Physiological and biochemical effects of Vamana Karma

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.

Physiological and biochemical effects of Vamana Karma

Changes in blood pressure

A rise in systolic BP and diastolic BP is observed in the patient during the procedure of Vamana. However, after completion of the procedure, systolic BP comes to normal range.The rise in systolic BP is usually more marked as compared to the rise in diastolic BP during the procedure.

Changes in pulse rate

It has been observed that the pulse rate increases during the procedure and comes to normal after the procedure.

Changes in body temperature

A mild rise in temperature is noticed during the procedure and is normal after the procedure.

Changes in respiration rate

A mild rise in respiration rate is noticed during the procedure and it becomes normal after the procedure.

Effect of Vamana on appetite

There is significant improvement in appetite of the person after Vamana. The person with poor or irregular appetite benefits with significant improvement in their appetite.

Effect of Vamana on bowel habits

There is also marked improvement in the bowel habit of the persons after Vamana. Persons with hard, loose consistency stool and irregular timings of bowel evacuation show improvement in their symptoms leading to regular bowel habits with normal consistency.

Effect of Vamana on heaviness in abdomen after food

There is reduction in complains of heaviness of abdomen after Vamana. Persons feel abdominal lightness with no distension related discomfort in abdomen.

Effect of Vamana on sleep pattern

There is a mild improvement in duration of sleep in persons after Vamana, However, the gross sleep pattern among most of the persons remains unchanged.

Effect of Vamana on intestinal flora

(a)  Pus cells count of intestinal flora before Vamana and 15 days after Vamana:

The pus cells in stool of healthy persons before and after Vamana remain within normal range. There is no change after 15 days of Vamana.

(b)  Bacteroids count of intestinal flora before Vamana and 15 days after Vamana:

 In some person, the bacteroids which are present in stools before Vamana become absent after 15 days of Vamana. But the changes are statistically insignificant.

(c)   E. coli count of intestinal flora before Vamana and 15 days after Vamana:

E. coli is the normal flora of the human intestine. After Vamana, mild shift in count is noticed as the E. coli count decreases, though it remains within the normal limits. However the changes are statistically insignificant.

Effect of Vamana on hematological parameters

a)    Hematology before Vamana and after 5 min of Vamana:

Erythrocyte Sedimentation Rate (ESR) decreases significantly. Total Leukocyte Count (TLC) increases significantly after 5 min of Vamana.

b)    Hematology before Vamana and after 15 days of Vamana:

A significant decrease is observed in ESR.

Effect of Vamana on lipid profile

(a)  Changes in lipid profile before Vamana and after 5 min of Vamana:

Significant increase in High Density Lipoproteins (HDL) and significant decrease in Low Density Lipoproteins (LDL) is observed. Total cholesterol when noticed after 5 min of Vamana, there is statistically insignificant decrease in the value.

(b)  Lipid profile before Vamana and after 15 days of Vamana:

It is observed that, HDL, Very Low Density Lipoproteins (VLDL), and serum triglycerides is insignificantly increased. Statistically insignificant decrease in LDL and total cholesterol is also seen.

Effect of Vamana on electrolytes

(a)  Serum electrolytes before Vamana and after 5 min of Vamana:

There is insignificant fall in serum sodium and serum potassium levels. All other values of serum electrolytes before and after Vamana remain within the normal range.

As Upadrava, some persons develops Bhrama (giddiness) following fall in serum electrolyte level just after Vamana.

(b)  Serum electrolytes before Vamana and after 15 days of Vamana:

It is observed that there is statistically insignificant fall in the values. All other levels of serum electrolytes before and after Vamana remains within the normal range.

Effect of Vamana on Liver Functional Test (LFT) and Renal Functional Test (RFT)

(a)  Liver Functional Test (LFT) and Renal Functional Test (RFT) before Vamana and after 5 min of Vamana:

It is observed that Blood Urea Level (BUL) decreases significantly. Total serum protein and serum creatinine also decreases insignificantly. Serum Glutamic Oxaloacetic Trasminase (SGOT), Serum Glutamic Pyruvic Trasminase (SGPT) are found to be increase significantly though all the values remain within normal range. Serum bilirubin increases insignificantly.

(b)  LFT and RFT before Vamana and after 15 days of Vamana:

It is observed that BUL, total serum protein and serum creatinine decreases insignificantly. SGPT, serum bilirubin is found to increase insignificantly. SGOT is found to increase significantly though all the values of above parameters remain within the normal range.

Effect of Vamana on immunological status

(a)  Immunological status before Vamana and after 5 min of Vamana:

It is observed that plasma histamine and plasma adrenaline decreases insignificantly. Similarly plasma dopamine and plasma nor-adrenaline increases insignificantly.

(b)  Immunological status before Vamana and after 15 days of Vamana

It is observed that plasma histamine and plasma adrenaline decreases insignificantly. Similarly plasma dopamine and plasma Nor-adrenaline increases insignificantly.

Effect of Vamana on IgE

There is insignificant increase in Immunoglobulin E (IgE) level when compared before Vamana with just after 5 min Vamana and 15 days after Vamana.

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.


Dr. Sarveshwar Saurabh (BAMS, IOM, TU)

पाइल्स, फिस्टुला र फिसर

यी रोगहरुसंग प्रायः मानिसहरु परिचित हुन्छन । किनकी धेरै मान्छेलाई स्वयम, आफ्नो परिवारका सदस्य, साथीभाई वा छर–छिमेकीमा कोही न कोही आक्रांत भएको देखेकै हुन्छन । अझ सहरी परिवेश, अहितकर खानपान र अव्यवस्थित जीवनशैलीले यो रोग बढ्दो छ । यी तीनवटै रोग मलद्वार सम्बन्धी रोगहरु हुन । हुन त धेरै मानिसहरु यी सबैलाई पाइल्स भन्दै झुकी रहेका पनि हुन्छन । तर यी तीन रोगहरुमा भिन्नता छ । आयुर्वेदमा पाइल्स वा हेमोरहोइडलाई अर्श, फिस्टुला–इन–एनोलाई भंगन्दर र फिसर–इन–एनोलाई परिकर्तिका भनिन्छ ।

विभिन्न कारणले यी रोगहरु हुने भएता पनि कब्जियत अर्थात दिसा कड़ा हुनु नै यसका मुख्य कारण, बल्झीने कारण र रोग निको नहुने कारण पनि हो । आम मानिसहरुमा यी रोग सम्बन्धी व्यापक भ्रम, डर र जानकारीको कमी देखिन्छ । मानिसहरुले मलद्वारमा केही पनि समस्या हुँदा पाइल्स, क्यान्सर भयो भन्दै अस्पताल धाउदै गरेका भेटिन्छन ।

मलद्वार भित्र र वरिपरि रक्तशिराहरु हुन्छन । यी रक्त शिराहरु सुन्निने, मासु पलाए झै ठुलो हुने समस्यालाई अर्श अर्थात पाइल्स भनिन्छ । यो भित्री र बाहिरी गरी दुइ प्रकारको हुन्छ । मलद्वार भित्र हुने अर्शमा दिसा कड़ा हुँदा घाउ भई दुखाइ रहित मलद्वारबाट रगत जाने हुन्छ । ठुलो हुदै जाँदा दिसा बस्दा त्यों मासु बाहिर आउने, शुरू शुरूमा आफै भित्र जाने, पछिपछि औलाले धकेल्नु पर्ने वा बाहिर नै बसी राख्ने पनि हुन्छ । बाहिरी अर्श÷पाइल्स भने मलद्वार वरिपरिका शिराहरु सुन्निएर हुने गर्दछ ।

भगन्दर अर्थात फिस्टुला–इन–एनो भनेको दुइ मुख भएको बाटो जस्तो हो जसको भीतरी मुख मलद्वार भित्र वा पक्वाशयमा हुन्छ भने बाहिरी मुख मलद्वारको बाहिरी भागमा हुन्छ । पटक पटक संक्रमण भइ बाहिरी मुखबाट पिप, रगत, दिसा आदि आउने हुन्छ । संक्रमण हुँदा अत्यन्त कष्टकर हुने र पिप निस्कि सकेपछि केही दिन आराम हुने हुन्छ । तर पछि फेरी संक्रमण भइ यो प्रक्रिया लगातार चलिरहने हुन्छ ।

परिकर्तिका अर्थात फिसर–इन–एनो भनेको दिसा कड़ा भइ निस्किदा मलद्वारको छाला च्यातिनु हो । यसमा अत्यन्त पीड़ा हुनुका साथै जलन, चिलाउने, दिसामा धर्को जस्तो रगत देखिने हुन्छ । यस्तो धेरै लामो समयसम्म भइ रहंदा त्यहाँ मासु पनि पलाउने हुन्छ जसलाई सेंटिनल टैग भनिन्छ ।

नेपालको मौलिक चिकित्सा पद्दतिका रूपमा रहेको आयुर्वेद चिकित्सामा यी रोगहरुको अत्यन्त प्रभावकारी, सरल, सस्तो, भरपर्दो र उपद्रव रहित उपचार उपलब्ध छ । पेट सफा राख्ने, दिसा नरम, खुलस्त र नियमित बनाउने जड़ीबूटीयुक्त औषधिहरु एकदम प्रभावकारी र दुष्प्रभाव (साइड इपÞmेक्ट) रहित छन । त्यस्तै स्नेहन, स्वेदन, लेप, विरेचन, वस्ति, घृत, लेप आदिको पनि प्रयोग गरिन्छ । आवश्यक परे शस्त्र कर्म अन्तर्गत क्षारसूत्र विधिको  प्रयोग अर्श, भंगन्दर र परिकर्तिकाको सेंटिनल टैगमा गरिन्छ । रोगीलाई पूरै बेहोश गर्नु नपर्ने, घाउ कम हुने, कम दिन अस्पताल भर्ना भइ बस्नु पर्ने, कम समयसम्म औषधि खानु पर्ने, फेरि बल्झिने वा रोग पुनः हुने अवस्था अत्यन्त न्यून हुने भएकाले आजकल यो विधि एकदम प्रचलित छ ।

स्वस्थ मानिसलाई स्वस्थ राख्ने र रोगीको रोग शमन गर्ने यी दुइ मुख्य उद्देश्य रहेको आयुर्वेदमा हरेक रोगको उपचारमा कारण परित्याग प्रथम चिकित्सा सूत्र विधान रहेको छ । तसर्थ रोगको मुख्य कारणका रुपमा रहेको कब्जियत हटाउने उपाय गर्नुका साथै मलद्वारको सर सफाइमा विशेष ध्यान दिनु पर्छ । विशेष गरी दशँैमा माछा, मासु, अण्डा, जाड़ रक्सी, चुरोट, मर मसला, गुरु भोजनको अत्याधिक सेवनका कारण कब्जियत हुन सक्छ । त्यसैले कब्जियत गराउने यी खानेकुराहरुका साथै मरिच, अदुवा, खुर्सानी, चिल्लो पिरो, मैदा परिकारहरु जस्तै मम, चाउमीन, बिस्कुट, दही, केरा, पिडालु, अनार, चिउरा, कालो दाल, सुपारी, पान, बाहिरी खानेकुरा, तैलीय पदार्थ, चिसो पेय पदार्थ, चिया कफी आदिको सेवन नगर्ने वा गर्नै परे एकदम कम मात्रामा गर्नुपर्छ । त्यस्तै प्रशस्त पानी, झोल पदार्थ, हरियो सागपात, सलाद,काक्रो, मुला, गाजर आदि, आटाको रोटी, रहर, मूँगको दाल, तर रहित दूध, फलफूल आदि सेवन गर्नुपर्छ । कदाचित कब्जियत भई हाले त्रिफला चूर्ण, पंचसकार चूर्ण, त्रिवृत्त चूर्ण, अभयारिष्ट आदि औषधिको प्रयोग अल्प समयसम्म गर्न सकिन्छ । केही समस्या भए चिकित्सकलाई देखाइ अरु औषध–उपचार गराउनु पर्छ । 

डाँ सर्वेश्वर सौरभ, बि.ए.एम.एस
त्रिभुवन विश्वविद्यालय, आयुर्वेद शिक्षण अस्पताल, कीर्तिपुरमा इन्टर्न डाक्टरका रुपमा कार्यरत

Ayurveda (BAMS) Study in Nepal

Introduction to BAMS

Q. What is BAMS?

BAMS is a bachelor level course in Ayurveda that stands for Bachelor in Ayurvedic Medicine and Surgery. After completion of which students are awarded with Doctor title (Ayurveda) to practice Ayurveda Medicine.

Q. Why should I study BAMS or Ayurveda?

Choosing an appropriate field/subject for your career should be solely based on your true interest, enthusiasm and ability to labor. In the era of 21^st  century, every field/subject has the scope and ability to grant you name, fame, money, success and satisfaction if you truly devote to it and become pioneer.

So choose a subject that you are ready to give 100% of yours. Ayurveda is a subject that will give you everything if you devote to it.

Some reasons for choosing (BAMS):

• If you have keen interest in Ayurveda

• To discover old jewels of medicine already prevalent and developed in own land.

• If your interested to herbs, medicinal plants, yoga, philosophy along with medical treatment.

• If you are frustrated with failure in MBBS entrance and still want to study medicine o, BAMS is the best alternative.
• 
  
• If you want to get combined knowledge of Ayurvedic, Allopathic medicine, Naturopathy and Yoga.

• If you are interested in research then there are many unfold mystery yo discover and justify in Ayurveda.

Q. Will I be able to write Dr. in front of my name and practice medicine like other MBBS doctors?

Yes, after completion of course, you will be awarded Dr. degree and will be a certified Ayurveda practioner registered in Ayurvedic Council of Nepal. You can practice medicine, treat patient off course.

Q. Are Ayurvedic doctors allowed to practice modern allopathic drugs?

Yes, they are allowed to practice common allopathic drugs according to necessity and beneficence of patient. However, first preference is to be given for Ayurvedic drugs.

Q. What are the scopes after BAMS completion?

After BAMS completion, you can practice medicines or opt for further higher study.

Practice

• You can set up own clinic and start practice as doctor.

• You can join several hospitals.

• You can appear for Lok Sewa Ayog exam to competite for government medical officer job, where you will be head of Ayurveda Aushadhalaya of respective district.

•  Join different Ayurveda college’s universities and start teaching profession.

• Join different Ayurveda Pharmaceutical companies.

• Practice and teach yoga and natural lifestyle.

• Set up medicinal plant farming and produce raw material manufacture medicine.

Higher Study:

You can join for Post graduate level degree e. MD/MS in Ayurveda in different branches like

·        MD Kaya Chikitsa (Internal Medicine)

·        MD Panchakarma

·        MD Salakya Tantra (ENT and head)

·        MD Stri Rog (Gynecology and Obstetrics)

·        MD Balrog (Pediatrics)

·        MD Drabyaguna (Medicinal Plant)

·        MD Rasa-shastra (Herbo-mineral drugs)

·        MD Bhaisajya Kalpana  (Drug preparation)

·        MD Maulik Sidhanta (Principle of Ayurveda)

Besides these Ayurveda degree, you can also study other non-clinical subject like

·        MPH

·        M.Sc. Anatomy

·        M.Sc. Physiology, etc.

Q. How hard or easy is studying Ayurveda?
It solely depends upon level of your enthusiasm, devotion and labor. If you will give the best of yourself to Ayurveda, you will get the best of it as well.
However in general, a student with at least 1st division in grade 12 or +2 can easily study and pass Ayurveda provided that he'she continues same labor as before.

Q. Where can I study BAMS?

You can study BAMS at different Ayurveda colleges in Nepal, India and abroad. In Nepal, currently Tribhuvan university and Nepal Sanskrit University are running BAMS course

Colleges Under Tribhuvam University, Institute of Medicine (IOM)
1.     Ayurveda Campus, Kirtipur (affliated campis of IOM, Maharajgunj)
2.     National Ayurveda Medical College (NAMC), Birgunj (Private)

Colleges under Nepal Sanskrit University:
1.     Central Ayurveda Campus, Dang
2.     Mithila Ayurveda College, Janakpur (Private) 
3.     Patanjali Ayurveda College, Dhulikhel (Private)

Q. What is course duration and course division?

BAMS is a total 5.5 year course. After completion of 4.5 year course, students have to complete 1 year intership in Tribhuvan University Ayurveda Teaching Hospital (TUATH).

The 4.5 year study course is divided into 3 professional of 1.5 year each as:

•  1^st Proff. – Basic Science (Modern and Ayurveda)
•   2nd Proff. – Pre-clinical study
• 3^rd Proff. – Clinical study

Q. How can I join BAMS course in IOM, Ayurveda Campus, TU?

You need to appear in entrance exam conducted by IOM , Maharajgunj, which is held on nect day after MBBS entrance exam (usually on Sunday)

For this you need to fill up entrance form at IOM website online.

Q. How many seats are there in IOM, Ayurveda Campus?

There are altogether 31 seats

15- Scholarship seat

15 – Paying seat

1 – Staff Quota

Q. How is entrance exam question pattern?

There are 100 MCQ with no negative markings. The 100 MCQs are in following format

1. Ayurveda – 20 marks
2.   Physics - 20 marks 
3.   Chemistry - 20 marks 
4.   Zoology - 20 marks
5.   Botany - 20 marks
6. TOTAL – 100marks

Q. What is medium of study in Ayurveda BAMS course?

Chief medium of study is English and Nepali for some subjects with a separate Sanskrit Subject only in the first proff.

Books are available in English, Nepali and Hindi medium

Q What subject will I have to study under BAMS course in IOM, Ayurveda campus?

1^st Proff.

• Sharir rachana – Human Anatomy (Both Ayurvedic and Modern)
•  Sharir Kriya – Human Physiology (Both Ayurvedic and Modern)
• Astang Sangraha (A treatie of Ayurveda)
• History of Ayurveda
• Sanskrit
• Padartha Vigyab (Fundamental and Physiology Of Ayurveda)

2^nd Proff

•  Rog tatha Vikriti Vigyan - Human Physiology and diseases (Both Ayurveda and Modern)
• Swasthavritta – Community Medicine and Yoga
• Drabya Guna – Medicinal Plant and modern Pharmacolgy
• Rasa-shastra – Herbo-mineral drugs
• Bhaisajya Kalpana – Preparation of Ayurvedic drugs
• Charak Samhita Part I – A treatie of Ayurveda

3rd Proff.

• Kaya Chikitsa - Internal Medicine, Epedemics, Emergency and Psychiatry (Both Ayurveda and Modern part)
• Salya Tantra - Surgery (Both Ayurveda and Modern part)
• Shalakya Tantra - ENT, Head, Neck diseases and dentistry - (Both Ayurveda and Modern part)
• Stri Rog tatha Prasuti Tantra - Gynaecology and Obstetrics (Both Ayurveda and Modern part)
• Kaumarbhritya - Pediatrics (Both Ayurveda and Modern part)
• Charak Samhita 2nd Part - A treatie of Ayurveda

Q. Where do students get Junior Intership and Intership during study? 

Q. How is hospital or clinical posting and educational visit?

In Ayurveda Campus, IOM, TU students get posted in different hospitals, visit in Pharma factory, botanical garden for medicinal plant study. All are summarized as follows:

2nd Proff

• Field visit to Godavari Botanical Garden, Dolalghat, Panchkhal and other places for identification, collection and study of medicinal plants
• About 7-10 days Community Health Research Tour in different places of Nepal
• Visit to Singha Durbar Vaidhyakhana, the oldest Ayurveda Drug manufacturer in Nepal for knowledge of medicine preparation, packaging, etc.
• About 15 days posting/class in a Naturopathy Hospital
• About 1 month posting in Forensic Department of Tribhuvan University Teaching Hospital, Maharajgunj 

3rd Proff

• Junior Intership in Tribhuvan University Ayurveda Teaching Hospital, Kirtipur - About 1 month
• Junior Internship at Sukraraj Tropical Hospital, Teku - About 15 days
• Junior Internship at Central Ayurveda Hospital, Nardevi - About 15 days
• Junior Intership in Tribhuvan University Teaching Hospital - rotating posting in different Departments for about 9 months

Internship

• Internship in Tribhuvan University Ayurveda Teaching Hospital, Kirtipur - About 6 months
• Internship at Central Ayurveda Hospital, Nardevi - 6 months
• All India Educational Tour - About 1 month

Q. Where can I know more about BAMS/Ayurveda Study?

Follow these links for the purpose:

• TU IOM Website
• Wikipedia, Ayurveda Campus, IOM