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Introduction

Panchakarma therapy is vital part of Samshodhana and this therapy has attracted the attention of the people worldwide as it is a unique type of treatment of various chronic, auto immune, hormonal, degenerative disorders etc., whereas other methods of treatment have no satisfactory answer for the cure of these diseases as well as equally beneficial for the promotion and preservation of health. Among five Karmas, Vamana is the Pradhana Karma of Panchakarma therapy and it has been considered as the best line of treatment for the Kaphaja disorders.The act or the action of expelling the impurities i.e. vitiated Doshas through the upper channel is known as Vamana. Vamana Karma is the best therapy for the elimination of vitiated Kapha Dosha from all over the body through Aamaashaya by means of vomiting. Vaman karma is one of the major pradhan karma procedures of panchakarma therapy. Vaman is an urdhvabhaga shodhana of the body. The word shodhana or samshodhana means to eradicate the doshas either through adhobhaga or urdhavabhaga. Ideal time period for Vaman is vasantritu i.e. month of February and March. As vaman is remedy for kaphadosha and in vasantritu, kapha is at its maximum level in the body. Environment heat also helps in its easy excretion from the body by melting it. But in diseased condition one can opt Vaman at any time according to the need. Vaman is useful for diseased as well as healthy individuals for preservation of health & prevention of disease. Vaman can be given according to the dosha predominant stage in any season but if it is given in vasant Ritu (Kaphaprakopkal) it gives wonderful result. As other Panchakarma procedures, Ayurveda mentioned various indications and contraindications for Vamana also and various complications of this procedure are also mentioned. In the process of Vamana various systems of body get involved and various physiological changes get happened in the body. Blood pressure is one of the factors involved in this process. Blood pressure is the lateral pressure exerted by the circulating blood on the wall of blood vessels. It is regulated by nervous and endocrine system of the body. The normal adult blood pressure is considered as 120/80 mm of Hg. It is seen that many CVS related complications are arises during this process. Therefore, various precautionary measures are taken in Vamana Process to avoid such complications. Hence it is necessary to observe the physiological variations of blood pressure in Vaman process and other certain factors.

Aim & Objective:

Aim: To Study of Physiological changes in Blood Pressure during Vaman Karma.

Objectives: To study the process of Vamana and its physiology and to study the variations in blood pressure during the various stages of Vamana process.

Materials & methods: The present study is a Clinical observational type of study with the objective to study the variations in blood pressure during the various stages of Vasantik Vamana Karma in healthy persons.

Study Design: Total sample size for this study was thirty healthy individuals. Total 30 Healthy individuals irrespective of sex & socio-economic condition, between 20 – 40 years of age, with normal blood pressure were selected for Vamana process after all necessary investigations, consent and observed during the study.  The blood pressure of each individual was assessed during following stages of Vamana process-

1. Before and after Vaman Dravya Pana
2. After Hrullasa,
3. During Vaman Vega,
4. During Vegantaravastha
5. After Samyak Vaman and
6. After Dhoomapana.

Assessment Criteria: -

Healthy individuals were selected for Vamana process after all necessary investigations were observed during the study. Total 30 individuals were taken for study. The blood pressure of each individual was assessed during following stages of Vamana process-

1. Before and after Vaman Dravya Pana
2. After Hrullasa
3. During Vaman Vega
4. During Vegantaravastha
5. After Samyak Vaman
6. After Dhoomapan

Criteria for Selection

1. Only healthy individuals irrespective of sex & socio-economic condition.
2. Age groups 20-40 years.
3. Blood Pressure within Normal limit.
4. Individuals having fitness for Vamana procedure.

Criteria for Rejection

1.  Individuals with systemic disorders, cardiac problems etc. were excluded.
2. Age less than 20 yrs and 40 years.
3. Hypertensive or hypotensive.

1. Individuals unfit for Vamana procedure.

Observations & Results:

Gender: In this study, totally 18 [60%] were male and 12[40%] were female it may be due to random selection of Participants.

Age: As per inclusion criteria of Participants were selected having age between 20 years to 40 yrs. and distributed it in two-sub age groups. Out of 30 Participants numbers of Participants found in age group 20-30 were 19[63.33%], in 31 to 40 yrs. were 11 [36.67%], in numbers and percentage respectively.

Discussion

After completion of Samyak Vamana Dhoompana was done. The mean ± SD for Systolic Blood pressure before vamana After Samyak Vaman was 121.93±6.33 and After Dhoompan it was 118.86±7.29 with p value 0.003 which was <0.01 at 5% level of significance, so there were very significant changes in blood pressure After Samyak Vaman and After Dhoompan. Next in Diastolic blood pressure the mean ± SD for diastolic Blood pressure before vaman dr After Samyak Vaman was 79.33±5.20 and After Dhoompan it was 78.20±5.69 with p value 0.0524 which was >0.05 at 5% level of significance, so there were no significant changes in blood pressure After Samyak Vaman and After Dhoompan.

Pashchaata Karma: Dhoompana remove the excessive Kapha which is accumulated in mouth and throat and helps to avoid Vyapada in Vaman Karma. After vamana there is agnimandya (loss of appetite). Agnimandya followed by Vamana has to be restored by Samsarjana course. Actually, after Vamana, the environments in the stomach got totally alkaline due to mucous secretions, bicarbonate flows and bile extraction. This ultimately hampers the pepsin activity. "Pepsin activity is significantly diminished at pH 4 and irreversibly inactivated and denatured at a pH of > 7 so; this might be the reason why diminution of Agni takes place after Vamana.

Comparison of Blood Pressure on every step of Vaman: In procedure of vaman karma Systolic and Diastolic Blood pressure variation during each stage of Vaman it was observed that there are very significant changes seen and it was not by chance as p value obtained is <0.0001. Before Vaman Dravya Pan  mean SD of Systolic BP was 119.7±7.12 and diastolic BP was 78.0±5.54. After Samyak Vaman. SD of Systolic BP was 121.9±6.33 and diastolic BP   was 79.3±5.20. while After Dhoompan Systolic BP was 118.8±7.2and diastolic BP was 78.2±5.69. Any type of exercise and stress increases the arterial pressure. There is increase in sympathetic activity during vomiting due to mental stress, muscular exercise and sudden change in body posture. But this increase is rapidly controlled by baro receptor feedback mechanism. A rise in pressure activates the baro receptor or pressure receptors, which are located in the walls of large systemic arteries. A rise in arterial pressure stretches the baro receptor and causes them to transmit signals to the C.N.S. and feedback signals, are sent back through A.N.S. to the circulation to reduce arterial pressure downwards to normal level.

Mode of Action of Vamana: From Ayurvedic point of view, Vamana is not merely a gastric lavage as considered by modern physicians, but it is a complete therapy of Kapha Dosha as well as disorders caused by it. Charaka has clearly mentioned that the drugs used in Vamana Karma get absorbed due to their Virya and reach heart (Hridaya). Wherefrom, through the circulation and then via Sthula and Sukshma Srotas, the Virya of the drug reaches at the site of the lesion which may be in the form of Dosha Sanghata. The drug first liquifies (Visyandayanti) the Dosha Sanghata then breaks (Vicchandati) it into smaller molecules which can flow through the Anu Srotas of the body and reach to Amashaya, wherefrom they are expelled out by the act of Vamana. Vamana Karma is a one type of medically induced inflammation. Every step of this Karma has its Own importance. First of all, by the Purvakarma, when Abhyantar Snehpana is done, it goes upto the cellular level where the Gatra Snigdhata, Gatra Mardavta, Tvaka Singdhata like Samyaka Snehana Lakshana are produced. Ghee is considered as an anti-oxidant and source of Vitamin A Dosha become loosen at cellular level by Snehana. Many substances, which are deposited at cellular level, they become loosen by the Snehana. In case of hypothyroidism, there is a deposition of mucinious ground substance at subcutaneous area. By the act of Abhyanga and Svedana loosen substance becomes mobilised and it comes in to the blood circulation. Vamana is always done with full stomach so the pyloric end of stomach is closed. The site of action of Vamana is Amashaya which is mentioned as a Kaphasthana. The Vamana Dravyas has the properties like Ushna, Tikshna, Sukshma, Vyavayi & Vikasi. Due to its Vyavayi Guna they get quickly circulated in to large and small capillaries of the body. Because of its Vikasi Guna, it detaches the Malas from Dhatus. By virtue of its Ushna and Teekshna qualities the accumulated Doshas gets liquified and disintegrated in to small particles at cellular level. Owing to the presence of Sukshma Guna and Anupravana nature, the Malas or Doshas float because already body has got Samyak Snigdhata and through smallest capillaries towards Koshtha ultimately reaches to Aamashaya. Detached Malas would not be obstructed even in the smallest capillaries (Asajjannamiti- Na Kwachidapi Sangha Gacchati ). Where fromVamana Dravya encouraged by “Udaana Vayu’ and owning the ‘Agni, Vayu Mahabhautika predominance”, they move in upward direction to expel the vitiated Doshas through mouth.

Conclusion

It was observed that there were not significant changes in Systolic as well as diastolic Blood pressure before and after vaman dravya pan.It was observed that, the Variation in systolic blood pressure during vaman vega in three reading was significant statistically however it was not significant in diastolic blood pressure.There was Variation in systolic blood as well as diastolic blood pressure during Vegantarvastha extremely significant statistically.

There was a very significant changes in Systolic Blood pressure After Samyak Vaman and After Dhoompan. There was no significant change in Diastolic blood pressure After Samyak Vaman and After Dhoompan. It was observed that Blood pressure might show variations during Vamana process and raise during Vegavastha of Vamana.