusion, erosions at joint margins, subchondral area and articular cartilage, slight
narrowing of the joint space and juxtra articular oesteopenia are seen after few weeks.
Generalized osteoporosis, pocketed erosions in the subchondral area, pseudo cysts in the articular
ends, marked narrowing of the joint space, subluxation and deformities are visualized in the later
stage of the disease (Harrison’s & Davidson’s).
Complications:
• Adverse effects on work and social life are common
• Many people with rheumatoid arthritis (RA) have restricted mobility and difficulties with
activities of daily living
• Depression is common
• Inability to work may occur early in the course of the disease, especially in someone with a
manual occupation
• Inflammatory conditions other than those involving joint and tendon
• Vasculitis, vasculitic ulcers
• Pleurisy/pleural effusions, pulmonary fibrosis
• Pericarditis
• Lymphadenopathy
• Dry-eye syndrome (keratoconjunctivitis sicca)
• Neuropathy
• Felty's syndrome (enlarged spleen and low white-cell count); can present with an infection or
leg ulcer
• Amyloidosis (rare)
• Anaemia
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• Orthopaedic complications: carpal tunnel syndrome, tendon rupture (particularly extensors of
fingers or thumb), cervical myelopathy (usually after severe and longstanding RA), osteoporosis
• Infectious complications: increased risk of infections. Pulmonary infection and generalized
sepsis are particular risks. Septic arthritis is a rare but serious complication.
CLINICAL COURSE AND PROGNOSIS:
The course of RA is quite variable and difficult to predict in an individual patient.Most
patients experience persistent but fluctuating disease activity, accompanied by a variable degree
of joint abnormalities and functional impairment. After 10 to 12 years,<20% of patients will have
no evidence of disability or joint abnormalities. Within 10years, ≈50% of patients will have work
disability.A number of features are correlated with a greater likelihood of developing joint
abnormalities or disabilities. These include :
• The presence of >20 inflamed joints
• A markedly elevated erythrocyte sedimentation rate
• Radiographic evidence of bone erosions
• The presence of rheumatoid nodules,
• High titers of serum rheumatoid factor
• The presence of functional disability
• Persistent inflammation
• Advanced age at onset
• Low socioeconomic status or educational level etc.
Remissions of disease activity are most likely to occur during the first year. Despite the decrease
in the rate of progressive joint damage with time, functional disability, which develops early in
the course of the disease, continues to worsen at the same rate, although the most rapid rate of
functional loss occurs within the first 2 years of disease.Drug therapy may also play a role in the
increased mortality rate seen in individuals with RA.
Factors correlated with early death include disability, disease duration or severity, glucocorticoid
use, age at onset, and low socioeconomic or educational status.
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DIAGNOSIS:
The diagnosis of RA is easily made in persons with typical established disease. In a majority
of patients, the disease assumes its characteristic clinical features within 1 to 2 years of onset.
The typical picture of bilateral symmetric inflammatory polyarthritis involving small and large
joints in both the upper and lower extremities with sparing of the axial skeleton except the
cervical spine suggests the diagnosis. Constitutional features indicative of the inflammatory
nature of the disease, such as morning stiffness, support the diagnosis.
TREATMENT:
General Principles:
The goals of therapy of RA are
(1) relief of pain,
(2) reduction of inflammation,
(3) protection of articular structures,
(4) maintenance of function and
(5) control of systemic involvement.
Management of patients with RA involves dealing with the various problems that these
individuals encounter with functional as well as psychosocial interactions.
1. Nonsteroidal anti-inflammatory drugs:
The first is the use of aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and
simple analgesics to control the symptoms and signs of the local inflammatory process. NSAIDs
e.g. ibuprofen, indomethacin and Salicylates.NSAIDs produce symptomatic relief of pain and
stiffness – will not abolish pain.It has rapid onset of benefit and rapid loss of effect on cessation
of therapy. Has no effect on laboratory parameters. Affects cyclo-oxygenase path way of
arachidonic acid metabolism and thus inhibits prostaglandins. Salicylates are relatively safe,
inexpensive analgesic and anti-inflammatory and can still be a cornerstone of drug therapy. e.g. -
acetylsalicyclic acid (aspirin).
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2. Glucocorticoid therapy:
The second line of therapy involves use of low-dose oral glucocorticoids. Although low-dose
glucocorticoids have been widely used to suppress signs and symptoms of inflammation, recent
evidence suggests that they may also retard the development and progression of bone erosions.
3. Disease-modifying antirheumatic drugs:
The third line of agents includes a variety of agents that have been classified as the disease-
modifying or slow-acting antirheumatic drugs. Recently, combinations of disease- modifying
antirheumatic drugs (DMARDs) have shown promise in controlling the signs and symptoms of
RA.
4. Anti-cytokine agents:
A fourth group of agents are the cytokine-neutralizing agents, which have been shown to have
a major impact on the signs and symptoms of RA and also to slow progressive damage to
articular structures.
5. Immunosuppressive therapy:
A fifth group of agents are the immunosuppressive and cytotoxic drugs that have been shown
to ameliorate the disease process in some patients.
6. Surgery for severely damaged joint:
Surgery plays a role in the management of patients with severely damaged joints.Although
arthroplasties and total joint replacements can be done on a number of joints, the most successful
procedures are carried out on hips, knees, and shoulders.Although synovectomy may offer short-
term relief of symptoms, it does not appear to retard bone destruction or alter the natural history
of the disease. In addition, early tenosynovectomy of the wrist may prevent tendon rupture.
7. Exercise and Physiotherapy:
• Active Exercise: to restore muscle mass and maintain the normal joint movements.
• Passive Exercise : to prevent contracture
• Joint Splinting : reduces local inflammation
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DRUG REVIEW
FOR THE PRESENT STUDY 6 GROUPS OF DRUGS WERE USED :
1. Drug for Pachana& deepana
2. Drug for the Kostha pariksha
3 Drug for Sneha paana
4 Drug for Swedana karma
5. Drug for Vamana karma : Vaamaka & Vamanopaga
6. Drug for Dhumapana
1. Drug for the Kosta pariksha:-
Koshta pariksha was carried out with Triphala Kashaya 150 ml at 9.30 am after breakfast.
Table No.36
Drug Rasa Guna Veerya Vipaka Karma
Haritaki
(Terminalia
Chebula)
LavanaVarjitha
Pancharasa.Kashay
a Rasa Pradhana
Laghu
Ruksha
Ushna Madhur
a
Tridoshahara,
Srotoshodana
Amlaki
(Emblica
officinalis)
Lavana Varjitha
Pancharasa,Amla
Rasa Pradhana
Guru,
Ruksha
Sheeta
Sheeta Madhur
a
Tridoshahara
Vibhitaki
(Terminalia
Bellirica)
Kashaya Laghu
Ruksha
Ushna Madhur
a
Tridoshahara, Kapha
Vikara & Medo Vikara
2. Drug for Paachana Dipana: Vadavanala churna:251
Its is a unique combination of Saindhava Pippalimula Pippali Chavaya Chitraka Shunti
Haritaki in an increment increase in quantity. (1:2:3:4:5:6:7) respectively, which is specifically
quoted as Agni Deepaka.
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Table No.37
Drug Rasa Guna Veery
a
Vipaka Karma
Saindhava
(Sodi
Chloridium)
Madhur
Lavana
La
gh
u,
Snigdh
a
Sheeta
Katu Tridosha Shamaka
Deepana,Pachana
Ruchya,Vrushya
Pippalimula
(Pipper
longum)
Katu Laghu
Ruksa
Ushna katu Vatakapha Shamaka
Deepana
Pippali
(Pipper
longum)
Katu
Laghu
Ruksa
Ushna Katu Vatakapha Shamaka Deepana
Chavaya
(Pipper
Chaba)
Katu Laghu
Ruksa
Ushna Katu Kaphavatashamaka
pittavardaka & deepaka
Chitraka
(Plumbago
Zeylanica)
Katu Laghu
Ruksa
Ushna katu Kaphavata shamaka pitta
vardaka
Deepana Pachana
Shunti
(Zingeber
Officinalis)
Katu Guru
Ruksa
Ushna Madhur
a
Kaphavata Shamaka Deepana
pachana triptighna
Haritaki
(Terminalia
Chebula)
LavanaVarj
ita
Pancharasa
Laghu
Ruksh
a
Ushna Madhur
a
Tridoshahara, Srotoshodana
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3. Drug for the Snehapana: Murchita Ghrita:252
Ama is one such entity which is not only seen in Shareera but also in Dravya, so the ideal
formulation should be free from Ama. Gritha murchana is the technique to remove the Ama
present. The esters present in the raw ghee hinders the Absorption as well as it won’t allow other
active principles to mingle with the lipid molecule. Murchana process removes these unwanted
esters.
Table No.38
Drug Rasa Guna Veerya Vipaka Karma
Ghrita Madhura SnigdhaSheeta Sheeta Madhura Vata pittahara
Tri phala ------------ --------- -------- --------- Kapha pittahara
Haridra
Curcumalonga
Tikta
Katu
Ruksha Laghu Ushna Katu Kaphavata shamaka
Matulunga
Citrus medica
Amla Laghu
Snigdha
Tikshna
Ushna Amla Kapha vata hara,
Dipana hrudya Ruchya
4. Drug used for Bahya snehana253
Drug selected for abhyanga - saindavadi taila
Rasapancaka of saindhavadi taila.
TableNo:39
Drug Latin name Properties
Rasa Guna Virya Vipaka Karma
Saindhava
Madhur Lavana
Laghu, Snigdha
Śīta Katu
Tridoṣa Śamaka Dīpana,Pācana Rucya,Vruśya
Devadaru Cedrus deodara Tikta Lagu Nigdh
Uśna Katu Vedanastapaka
Vaca Acorus calamus Katu Tikta
Lagu Uśna Katu Medhya Lekhana
Zingiber officinale Katu Laghu Uśna Madura Truptighna
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Śunti snigda Dīpana Katphala
Myrica nagi thumb Tikta Laghu Tiksna
Uśna Katu Rucya, Vedanasthapana
Śatahwa
Anethum sowa kurz Katu Snigdh Uśna Katu Dīpana,
Musta
Cyperus rotundus linn
Tikta, Katu
Rukśa, Laghu,
Śīta Katu Dipana-pācana
Cavya
Piper retrofractum Katu Lagu Rukśa
Uśna Katu Dīpana
Medha Polygonatum cirrhifoliumm
Madhura Guru Śīta Madhura Rasayana, balya
Jayapala Croton tiglian linn Katu Guru Uśna katu Virecana, Dīpana
Trivrith Operculina turpeethum
Tikta, Katu
Laghu, Rukśa
Uśna Katu Virecana
Hiijala twak
Barringtonia acutangula
Tiktha katu,
Laghu, rukśa
Uśna
Katu Vātahara, viśagna,
Netra bala Pavonia odorata Tikta Laghu Rukśa
Śīta Katu Balya, dīpana pācana, pittahara
Citraka Plumbago zeylanica Katu Lagu Rukśa tikśna
Uśna Katu Dīpana Lekhana
Bramhana estika
Clerodendron siphonatus
Tikta Laghu
Uśna Katu Dīpana pācana
Śati Kaempferia galangal linn
Tikta Tikśna
Uśna Katu Ruciprada
Vidanga Emblica Ribes
Katu Kaśay
Lagu Uśan
Uśna Katu
Kuśtagna Krimighna
Madhuka Gkycyrrhiza glabra linn
Madhura Guru snigdha
Śīta Madhura Tridoṣa hara, rasāyana, vruśya
Renuka Vitex negundo Katu tikta Laghu, rukśa
Uśna Katu
Vāta, kapha hara śulahara śopha hara
Aconitum Katu Uśna Uśna Katu Lekhana
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Ativiśa Hetrophyllum Tikta
Samgrahak Dīpana
Eraṇda Ricinus communis linn
Madura Snigdha Uśna Madura Recana, Vriśya
Ambasta Cissampelos pariera
linn
Tikta Laghu,
tīkśna
Uśna Katu Vāta kapha hara,
grahi, balya
Nilini
Indigofera tinctoria
linn
Tikta Laghu,
Rukśa
Uśna Katu Kapha vāta hara
Danti-mula Baliospermumontanum Katu Guru,tiksna Uśna Katu Recana,
Dipana
Marica Piper nigrum Katu Laghu
snigda
Uśna Uśna Śirovircana
Ajamoda
Carum roxburghian Katu
Tikta
Lagu
Rukśa
Uśna
tikśna
Katu Dīpana
Pippali Piper longum Katu Laghu
tikśna
Uśna Madura Dīpana truptighna
Kuśta
Saussurea lappa
Tikta
Katu
Lagu
rukśa
Uśna Katu Sukra śodaka
Lekhana
Rasna Alpinia officinarum
hance
Tikta Guru Uśna katu Ama pācana
Pippali
Mula
Piper longum Katu Lagu
Rukś
Uśna Katu Dīpana
5. Drugs for Swedana: Balamula kwatha was used for the purpose of Bashpasweda254
Table no:40
Drug Rasa Guna Veerya Vipaka Karma
Bala (Sida acuta) Madhura Snigdha sheeta Ushna Madhura Kaphavatahara
vatavyadhi.
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6. Drug for Vamana Karma:
There are innumerable disease complex because of dosha dushya combination & their
disunion is only possible by Vamanadi karma hence there are inumerable Vamaka Yogas. In the
present study Vamana was carried out with two distinct yogas.
1)GROUP- A Fresh raw powder of Madana phala pippali (4-6gms) mixed with vacha
choorna(2-3gms) Madhu(15ml)& Saindhava (5gms) adminishtered after Akanta pana with
Ksheera.255
2)GROUP - B Madana phala powder(4-6gms) is boiled in 8 parts of milk (50ml) with the
addition of 32 parts of water(200ml). The boiling is continued till the water gets evaporated and
milk alone is left(ksheeravashesha i.e 50ml)256.
Chemical constituents of Cow`s Milk 257
Nutritional value per 100gram
• Water – 87.8 gm
• Protein – 3.2 gm
• Carbohydrate – 4.8 gm
• Energy – 66 kcal
• Sugar (lactose) – 4.8
• Fatty acids
1. Saturated – 2.4 gm
2. Mono-unsaturated – 1.1 gm
3. Polyunsaturated – 0.1 gm
4. Cholesterol – 14 mg
5. Calcium – 120 IU
Madanaphala
“Vamane Madanam Shreshtam”258 From Vamana karma point of view Madana Phala is the
supreme drug because of two reasons.
i) ‘Nirapayatvat’ – when compared to other Vamaka drugs Madana is the safest one.
ii) ‘Vyadhivashat Anyasya’- Other Vamaka drugs specific to specific diseases. But where as
Madana is a broad spectrum emetic drug due to its synergetic action.
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Rasa Panchaka of Madana phala acording to various authors
Table no:41
Text Varga Rasa Guna Virya Vipa
ka
Karma Rogaghnata
B.P Haritakyadi Madhur
a
Tikta
Ruksh
a
Laghu
Ushn
a
Katu Vamaka,Lekhan
a,
Vidradhi,pratishyaya,
Vrana, Kushta,
Kapha Anaha,
Shotha, Gulma
D.N Guduchyadi Katu
Tikta
- Ushn
a
- Vamaka &
Niruha
Shleshmajvara
Vidradhi pratishyaya,
Gulma Shotha
K.N Aushadhi Madhur
a
Tikta
Ruksh
a
Laghu
Ushn
a
- Vamanagri
Lekhana
Vidradhi,pratishyaya,
Vrana, Shotha,
Gulma Kushta,Jwara
Anaha,
R.N Shalmalyad
i
Katu
Tikta
Laghu Ushn
a
- Vamaka
Lekhana
Kapha vatahara
Vruna hara
Shopha doshapaha
Sha.
N
Ashta varga Katu
Tikta
Madhur
a
Ruksh
a
Laghu
Ushn
a
Bhedaka
VamakaLekhan
a
Kapha vatahara,
Pakva-
Amashaya
shodhaka
Vishamajwara
Vidradhi,pratishyaya,
Vrana, Kushta,
Kapha Anaha,
Shotha, Gulma
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Aberration to Madana phala action:259 All the authors have considered that Madana phala is a
Shreshta Vamaka but in Arka prakasha it has been quoted that Arka of Madana is Chardighna.
certain other drugs like Jyotishmati, Dhatura, Hemahva, Naginiphala, Makshika, Devadali phalas
are considered as Vamaka Drugs & Vacha is the best Vamaka Drug
Part used and uses: The fruit of this is used by the natives as a fish poison, and is said to act in
man as an irritating emetic.
Fruits - Used as Emetic, fish poison, dysentery, anthelmintic, abortifacient, fevers.
Constituents:
Neutral and acid saponin (active constituent). 2. Acid resin. (36) – UHM.According to the
Pharmacographia Indica, each fruit contains about four grains (0.26 Gm.) of saponin, besides
valeric acid. The tincture has been used by James Sawyer (L. L., 1891) as an
antispasmodic.Oleanolic acid 3-/3-Glucoside (RDG-1) was isolated from the seeds of the plant
Randia dumetornm (Rubiaceae). The compound showed significant anti-inflammatory activity in
the exudative and proliferative phases of inflammation in the doses of 25 and 100 mg/kg orally.
Significant analgesia was observed only on thermal stimulus. It did not show any antipyretic
activity against Brewer’s yeast induced pyrexia in rats. The approximate oral LD were found to
be 3600 mg/kg and 1500 mg/kg in mice and rats respectively. –
Glycosides – Saponins
Glycosides are compounds containing a carbohydrate and a noncarbohydrate residue in the same
molecule.
Classification of Glycosides: these may be grouped under following headings.
1.Tanin Glycosides, 2. Cardio active Glycosides,3.Aldehyde Glycosides, 4.Anthraquine
Glycosides 5. Alcohol Glycosides, 6 Lactone Glycosides, 7. Cyanophore Glycosides,
8.Isotheocynate Glycosides, 9.Phenol Glycosides 10.Flavanol Glycosides, 11.Saponin
Glycosides
Saponin Glycosides: Saponins are the glycosides of 27 carbon atom steroids, or 30 carbon atom
triterpenes in plants. They are found in various parts of the plant: leaves, stems, roots, bulbs,
blossom, and fruit. They are characterized by their bitter taste, and their ability to hemolyze red
blood cells.
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Properties: Saponins are the plants' immune system, acting as a natural antibiotic to protect the
plant against microbes and fungus.
Saponins dissolve in water to form a stable soapy froth; this is thought to be due to their
amphiphilic nature. The word sapon means 'soap', referring to the permanent froth saponins
make on being mixed with water.
Saponin glycosides are divided into 2 types based on the chemical structure of their aglycones
(sapogenins). Saponins on hydrolysis yield an aglycone known as "sapogenin".
Stucture of Saponin
Saponin = GLYCONE(Sugar-Carbohydrate compound) + AGLYCONE( sapogenin-Non
carbohydrate)
Type I:Neutral Saponin= Here GLYCONE is attached to steroid derivative of AGLYCONE
Type II Acid Saponin = Here GLYCONE is attached to tripeptinoids of AGLYCONE0.
Medicinal use
Soap nuts (sapindus), especially Sapindus mukorossi, are used medically as an
expectorant, Emetic, and for treatment of excessive salivation, epilepsy, chlorosis, and
migraines.
Saponins are believed to be useful in the human diet for controlling cholesterol. Bile
cholesterol is secreted into the intestine. Much of it is later reabsorbed into the body. Saponins
bind to bile acids and cholesterol, so much of it is not reabsorbed, and instead excreted from the
body. Digitalis-type saponins strengthens heart muscle contractions, causing the heart to pump
more efficiently.
Saponins inhibit some kinds of cancer cell tumor growth in animals, particularly lung and
blood cancers, without killing normal cells. Cancer cells contain more cholesterol compounds
than normal cells. Saponins bind to cholesterol, interfering with cell growth and division. In the
colon, bacteria metabolize primary bile acids into secondary bile acids, which are a cause of
colon cancer
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Saponins stimulate the immune system and enhance both injected and oral vaccines.
Saponin kills protozoa in the intestines by causing it's cell membrane to lyse. Scientists are
experimenting with saponin-based antibiotics, fungicides, yeast disinfectants, and vaccines
against HIV.
Symptoms of saponin Poisoning
Saponins are highly toxic to cold-blooded animals, due to their ability to lower surface tension
Humans generally do not suffer severe poisoning from saponins
• irritated mucous membranes of the mouth and digestive tract -->
• reduced feed intake,
• low dietary protein quality (supplemental methionine will counteract this).
• the above factors lead to--> decreased performance and growth rate.
• increased excretion of cholesterol.
• anorexia
• weight loss
• rough hair coat
• gastroenteritis and diarrhea
Mode of action : Saponin cause vomiting by :-1) Directly stimulating the medullary
chemoreceptor trigger zone to induce vomiting.
2) Irritating the gastric mucosa and there by stimulating vagus nerve & causes Vomiting
6.b) Yashti Madhu:260,261,262,263,264,265 Synonyms of Yashti Madhu according to various Texts:
Yashti, Madhuka, Klitaka, Madhulika, Madhusrava, Yashtika, Yashtyahva, Madhuparni,
Madhuvalli, Vasusammitam, Saumya
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113
Table no: 42
Text Varga Rasa Guna Virya Vipaka Karma Roga
B.P Guduchyadi Swadu Guru Shita Madhura Pitta
anilaasra
hara,
chakshushya
bala varna
kara
shukrala
Vruna
shotha
visha
chardi
trushna
glani
kshayapaha
D.N Guduchyadi Swadu - Shita - Pitta
vinashini
vrushya
Shosha
visha
chardi
kshaya
vinashi
K.N Swadu Guru
Snighdha
Shita - Vata pitta
kaphaapaha
-
R.N Pippalyadi Swadu
tikta
Guru Shita - Ruchya
chakshushya
pitta hara
Shisha
trushna
vrunapaha
Sha.N Ashtavarga Swadu Guru
Snighdha
Shita - - -
Sho.N Guduchyadi Swadu - - - - Shosha
hara
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Yashti madhu Phanta Kalpana:
Here one pala of dravya is added to one Kudava of boiling water and kept closed. Only 2
pala of Phanta is administerd along with sugar candy /jagerry / Honey.
Many Phanta yoga’s are explained by Sharangadhara, among them Yasti madhu is one of
the important ingredient. And most of these Yogas are indicated in certain emergency
Conditions like Murcha, Bhrama, RaktapittaTushna, etc.so we may consider that using
Yastimadhu phanta in Vamana will prevent the chances of complications during the Procedure.
Pharmacological activity ;-
Smooth muscle depressant, antimicrobial, antiatherosclerotic hypotensive ,spasmolytic,
antipyretic ,anti oxidant expectorant.
6.C) SAINDAVA LAVANA :-
It is best drug in helping to induce the process of vomiting .it has got the gunas like
vishyandhi,aruksha,vyavayi,sukshma ,ushna. It has the capacity to penetrate to sukshma srotas
spreads quickly to the whole body.Caraka says its use when is mixed with vamaka dravya as it
helps in liqification of kapha dosha and separate it from minute channels.
ROCK SALT:266
The common name for the mineral ‘halite ‘ is the Rock salt .Its chemical formula is NaCl. It is
not K2So4. It is typically formed by the evaporation of salty water which contain dissolved
Na=and Cl- ions..
7. Drug used for Dhumapana: Haridra dhumapana
Table no:43
DRUG RASA GUNA VIRYA VIPAKA KARMA
Haridra
Curcumalonga
Tikta
Katu
Ruksha
Laghu
Ushna Katu Kaphavata shamaka
Kushtaghna
Methodology
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CLINICAL STUDY Vamana karma is considered as an idyllic treatment in morbid kapha, its associated
conditions and in case of kapha sthanagatha doshas. In Amavata mainly kapha sthana like sandhi
is affected. Langhana is considered as the prime line of treatment for Amavata. Vamana is
considered under Shodhana Langhana by Charaka. Here an attempt is made to evaluate the
efficacy of vamana in Amavata by madhanaphala kalka and madhanaphala ksheerapaka.
OBJECTIVES OF THE STUDY:
To evaluvate the action of vamana karma in patients of Amavata
PATIENTS AND METHODS:-
SOURCE OF DATA:
Patients who were attending the OPD & IPD section of S.D.M. Ayurveda Hospital Udupi
fulfilling the criteria of selection were incorporated in the study irrespective of the caste, sex,
race, and religion. Patients were examined clinically. For this study 22 patients were selected.
METHODS OF COLLECTION OF DATA:
It is a comparative clinical study to evaluvate the effect of vamana karma in Amavata.Subjects
of either sex are based on the inclusion criteria and a detailed proforma will be prepared based on
the ayurvedic books and the patients shall be evaluvated accordingly.
INCLUSION CRITERIA:
1) Persons suffering from Amavata.
2) Person who is Vamana arha.
3) Patients in the age group of 16 to 70.
EXCLUSION CRITERIA:
1) Patients suffering from confirmative systemic diseases.
2) Patients who are unfit for vamana karma.
3) Patients suffering from Rheumatic fever.
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STUDY DESIGN :
It is a comparative clinical study with pre-test and post-test design where in 22 patients
diagnosed as Amavata of either sex will be selected. All the patients falling in the inclusion
criteria shall be subjected to Vamana karma.
DURATION OF STUDY :
• Deepana and pachana 3 – 7 days.
• Snehapana 3 – 7 days.
• Abhyanga and Swedana 2 days.
• Vamana karma for 1 day.
• Samsarjana krama 3 – 7 days.
Total duration of study; maximum 11 – 23 days.
INTERVENTIONS :
Poorva karma –
Kosta pariksha:
Triphala kvātha 150 ml was administered at 9.30 am after breakfast for the assessment of koṣṭa.
Deepana pacahana
3-5gms vadavanala choorna with sukhośna jala was administered to patients depending
on their status of Agni in terms of Sāma and Nirāmata for 3-7 Days till Nirāma Lakhṣanas are
seen.
Snehapana
The moorchita gritha was given to all the patients. The initial dose was 25ml (Hrisiyasi
matra) with Luke warm water as anupāna in early morning, after the digestion of the last night
meal.
During this period the patients were advised to consume little quantity of hot water in between
and to follow all the restriction of Snehapāna in terms of diet (Time of food intake, Nature of
food) , Sleep (Avoid Divasvapna & Rathri jagarana) etc.
Thus Ārohanakarma Snehapāna was administered still samyak snigdha laksana arises in all the
patients. Then patients were constantly observed for the appearance of Sneha Jīryāmana, Sneha
Jīrna features. Based on the time of Snehajīrna laksana the dose of Sneha for next day was
decided. As soon as Samyak Snigdha Laksana are seen, the Snehapāna was stopped.
Methodology
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Vamana pūrva dina: Once the Samyak snigdha symptoms were achieved, intake of ghee was
stopped and later;
Abhyanga and Svedana :
Patient was subjected for abhyanga with lukewarm saindhavadhi for 35 min in 7 positions to the
whole body. After Abhyanga, patient was shifted to baspa sveda chamber. There patient was
given baspa sveda until samyak svinna laksana (usually 20-25 minutes). Patient was then advised
to take rest for 10 - 15 minutes and take a hot water bath. Later the patient was advised to have
complete rest on that day and not to wander outside.
Vamana pūrva dina bhojana vyavasta:
On the previous day, the individual was instructed to have lots of curds (up to 3 lts) along with
Blackgram and food articles like Idli, Vada, Dosa, etc as kaphotkleśakara āhāra.
Counseling:
On the previous evening of Vamana, a casual meeting was held to assure the patient about the
process and clear any anxiety or doubts in their mind.
On the Day of Vamana:
Patients was allowed to brush the teeth and were kept on empty stomach untill the process was
started. At 6.00 am, the patient was subjected for the abhyanga and svedana followed by snāna in
the similar manner like that on the previous day. After snāna, the patient was made to sit on a
chair and allowed to rest for 5 min to acclimatize with the atmosphere. Then systemic
examination was done and checked for the routine things like defecation, micturation, also tried
to rule out presence of any discomfort in any other part of the body. Vital data (pulse, blood
pressure, temperature, respiratory rate) were recorded.
PRADHĀNA KARMA:
Patients were made to sit comfortably in the chair and they were covered with a clean cloth.
Ākanthapāna:
For the purpose of ākanthapāna, milk (2-4 glass ≈ 700ml to 1400ml) was administered.
Administration of Vāmaka yoga:
Madanaphala yoga which is in the bolus form form/ksheerapaka was administered to the patient
and instructed to consume as early as possible. Meanwhile, if vegas started the time of beginning
Methodology
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of first vega, was recorded. If no vega was observed for 10 minutes, for the purpose of inducing
vamana yastimadhu phanta was administered. The recording regarding quantity of the drug, time
at which the liquid is administered, was recorded. Patients were allowed to sit comfortably till
the first bout of vega comes out. Patient was asked to inform any symptoms which may be felt
during that resting period. Signs were observed carefully.
Continuation of process of Vamana with Vamanopaga dravya:
If Vamana did not start, 350 ml of yastimadhu phanta was administered. The time at which the
bout appeared after the administration of Vāmaka Yoga was noted. Then the process was
continued with the Vamanopaga medicine or sukhosna jala. During the bout, the individual was
asked to bow forward, to open the mouth widely for expelling the vomitus comfortably. Massage
over the back and on the sides of vertebral column was done in upward direction, forehead was
held to provide the support to neck, a gentle pressure was given over the abdominal region
around the umbilicus with the palms, sides of the chest were supported to avoid pain in the sides,
so that Vamana could go on effortlessly. At the end if the medicine was not coming outside
completely, patient was instructed to touch the pharynx with a finger or rubber catheter. When
the associated symptoms are suggestive of completion of Vamana, 1-2 glass of hot water served
in order to expel the remnant medicine.
PAŚCĀT KARMA:
After finishing Vamana, again blood pressure, pulse, temperature and weight were recorded.
Then a glass of warm water was provided for gargling and washing the hands and allowed to rest
for 45 minutes. Meanwhile the patient was asked for observation of symptoms.
Dhūmapāna:
Dhūmapāna was done with Haridrā cūrna.
Samsarjana Krama:
After analyzing the procedure, conclusion regarding the grade of purification was made. It was
judged whether the purification was Uttama, Madhyama or Hīna, and accordingly the sequence
of Samsarjana was planned. For the respective three types (Grades) of the purification, the
regimen of 7(Uttama), 5(Madhyama) and 3(Avara) days were opted for. In case of Hīna,
Madhyama or Uttama purification Peya-Vilepī-Mudga Yusa and Rice with Mudga Yusa were
served for one meal time, two meals time and three meals time respectively starting from the
Methodology
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evening of the Vamana day. Peya and Vilepī were prepared from 50 gm of the rice, as per
standard methods. Mudga Yūṣa was cooked by 50 gm of green gram in the required quantity of
water. Finally, Odana prepared from 50 gm of rice along with Mudga Yusa prepared from 50 gm
of green gram was served.
ASSESSMENT CRITERIA:
Signs and symptoms of samyak vamita lakshana.
Patients will be evaluated for severity of illness during
and after the intervention.
SUBJECTIVE PARAMETERS :
Symptoms of Amavata.
Symptoms of samyak vamitha lakshana.
OBJECTIVE PARAMETERS:
• Joints(for movement, tenderness, temperature, Swelling)
• Ring test.
• Grip test.
• Foot pressure.
• Circumference.
• Goniometry test.
SUBJECTIVE PARAMETERS:
1. Pain in the joints:
Symptom Grading
No pain 0
Mild (on motion only) 1
Moderate (at rest) 2
Severe (wakes patient from sleep) 3
2. Morning stiffness (duration in hours):
Symptom Grading
0-5 min. 0
Methodology
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5 min. - 2 hrs. 1
2 - 8 hrs. 2
8 hrs. or more 3
3. Swelling in the joints:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3
4. Redness:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3
5. Warmth:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3
6. Tenderness in the joints:
Symptom Grading
No tenderness 0
Says tender 1
Patient winces 2
Winces and withdraws 3
Not allowed to be touched 4
Methodology
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7. Alasya:
Symptom Grading
Fully active 0
Mild laziness, slow initiative in work 1
Initiative in some works, absent in others 2
Absolute lack of initiative even though capacity for work exists 3
8. Dourbalya:
Symptom Grading
No feeling of weakness 0
Slight weakness 1
Feeling of weakness but ability unimpaired 2
Ability to do duties affected 3
9. Knuckle swelling:
Jewellers rings were used to measure the knuckle swelling. The ring which passes
through knuckle with least resistance was noted. Any change in the number of the ring after the
treatment was recorded.
10. Muscle wasting:
The circumference of arm, fore arm, thigh and calf were measured in cms using a
measuring tape both before and after treatment to have an objective view of muscle wasting.
11. Malabaddhata/Vibandha (Constipation):
Symptom Grading
Absent 0
Slight with one motion per day 1
Marked constipation with one motion after two days or more 2
12. Jwara (in degree Fahrenheit):
Symptom Grading
No fever 0
Mild (990 F-1010 F) 1
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Moderate (1010 F-1030 F) 2
Severe (>1030 F) 3
13. Sadana - fatigue:
Symptom Grading
No fatigue 0
Works full-time despite some fatigue 1
Patient must interrupt to rest 2
Fatigued at rest 3
14. Bahumūtrata (frequency of micturition per 24 hours):
Symptom Grading
Absent (less than 4 times/24 hrs) 0
Mild (upto 6 times/24 hrs) 1
Moderate (6-10 times/ 24 hrs) 2
Severe (> 10 times/ 24 hrs) 3
15. Chardi (frequency of bouts per 24 hours):
Symptom Grading
Absent 0
Mild (upto 2 vegas/24 hrs) 1
Moderate (2-4 vegas/24 hrs) 2
Severe (4 vegas/24 hrs) 3
16. The other symptoms like Angamarda, Aruci, Gourava, Brama, Kukśiśoola, Hrithgraha,
Anaha, Praseka, Triśna, Hasta pada daha, Kandu are scored as mentioned below.
Grading
No symptoms 0
Mild symptoms 1
Moderate symptoms 2
Severe symptoms 3
Methodology
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FUNCTIONAL ASSESSMENT:
To assess the objective improvements following functional assessments were carried out
in patients of Āmavāta.
Grip strength: The patient’s ability to compress the inflated ordinary Sphygmomanometer
cuff under standard conditions to assess the functional capacity of effected upper limb, both
before and after treatment.
Foot pressure: Foot pressure was recorded both before and after treatment by the ability
of the patient to press a weighing machine, to an objective view of functional capacity of lower
limb.
Range of joint movement: By using the Goniometer the range of movement of all
effected joints was noted both before and after treatment.
Total Duration of study: 23 days (max).
Patients were administered with Triphala kvātha 150 ml at 9.30am for the
assessment of koṣta. After assessing koṣta, vadavanala curṇa in the dose of 3-5 gms three times
a day with 100 ml of hot water before food till the appearance of nirāma lakṣanas. On the first
day of Snehapāna patients were given test dose 25ml of mūrcita gŗitha at around 6.00 to 6.30 am.
From second day onwards dose of gŗitha was decided on the basis of jīryamaana , jīrna lakṣana
.Thus the dosage of gŗitha was not fixed and the dose varied from person to person. When the
Subject attains samyak snigdha lakṣanas one day gap was given for consuming kapha
utkleshakara aharas and vamana is given on the next day . Saṁsarjana krama is advised
according to śuddi.
Patients are diagnosed on the basis of signs and symptoms of Āmavāta and criteria as
approved by ARA, 1987 revision.
Joints [for movements, tenderness, temperature, swelling]
Ring test
Grip test
Foot pressure
Circumference
Investigations: -
Blood - H.b%, T.C,. D.C, E.S.R ., R A Factor,ASO Titre, C Reactive. Protien.
Methodology
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Samsarjana krama: -
After analyzing the procedure, conclusion regarding the grades of purification was made.
It was judged weather purification was uttama, madhyama, or heena yoga and accordingly the
sequence of samsarjana was palaned, 7, 5 & 3 days respectively. Rice gruel water, Rice gruel,
Rice with Green gram soup is used for Samsarjana krama Peya.
Observation
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125
OBSERVATION
In this clinical study, 22 patients suffering from Amavata, fulfilling the inclusion criteria
were registered. The Following are detailed descriptive statistical analysis of the patients
included in the study.
Number of Individuals registered for the Study – 22
Number of Individuals completed the Study – 22
Number of Dropouts – Nil
AGE GROUP:
Table No:44 Graph No:1
Out of 22 patients of Āmavāta studied in this work, 27.27% patients were belonged to the age
group of 36-45 years & 46-55 years, 18.18% patients each in age group of 26-35years and 56-65
years, 9.09%patient from the age group of 16-25 years.
SEX: Table No:45 Graph No:2
AGE NO OF PATIENTS %
16-25 2 9.09 %
26-35 4 18.18 %
36-45 6 27.27 %
46-55 6 27.27 %
56-65 4 18.18%
SEX NO OF
PATIENTS %
MALE 6 27.27 %
FEMALE 16 72.72%
Observation
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126
Among the 22 patients of this study 72.72% patients were females and 27.27% patients were
males.
RELIGION:
Table No: 46 Graph No:3
Among 22 patients of these series maximum 68.18% of patients were belonged to the Hindu
community, 18.18% from Christian religion and 13.63% from Muslim.
MARITAL STATUS:
Table No:47 Graph No:4
Out of 22 patients of Āmavāta studied in this work. Maximum 90.90% of patients were married.
And 9.09% were unmarried.
RELEGION NO OF PATIENTS
%
HINDU 15 68.18%
CHRISTIAN 4 18.18%
MUSLIM 3 13.63%
MARITAL STATUS
NO OF PATIENTS %
MARRIED 20 90.90 %
UNMARRIED 2 9.09 %
Observation
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127
EDUCATION :
Table No: 48 Graph No:5
Out of 22 patients of Āmavāta studied in this
work, maximum 45.45% were studied upto matric, 27.27% of the patients were graduates,
22.72% studied up to primary school, And 4.54% were uneducated.
SOCIO ECONOMIC STATUS:
Table No:49 Graph No:6
Out of 22 patients of Āmavāta studied in this work, 36.36% of the patients belonged to upper
middle class, 27.27% belonged to middle class, 13.63% belonged to both lower middle class and
poor, and 4.54% belonged to rich class.
EDUCATION NO OF
PATIENTS %
UNEDUCATED 1 4.54 %
PRIMARY 5 22.72%
METRIC 10 45.45%
GRADUATE 6 27.27 %
SOCIO
ECONOMIC
STATUS
NO OF
PATIENTS %
Poor 3 13.63 %
Lower
middle class 3 13.63 %
Middle class 6 27.27 %
Upper
middle class 8 36.36 %
Rich 1 4.54 %
Observation
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OCCUPATION:
Table No:50 Graph No:7
Out of 22 patients of Āmavāta studied in this work, it was observed that maximum number of
patients were house wife I.e. 40.09%. 9.09 % were nurses, students and employees, and 4.54%
were teachers and business people.
DESHA
Table No:51 Graph No:8
Out of 22 patients of Āmavāta studied in this work 72.72% of the patients belonged to anupa
desha, 22.27% belonged to jangala desha and 4.54% belonged to sadharana desha.
OCCUPATION NO OF
PATIENTS %
HOUSE WIFE 9 40.90%
NURSE 2 9.09%
TEACHER 1 4.54%
EMPLOYEE 2 9.09%
FARMER 5 22.72%
STUDENT 2 9.09%
BUSINESS 1 4.54%
DESHA NO OF
PATIENTS %
JANGALA 5 22.72 %
ANUPA 16 72.72 %
SADHARANA 1 4.54 %
Observation
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129
CHRONICITY OF DISEASE:
Table No:52 Graph No:9
Out of 22 patients of Āmavāta studied in this work maximum patients were suffering from the
disease less than 1 year i.e. 13.63% and 31.81% suffered since more than 2 years. And 54.54 %
were suffering the disease since 1 to 2 years.
ADDICTION :
Table No:53 Graph No:10
Out of 22 patients of Āmavāta studied in this work, 95.45% were addicted to coffe/tea. And
4.54% were addicted to tobacco
DIET:
CHRONICITY NO OF
PATIENTS %
LESS THAN 1
YEAR 3 13.63 %
1-2 YEARS 12 54.54 %
MORE THAN
2 YEARS 7 31.81 %
ADDICTION NO OF
PATIENTS %
COFFEE /
TEA 21 95.45%
ALCOHOL 1 4.54 %
Observation
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130
Table No:54 Graph No:11
Out of 22 patients of Āmavāta studied in this work 86.36% were of mixed diet and 13.63%
vegitarians.
SLEEP PATTERN :
Table No:55 Graph No:12
Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed sleep and
18.18% had sound sleep.
PRAKRITHI :
DIET NO OF
PATIENTS %
MIXED 19 86.36%
VEG 3 13.63 %
SLEEP
PATTERN
NO OF
PATIENTS %
SOUND 4 18.18 %
DISTURBED 18 81.81 %
Observation
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131
Table No:56 Graph No:13
Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 36.36% were Vāta
pittaja prakrithi and remaining 18.18% were kapha pittaja prakrithi.
SATVA :
Table No: 57 Graph No:14
Maximum of 81.81% of the patients were of madhyama satva, 18.18% were avara satva.
RASA SATMYA: Table No: 58 Graph No: 15
PRAKRITHI NO OF
PATIENTS %
VĀTA
KAPHA 10 45.45 %
KAPHA
PITTA 4 18.18 %
VĀTA
PITTA 8 36.36 %
SATVA NO OF
PATIENTS %
PRAVARA 0 0.00 %
MADHAYAMA 18 81.81 %
AVARA 4 18.18 %
Observation
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132
Maximum of 36.36 %were of amla rasa satmya, and 27.27% were madhura rasa satmya 22.72 %
were katu rasa satmya and 13.63% were lavana rasa satmya.
SAMHANANA:
Table No: 59 Graph No:16
Maximum of 72.72% of the patients were of madhyama samhanana, 18.18% were avara, 9.09%
were pravara.
SĀRA : Table No: 60 Graph No:17
RASA NO OF
PATIENTS %
MADHURA 6 27.27 %
AMLA 8 36.36 %
LAVANA 3 13.63 %
KATU 5 22.72 %
SAMHANANA NO OF
PATIENTS %
PRAVARA 2 9.09 %
MADHAYAMA 16 72.72 %
AVARA 4 18.18 %
Observation
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133
Maximum of 59.09 % patients were twak Sāra, and 9.09% of rakta Sāra and 31.81 % māmsa
Sāra .
ABHYAVARANA ŚAKTI
Table No:61 Graph No:18
Maximum of 86.36% patients were having madhyama abhyvarana śakti and 13.63% were having
avara abhyvarana śakti.
JARANA SHAKTI :
Table No:62 Graph No:19
SĀRA NO OF
PATIENTS %
TWAK 13 59.09 %
RAKTA 2 9.09 %
MAMSA 7 31.81 %
Abhyavaraṇa
ŚAKTI
NO OF
PATIENTS %
Pravara 0 0.00 %
Madhayama 19 86.36 %
Avara 3 13.63 %
Observation
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134
Maximum of 86.36% patients had madhyama jaraṇa shakti, 13.63% had avara jaraṇa shakti VYAYAMA SHAKTI :
Table No: 63 Graph No:20
Out of 22 patients taken for this study, Maximum of 72.72% patients had madhyama vyāyāma
shakti and the remaining 27.27 % had avara vyayama shakti.
VAYA :
Table No:64 Graph No:21
JARANA
SHAKTI
NO OF
PATIENTS %
PRAVARA 0 0.00 %
MADHAYAMA 19 86.36 %
AVARA 3 13.63 %
VYAYAMA SHAKTI
NO OF PATIENTS
%
PRAVARA 0 0.00 %
MADHAYAMA 16 72.72%
AVARA 6 27.27 %
Observation
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
135
It is observed that maximum of 86.36% of the patients taken for this study belongs to madhya
vaya, 13.63% belongs to vrudha.
KOSTA : Table No: 65 Graph No:22
Out of 22 patients taken for this study it is observed that maximum of 81.81% of the patients had
madhyama koṣta and 18.18% had mridhu kosta.
VAYA NO OF PATIENTS %
Bala 0 0.00 %
Madhya 22 100% %
Vrudha 0 0.00 %
KOSTA NO OF PATIENTS
%
KRURA 0 0.00%
MRIDHU 4 18.18 %
MADHAYAMA 18 81.81 %
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EFFECT OF THERAPY
Day of attainment of Samyak Snigda Lakshnas
Table No.66 Graph. No .23
In this study maximum numbers of patients were 50% (11) attained Samyak Snigda Lakshanas
on 4 th day. Followed by 39.13% on 3rd day, 9.09% on 5th day. As shown in Table No.66 and
Graph No.23
Total number of Samyak Snigdha Lakshanas observed on last day of Snehapana
Table No.67 S.No Samyak snigda
Lakshanas Total number
of patients Percentage [%]
1 Vatanulomana 22 100 2 Deeptagni 22 100 3 Asamhata Varcha 19 86.36 4 Snigdha Varcha 22 100 5 Snigda tvak 22 100 6 Gatra mardava 16 72.72 7 Anga Laghava 15 68.18 8 Klama 16 72.72 9 Snehodvega 21 95.45
10 Adastath sneha darshana 22 100
Total number of Samyak Snigdha Lakshanas observed on last day of Snehapana in Arohana.The
above tables reveals that 100% patients showed the symptoms of Vatanulomana,Agni
deepthi,Sniga varcha,snigdha twak and Adastath Sneha darshana..The symptom Snehodvega
No of days
No. of Patients
%
3 9
39.13
4 11
50.00
5 2
9.09
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seen in 95.45% of patients, 86.36% showed Asamhatha Varchas, 72.72 % showed the symptoms
of Gatra Mardhava, Klama.and Angalaghava was noted in 68.18% of the patients.
Average amount of Ghrita required to attain Samyak Snigda Lakshanas
Table No.68
In this study mean of total amount of ghrita required were 335 ml however a minimum of 125 ml
and a maximum of 600 ml were administered in different patients.
Average Time Taken for Digestion of Sneha
Table No. 69 Graph. No.24
In the present study everyday observations were done on Sneha Jirna Kala i.e., time taken
for digestion of Sneha (Table-). On the first day the Hrasiyasi Matra (25ml) Sneha was given to
all, the mean duration for the digestion of sneha was 390 minutes. On 2nd day the mean duration
for the digestion of sneha was 452 minutes On 3rd daythe mean duration for the digestion of
sneha was 491 minutes On the 4th day he mean duration of the mean duration for the digestion of
sneha was 493min. On 5th day the the mean duration of the mean duration for the digestion of
sneha was 523minutes.
Total number
of patients Mean of total Ghrita required
to attain samyak snigdata 22 335 ml
No of day 1st 2nd 3rd 4th 5th
Minutes 390 452 491 493 523
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Appearance of Samyak Snigdha Lakshana day wise
Table No.70
No of days S.No Samyak Snigdha Lakshanas 1 2 3 4
5 1 Vatanulomana 14 21 21 10 1 2 Deeptagni 22 21 21 11 1 3 Asamhata Varcha 0 3 13 6 2 4 Snigdha Varcha 0 8 21 10 2 5 Snigdha Gatra 0 1 14 9 1 6 Mrdu Gatra 0 1 12 8 1 7 Anga Laghava 2 6 11 7 2 8 Klama 6 10 14 11 2
9 Snehodvega 1 9 21 11 1
10 Adastath Sneha darshana 0 0 11 11 2
Samyak Snigdha Lakshana:-Numbers in the above table depicits number of days In the
study 21 patients presented with Vata anulomana,Deeptagni,Snigda varcha, Sneha udvega on 3rd
day,snigdha gatra and klama was observed in 14 of Volunteers on 3rd day.In 12 Patients Mrudu
Gatra was observed on 3rd day, In 13 patients asamhata varcha was observed from 3rd day
onwards.In 11 patients Anga laghavata and adastath sneha darshana was observed on 3rd day.
Graph.No.25
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139
Samyak Swinna Lakshana
Table No.71
The above Table Shows that percentage of the patients attained Samyak Swinna Lakshana on
administrastion by Bashpa sweda for two days.
The average time taken to expel first Vega
Table No.72
No. of patients Average time taken for
Expulsion of first Vega
22 9.52 minutes
22 patients took an average of 9.52 minutes starting from Akanthapana to the first bout (Vega)
was noted. Maximum time noted was 12 minutes and minimum time was 3 minutes.
Symptoms after Administration of Vamaka yoga Table No. 73
SYMPTOMS NO OF PATIENTS %
1 ADHMANA 18 81.81 2 LALA SRAVA 7 31.81 3 SWEDAPRADURABHAVA 21 95.25 4 AKSHI SRAVA 4 18.18
S.No Samyak Swinna
Lakshanas No of patients %
1 Seetoparam 22 100 2 ShooluParam 22 100 3 Stambha Nigraha 22 100 4 Gourava Nigraha 21 91.3
5 Mardhavata 21 91.3
6 Laghuta 21 91.3
7 Sweda pradurbhava 23 100
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5 NASA SRAVA 6 27.27 6 HRILLASA 22 100 7 UDGARA 4 18.18 8 MADHURAASYATA 6 27.27 9 NISTIVANA 11 50 10 DAHA 7 31.81 11 KASA 2 9.09 12 ROMAHARSHA 5 22.72 13 SHIROGOURAVA 2 9.09
The above tables reveals that all patients i.e. 100% showed the Symptom(Hrllasa) and 95.25%
showed sweating (swedapravartanam) ,81.81% had Kukshi Adhmana, 50% had Nisteeva,31.81%
had Daha, Lala srava,27.27% showed Madhura asyata, Nasa srava,22.72% had Romaharsha,
18.18 % presented with Akshi srava and Udgara, 9.09% individuals exhibited Kasa and
Shirogaurava.
Changes observed in Blood pressure during the Vamana procedure: Table No. 74
Initial blood pressure (mean in mm of Hg)
During the procedure
(mean in mm of Hg ) After the procedure (mean in mm of Hg )
126.2 / 80.5 142.6/94.6 122.2/84
Graph No 26
Blood pressure was taken just prior to the procedure, and then continuously monitored during
the process. For calculation the peak increase in Blood pressure was taken for consideration to
Results
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141
get exact idea of how much increase may be there during the procedure and after the cessation of
the procedure, the Blood pressure was again measured. Thus initially average value of Blood
pressure was 126.2/80.5mm of Hg, Which further rose up to 142.6/94.6 mm of Hg within 23
minuets and come down as the process came to end within 28 minuets. Showing the value of
122.2/84 mmHg.
Changes observed in the Pulse rate during the Vamana Karma Table No.75
Pulse before the procedure (Mean )
Pulse During the procedure
(Mean ) Pulse after the procedure
(Mean ) 80.4 106.7 82.4
Graph. No: 27
In the present study Pulse of the individual was examined continuously. It was measured initially
before starting the Vamana procedure, then monitored continuously thought the process to note
the variation occurring in it and at the end of the procedure, it was checked again. The mean
value of pulse of all the 22 patients at each level is considered here. Then mean value of the
pulse at the beginning was 80.4/min., which increased up to 106.7/min.within 23 minutes during
the process and then declined to 82.4/min. within 28 minutes at the end. As shown in Table
No.75 Graph No. 27
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142
Average time taken to complete the process of Vamana
Table No.76
No of patients Average time taken to complete the procedure
22 43.28min
Average time taken for the completion of Vamana was 43.28 minutes.
Average value of Vega observed in 22 individuals
Table No.77
No of patients No of Vega
22 4.954
In this study an average value of Vega observed was 4.954, minimum vega of 3 and maximum
vega of 7 was noted. As shown in Table No.77
Distribution of 22 patients according to Vaigiki Shuddhi
Table No.78
Out of 22 patients observed in the study 31.81% got pravara vegas (≤8).68.18 % subjects got ≤6
vega, 0.00% subject got vega ≤4. Table No.78
Shuddhi No of Vega
subjects %
Hina ≤4 0 0.00%
Madhyama ≤6 15 40.90%
Pravara ≤8 7 22.72%
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Laingiki Shuddhi in patients
Table No.79
Sr. No. Lakshana No of patients % 1 Kalepravritti 20 100 2 Anati mahati Vyatha 20 90.9 3 Yatha kramama kaphapitta vata dosha harana 22 100 4 Swayam cha avasthanam 22 100 5 Laghuta 22 100 6 Karshya 19 86.3 7 Dourbalya 22 100 8 Kantha shuddhi 20 90.9 9 Kapha samsrava 20 90.9
10 Hridaya shuddhi 17 77.2 11 Parshva shuddhi 15 68.1
12 Sroto shuddhi 17 77.2 13 Indriya shuddhi 15 68.1` 14 Murdha shuddhi 15 68.1
The study reveals 100% of individuals manifested Kale pravrithi,swayam avasthana ,
Yathakrama dosha harana ,Laghuta ,Dourbalya .Anathi mahathi vyatha, .Kanta shuddhi,Kapha
samsrava seen in 90.09 % of individuals,karshya in 86.3% of individuals, Murdha shuddhi seen
in 68.10% ,in 77.2% both Hridaya shuddhi, Sroto shuddhi was observed.
Distribution of "Antiki signs & symptoms" observed in 22 Patients
Table No.80
No of individuals
Signs& Symptoms Total %
1 Burning sensation in throat 22 100 2 Bitter taste in mouth 22 100 3 Pungent taste in mouth 13 59.09 4 Appearance of Pitta 22 100 5 Lightness in abdomen 22 100
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6 Lightness in head 19 86.36 7 Lightness in sides 19 86.36 8 Increase in freshness 21 95.45 9 Sweating 22 100 10 Spontaneous cessation of vomiting 22 100
To end Vamana, certain signs and symptoms are taken. In the present study; more emphasis
was given to the symptoms. No leading questions were asked suggesting the specific answers.
The signs and symptoms were noted randomly and assessed. At that time, When Pitta started
vomiting out 100% (22) of the patients’ experienced bitter taste in the mouth and experienced
burning sensation in the throat. Pittanta Vamana was observed in 100 % patients.Appearance of
Sweda,lightness of abdomen was also seen in all patients just after Pittanta. 95.45% (21) of the
patients were experienced increased fresh ness, lightness in the head and sides (86.36%). In
100% (22) of the patients had spontaneous cessation of the vomiting were observed (Swayam
cha Avasthanam). In 59.09% of patients pungent taste was observed.
Quantitative study showing the drug Input viz drug Output
Table No.81
Drug Input (Mean volume in ml)
Drug Output (Mean volume in ml)
Difference (Mean volume in ml)
4469.523 4740.95 271.427
To comprehend the quantity of drug was ingested, volume of the same were counted before
commencing to and after completion of the procedure. The difference between them provided us
that the amount of medicine that was ingested. The measurement helped us to estimate how
much quantity of medicine came out along with the vitiated doshas. The difference between
these two aggregate assisted us to conclude status of the ingested materials, weather it had come
out or remained inside. Average value of total ingested material of 22 patients is 4469.523 ml
and total expelled amount is 4740.95 ml. That means the amount of 271.427 ml was excess in
average.
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145
Samyak and Asamyak Yoga (Laingiki shuddhi)
Table No. 82 Yoga No.of Subjects % Samyak Yoga 22 100
100% of patientss attained Samyak yoga of Vamana .
Distribution of 22 patients according to Samsarjana Krama they followed
Table No.83 Graph. No.28
After the completion of the Vamana, sequence of the Samsarjana was adviced to the patients and
instructed them to follow it strictly. The factors like the nature of Vaigiki shuddhi and strength of
the patients were kept in mind while advising the sequence of samsarjana Krama. So maximum
patients 50% (21) were advised with 5 days of Samsarjana krama, whereas 31.81 % (6) advised
with 7 days of Samsarjana Krama.
Changes in the weight due to Vamana karma
Table No.84
Weight before the Vamana process ( in kg)
Weight after the Vamana process (in kg)
Mean defference (Weight loss in kg)
57.861 57.192 0.669
No.of days of Samsarjana Krama
No.of Patients
%
3 days 0 0.00
5days 15 68.18
7 days 7 31.81
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To analyze the changes taking place in weight due to the process of Vamana, the weight of the
patients was recorded before Vamana & after completion of the procedure. It was 57.861Kg
before & 57.192Kg. after completion of the karma mean loss of 0.669 kg.
Effect on the Cardinal signs and symptoms of Amavata:- The administration of vamana karma showed the following results:
GROUP A(MADHANAPHALA KALKA)
Effect on Sandhi Sula
Table NO: 85a
Mean N Std. Deviation Std. Error Mean BT 2.818 11 .405 .122 AT1 2.727 11 .467 .141 BT 2.818 11 .405 .122 AT2 2.545 11 .688 .207 BT 2.818 11 .405 .122 AT3 2.00 11 .632 .191 BT 2.818 11 .405 .122 AT4 1.636 11 .674 .203 BT 2.818 11 .405 .122 AT5 1.182 11 .405 .122
Table NO: 85 b
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = 0.341), (P=0.192) and at (P=<0.001)
Paired Differences
95% Confidence Interval of the Difference
Mean± % Std. Deviation
Std. Error Mean
Lower Upper
t Df Sig. (2-tailed)
BT-AT1 0.091 3.22 .467 .122 -.122 .293 1.00 10 P = 0.341 BT-AT2 0.273 9.68 .688 .207 - .162 .707 1.399 10 P = 0.192 BT-AT3 0.818 29.09 .632 .191 .413 1.223 4.500 10 P =<0.001 BT-AT4 1.182 54.58 .405 .203 .777 1.587 6.500 10 P = <0.001 BT-AT5 1.636 58.05 .674 .141 1.297 1.975 10.757 10 P = <0.001
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BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehapana, AT3- Before
vamana, AT4 – After vamana(evening),AT5 – After samsarjana karma.
There was significant reduction in the sandhi śūla .The improvement was of 3.22% during AT1
and during AT5 the improvement was 58.05%.
Graph No : 29
Effect on Sandhi shotha:
Table NO86a
Mean N Std. Deviation Std. Error Mean BT 2.636 11 .505 .152 AT1 2.182 11 .405 .122 BT 2.636 11 .505 .152 AT2 2.091 11 .539 .163 BT 2.636 11 .505 .152 AT3 2.000 11 .447 .135 BT 2.636 11 .505 .152 AT4 1.636 11 .505 .152 BT 2.636 11 .505 .152 AT5 1.182 11 .405 .122
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Table NO: 86b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
.454 17.22 .405 .122 .104 .805 2.887 10 P = 0.016
.545 20.67 .539 .163 .195 .896 3.464 10 P = 0.006
.636 24.12 .447 .135 .297 .975 4.183 10 P = 0.002
1.00 37.93 .505 .152 .575 1.425 5.244 10 P = <0.001
1.454 55.15 .405 .122 1.104 1.805 9.238 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.016) (P=0.006)( P = 0.002) (P = <0.001)
Graph no : 30
There was significant reduction in the sandhi śotha i.e during AT1 the improvement was seen at
17.22% , during AT5 55.15% of improvement is seen.
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149
Effect of the therapy on Stabdhata Table NO: 87a
Mean N Std. Deviation Std. Error Mean BT 1.727 11 .467 .141 AT1 1.818 11 .603 .182 BT 1.727 11 .467 .141 AT2 1.727 11 .647 .195 BT 1.727 11 .467 .141 AT3 1.364 11 .505 .152 BT 1.727 11 .467 .141 AT4 1.182 11 .603 .182 BT 1.727 11 .467 .141 AT5 .727 22 .467 .141
Table NO: 87b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-0.865 5.26 .603 .182 -.293 .112 -1.00 10 P = 0.341
0.000 0.00 .647 .195 -.300 .300 .000 10 P = 1.000
0.363 21.01 .505 .152 .024 .703 2.390 10 P = 0.038
0.545 31.55 .467 .141 .195 .896 3.464 10 P = 0.006
1.000 57.90 .603 .182 0.000 0.000 0.000 10 P = 1.000
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
There was significant reduction in the stabdatha i.e during AT1 the improvement was seen at
5.26% , during AT5 57.90of improvement is seen.
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = 1.000)
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Graph no : 31
Effect of the therapy on Tenderness
Table NO: 88a
Mean N Std. Deviation Std. Error Mean
BT 2.455 11 .820 .247 AT1 2.182 11 .751 .226 BT 2.455 11 .820 .247 AT2 2.0000 11 .775 .234 BT 2.455 11 .820 .247 AT3 1.636 11 .809 .244 BT 2.455 11 .820 .247 AT4 1.364 11 1.027 .310 BT 2.455 11 .820 .247 AT5 .545 11 .522 .157
Table NO: 88b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig.(2-tailed)
.273 11.12 .751 .226 -.041 .587 1.936 10 P = 0.082
.455 18.53 .775 .234 -.0073 .916 2.193 10 P = 0.053
.819 33.36 .809 .157 .413 1.223 4.500 10 P = 0.001
1.091 44.43 .522 .310 .620 1.562 5.164 10 P = <0.001
1.91 77.80 1.027 .244 1.438 2.380 9.037 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
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The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
There was a significant reduction in the tenderness is observed. During AT2 18.53%, AT3
33.36%, AT5 77.80% of improvement is observed.
Graph no : 32
Effect on the Range of joint Movements
Table NO: 89a
Mean N Std. Deviation Std. Error Mean
BT 4522.727 11 426.54 128.464
AT1 4550.909 11 413.387 124.641
BT 4522.727 11 426.54 128.464
AT2 4770.00 11 368.619 111.143
BT 4522.727 11 426.54 128.464
AT3 4873.636 11 352.485 106.78
BT 4522.727 11 426.54 128.464
AT4 4090.00 11 3710.73 93.702
BT 4522.727 11 426.54 128.464
AT5 5249.091 11 300.015 90.458
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Table NO:89b
Paired Differences
95% Confidence Interval of the Difference
Mean ±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-28.18 0.62 413.387 124.641 -71.389 15.025 -1.453 10 P = 0.177 -247.27 5.46 368.619 111.143 -306.23 -188.315 -9.345 10 P = <0.001 -350.90 7.75 352.485 90.458 -414.67 -287.143 -12.26 10 P = <0.001 432.72 9.56 300.015 93.702 -587.19 -307.346 -7.122 10 P = <0.001 -726.36 16.06 3710.73 106.78 -906.83 -545.891 -8.968 10 P = <0.001
AT1 -BT AT2 -BT AT3-BT AT4-BT AT5-BT
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P<0.001)
There was a significant improvement is seen in the range of joints movement AT1 showed
0.62% and AT5 showed 16.06% of improvement .
Graph no : 33
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Effect of the therapy on hand grip power in mm of Hg Table NO: 90a
Mean N Std. Deviation Std. Error Mean
BT 79.091 11 6.348 1.914 AT1 79.818 11 6.838 2.062 BT 79.091 11 6.348 1.914 AT2 83.818 11 7.454 2.247 BT 79.091 11 6.348 1.914 AT3 87.636 11 7.632 2.301 BT 79.091 11 6.348 1.914 AT4 90.909 11 7.286 2.197 BT 79.091 11 6.348 1.914 AT5 104.18 11 12.082 3.643
Table NO: 90b
Paired Samples Test Paired Differences
95% Confidence Interval of the Difference
Mean ±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-0.727 0.919 6.838 2.062 -1.633 .179 -1.789 10 P = 0.104 -4.727 5.976 7.454 2.247 -6.832 -2.622 -5.004 10 P = <0.001 -8.545 10.80 7.632 2.301 -10.801 -6.290 -8.441 10 P = <0.001 -11.81 14.94 7.286 2.197 -13.834 -19.347 -9.734 10 P = <0.001 -25.08 31.72 12.082 3.643 -20.154 -12.027 -8.235 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and after AT5
31.72% The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P<0.001)
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Graph no : 34
Effect of the therapy on foot pressure
Table NO: 91a Mean N Std. Deviation Std. Error Mean BT 33.00 11 4.980 1.502 AT1 33.273 11 4.839 1.459 BT 33.00 11 4.980 1.502 AT2 36.364 11 5.555 1.675 BT 33.00 11 4.980 1.502 AT3 36.909 11 5.873 1.771 BT 33.00 11 4.980 1.502 AT4 37.818 11 5.600 1.689 BT 33.00 11 4.980 1.502 AT5 41.909 11 7.816 2.357
Table NO: 91b Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-.273 .827 4.839 1.459 -.0.707 .1622 -1.399 10 P = 0.192
-3.364 10.19 5.555 1.675 -4.1716 -2.011 -5.540 10 P = <0.001
-3.909 11.84 5.873 1.771 -5.011 -2.807 -7.904 10 P = <0.001
-4.818 14.6 5.600 2.357 -6.121 -3.515 -8.237 10 P = <0.001
-8.909 26.99 7.816 1.689 11.829 -5.989 -6.798 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P<0.001)
There is significant improvement is seen in the foot pressure after AT1 the improvement is seen
at 0.827% which is statistically significant at P= 0.192 and after AT5 the improvement was of
26.99%
Graph no : 35
Effect of the therapy on knuckle swelling Table NO: 92a
Mean N Std. Deviation Std. Error Mean BT 112.364 11 7.553 2.277 AT1 112.364 11 7.553 2.277 BT 112.364 11 7.553 2.277 AT2 110.727 11 7.695 2.320 BT 112.364 11 7.553 2.277 AT3 108.909 11 7.395 2.230 BT 112.364 11 7.553 2.277 AT4 107.182 11 7.547 2.276 BT 112.364 11 7.553 2.277 AT5 106.273 11 7.240 2.183
Results
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Table NO: 92b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.000 7.695 2.277 0.000 0.000 0.000 10 P = 1.000
1.637 1.456 7.553 2.320 .884 2.389 4.845 10 P = <0.001
3.455 3.074 7.395 2.230 1.972 4.938 5.190 10 P = <0.001
5.182 4.611 7.547 2.276 3.597 6.766 7.286 10 P = <0.001
6.091 5.420 7.240 2.183 4.699 7.483 9.752 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is not great enough to exclude the possibility that
the difference is due to chance (P = <0.001),
The improvement is seen with only 1.45% after AT2 and 5.42% after AT5.
Graph no : 36
Results
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EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS
Table NO: 93a
Mean N Std. Deviation Std. Error Mean
BT 39.273 11 1.849 .557 AT1 39.273 11 1.849 .557 BT 39.273 11 1.849 .557 AT2 38.818 11 1.940 .585 BT 39.273 11 1.849 .557 AT3 38.091 11 1.446 .436 BT 39.273 11 1.849 .557 AT4 37.364 11 1.362 .411 BT 39.273 11 1.849 .557 AT5 37.364 11 1.433 .432
Table NO: 93b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.000 1.849 1.849 .000 .000 0.000 10 P = 1.00
0.455 1.15 1.940 1.940 .104 .805 2.887 10 P = 0.016
1.182 3.00 1.433 1.433 .677 1.686 5.221 10 P = <0.001
1.909 4.86 1.362 1.362 1.275 2.543 6.708 10 P = <0.001
1.909 4.86 1.446 1.446 1.438 2.380 9.037 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Here after dīpana and paachana i.e. AT1 there is no difference in the improvement. The
correlation and t cannot be computed because the standard error of the difference is 0.
After AT5 4.86% of the improvement is seen, The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Results
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Graph no : 37
Effect of the therapy on circumference of forearms
Table NO: 94a
Mean N Std. Deviation Std. Error Mean
BT 32.091 11 1.700 .513 AT1 32.091 11 1.700 .513 BT 32.091 11 1.700 .513 AT2 31.364 11 1.748 .527 BT 32.091 11 1.700 .513 AT3 30.364 11 1.690 .509 BT 32.091 11 1.700 .513 AT4 29.727 11 1.679 .506 BT 32.091 11 1.700 .513 AT5 28.273 11 1.849 .557
Table NO: 94b
Paired Differences
95% Confidence Interval of the Difference
Mean % Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
BT-AT1 0.000 0.000 1.700 .513 0.000 0.000 0.000 10 P = 1.000 BT-AT2 0.727 2.26 1.748 .527 .0494 1.405 2.390 10 P = 0.038 BT-AT3 1.727 5.38 1.849 .557 1.049 2.405 5.677 10 P = <0.001 BT-AT4 2.364 7.36 1.679 .506 1.743 2.985 8.480 10 P = <0.001 BT-AT5 3.818 11.89 1.690 .509 2.785 4.851 8.237 10 P = <0.001
Results
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As the table shows after AT2 2.26% of the improvement at P=1.000 and after AT5 11.89% of
improvement is seen The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
Graph no : 38
Effect of the therapy on circumference of thighs Table NO: 95a
Paired Samples Statistics
Mean N Std. Deviation Std. Error Mean
BT 76.727 11 5.350 1.613 AT1 76.545 11 5.336 1.609 BT 76.727 11 5.350 1.613 AT2 75.727 11 5.479 1.652 BT 76.727 11 5.350 1.613 AT3 73.809 11 5.924 1.786 BT 76.727 11 5.350 1.613 AT4 72.636 11 5.626 1.696 BT 76.727 11 5.350 1.613 AT5 70.727 11 5.968 1.799
Results
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Table NO: 95b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.182 0.237 5.336 1.609 -.0899 .454 1.491 10 P = 0.167
2 2.360 5.479 1.652 ..205 1.795 2.803 10 P = 0.019
2.918 3.80 5.968 1.799 1.662 3.975 5.429 10 P = <0.001
4.091 5.33 5.626 1.696 2.910 5.272 7.717 10 P = <0.001
6 7.81 5.924 1.786 5.099 6.901 14.832 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
After AT1 only 0.237% of improvement is seen at P=0.167 and after AT5 7.81% of the
improvement is seen .The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001)
Graph no :39
Results
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EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF Table NO: 96a
Mean N Std. Deviation Std. Error Mean
BT 47.091 11 2.300 .694 AT1 46.636 11 2.157 .650 BT 47.091 11 2.300 .694 AT2 44.818 11 2.272 .685 BT 47.091 11 2.300 .694 AT3 43.818 11 2.639 .796 BT 47.091 11 2.300 .694 AT4 42.545 11 2.018 .608 BT 47.091 11 2.300 .694 AT5 41.273 11 2.102 .634
Table NO: 96b
After AT1 only 0.966% of improvement is seen at P=0.138 and after AT5 12.35% of
improvement is seen .
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t Df Sig. (2-tailed)
0.455 0.966 2.157 .650 -.173 1.083 1.614 10 P = 0.138
2.273 4.82 2.102 .685 1.418 3.127 5.926 10 P = <0.001
3.273 6.95 2.639 .796 2.031 4.515 5.871 10 P = <0.001
4.546 9.65 2.018 .634 3.258 5.833 7.866 10 P = <0.001
5.818 12.35 2.272 .608 4.623 7.013 10.849 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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Graph no : 40
EFFECT ON GENERAL SYMPTOMS Table NO: 97
PAIRED TEST
%
Symtoms BT AT1 AT2 AT3 AT4 AT 5 d
Aruchi 2.364 2.000 1.455 1.000 .818 .182 .364 88.37
Malabadhata .909 .818 .636 .455 .0909 .0909 .59091 92.85
Angamarda 2.364 2.273 1.727 1.364 .636 .273 1.81818 81.63
Sadana 1.909 1.545 1.182 1.091 .455 .364 1.45455 79.99
Alasya 1.818 1.818 1.182 1.182 .636 .182 1.18182 68.42
Anaha 2.091 2.000 1.273 1.182 .636 .455 1.18182 72.22
Praseka 2.000 2.000 1.273 1.000 .545 .273 1.45455 84.20
Truśna 1.727 1.727 1.636 .727 .636 1.727 1.40909 100
Hasta Pada
daha 1.818 1.818 1.455 1.000 .727 .0909 1.45455 91.42
Jwara .545 .0909 .000 .000 .000 .000 .3636 100
Śareera gowrava 2.091 1.909 1.545 1.000 1.818 .273 1.45455 78.05
The correlation and t cannot be computed because the standard error of the difference is 0
Results
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Graph no: 41
Effect on Total score of General symptoms Table NO: 98a
Paired Samples Statistics Mean N Std. Deviation Std. Error Mean
BT 1.785 11 .568 .171 AT1 1.636 11 .634 .191 BT 1.785 11 .568 .171 AT2 1.215 11 .499 .150 BT 1.785 11 .568 .171 AT3 .909 11 .386 .116 BT 1.785 11 .568 .171 AT4 .636 11 .467 .141 BT 1.785 11 .568 .171 AT5 .356 11 .473 .143
Table NO: 98b
Paired Samples Test Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.149 8.34% .634 .191 .0353 .262 2.921 10 P = .015
0.573 32.10% .499 .150 .406 .734 7.744 10 P = <0.001
0.876 49.07% .386 .116 .700 1.052 11.111 10 P = <0.001
1.149 64.36 % .467 .141 .847 1.451 8.473 10 P = <0.001
1.429 80.05 % .473 .143 .972 1.887 6.968 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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The patients who are treated with Vamana karma showed significant improvement in the general
symptoms the percentage of improvement is increase from 8.33% during AT1 to 68.01% during
AT5.
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Graph no : 42
GROUP B(MADHANAPHALA KSHEERAPAKA)
Effect on the Cardinal signs and symptoms of Amavata:-
The administration of vamana karma showed the following results:
Effect on Sandhi sula
Table NO: 99a
Mean N Std. Deviation Std. Error Mean BT 2.727 11 .467 .141 AT1 2.273 11 .647 .195 BT 2.727 11 .467 .141 AT2 2.273 11 .467 .141 BT 2.727 11 .467 .141 AT3 1.909 11 .701 .211 BT 2.727 11 .467 .141 AT4 1.273 11 .467 .141 BT 2.727 11 .467 .141 AT5 1.091 11 .302 .0909
Results
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The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = 0.053), (P=0.116) and at (P=<0.001)
BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehapana, AT3- Before
vamana, AT4 – After vamana(evening),AT5 – After samsarjana karma.
There was significant reduction in the sandhi śūla .The improvement was of 16.68% during AT1
and during AT4 the improvement was 59.99%.
Graph No :43
Table NO:99b
Paired Differences
95% Confidence Interval of the Difference
Mean± % Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
BT-AT1 0.455 16.68 .647 .195 -.0073 .916 2.193 10 P = 0.053 BT-AT2 0.455 16.68 .467 .141 .104 .805 2.887 10 P = 0.016 BT-AT3 0.818 29.99 .701 .211 .314 1.323 3.614 10 P =0.005 BT-AT4 1.455 53.35 .467 .141 .993 1.916 7.016 10 P = <0.001 BT-AT5 1.636 59.99 .302 .0909 1.297 1.975 10.757 10 P = <0.001
Results
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Effect on Sandhi shotha
Table NO: 100a
Mean N Std. Deviation Std. Error Mean BT 2.273 11 .467 .141 AT1 2.182 11 .405 .122 BT 2.273 11 .467 .141 AT2 2.182 11 .405 .122 BT 2.273 11 .467 .141 AT3 1.818 11 .405 .122 BT 2.273 11 .467 .141 AT4 1.545 11 .522 .157 BT 2.273 11 .467 .141 AT5 1.000 11 0.000 0.000
Table NO: 100b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
.0909 3.95 .405 .122 -.112 .293 1.000 10 P = 0.341
.0909 3.95 .405 .122 -.271 .453 .559 10 P = 0.588
.455 20.00 .405 .122 .104 .805 2.887 10 P = 0.016
.727 31.98 .522 .157 .199 1.255 3.068 10 P = 0.012
1.273 56.00 0.000 0.000 .959 1.587 9.037 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Results
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Graph no : 44
There was significant reduction in the sandhi śotha i.e during AT1 the improvement was seen at
3.95% , during AT5 56.00% of improvement is seen.
Effect of the therapy on Stabdhata Table NO: 101a
Mean N Std. Deviation Std. Error Mean BT 2.182 11 .751 .226 AT1 2.000 11 .632 .191 BT 2.182 11 .751 .226 AT2 1.727 11 .647 .195 BT 2.182 11 .751 .226 AT3 1.727 11 .647 .195 BT 2.182 11 .751 .226 AT4 1.273 11 .467 .141 BT 2.182 11 .751 .226 AT5 .909 11 .302 .0909
Table NO: 101b
Paired Samples Test
Paired Differences 95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean Lower Upper
t df Sig. (2-tailed)
.182 8.34 .632 .191 -.0899 .454 1.491 10 P = 0.167
.455 20.85 .647 .195 .104 .805 2.887 10 P = 0.016
.455 20.85 .302 .195 .104 .805 2.887 10 P = 0.016
.909 41.65 .467 .141 .438 1.380 4.303 10 P = 0.002
1.273 58.34 .647 .0909 .838 1.707 6.528 10 P =<0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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There was significant reduction in the stabdata i.e. 20.85% of improvement is seen during AT2,
41.65% during AT4, 58.34% of improvement is seen during AT6
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Graph no : 45
Effect of the therapy on Tenderness
Table NO: 102a
Mean N Std. Deviation Std. Error Mean
BT 2.364 11 .674 .203 AT1 2.273 11 .647 .195 BT 2.364 11 .674 .203 AT2 2.0000 11 .632 .191 BT 2.364 11 .674 .203 AT3 1.727 11 .647 .195 BT 2.364 11 .674 .203 AT4 1.182 11 .751 .226 BT 2.364 11 .674 .203 AT5 .636 11 .505 .152
Results
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Table NO: 102b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean± %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
.0909 3.84 .647 .195 .271 .453 .559 10 P = 0.588
.364 15.39 .632 .191 -.0893 .817 1.789 10 P = 0.104
.636 26.90 .505 .152 .183 1.089 3.130 10 P = 0.011
1.182 50.00 .751 .226 .677 1.686 5.221 10 P = <0.001
1.727 73.05 .647 .195 1.199 2.255 7.286 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
There was a significant reduction in the tenderness is observed. During AT2 15.39%, AT3
26.90%, AT5 73.05% of improvement is observed.
Graph no :46
Results
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Effect on the Range of joint Movements
Table NO: 103a
Mean N Std. Deviation Std. Error Mean
BT 4310.909 11 549.990 165.828
AT1 4361.818 11 502.271 151.440
BT 4310.909 11 549.990 165.828
AT2 4575.455 11 454.937 137.169
BT 4310.909 11 549.990 165.828
AT3 4731.818 11 456.439 137.621
BT 4310.909 11 549.990 165.828
AT4 4850.000 11 414.150 124.871
BT 4310.909 11 549.990 165.828
AT5 5076.364 11 359.980 108.538
Table NO: 103b
Paired Differences
95% Confidence Interval of the Difference
Mean ±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-50.909 1.18 502.271 151.440 -113.24 11.425 -1.820 10 P = 0.099 -264.54 6.13 454.937 137.169 -391.77 -137.314 -4.633 10 P = <0.001 -420.90 9.76 456.439 137.621 -557.84 -283.970 -6.849 10 P = <0.001 -539.09 12.50 414.150 124.871 -694.87 -383.311 -7.711 10 P = <0.001 -765.46 17.75 359.980 108.538 -938.96 -591.941 -9.829 10 P = <0.001
AT1 -BT AT2 -BT AT3-BT AT4-BT AT5-BT
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P<0.001)
There was a significant improvement is seen in the range of joints movement AT1 showed
1.18% and AT5 showed 17.75% of improvement .
Results
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Graph no : 47
Effect of the therapy on hand grip power in mm of Hg Table NO: 104a
Mean N Std. Deviation Std. Error Mean
BT 75.818 11 13.159 3.968 AT1 75.818 11 13.159 3.968 BT 75.818 11 13.159 3.968 AT2 83.273 11 19.601 5.910 BT 75.818 11 13.159 3.968 AT3 86.182 11 19.482 5.874 BT 75.818 11 13.159 3.968 AT4 87.636 11 20.314 6.125 BT 75.818 11 13.159 3.968 AT5 90.727 11 23.053 6.951
Results
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Table NO: 104b
Paired Samples Test Paired Differences
95% Confidence Interval of the Difference
Mean ±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.00 13.159 3.968 0.000 0.000 0.000 10 P = 0.100 -7.455 9.82 19.601 5.910 -12.798 -2.111 -3.108 10 P = 0.011 -10.36 13.66 19.482 5.874 -15.384 -5.343 -4.599 10 P = <0.001 -11.81 15.58 20.314 6.125 -17.565 -6.072 -4.582 10 P = 0.001 -14.90 19.66 23.053 6.951 -22.447 -7.371 -4.407 10 P = 0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Improvement is seen after AT2 is 9.82% statistically significant at p=0.100 and after AT5
19.66% The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P<0.001)
Graph no : 48
Results
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Effect of the therapy on foot pressure
Table NO: 105a
Mean N Std. Deviation Std. Error Mean
BT 30.727 11 3.379 1.019 AT1 31.455 11 3.475 1.048 BT 30.727 11 3.379 1.019 AT2 34.273 11 2.533 .764 BT 30.727 11 3.379 1.019 AT3 35.091 11 4.036 1.217 BT 30.727 11 3.379 1.019 AT4 37.818 11 4.687 1.413 BT 30.727 11 3.379 1.019 AT5 38.364 11 4.653 1.403
Table NO: 105b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean±
% Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
-.727 2.36 3.475 1.048 -1.405 -.0494 -2.390 10 P = 0.038
-3.545 11.53 2.533 .764 -4.241 -2.850 -11.353 10 P = <0.001
-4.364 14.20 4.036 1.217 -5.683 -3.045 -7.372 10 P = <0.001
-6.091 19.82 4.687 1.413 -8.116 -4.065 -6.700 10 P = <0.001
-7.636 24.85 4.653 1.403 -9.343 -5.930 -9.969 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P<0.001)
There is significant improvement is seen in the foot pressure after AT1 the improvement is seen
at 1.51% which is statistically significant at P= 0.192 and after AT5 the improvement was of
16.25%
Results
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174
Graph no : 49
Effect of the therapy on knuckle swelling Table NO: 106a
Mean N Std. Deviation Std. Error Mean BT 113.909 11 3.754 1.132 AT1 113.636 11 3.802 1.146 BT 113.909 11 3.754 1.132 AT2 112.545 11 4.591 1.384 BT 113.909 11 3.754 1.132 AT3 111.182 11 3.910 1.197 BT 113.909 11 3.754 1.132 AT4 110.364 11 5.201 1.568 BT 113.909 11 3.754 1.132 AT5 110.00 11 4.899 1.477
Results
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Table NO: 106b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
.273 0.23 3.802 1.146 -0.162 0.707 -1.399 10 P = 0.192
1.364 1.197 4.591 1.384 .611 2.116 4.038 10 P = 0.002
2.727 2.394 3.910 1.197 1.381 4.074 4.512 10 P = 0.001
3.545 3.112 5.201 1.568 1.709 5.382 4.302 10 P = 0.002
3.909 3.431 4.899 1.477 2.046 5.772 4.675 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
The change that occurred with the treatment is not great enough to exclude the possibility that
the difference is due to chance (P = <0.001),
The improvement is seen with only 0.23% after AT1 and 3.43% after AT5.
Graph no : 50
Results
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176
Effect of the therapy on circumference of arms
Table NO: 107a
Mean N Std. Deviation Std. Error Mean
BT 39.091 11 2.773 .836 AT1 39.091 11 2.773 .836 BT 39.091 11 2.773 .836 AT2 38.364 11 2.803 .845 BT 39.091 11 2.773 .836 AT3 37.545 11 2.464 .743 BT 39.091 11 2.773 .836 AT4 37.091 11 2.625 .791 BT 39.091 11 2.773 .836 AT5 36.727 11 2.901 .875
Table NO: 107b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.000 2.773 .836 .000 .000 0.000 10 P = 1.00
.727 1.85 2.803 .845 .413 1.041 5.164 10 P = <0.001
1.545 3.95 2.464 .743 1.195 1.896 9.815 10 P = <0.001
2.000 5.11 2.625 .791 1.480 2.520 8.563 10 P = <0.001
2.364 6.04 2.901 .875 1.911 2.817 11.628 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Here after dīpana and paachana i.e. AT1 there is no difference in the improvement. The
correlation and t cannot be computed because the standard error of the difference is 0.
After AT5 6.04% of the improvement is seen, The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant change (P = <0.001)
Results
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177
Graph no : 51
Effect of the therapy on circumference of forearms Table NO:108a
Mean N Std. Deviation Std. Error Mean
BT 33.000 11 3.066 .924 AT1 32.818 11 3.157 .952 BT 33.000 11 3.066 .924 AT2 32.182 11 2.822 .851 BT 33.000 11 3.066 .924 AT3 31.545 11 3.205 .966 BT 33.000 11 3.066 .924 AT4 31.364 11 3.202 .966 BT 33.000 11 3.066 .924 AT5 31.0909 11 2.945 .888
Table NO: 108b
Paired Differences 95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean Lower Upper
t df Sig. (2-tailed)
.182 0.55 3.157 .952 -.0899 0.454 1.491 10 P = 0.167
.818 2.47 2.822 .851 .231 1.405 3.105 10 P = 0.011
1.455 4.40 3.205 .966 .993 1.916 7.016 10 P = <0.001
1.545 4.68 3.202 .966 1.183 2.089 8.050 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5 1.636 4.95
2.945 88 1.084 2.007 7.405 10 P = <0.001
Results
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178
As the table shows after AT1 0.55% of the improvement at P=0.167 and after AT5 4.95% of
improvement is seen The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001)
Graph no : 52
Effect of the therapy on circumference of thighs
Table NO: 109a
Mean N Std. Deviation Std. Error Mean
BT 78.000 11 3.950 1.191 AT1 78.000 11 3.950 1.191 BT 78.000 11 3.950 1.191 AT2 77.727 11 4.292 1.294 BT 78.000 11 3.950 1.191 AT3 77.273 11 4.452 1.342 BT 78.000 11 3.950 1.191 AT4 76.727 11 4.384 1.322 BT 78.000 11 3.950 1.191 AT5 76.636 11 4.411 1.330
Results
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179
Table NO: 109b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.00 3.950 1.191 0.000 0.000 0.000 10 P = 1.000
0.273 0.35 4.292 1.294 -.041 .587 1.936 10 P = 0.082
0.727 0.93 4.452 1.342 .199 1.255 3.068 10 P = 0.012
1.273 1.63 4.384 1.322 .473 2.073 3.545 10 P = 0.005
1.364 1.74 4.411 1.330 .499 2.228 3.516 10 P = 0.006
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
After AT2 only 0.35% of improvement is seen at P=0.082 and after AT5, 1.74% of the
improvement is seen .The change that occurred with the treatment is greater than would be
expected by chance; there is statistically no significant change (P = 0.006)
Graph no : 53
Results
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180
Effect of the therapy on circumference of calf Table NO: 110a
Mean N Std. Deviation Std. Error Mean
BT 47.000 11 3.550 1.070 AT1 47.000 11 3.550 1.070 BT 47.000 11 3.550 1.070 AT2 45.545 11 3.934 1.186 BT 47.000 11 3.550 1.070 AT3 44.636 11 4.319 1.302 BT 47.000 11 3.550 1.070 AT4 43.818 11 3.790 1.143 BT 47.000 11 3.550 1.070 AT5 43.636 11 3.957 1.193
Table NO: 110b
After AT2 only 3.09% of improvement is seen at P=0.100 and after AT5 7.15 % of improvement
is seen .
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
0.000 0.000 3.550 1.070 0.000 0.000 0.000 10 P = 1.000
1.455 3.09 3.934 1.186 .535 2.374 3.525 10 P = 0.005
2.364 5.02 3.957 1.302 1.269 3.458 4.812 10 P = <0.001
3.182 6.17 3.790 1.143 2.290 4.074 7.946 10 P = <0.001
3.364 7.15 4.319 1.193 2.401 4.327 7.783 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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181
Graph no :54
Effect on general symptoms
Table NO: 111
PAIRED SAMPLE TEST %
Symtoms BT AT1 AT2 AT3 AT4 AT 5 d %
Aruchi 1.545 1.455 1.00 .545 .455 .455 .364 88.37
Malabadhata .455 .455 .455 .455 .182 .182 .59091 92.85
Angamarda 2.091 1.727 1.364 1.182 .545 .364 1.81818 81.63
Sadana 1.727 1.182 .909 .636 .455 .545 1.45455 79.99
Alasya 1.636 1.455 .636 .636 .636 .636 1.18182 68.42
Anaha 1.273 1.273 .727 .727 .545 .545 1.18182 72.22
Praseka 1.455 1.364 .909 .909 .455 .455 1.45455 84.20
Truśna 1.091 1.091 1.091 .545 .545 .545 1.40909 100
Hasta Pada
daha 1.364 1.364 1.182 .545 .364 .182 1.45455 91.42
Jwara .182 .182 .000 .000 .000 .000 .3636 100
Śareera
gowrava 1.636 1.636 1.455 1.273 .909 .636 1.45455 78.05
a. The correlation and t cannot be computed because the standard error of the difference is 0
Results
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182
Graph no :55
Effect on Total score of General symptoms
Table NO: 112a
Mean N Std. Deviation Std. Error Mean
BT 1.314 11 .559 .169 AT1 1.199 11 .475 .143 BT 1.314 11 .559 .169 AT2 .884 11 .419 .126 BT 1.314 11 .559 .169 AT3 .678 11 .351 .106 BT 1.314 11 .559 .169 AT4 .463 11 .235 .0709 BT 1.314 11 .559 .169 AT5 .413 11 .209 .0629
Table NO: 112b
Paired Samples Test
Paired Differences
95% Confidence Interval of the Difference
Mean %
Std. Deviation
Std. Error Mean
Lower Upper
t df Sig. (2-tailed)
.116 8.82% .475 .143 -.00683 .238 2.104 10 P = .062
.430 32.72% .419 .126 .201 .658 4.187 10 P = 0.002
0.636 48.40% .351 .106 .395 .878 5.879 10 P = <0.001
0.851 64.76 % .235 .0709 .575 1.127 6.870 10 P = <0.001
0.901 68.56 % .209 .0629 .603 1.199 6.728 10 P = <0.001
BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5
Results
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183
The patients who are treated with Vamana karma showed significant improvement in the general
symptoms the percentage of improvement is increase from 8.82% during AT1 to 68.56% during
AT5.
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Graph no : 56
Effect on the Cardinal signs and symptoms of Amavata:-
COMPARISON BETWEEN 2 GROUPS
Effect on Sandhi sūla
Table NO: 113
Mean Std Dev SEm Diff Lo UP T Sig.(2 tailed
AT4K 1.727 .647 .195 AT4Ks 1.273 .467 .141
0.3636 - .162 .707 1.399 P = 0.192
AT5Ks 1.545 .522 .157 Sandhi śūla
AT5K 1.091 .302 .0909 .455 .413 1.223 4.500 P =<0.001
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.073).
The difference in the mean values of the two groups is greater than would be expected by
chance; there is a statistically significant difference between the input groups (P = 0.021).
Results
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184
Effect on Sandhiśotha Table NO: 114
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 1.636 .603 .152 AT4Ks 1.545 .467 .157
.0909 -.366 .548 .415 P = <0.682
AT5Ks 1.000 .467 0.00 Sandhi shotha
AT5K 1.000 .302 0.00 0.000 0.000 0.000 0.000
P = 1.000
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.682).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 1.000).
Effect of the therapy on Stabdhata
Table NO:115
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 1.182 .647 .182
AT4Ks 1.273 .467 .141 -.0909
-.571
.389 -.395
P = 0.697
AT5Ks .727 .522 .141 Stabdhata
AT5K .909 .302 .0909 -.182
-.531 0.168 -1.08
P = 0.291
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.697).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.291).
Results
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185
Effect of the therapy on Tenderness Table NO: 116
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 1.364 1.027 .310
AT4Ks 1.182 .751 .226 .182
-.618
.982 .474 P = 0.641
AT5Ks .727 .786 .237 Tenderness
AT5K .636 .505 .152 .0909
-.497
.678 .323 P = 0.750
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.641).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.750)
Effect on the Range of joint Movements: Table NO.117
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.572).
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed
Range f j i t
AT4K 4942.72
339.06
102.23 92.70 243 429. .575 P =
AT4Ks 4850.00
414.15
124.87
AT5Ks 5142.72
365.95
110.33
AT5K 5076.36
359.98
108.53
66.36 256.49
429.32
.429 P = <0.673
Results
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186
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.673).
Effect of the therapy on hand grip power in mm of Hg:
Table NO: 118
Mean Std Dev SEm Diff Lo UP T Sig.(2 tailed
AT4K 90.909 7.286 2.197
AT4Ks 87.636 20.314 6.125 3.273
-10.30
-16.84 0.503 P= .62
AT5Ks 104.182 12.082 3.643 Hand grip
AT5K 90.727 23.053 3.643 13.455
-2.915
29.824 1.715 P= .10
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.620).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.102).
Effect of the therapy on foot pressure
Table NO:119
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 37.818 1.689 .195 1.000
AT4Ks 36.818 1.413 .141 3.545
-3.59
5.593 .454 P = 0.65
AT5Ks 41.909 2.357 .157 1.000
foot pressure
AT5K 38.364 1.403 .0909 3.545
-2.17
9.267 1.293 P = 0.21
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.655).
Results
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187
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.211).
Effect of the therapy on knuckle swelling Table NO: 120
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 107.18 7.54 2.27
AT4Ks 110.36 5.20 1.56
-3.18
-8.94
2.583 -1.15
P= 0.263
AT5Ks 106.27 7.24 2.18 knuckle swelling
AT5K 110.00 4.89 1.47
-3.72
-9.22
1.771 -1.41
P= 0.173
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.263).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.173).
Effect of the therapy on circumference of arms Table NO: 121
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 37.364 1.362 .411
AT4Ks 37.091 2.625 .791 0.273
-1.58
2.133 0.306 P= <0.763
AT5Ks 37.364 1.433 .432 Circumference of arms
AT5K 36.727 2.901 .875 0.636
-1.39
2.672 0.652 P= 0.522
Results
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188
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.763).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.522).
Effect of the therapy on circumference of forearms Table NO: 122
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 29.727 1.679 .506
AT4Ks 31.364 3.202 .966
-1.63
-3.91
0.63 -1.50
P = 0.149
AT5Ks 28.273 1.849 .557
circumference of forearms
AT5K 31.455 2.945 0.888
-3.19
-5.36
-0.99
-3.03
P= 0.007
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.149).
The difference in the mean values of the two groups is greater than would be expected by
chance; there is a statistically significant difference between the input groups (P = 0.007)
Effect of the therapy on circumference of thighs Table NO: 123
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 72.636 5.626 1.696
AT4Ks 76.727 4.384 1.322
-4.09
-8.57
0.63 -1.50
P= 0.149
AT5Ks 70.727 5.968 1.799
circumference of thighs
AT5K 76.636 4.411 1.330
-5.90
-10.5
-1.24
-2.64
P= <0.016
Results
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189
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.072).
The difference in the mean values of the two groups is greater than would be expected by
chance; there is a statistically significant difference between the input groups (P = 0.016).
Effect of the therapy on circumference of calf
Table NO: 124
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 42.545 2.018 .608
AT4Ks 43.818 3.790 1.143 1.273
-3.97
1.428 -0.98
P= 0.337
AT5Ks 41.273 2.102 .634
circumference of calf
AT5K 43.636 3.957 1.193 -2.36
-5.18
.454 -1.75
P= 0.095
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.337).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.095).
EFFECT ON GENERAL SYMPTOMS
Effect on Aruchi
Table NO: 125
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .818 .603 .182 AT4Ks .455 .522 .157
.364 -.138 .865 1.512 P=0.146
AT5Ks .182 .405 .122 Aruchi
AT5K .455 .522 .157 -.273 -.688 .143 -
1.369 P=.186
Results
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190
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.146).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.186).
Effect on malabhadhatha Table NO: 126
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .0909 .302 .0909 AT4Ks .182 .405 .122
-.090 -.408 .226 -
.598 P=0.557
AT5Ks .0909 .302 .0909 Malabhadhatha
AT5K .182 .405 .122 -.090 -
.408 .226 -.598 P=0.557
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.557).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.557).
Effect on Angamarda
Table NO: 127
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .635 .809 .244 AT4Ks .545 .820 .247
.0909 -.634 .815 .262 P=0.796
AT5Ks .273 .467 .141 Angamarda
AT5K .364 .505 .152 -.0909 -.523 .342 -.439 P=0.666
Results
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191
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.796).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.666).
Effect on sadhana
Table NO:128
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .455 .522 .157 AT4Ks .455 .522 .147
.000 -.465 .465 .000 P=1.000
AT5Ks .364 .505 .152 sadhana
AT5K .545 .522 .157 -.182 -.639 .275 -.830 P=0.416
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 1.000).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.416).
Effect on Alasya Table NO:129
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .636 .674 .203 AT4Ks .636 .505 .152
.000 -.530 .530 0.000 P=1.00
AT5Ks .182 .405 .122 Alasya
AT5K .636 .505 .152 -.455 -.861 -
.0478 -2.331 P=0.030
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 1.000).
Results
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192
The difference in the mean values of the two groups is greater than would be expected by
chance; there is a statistically significant difference between the input groups (P = 0.030).
Effect on Anaha Table NO: 130
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .636 .505 .152 AT4Ks .545 .522 .157
.0909 -.366 .548 .415 P=0.682
AT5Ks .445 .522 .157 Anaha
AT5K .545 .522 .157 -.0909 -.555 .374 -.408 P=.687
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.682).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.687).
Effect on praseka Table NO: 131
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .545 .522 .157 AT4Ks .455 .522 .157
.0909 -.374 .555 .408 P=0.687
AT5Ks .273 .467 .141 praseka
AT5K .455 .522 .157 -.182 1.622 .259 -.861 P=0.400
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.687).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.400).
Results
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193
Effect on Trushna Table NO:132
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .636 .505 .152 AT4Ks .545 .522 .157
.0909 -.366 .548 .415 P=.682
AT5Ks .000 .000 .000 Trushna
AT5K .545 .522 .157 -.545 -.874 -.217 -
3.464 P=0.002
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.682).
The difference in the mean values of the two groups is greater than would be expected by
chance; there is a statistically significant difference between the input groups (P = 0.002).
Effect on Hasta pada daha Table NO: 133
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .727 .647 .195 AT4Ks .364 .505 .152
.364 -.152 .879 1.470 P=0.157
AT5Ks .0909 .302 .0909
Hasta pada daha
AT5K .182 .405 .122 -.0909
-0.408 .226 -.598 P=.557
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.157).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.557).
Results
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194
Effect on Jwara Table NO: 134
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K .000 .000 .000 AT4Ks .000 .000 .000
.000 .000 .000 .000 P=1.000
AT5Ks .000 .000 .000 Jwara
AT5K .000 .000 .000 .000 .000 .000 .000 P=1.000
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 1.000).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 1.000).
Effect on Shareera gaurava Table NO:135
Mean Std Dev SEm Diff Lo UP T Sig.(2
tailed AT4K 1.818 .603 .182 AT4Ks .909 .831 .251
-.0909 -.737 .555 -.294 P=0.772
AT5Ks .273 .467 .141 Shareera gaurava
AT5K .636 .674 .203 -.364 -.879 .152 -
1.470 P=0.157
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.772).
The difference in the mean values of the two groups is not great enough to reject the possibility
that the difference is due to random sampling variability. There is not a statistically significant
difference between the input groups (P = 0.157).
Results
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THE RESULTS OF THE STUDY
Parameters MPK MPKs Sandhi sula Significant Significant Sandhi shota Significant Significant
Stabdhata Significant Significant Tenderness Significant Significant
Range of joint movements Significant Significant Hand grip power Significant Significant
Foot pressure Significant Significant Knuckle swelling Significant Significant
Circumference of arms Significant Significant Circumference of forearms Significant Significant
Circumference of thighs Significant Not Significant Circumference of calf Significant Significant
Aruchi Significant Significant Malabadhata Significant Significant Angamarda Significant Significant
Sadana Significant Significant Alasya Significant Significant Anaha Significant Significant Praseka Significant Significant Truśna Significant Significant
Hasta pada daha Significant Significant Jwara Significant Significant
Śareera gowrava Significant Significant
Discussion
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DISCUSSION Conceptual Study
Vamana is mentioned as an ideal choice in disorders caused by Kapha Dosha, Pitta
Samsrushtha Kapha and Pitta sthanagata Kapha.Vamana karama will helps to eliminate the
morbidity which is particularly related with Kapha.
Among the joint disorders amavata is considered to be most serious, owing to its chronicity,
crippling nature and pain. Amavata is distressing and frustrating ailment both for the patient and
the physician as well.
Amavata being a disease having the predominance of morbid Kapha and Ama running in
Shleshmasthana, requires potent Vatahara, Kaphahara and Rasayana procedure through which
disease may be controlled.
Amavata is a bhahudoshavastajanya vyadhi where simple treatment like Langhana,
Langhana Pachana is not beneficial.So one has to go for Shodana procedure.
As in this disease mainly Ama and Kapha dominancy is seen and also the Shleshma sthana is
affected the Vamana which is a Shodana & langhana is beneficial.
Complete management of systemic diseases caused by Kapha can be attained by vamana
karma. Amashaya particularly Urdva Amashaya is the seat of Kapha. The active principle of
Vamaka drug taken orally is absorbed from the stomach into circulatory system from where it is
circulated all over the body reaching at the site of Dosha Sanghata, it breaks the dosha dushya
samurchana and bring back the harmful substances thus released into the stomach, where from
they are expelled out of the body by the action of vomiting.
Mode of Action of vamana Aushadhi: The vamana aushada is comprised of qualities like
Ushna, Tikshna, Sukshma, Vyavayi, and Vikasi.and formed with predominance of agni and
Vayu Mahaboota. But the main action is attained by the urdhvabhaga hara prabhava possessed
by these drugs.The drugs due to their virya will reach hridaya, and dhamani there by reaches
Stula and anu srotas of body. The vyavayi Guna of the drug will help in quick absorption and
movement of the drug. Vikasi Guna will helps in breaking the binding of dosha and dushya. Due
to Ushna Guna drug will cause vishyandhana and due to Tikshna Guna causes Chedhana of
Doshas. The Sukshma Guna helps to reach minutest channels.
Discussion
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The agni and Vayu mahabhutha because of its qualities like laghutva and tendency to move
upwards will help in bringing Vamaka effects. More importantly Prabhava of the drug is
especially responsible in brining about the Vamaka action.
The assessment of Vamana is done based on Vaigiki, Maniki, Laingiki and Antiki lakshana.
Here the laingiki and antiki lakshana are indicative of samyak yoga or Ayoga of the Vamana.
Where as Maniki, Vaigiki lakshanas are helpful to assess Pravara, Madhyama and Avara
shuddhi. These measures are also helpful in planning Samsarjana Krama.
CLINICAL STUDY:
A total of 22 patients suffering from Amavata fulfilling the inclusion criteria were studied.
Statistical analysis was done based on Sigma Stat version 3.1. The observations and the results as
well as statistical analysis of these are elaborated below.
Number of patients registered in study -22
Number of patients completed the study - 22
Number of dropout - 0
Discussion on observations (Demographic Data):
AGE: - Out of 22 patients of Āmavāta studied in this work, 27.27% patients were belonged to
the age group of 36-45 years & 46-55 years, 18.18% patients each in age group of 26-35years
and 56-65 years, 9.09%patient from the age group of 16-25 years.
SEX: - Among the 22 patients of this study 72.72% patients were females and 27.27% patients
were males.
RELIGION: - Among 22 patients of these series maximum 68.18% of patients were belonged
to the Hindu community, 18.18% from Christian religion and 13.63% from Muslim.This shows
geographical predominance of Hindus in and around UDUPI area. The details are elaborated in
the Table No46. and Graph No.3
MARITAL STATUS: Out of 22 patients of Āmavāta studied in this work. Maximum 90.90% of
patients were married. And 9.09% were unmarried.
EDUCATION: Out of 22 patients of Āmavāta studied in this work, maximum 45.45% were
studied upto matric, 27.27% of the patients were graduates, 22.72% studied up to primary
Discussion
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school, And 4.54% were uneducated. But from the above said data no definite conclusion can be
drawn regarding education with disease Table No.48 and Graph No.5
SOCIO-ECONOMIC STATUS: Out of 22 patients of Āmavāta studied in this work, 36.36% of
the patients belonged to upper middle class, 27.27% belonged to middle class, 13.63% belonged
to both lower middle class and poor, and 4.54% belonged to rich class.
OCCUPATION: Out of 22 patients of Āmavāta studied in this work, it was observed that
maximum number of patients were house wife i.e. 40.09%. 9.09 % were nurses, students and
employees, and 4.54% were teachers and business people. As in the study more of the house
wives were observed who can be considered under manual labour category, they have a more of
physical work which may provoke Vata dosha. Table No.50 and Graph No.7
DESHA: Out of 22 patients of Āmavāta studied in this work 72.72% of the patients belonged to
anupa desha, 22.27% belonged to jangala desha and 4.54% belonged to sadharana desha. The
Anupa Desha which is having predominance of Kapha dosha, this shows the relation of Anupa
desha one among the factor influencing in the disease. The details are shown in the Table No.51
and Graph No.8
CHRONICITY OF DISEASE: Out of 22 patients of Āmavāta studied in this work maximum
patients were suffering from the disease less than 1 year i.e. 13.63% and 31.81% suffered since
more than 2 years. And 54.54 % were suffering the disease since 1 to 2 years.
ADDICTION: Out of 22 patients of Āmavāta studied in this work, 95.45% were addicted to
coffe/tea. And 4.54% were addicted to tobacco
DIET:
Out of 22 patients of Āmavāta studied in this work 86.36% were of mixed diet and 13.63%
vegitarians.The diet plays an important role in causing the disease.The ahara which are Guru,
Abhisyandi etc which may provoke both Kapha kara and Ama. This favors the Amavata Nidana.
The details are shown in the Table No.54 and Graph No. 11
SLEEP PATTERN:
Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed sleep and
18.18% had sound sleep. The disturbed sleep was due to pain .The details are shown in the Table
No.55 and Graph No.12
Discussion
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PRAKRITI: Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 36.36%
were Vāta pittaja prakrithi and remaining 18.18% were kapha pittaja prakrithi. Involvement of
Kapha as a part of body constituents is observed. Table No.56 and Graph No.13
SATVA: In this study Maximum of 81.81% of the patients were of madhyama satva, 18.18%
were avara satva.
SATMYA: Maximum of 36.36 %were of amla rasa satmya, and 27.27% were madhura rasa
satmya 22.72 % were katu rasa satmya and 13.63% were lavana rasa satmya.It is very difficult to
conclude the relationship between Satmya and Amavata.The details are shown in the Table
No.58 and Graph No.15
SAMHANANA: Maximum of 72.72% of the patients were of madhyama samhanana, 18.18%
were avara, 9.09% were pravara.The details are shown in the Table No.59 and Graph No.16
SARATAHA:
Maximum of 59.09 % patients were twak Sāra, and 9.09% of rakta Sāra and 31.81 % māmsa
Sāra .
AHARA - AHYAVAHARANA SHAKTI: Out of 22 patients Maximum of 86.36% patients
were having madhyama abhyvarana śakti and 13.63% were having avara abhyvarana śakti.This
data suggests the relation of Ama and Ahara Abhyavaharana Shakti. Details are given in the
Table No.61 and Graph No.18
AHARA - JARANA SHAKTI: Jarana Shakti of 22 patients revealed that
Maximum of 86.36% patients had madhyama jaraṇa shakti, 13.63% had avara jaraṇa shakti
The jarana shakthi plays an important role in formation of Ama. The same is shown in the Table
No. 62 and Graph No.19
VYAYAMA SHAKTI: Out of 22 patients taken for this study, Maximum of 72.72% patients
had madhyama vyāyāma shakti and the remaining 31.81 % had avara vyayama shakti. From
above said data it may be noticed like due to the disease nature the patients functional ability
reduced and and therefore Vyayama Shakti also. The same is given in the Table No.63 and
Graph No20
VAYA: It is observed that maximum of 86.36% of the patients taken for this study belongs to
madhya vaya, 13.63% belongs to vrudha.
Discussion
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INCIDENCE OF KOSHTA: - Out of 22 patients taken for this study it is observed that
maximum of 81.81% of the patients had madhyama koṣta and 18.18% had mridhu koṣta. As
shown in the Table No.65 and Graph No.22
EFFECT OF THE THERAPY
Observation of Pachana and Deepana: Vadavanala choorna 5gm is used with hot water thrice
daily till the Nirama lakshanas observed in the patients.It has Pachana-Deepana effect and its
vata kapha hara quality helps in attaining nirama avasta easily.During the Pachana Deepana there
was no much improvement in the symptoms of the Amavata like shoola, shotha etc.
Observation of Snehapana:- Snehapana was started with the Moorchitha Ghrita & the dose was
25ml (Hrasiyasi Matra). On the basis of the time taken to digest first day of Sneha, a subsequent
dose of Ghrita was planned. The Sneha was given in Arohana Matra till patients has developed
Samyak Snigdha Lakshanas or upto maximum of seven days, whichever is earlier. The average
days of Samyak Snigda Lakshnas was observed in patients were three days. However a
maximum of five days is also noted. Mean of the total amount of the ghrita to attain the samyaka
Snigdha Lakshans were 335 ml . Minimum dose of 125ml at the maximum doses of 600ml was
also noted. The mean time taken for digestion of sneha on first day was 390min and the time
duration was increasing day by day the 5th day mean time taken was 523min.All the patients
were shown features of the Samyak Snigdha lakshna. None of the patients were shown
complications like that of Sneha Vibhrama. During the snehapana with Moochitha Ghrita there
was marked reduction in the Pain, Tenderness, Stiffness, Swelling was observed. There was
improvement in the agni. Maximum Samyak snigdha lakshanas were seen on 4th day.
Observation of Swedana Karma: - After attaining of Samyak Snigdha lakshana one day gap
was given during which Abhyanga was done with saindavadi taila followed by Bashpa sweda.
In this study after the Swedana, 100% patients manifested with Sheetoparama,
Shooloparama,Stamba nigraha, Sweda pradurabhava lakshanas.. But Lagutva, Mardavata,
Gourava nigraha was noted in 91.3% patients.During the rest day patients were advised to take
minimum of 2 liters of curds with rice,idlli,vada and ample amount of Sweets for the purpose of
Kaphothkleshana. As curds is the best abhishyandi and does Kaphothkleshana quickly, it has
been selected.
Discussion
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Observation of Vamana Karma: On the day of Vamana after performing Abhyanga with
saindavadi taila followed by Bashpa sweda in the early morning between 6.15 Am to 6.45Am in
accordance with sunrise Vamana karma was administered. Madanphalapippali (3-
5gms),Saindhava Lavana(5gms),Vacha choorna(2-4gms) with sufficient quantity of Madhu was
used and it was mixed and made in to kalka form or Madanaphala Ksheerapaka in which Madana
phala powder(4-6gms) is boiled in 8 parts of milk (50ml) with the addition of 32 parts of
water(200ml). The boiling is continued till the water gets evaporated and milk alone is
left(ksheeravashesha i.e 50ml) was selected according to the Group. Madanaphala kalka can be
rolled into small pills for easy consumption. For akanthapaana, Ksheera was used, Yastimadhu
phanta was used as Vamanopaga dravya.. Vital data like B.P, Pulse Temperature, and
respiratory rate were noted at regular intervals.
Symptoms after Administration of Vamaka yoga: The Table No. reveaels that maximum
number of patients 100% (22) attained Hrillasa followed 95.25% showed sweating
(swedapravartanam) ,81.81% had Kukshi Adhmana, 50% had Nisteeva,31.81% had Daha, Lala
srava,27.27% showed Madhura asyata, Nasa srava,22.72% had Romaharsha, 18.18 % presented
with Akshi srava and Udgara, 9.09% individuals exhibited Kasa and Shirogaurava. The
symptoms explained above in sequential manner did not occur in each Vamana; hence it is
difficult to assess the perfect sequence in each time.
Expulsion of first Vega: In the present study, after the administration of Vamaka Yoga, a gap of
8-10minutes was given for its action. An average time of 9.52 minutes was noted for the
expulsion of first Vega. Here minimum of 3 minutes and maximum of 20 minutes was observed
for the expulsion of first Vega. As shown in Table No.72
In each of the Vega the change in the colour and nature of the expelled materials was observed.
Duration of total procedure:
In this study average time taken to finish the Vamanakarma was 43.28 min (Table No 76 .) in all
22 patients. So the concept “Muhurtham anukamkshayet” this is the time duration to end with
Pittanta Vamana. So here it gives the clear meaning that one has to finish the whole procedure
within 45 Minutes. In the study all patients was ended up with pittanta Vamana within one
muhurtha.
Discussion
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Distribution of patients according to Vaigiki Shuddhi:
Out of 22 patients of this study, maximum 68.18% patients exhibited Madyama vega 31.81%
patients shown Pravara vega. As shown in Table No.78 . But the Vaigiki shuddhi is not reliable
to predict anything about the result. It only helps us to come to a conclusion about shuddi and
plan the Samsarjana karma accordingly.
Antiki Symptoms:
Whatever the amount that is ingested most of it will be thrown out of the body, hence 100% of
the patients exhibited lightness in the abdomen after vamana karma. Pittanta Vamana is
important feature as per Antiki shuddi is considered. All the patients ended up with Pittanta
Vamana.Due to appearance of Pitta 100% patient’s experienced bitter taste in the mouth and
burning sensation in the throat. Pungent taste was exhibited by 59.09% of patients.
Increased in freshness was seen in 95.45% patients. 86.36% patients showed lightness in the
head, and sides. 100% of the patients showed spontaneous cessation of the vomiting. (Swayam
cha Avasthanam) It was noted that when the patients were properly advised with Snehana,
Swedana and Kaphothkleshakara Ahara Vamana will be much easier and Pittanta takes place
faster. Vamana removes Kapha from the channels in the head region may bring the feeling of
lightness of the head. As Vamana is clearing all the channel pathways throughout the body, so
lightness in chest, lightness in sides, appearance of clear and tasteless belching were observed as
these are subjective criteria it is not possible to score in percentage.
Manki Shuddhi:
In the present study average value of total ingested material in 22 patients was 4469.523ml and
total expelled amount was 4740.95ml, that means the amount of 271.427 ml was in excess
(average), it was found that the mean quantity of difference between input and output was
indicates the quatity of doshas expelled during Vamana. If the expulsion of the viscous matter
showed an increase then there better chances to getting relief in the diseases afterwards.
Discussion
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Laingiki Suddhi :
The laingiki shudhi is assessed in three stages.During Vamana,After vamana And After
samsarjana.krama. During vamana 100% patients had shown kale pravruthi, swayam cha
avashanam, yathakrama kapha pitta vata dosh harana.Where as 90.9 % patients shown anathi
mahathi vyadha ,After vamana 90.9% showed Kanta shudhi, Kapha samsrava, 77.2% exhibited
Hrudaya shudhi, Sroto shuddhi, 68.1% exhibited Parshva shudhi features.These Laingiki
lakshanas are much important to conclude the Samyak Vamana.
Changes observed in Blood pressure: The blood pressure initially raised during the process and
again came down. In all 22 patients in the beginning mean B.P was 126.2/80.5 mm of Hg which
got raised up to 142.6/94.6 mm of Hg during the procedure and came down to 122.2/84 mm of
Hg at the end of the procedure. This mechanism can be explained as follows- Normally,
whenever a change (for example, increased activity or a strong emotion) causes a transient
increase in blood pressure. Any type of mental and physical activities increases the arterial
pressure.In cardiovascular physiology, the baroreceptor reflex is one of the body's homeostatic
mechanisms for maintaining blood pressure. It provides a negative feedback loop in which an
elevated blood pressure reflexively causes blood pressure to decrease; similarly, decreased blood
pressure depresses the baroreflex, causing blood pressure to rise.These specialized neurons
(baroreceptors) in the aortic arch, carotid sinuses, and elsewhere to monitor changes in blood
pressure and relay them to the brainstem. When blood pressure rises, the carotid and aortic
sinuses are distended, resulting in stretch and therefore activation of the baroreceptors. The end
result of baroreceptor activation is inhibition of the sympathetic nervous system and activation of
the parasympathetic nervous system. Sympathetic inhibition leads to a drop in peripheral
resistance, while parasympathetic activation leads to a depressed heart rate and contractility. The
combined effects will dramatically decrease blood pressure.
There might be slight increase in initial B P than normal in all patients due to anxiety before
leading to vamana.After acclimatizing with vamana process and with negative feed back
mechanisms it almost returned to normal after the procedure.
Changes in pulse: Pulse also showed the same changes, average pulse recorded before
commencement to the process was 80.4/min, which elevated up to 106.7/min and then again
came down to 82.4/min. This increment was due to activation of autonomous nervous system,
Discussion
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which stimulates the heart for more cardiac output to fulfill the need of increased blood flow in
the visceral region and the muscles helping the process.
Samsarjana Krama: After the completion of the Vamana Samsarjana was advised to the
patients and instructed them to follow it strictly. Looking in to the Vaigiki shuddhi and strength
of the patients Samsarjana Karma was planned. So maximum patients 68.18% were advised with
5 days of Samsarjana karma, where as 31.81% advised with 7 days of Samsarjana Krama. Table
No. 83.
EFFECT OF THERAPY:
Effect on Cardinal signs and symptoms:-
The administration of Vamana karma showed the following results,
Effect on Sandhi Shoola:-
In Group A there was significant reduction in the sandhi śūla .The improvement was of 3.22%
during AT1 and during AT5 the improvement was 58.05%.The therapy shows statistically
significant change at the level of P = <0.001, as shown in Table No.85a and Graph No.29.There
was significant reduction in the sandhi śūla in Group B .The improvement was of 16.68% during
AT1 and during AT4 the improvement was 59.99%. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically significant change
(P=<0.001)
Effect on Sandhishotha:-
In Group A there was significant reduction in the sandhi śotha i.e during AT1 the improvement
was seen at 17.22% , during AT5 55.15% of improvement is seen. There is a statistically
significant change at the level of P = <0.001. as shown in Table No 86a and Graph No.30.In
Group B there was significant reduction in the sandhi śotha i.e during AT1 the improvement was
seen at 3.95% , during AT5 56.00% of improvement is seen. The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically significant change
(P = <0.001).So comparatively Group B shows better result.
Effect on Stabdhata:-
There was significant reduction in the stabdatha i.e during AT1 the improvement was seen at
5.26% , during AT5 57.90of improvement is seen. The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant change (P = 1.000)
Discussion
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in Group a.There was significant reduction in the stabdata i.e. 20.85% of improvement is seen
during AT2, 41.65% during AT4, 58.34% of improvement is seen during AT6 The change that
occurred with the treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001) IN Group B. So comparatively Group B shows better result.
Effect on Tenderness:
There was a significant reduction in the tenderness is observed. During AT2 18.53%, AT3
33.36%, AT5 77.80% of improvement is observed. The change that occurred with the treatment
is greater than would be expected by chance; there is a statistically significant change (P =
<0.001) in Group A. There was a significant reduction in the tenderness is observed. During AT2
15.39%, AT3 26.90%, AT5 73.05% of improvement is observed. The change that occurred with
the treatment is greater than would be expected by chance; there is a statistically significant
change (P = <0.001) in Group B. So comparatively Group A shows better result.
Effect on General Symptoms:-
• The symptoms like Jwara, trushna after the AT5 score became zero in all parameters
respectively. The percentage of improvement was 100%
• Aruchi had mean initial score 2.364 unit before treatment, after samsarjana krama it was
0.182 unit. This data shows 88.37% of improvement in Group A. Aruchi had mean initial
score 1.545 unit before treatment, after samsarjana krama it was 0.364 unit. This data
shows 88.37% of improvement in Group B.
• Alasya, Shareera gaurava features have the mean initial scores 1.818 and 2.091 units
each respectively. After AT5 the score reduced to 0.273 and 68.42 units respectively. The
percentages of improvement were 68.42% and 78.05% respectively in Group A. Alasya,
Shareera gaurava features have the mean initial scores 1.636 units each. After AT5 the
score reduced to 0.636 units. The percentages of improvement were 78.05% in Group B .
• In Group A the feature Sadana had the initial score of 1.909 units before treatment
which reduced to 0.364 units after treatment. The percentage of improvement was
79.99% . The feature Sadana had the initial score of 1.727 units before treatment which
reduced to 0.545 units after treatment. The percentage of improvement was 79.99% in
Group B
Discussion
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• In patients treated with Vamana karma the Angamarda showed average improvement as
the initial score was 2.364 which reduced to 0.273 units after AT4 showing 81.63% of
improvement in Group A. In patients treated with Vamana karma the Angamarda showed
average improvement as the initial score was 2.091 which reduced to 0.364 units after
AT4 showing 81.63% of improvement in Group B.
• Malabadatha,praseka features have the mean initial scores 0.909 and 2.000 units each
respectively. After AT5 the score reduced to 0.090 and 0.273 units respectively. The
percentages of improvement were 92.85% and 84.20% respectively in Group A.
Malabadatha,praseka features have the mean initial scores 0.455 and 1.455units each
respectively. After AT5 the score reduced to 0.182 and 0.455 units respectively. The
percentages of improvement were 92.85% and 84.20% respectively in Group B.
• The symptoms like Anga shoonata,Kandu, Hrutgraha, Bahumootrata,Kukshi shoola,
Chardi, Bhrama, Antrakoojana was not recorded in any of 22 patients.
Effect on Total score of General symptoms:-
The patients who are treated with Vamana karma showed significant improvement in the general
symptoms the percentage of improvement is increase from 8.33% during AT1 to 68.01% during
AT5 in Group A.
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
The patients who are treated with Vamana karma showed significant improvement in the general
symptoms the percentage of improvement is increase from 8.82% during AT1 to 68.56% during
AT5 in Group B.
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P = <0.001)
Effect on Clinical Parameters:-
Effect on the Range of joint Movements:
The change that occurred with the treatment is greater than would be expected by chance; there
is a statistically significant change (P<0.001) There was a significant improvement is seen in the
range of joints movement AT1 showed 0.62% and AT5 showed 16.06% of improvement in
Discussion
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Group A. There was a significant improvement is seen in the range of joints movement AT1
showed 1.18% and AT5 showed 17.75% of improvement in Group B. The change that occurred
with the treatment is greater than would be expected by chance; there is a statistically significant
change (P<0.001)
Effect on Hand grip power in mm of hg:
In Group A improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and
after AT5 31.72% The change that occurred with the treatment is greater than would be expected
by chance; there is a statistically significant change (P<0.001) In Group B improvement is seen
after AT2 is 9.82% statistically significant at p=0.100 and after AT4 19.66% The change that
occurred with the treatment is greater than would be expected by chance; there is a statistically
significant change (P<0.001)
Effect on Foot Pressure in kgs :-
There is significant improvement is seen in the foot pressure after AT1 the improvement is seen
at 0.827% which is statistically significant at P= 0.192 and after AT5 the improvement was of
26.99% The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P<0.001) in Group A. There is significant
improvement is seen in the foot pressure after AT1 the improvement is seen at 1.51% which is
statistically significant at P= 0.192 and after AT4 the improvement was of 16.25%.The change
that occurred with the treatment is greater than would be expected by chance; there is a
statistically significant change (P<0.001) in Group B.
Effect on knuckle swelling which was measured using jewelers ring:-
The improvement is seen with only 1.45% after AT2 and 5.42% after AT5. The change that
occurred with the treatment is not great enough to exclude the possibility that the difference is
due to chance (P = <0.001) in Group A. The change that occurred with the treatment is not great
enough to exclude the possibility that the difference is due to chance (P = <0.001).The
improvement is seen with only 0.23% after AT1 and 3.43% after AT5 in Group B.
Effect on Circumference of limbs:-
• In the arm circumference of the patients 3% of the decrease was observed after AT3
which was again increased after AT5 (4.86%).So there is a statistically significant change
at the level of P = <0.001 in Group A. After AT5 6.04% of the improvement is seen, The
Discussion
“Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata”
208
change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001) in Group B.
• In the forearm circumference of the patients 5.38% of the decrease was observed after
AT3 which was again increased after AT5 (11.89%).So there is a statistically significant
change at the level of P = <0.001 in Group A. As the table shows after AT1 0.55% of the
improvement at P=0.167 and after AT5 4.95% of improvement is seen The change that
occurred with the treatment is greater than would be expected by chance; there is a
statistically significant change (P = <0.001) in Group B.
• In Group A the circumference of the thigh of the patients 3.80 % of the decrease in the
circumference was observed after AT3 which was again increased after AT5 (7.81%).
So there is a statistically significant change at the level of P <0.001. After AT2 only
0.35% of improvement is seen at P=0.082 and after AT5, 1.74% of the improvement is
seen .The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = 0.006) in Group B.
• In the circumference of the calf of the patients 6.95 % of the decrease in the
circumference was observed after AT3 which was again increased after AT5 (12.35%).
So there is a statistically significant change at the level of P = <0.001 in Group A. After
AT2 only 3.09% of improvement is seen at P=0.100 and after AT5 7.15 % of
improvement is seen .The change that occurred with the treatment is greater than would
be expected by chance; there is a statistically significant change (P = <0.001) in Group B.
• The details of the same are given in the From above observations it is clear that the
patients of Amavata who are treated with Vamana karma shown good response to the
treatment with regards to cardinal symptoms of Amavata, general symptoms of Amavata,
clinical parameters, and overall effect of the medication. The improvement was marked
soon after the Abhyantara Snehapana and Swedana Then improvement was Satisfactory
after soon Vamana. But again there was good improvement noted after the Samsarjama
karma. Most of these improvements are found to be statistically significant as per the
paired‘t’ test.
Conclusion
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
209
CONCLUSION Conceptual study:
• Importance for Shodhana high lighted in all the classics in treating Amavata.
• Vamana is beneficial after the Vata is controlled by Basti etc.
• Indirect reference available for Vamana Karma in Amavata.
• Vamana should be given when Kapha predominance is seen.
Observations:
• Maximum patients (27.27%) were belonged to age group of 36-55 years.
• Physically strenuous (40.90%) work was found in maximum patients.
• Maximum patients (72.72%) were from Anupa desha.
Results:
• On an average on the 4th day patients (50.00%)attained samyak snigda lakshnas.
• 100% of the patients attained the Samyak Snigda lakshnas like Vatanulomana,
Deeptagni, snigda Varcha, Gatra snigdata,Adastath sneha darshana.
• Mean total of 335 ml Ghrita was required to attain the Samyak Snigda Lakshnas.
• Average time taken for the initiation of the first vega of Vamana was 9.52
minutes.
• Average time taken for the completion of vamana was 43.28 minutes whereas a
minimum of 25 minutes and maximum of 55 minutes was observed in this study.
• 100% patients possessed with Samyak yoga.
• All the patients ended with Pittantha Vamana
• There was significant reduction in the sandhi shoola(58.05%)in groupA
and(59.99%) in group B, Stabdhata(58.34%) in group A and (57.90) in group B
,Sandhishota(55.15%) in group A and (56.00) in group B,Tenderness (77.80% ) in
group A and (73.05%) in group B
• General symptoms of Amavata were decreased significantly by 80.05% in group
A and 68.56% in group B
Conclusion
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
210
• Range of joint Movements was improved significantly by 16.06 in group A and
17.75% in group B
• Hand grip power was improved significantly by 31.72% in group A and 19.66%
in group B
• Foot Pressure was improved significantly by 26.99% in group A and 24.85% in
group B
• knuckle swelling was improved significantly by 4.86% in group A and
3.43% in group B
After going through the available data’s, author is having the opinion of during
kaphothklista state, instead of going through upavasa or such measures, Vamana will
yield maximum benefits in the patients of Amavata. Further other Sodhana
procedures like Virechana, Kshara Vasti are employed at appropriate time and
condition of the patients complete cure from disease is a possibility.
Summary
Comparative Study to Evaluvate The Effectiveness of Vamana Karma by Madhana Phala Kalka and Madhanaphala Ksheerapaka in Amavata
211
SUMMARY The thesis entitled "Comparative study to evaluvate the effectiveness of Vamana
Karma by madhana phala kalka and madhana phala ksheerapaka in Amavata" comprises
of seven parts, viz. conceptual study, Conceptual Study of Vamana Karma and Amavata, Drug
Profile, Methodology, Clinical Study-Result, Discussion, Summary and Conclusion.
Chapter (1): Historical review deals with the historical aspect related of Vamana process,
etymology and definition of Vamana and indications-contraindications explained a glimpse on
utility of Vamana Karma in various conditions obtained from several texts.Vamana Karma was
studied under three major divisions as Purvakarma, Pradhanakarma and Pascata Karma. Vyapad
of vamana karma is briefly discussed. "Mechanism of Vamana" through Ayurvedic point and
also briefly a review on current physiology. Conceptual study of Amavata includes Etymology,
Definition, Nidana, Lakshana, Samprapti, Upadrava, Upashayaanupashaya, Pathyapathya and
Rheumatological Correlation to rheumatoid Arthritis.
Chapter (2): Explains the properties of drugs used for Deepana Pachana, Koshta pareeksha,
Snehapana, Sweda, Vamana , Dhumapana .
Chapter (3): The materials and methods adapted for the study are described here.
This chapter deals with the
• Protocol of the study Viz objective of the study.
• Inclusion and exclusion criteria of the patients.
• Intervention and criteria of assessment.
• Review of previous work done on Vamana karma and Amavata.
Chapter (4): The observation made on demographic incidence of age, sex, habits etc are
presented in the form of diagrams. The results of the clinical study are presented with statistical
analysis in the form of tables and brief narrations.
Chapter (5): Discussion, deals with the discussion of entire thesis. The conceptual part of
Vamana and its action on Amavata are explained. Clinical data is discussed in details. The result
obtained in clinical study, as well as Observations in it are discussed with relevant arguments.
Chapter (6): Conclusion, the conclusion of whole clinical study and Vamana is explained in this
chapter.
Chapter (7): Summary, summarized the whole thesis.
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45RESEARCH PROFORMA
DEPARTMENTOFPANCHAKARMA S.D.M COLLEGE OF AYURVEDA
KUTHPADY, UDUPI
COMPARITIVE STUDY TO EVALUVATE THE EFFECTIVENESS OF VAMANA BY MADHANA PHALA KALKA AND MADHANA PHALA KSHEERA PAKA IN AMAVATA. Guide:Dr. NIRANJAN.RAO. Co- Guide:Dr. SHREEKANTH.U
Researcher: Dr. RIYAS. K. A Name : Serial No : Age : Group (MPK/MPKP) Sex : M / F OPD No : Religion : H / M / C / O IPD No : Education : UE / P / M / MS / GR / PG DOA : Marital Status : UM / M / D / W DOD : Social Status : VP / P / LM / M / UM / R/VR Occupation : Physical strain/Mental strain Diagnosis : Desha : Anupa / Jangala / Sadarana Result : Postal Address : MAIN COMPLANTS:
SYMPTOMS Duration BT AT 1 AT 2 AT 3 AT 4 AT5 AT6 Jwara Stabdatha Aruchi Mala Bhaddatha Angamarda Sadana Alasya Hrutgraha Anaha Preseka Trushna Hasta-Pada Daha Bahumootrata Kukshi Shoola Chardi Bhrama Shareera Bhara Antrakoojana Kandu Anga shoonata
BT-Before treatment, AT1-After amapachana,
AT2-Aftrer Snehapana, AT3-Before vamana,
AT4-After vamana (evening), AT5-After samsarjana krama,
AT6-After follow up period.
HISTORY OF PRESENT ILLNESS: Onset: insidious / gradual / sudden
Sequence of joint involvement:
1……Since……2……Since……3……Since……4……Since……
5……Since……6……Since……7……Since……8……Since……
Course: Progressive / receding / relapsing / stationery
Aggravating factors:
Relieving factors:
Symmetry of joint involvement: 1 2 3 4 5 6
HISTORY OF PAST ILLNESS:
FAMILY HISTORY:
TREATMENT HISTORY: Drugs Dosage Duration Details NSAID’S STEROIDS DISEASE MAGNIFYING AGENTS OTHERS
PERSONAL HISTORY: Vyasana: Coffee/Tea…… Alcohol…… Cigarette…… Tobacco Chewing…… Others……
Duration: Since………Occational / Regular / Stopped / Reduced / Continued
Ahara: Veg / Mixed Samasana / Visamasana / Adyasana / Anasana Dominant Rasa - M / A / L / K / T / Ka Dominant Guna – R / S / U / Sh / G / L
Nature of work: Manual /Sedentary / Labour / Traveling / Walking / Studying / Sitting/Day/Night,
Strain-physical/mental
Vishrama: ……Hours Proper / Less / Excessive
Vyayama: No / Proper / Excessive / Irregular
Nidra: Sound / Disturbed/Delayed/ Night …… Day ……Difficulty in falling Asleep / Staying Asleep
Bowel: Frequency ……… Consistency ………… Colour
Micturition: ………Frequency………quantity………Colour
OBSTETRIC HISTORY: No. of delivery ……. Normal…… Surgical Intervention……
Abortions …… Miscarriages …… Last Delivery ……
Years Back……
GYNAECOLOGICAL HISTORY:
Menstrual cycle: …… Regular / Irregular / Menarche …… years
Bleeding ….. days Menorrhagia / Metrorrhagia / Dysmenorrhoea / Leucorrhoea
Menopause since……years
GENERAL EXAMINATION: DASHAVIDHA PARIKSHA
Pulse …… / min,reg/irregular Prakrutitah:V/P/K/VP/VK/PK/VPK B.P …… mm / Hg Vikrutitah: P / M / A Dosha : Dushya : Srotas : Udbavasthana : Sancharasthana : Vyakthasthana : Temperature……0F Satwatah: P / M / A Respiratory rate…… / min Saratah: P / M / A Nourishment: G / F / P Satmyatah: RASA SATMYA Built: Samhanatah: P / M / A Nails: Ahara Shaktitah: Abyavaharana: P / M / A Conjunctiva: JaranaShaktitah: P / M / A Sinuses: Vyayama Shaktitah: P / M / A Lymph nodes: Pramanatah: P / M / A Deformities: Height …… cms Contractures:SD/BD/DC/VD Weight …… Kgs Rh.Nodules: Y / N Vayataha; Bala / Madya / Vradha Others:
SYSTEMIC EXAMINATION:
CNS : CVS : RS : GUS : P/A : LOCOMOTOR SYSTEM ASSESSMENT CRITERIA-FUNCTIONAL TEST
BT 1 2 3 4 5 6 Joint Motion Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
Flexion Extension Abduction Adduction Lat. Rot.
Shoulder
Medi. Rot. Flexion Elbow Extension Supination Forearm Pronation Uln. Devi. Radi. Devi. Flexion
Wrist
Extension Flexion Extension Abduction Adduction Lat. Rot.
Hip
Medi. Rot Extension Knee Flexion Plant. Flex. Ankle
Dorsi. Flex. Inversion Foot Eversion
MCP1 Flexion Extension Abduction Adduction MCP2 Flexion Extension
Abduction Adduction MCP3 Flexion Extension MCP4 Flexion Extension Abduction Adduction MCP5 Flexion Extension Abduction Adduction PIP1 PIP2 PIP3 PIP4 DIP1 DIP2 DIP3 DIP4
Flexion TOE Extension
Spine Flexion Extension Lat. Bend.
Neck
Rotation
RING TEST BT 1 2 3 4 5 6 No. Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
1 2 3 4 5
BT 1 2 3 4 5 6 TEST Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
Grip Test Foot Pressure Gen. Functions
BT 1 2 3 4 5 6 Circumference (CMS) Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt LtArm Forearm Thigh Calf
INVESTIGATION:
Test BT AT HB% T.L.C D.C / N D.C / L D.C / E D.C / B D.C / M E.S.R RA Factor C-reactive protein
E.C.G ASO Titer JOINT EXAMINATION
Pain Swelling Stiffness Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 Rt
DIP Lt Rt
PIP Lt Rt
WRI Lt Rt
ELB Lt Rt
SH Lt Rt
DIP Lt Rt Lt PIP
Lt Rt
ANK Lt Rt
KN Lt Rt
HIP Lt Rt
TMJ Lt Rt
STC Lt Rt
ARC Lt SPINE C/T/L/S
TREATMENT SCHEDULE: POORVA KARMA: Administration of Deepana Pachana: vadavanala choorna with Ushna Jala Dose: 3/5gmsTDS for 3 days Koshta pariksha- Triphala kwatha - Dose.........ml Time- No.of malapravriti: .......... Koshta------------- SNEHAPANA VIDHI: Name of Sneha given- moorchitha gritha with Ushana jala as Anupaana SNEHAPANA DAY Date
Time Quantity Time of Snehajeernata
Tenderness Warmth Redness Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 Rt
DIP Lt Rt
PIP Lt Rt
WRI Lt Rt
ELB Lt Rt
SH Lt Rt
DIP Lt Rt Lt PIP
Lt Rt
ANK Lt Rt
KN Lt Rt
HIP Lt Rt
TMJ Lt Rt
STC Lt Rt
ARC Lt SPINE C/T/L/S
Sneha jeeryamana lakshanas LAKSHAN Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Shiroruk Bhrama Nishtiva Moorcha Saada Aruchi Klama Trishana Daha Snehaudgara Arati Sneha jeerna Lakshanas
LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Trishna Kshudha Udgarashudhi Shiralaghavata Vatanulomata Samyak snigdha lakshanas
LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Vatanulomata Agnideepti Snigdha asamhata varcha
Gatramardava Twaksnigdhata Snehodvega Klama Shaitya Angalaghava
VISHRAMA KALA: Sarvanga abhyanga with saindhavadi taila followed by bhashpa sweda. SAMYAK SWINNA LAKSHANAS
LAKSHNAS DAY1 DAY 2 Sheeta uparama Shoola uparama Stambha nigraha Gaurava nigraha Mardavata Sweda virathi/sheetaartitva
Vyadi haani Laghutava Sweda srava Agni deepti Twak prasada Bhakta shrudda Strotasam nirmalatva
Nidra hani Tandra hani Chetayedh Aashu Stabdha
Sandheen
PRADHANA KARMA: Administration of milk followed by madanaphala kalka/madanaphala ksheerapaka followed by milk upto stomachfull and later yastimadhu phanta(vamanopaga) Time of administration of Vamana Dravys-….......
OBSERVATION Liquid given
Time of administn
Quantity in ml
No of vegas Sharira
sambhandhi lakshana
Colour Consistency Temp BP/mmhg
Pulse/min
2]LAINGIKI Total input = ml Total output = ml Total vaanta dravya = ml Weight before vamana = kgs Weight immediately after vamana = kgs Weight in the evening before manda pana = kgs
Samyak Yoga Ati Yoga Ayoga Kale pravruthi Phenila vamana Vega apravarti Yathakarma.kapha,pitta,vata doshaharanam
Raktha,chandrikavata vamana Kevala.oushada pravruthi
Swayam avasthana Athyanta rakthasrava Jwara Hridaya suddhi Trusna Hridaya asuddhii Parsva suddhi Moha Srotoasuddhii Mrudha suddhi Murcha Vegavibandhaa Srotosuddhi Nidra haani Gurugatrat Indriya suddhi Bala haani Spota Laghuta Hritapida Kota Karshya Kanta pida Kandu Dourbalya Tamha pravesa Kaphaprasekha Kantasuddhi Brhama Kapha samsravha Pittati yoga Vata prakopa Daha
ANTHAKI
VEGAKI
MANAKI
LYNGIKI
OBSERVATION
OBSERVATION OF VITAL DATA
Time Pulse Blood Pressure Resp.Rate
PASCHAT KARMA
CONDITION OF THE PATIENT AFTER TREATMENT
COMPLETE REMISSION MAJOR IMPROVEMENT MINOR IMPROVEMENT No Improvement / PROGRESSION Signature of scholar: signature of guide:
No. of Annakalas Diet Regimen Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi
Peya Vilepi Akrita Yusha Krita Yusha
Assessment criteria: Changes in the subjective signs and symptoms will be assessed by scoring method. By using appropriate clinical tools objective signs are assessed A. Subjective criteria: 1. Pain in the joints: Symptom No 0 Mild (on motion o 1 Moderate (at rest) 2 Severe (wakes patient from sleep) 3 2. Morning stiffness (duration in hours): 0-5 min. 0 5 min. - 2 hrs. 1 2 - 8 hrs. 2 8 hrs. or more 3 3. Swelling in the joints: Absent 0 Mild 1 Moderate 2 Severe 3 4. Redness: Absent 0 Mild 1 Moderate 2 Severe 3 5. Warmth: Absent 0 Mild 1 Moderate 2 Severe 3 6. Tenderness in the joints: 0 No tenderness 1 Says tender 2 Patient winces 3 Winces and withdraws Not allowed to be touched 7. Alasya: Fully active 0 Mild laziness, slow initiative in work 1 Initiative in some works, absent in others 2 Absolute lack of initiative even though capacity for work exists 3 8. Dourbalya: No feeling of weakness 0 Slight weakness 1 Feeling of weakness but ability unimpaired 2 Ability to do duties affected 3
11. Malabaddhata/Vibandha (Constipation): Absent 0 Slight with one motion per day 1 Marked constipation with one motion after two days or more 2 12. Jwara ( in degree farhenheit ) No fever 0 Mild (990 F – 1010 F) 1 MODERATE ( 1010 F – 1030 F) 2 SEVERE ( > 1030 F) 3 13. Sadana - fatigue: No fatigue 0 Works full-time despite some fatigue 1 Patient must interrupt to rest 2 Fatigued at rest 3 14. Bahumootrata (frequency of micturition per 24 hours): Absent (less than 4 times/24 hrs) 0 Mild (upto 6 times/24 hrs) 1 Moderate (6-10 times/ 24 hrs) 2 Severe (> 10 times/ 24 hrs) 3 15. Chardi (frequency of bouts per 24 hours): Absent 0 Mild (upto 2 vegas/24 hrs) 1 Moderate (2-4 vegas/24 hrs) 2 Severe (4 vegas/24 hrs) 3
16. Angamarda :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 17. Aruchi :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 18. Gourava : No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 19. Bhrama : 0 No symptoms 1 Mild symptoms 2 Moderate symptoms 3 Severe symptoms 20. kukshishoola :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3
21. Hritgraha :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 22. Anaha
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 23. Praseka :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 23. Trishna :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 24. Hasta pada daha :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 25. Kandu :
No symptoms 0 Mild symptoms 1 Moderate symptoms 2 Severe symptoms 3 26. Moorcha :
Present / Absent 27. Apaka :
Present / Absent B. Functional assessment: The objective improvements are assessed as following methods.
1. Grip strength: The functional capacity of effected upper limb of the patient is assessed by compressing the inflated ordinary sphygmomanometer cuff which will be carried out under standard conditions both before and after treatment.
2. Foot pressure:
The functional capacity of lower limb of the patient is assessed by pressing a weighing machine under standard conditions both before and after the treatment
3. Range of joint movement :
Goniometer is used to see the range of movement of all effected joints both before and after the treatment.
4. General functional capacity:
• Complete ability to carry on all usual duties without handicap 1
• Adequate normal activity despite handicap of discomfort or limited joint movement 2 • Limited only to little or none of the usual occupation or self care 3 • Bedridden or confined to wheel chair, little or no self care 4
C. Investigations: To confirm the diagnosis and to assess the general condition following investigations are conducted before after the treatment
1. Hemoglobin percentage (Hb% using Sahli’s method) 2. Total Leukocyte count (TC using Neubauer’haemocytometer) 3. Differential Leukocyte count (DC using Neubauer’haemocytometer) 4. Erythrocyte sedimentation rate (ESR using Westergren’s method) 5. Rheumatoid arthritis factor (using immunoglobulin agglutination method) 6. Antistreptolycin o Titer
D. Disease activity degrees: On basis of criteria laid down by American rheumatism association (1967) the degree of disease activity was estimated for the diagnosis and therapeutic purpose. Details are as follows:
Grade 0 1 2 3 Morning stiffness 5 minutes or less 5 minutes to 2 hours 2 to 8 hours 8 hours or Fatigue None Works full time
despite some fatigue must interrupt work to rest
Fatigue at rest
Pain None only on movement At rest Wakes patient from sleep.
Patients estimation Fine Almost well Pretty good Pretty bad General function Full activity without
difficulty Most activities but with difficulty
Few activities cares for self
Little self care mainly chair and bed
Grip strength 200mm/Hg or more 195 to 120 mm/Hg 115 to 70 mm/Hg under 70mm/Hg Spread of joint Involvement
None 0to50 51to100 Over 100
Westergren ESR 0to20mm 20to35 35to50 above 50 Haemoglobin 12.5gms% 12.4to11gms% 10.9to9.5gms% Less than 9.5gms% Physicians estimate Inactive Minimal active moderately active severely active
E. Overall assessment of the treatment: The overall effect of the therapies assessed on the basis of criteria laid down by ARA (1967) was adopted. The results are classified as four groups as listed below. Grade I: Complete remission
• No systemic signs of rheumatoid activity. • No sign of inflammation. • No evidence of activity in any extra articular process, including nodules, tino-vaginitis and iritis. • No lasting impairment of joint mobility other than that associated with irreversible changes. • No elevation of erythrocyte sedimentation rate. • Articular deformity or extra articular involvement due to irreversible changes may be present.
Grade II: Major improvement • No systemic sign of rheumatoid activity, with the exception of an elevated sedimentation rate and vasomotor imbalance. • Major signs of inflammation resolved, such as heat, redness of joint structures. • No new rheumatoid process of intraarticular or extraarticular structures. • Minimum joint swelling may be present. • Impairment of joint mobility associated with minimum residual activity may be present. • Articular deformity or extra articular involvement due to irreversible changes may be present.
Grade III: minor improvement Any decrease in the signs of rheumatoid activity inadequate to fulfill the criteria of grade II.
• Diminution of systemic signs of rheumatoid activity. • Signs of joint inflammation only partially resolved. • No evidence of extension of rheumatoid activity into additional articular or extra articular structures. • Decreased but not minimum joint swelling present. • Impairment of joint mobility may be present. • Articular deformity or extraarticular involvement due to irreversible changes may be present.
Grade IV: Un improvement or progression
• Undiminished signs of rheumatoid activity, regardless of functional capacity. • Exacerbation of any previously involved joint or joints, or development of sites of rheumatoid activity. • Roentgenologic changes indicative of progression of the rheumatoid process, excepting hypertrophy changes. • In the presence of one or more of the aforesaid criteria, involvement in other features, including a normal or lowered ESR, not
significant. ************
Madhanaphala Madhanaphala Unripened
Madhanaphala Pippali Madhanaphala ripened
Saindhava Lavana Madhanaphala Choorna Honey Vacha Choorna