Clinical Physiological and biochemical changes with Vamana procedure

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


Introduction
Vamana and Virecana are mainly used for extraction of vitiated Doshas from the body. [1] If the Vamana procedure is adopted properly, lightness of the body, clarity of precordium (Hridya), throat (Kantha) and head (Shirah), happiness and weakness are the usual symptoms following Samyak Shuddhi (proper purification). [2,3]     about the study was provided in information sheets on the day of registration. Physical examination along with physiological parameters were assessed before, during and after Vamana. Routine blood examinations like Total Leukocyte Count, Differential Leukocyte Count, Hemoglobin%, Blood Sugar, Kidney Function Tests, Liver Function Tests, etc. were done so as to exclude any underlying disease in the volunteers.
The procedure of Vamana is as per the standard protocol prescribed in classics and adopted in earlier works. [6] Observations

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

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

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

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

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

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

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

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

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

DISCUSSION
Panchakarma procedures are also recommended in healthy individuals in Ayurvedic classics. It is important to understand the physiolological, biochemical and immunological changes in the healthy volunteers. The present study was carried out on 30 apparently healthy volunteers, between the age group of 18 and 60 years to observe the changes during and after Vamana procedure.
Volunteers with lactose intolerance were excluded as milk was used in this study. Pregnant and lactating mothers were also excluded from the study because of physiological variations and specified Do's and Don'ts for them.
The physiological parameters were assessed before, during and after Vamana. Rise in systolic and diastolic BP, pulse rate, temperature and respiration rate were noticed during the Vamana procedure which may be attributed to the sympathetic system involvement caused by physiological stress.
There was an improvement in appetite (Agni) of the volunteers after Vamana. Volunteers with poor or irregular appetite showed improvement. Volunteers with hard, loose consistency of stool and irregular timings of bowel evacuation showed improvement in symptoms. Maximum volunteers developed

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