Vamana – Emesis In Fever

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Therapeutic emesis is the best and most praised treatment for kapha predominant doshas and diseases which have their origin from stomach and intestine.

Fever too is manifested from the stomach. To be precise fever is manifested due to the presence of weak digestive fire in the stomach. Since the fever has its origin from the stomach and since kapha is the main dosha residing in the stomach, therapeutic emesis forms an ideal treatment to expel the fever causing doshas from the stomach.
Read – Ayurveda Home Remedy For Fever

When emesis should be administered?

Emesis should not be administered in acute stage of fever

Acute fever i.e taruna jwara in Ayurveda includes the first 6-7 initial days of the fever. In this condition Langhana is said to be the primary treatment strategy. Langhana means lightening therapies – the treatments which bring about lightness in the body. They are of 10 kinds. Vamana too is one among those 10 kinds.

Master Charaka and commentator Chakrapani opine that among 10 kinds of lightening therapies, only ‘upavasa / anashana rupa langhana’ i.e. fasting form of intervention should be adopted. Other 9 forms of langhana should not be resorted to in this acute phase of fever. As per this rule, emesis too should not be given to the patient of fever in its initial days.
Read – Langhana Therapy – A Unique Ayurvedic Treatment Principle – A Unique Ayurvedic Treatment Principle

Emesis is the only purification therapy that should be conditionally administered in acute fevers

Among the five purification therapies of Panchakarma, 4 types of samshuddhi i.e. cleansing measures have been mentioned among the 10 types of langhana. They are –

  • Therapeutic emesis
  • Therapeutic purgation
  • Decoction enemas
  • Nasal errhines – medicines instilled in the form of nasal drops

Oil enemas are not included since they are nourishing in nature and not cleansing.

Among the four types of langhana, only emesis should be conditionally administered in acute fevers.
Read – Vamana Therapy – Right Method, Side Effects, Management

What does conditionally mean?

Generally no purification therapies should be administered in the acute phase of fevers. But emesis shall be conditionally administered. This is a specific or special rule for administering emesis in –                                                                                                

  1. Kapha pradhanan – Predominant vitiation of kapha or kapha predominant doshas in amashaya – Immaterial of the dosha(s) involved in the manifestation of fever (as causal doshas), this rule is applicable for administering emesis in the acute stages of fever. Kapha predominant doshas means – when more than one dosha is causal of fever, the condition is eligible for emesis only if kapha is predominantly aggravated in the combination. This applies to fevers caused by aggravation of dual or all three doshas.
  2. Utklishtan doshan – Kapha is in utklishta avastha – Utklesha means an excited state. Utklishta Kapha is a state in which kapha is in a stage of excitation. Stage of excitation also means that dosha shows readiness to get expelled out of the body. If a dosha, kapha in this instance doesn’t show signs of excitation and readiness to get expelled, should not be forcibly expelled from the body. The signs of excitation of kapha can be known by signs such as nausea etc.
  3. Amashaya sthitan – The kapha which is exited should be present in amashaya – stomach, the nearest route for doshas to be expelled through emesis.
  4. Buddhva Jwarakaran – If that kapha is causing fever – If the physician concludes through his diagnosis that such exited kapha in the stomach is causing fever and it is necessary to expel it, should plan to administer emesis in that condition.
  5. Kale – Emesis should be administered in proper time i.e. in the part of the day when kapha is naturally exacerbated – early in the morning. Kapha being in state of excitation is also the proper time to expel it through emesis.
  6. Vamyanam – To those eligible for undergoing emesis. To administer emesis in acute stage of fever, the patient too should fit into the category of those eligible to undergo emesis therapy.
  7. Vamanaih Haret – Expel such doshas through administration of emesis – when all the above said criteria are satisfied emesis should be administered with various ‘vomiting inducing formulations’ i.e. different kinds of emetics.

The entire above mentioned are not different conditions. They need to be collectively understood.

‘In taruna jwara or acute stage of fever emesis shall be administered when the aggravated kapha or kapha predominant doshas showing excitation and preparedness to get expelled are located in the stomach. If such doshas are considered to cause fever and if the patient is eligible to undergo emesis, the physician should plan to administer emesis in proper time using many effective formulations’.

The other stages of kapha are not suitable.
Read – Types Of Doshas And Their Functions

Sanskrit verses

Should the patient be prepared with snehana and swedana before administering emesis in acute fever?

Generally, oleation and sudation therapies are administered before administering emesis or purgation therapies as part of preparing the patient to undergo easy cleansing experience. They are also administered to flush the doshas from the tissues and also cause excitation of doshas so that removing them will be easy. But in this condition of acute fevers since the doshas are excited all by themselves and show preparedness to get expelled, there will be no need of oleation or sudation therapies. If the physician desires to administer them, they may be administered in small scale.

Effects of giving vamana in anutklishta dosha condition

In acute fever if emesis is administered in anutklishta dosha i.e. non-excitation of doshas (kapha here), it causes the below mentioned complications in a severe way – 

  • Heart diseases
  • Breathlessness
  • Distension of abdomen
  • Unconsciousness / confusion

Effect of expelling ama dosha

If dosha (kapha here) is associated with ama, it will get adhered to the walls of the tissues and organs. In such condition if we try to expel the dosha with purifying therapies, the dosha will damage the tissue and organ and also may cause death.

Just like an unripe fruit will be destroyed if we try to extract juice from it, the body tissues and organs too will be destroyed if we try to expel the unripe doshas i.e. doshas associated with ama. Therefore, only ripe doshas which are excited should be expelled.

Added reference from Harita

Emesis should be administered first to expel pitta and kapha. This means to tell that – emesis should be conditionally administered at the beginning of pitta and kapha predominant fevers and not in all fevers. So, emesis is the first line of treatment in fevers caused by vitiated pitta and kapha.

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