JCDR - Register at Journal of Clinical and Diagnostic Research
Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X
Ayurveda Section DOI : 10.7860/JCDR/2024/71388.20212
Year : 2024 | Month : Oct | Volume : 18 | Issue : 10 Full Version Page : BC07 - BC11

Efficacy of Vasantik Vaman Karma (Therapeutic Emesis) on Oxidative Stress Markers in Healthy Volunteers- A Pilot Randomised Controlled Study

Pradnya D Dandekar1, Vaishali Kuchewar2

1 Professor and Head, Department of Kriyasharir, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H.), Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.
2 Professor, Department of Kayachikitsa, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H.), Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.


NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Pradnya D. Dandekar, Professor and Head, Department of Kriyasharir, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H.), DMIHER, Wardha-442001, Maharashtra, India.
E-mail: drpddandekar@gmail.com
Abstract

Introduction

Vamana karma is a therapeutic emesis procedure recommended for maintaining health in healthy individuals. It is said to be conducted during the Vasant rutu (spring season) and is referred to as VasantikVaman. During this season, there is an aggravation of Kapha dosha, which can lead to various diseases. The bio-purification of the body in Vasant rutu through the Vaman procedure helps to detoxify and rejuvenate the body. To make this practice evidence-based, the present study was planned to evaluate the efficacy of Vamana karma, which is also considered a shodhana karma, in reducing oxidative stress.

Aim

To compare the efficacy of VasantikVamana karma on Malondialdehyde (MDA) and Superoxide Dismutase (SOD) levels as markers of oxidative stress in healthy volunteers, compared to a non interventional group.

Materials and Methods

The present randomised controlled study was conducted in the Department of Kriyasharir, Mahatma Gandhi Ayurved College, Hospital and Research Centre, under the auspices of Datta Meghe Institute of Higher Education University, Wardha, Maharashtra, India, from March 2023 to April 2023 during the Vasant rutu. A total of 58 healthy individuals aged between 20 years and 40 years were sensitised regarding the procedure and benefits of VasantikVamana karma. After sensitisation, 30 volunteers who provided written consent for participation in the study were enrolled, examined and randomly divided into two groups: Group A (non interventional) and Group B (interventional). Both groups were assessed on the 0th day and the 15th day for oxidative stress markers, specifically free radicals (MDA) and antioxidant (SOD) levels. Statistical analysis was done using descriptive and inferential statistics, including Student’s paired and unpaired t-tests.

Results

The mean±Standard Deviation (SD) age of participants was 21.23±0.37 years, with participation almost equal from both genders. Before the intervention, SOD and MDA levels were similar in both the control and interventional groups. After the intervention of VasantikVamana karma, Group B showed an increase in SOD levels and a decrease in MDA levels, which were statistically highly significant according to the paired t-test (p-value≤0.001) in comparison to the non interventional group. In the non interventional group, p-value=0.951 for SOD levels and 0.551 for MDA levels by paired t-test, which were not significant. When both groups were compared using an unpaired test, at pre-intervention, both groups were at the same level, but after the intervention, statistically significant results were observed in Group B (p-value0.001).

Conclusion

The present study concluded that VasantikVamana karma, as a bio-purification process, VasantikVamana karma has proven to be highly effective in detoxifying the body by reducing oxidative stress in healthy volunteers.

Keywords

Bio-purification process,Malondialdehyde,Shodhana karma,Superoxide dismutase

Introduction

Day by day, due to our changing lifestyles, the burden of non communicable diseases is increasing tremendously. In India, non communicable diseases contribute to around 5.87 million (60%) of all deaths, while globally, the rate is 38 million (68%). Cardiovascular diseases, respiratory diseases, cancers and diabetes mellitus, which fall under the category of lifestyle disorders, account for 82% of all these deaths [1]. This situation presents a significant challenge to control. The pathophysiology of these non communicable diseases reveals the need to modify our lifestyles and incorporate dinacharya (daily regimen) and rutucharya (seasonal regimen) as mentioned in Ayurveda for their prevention.

For all these non communicable diseases, the triggering factor is oxidative stress. Oxidative stress is defined as a state in which oxidation exceeds the antioxidant systems in the body due to the loss of balance between them [2]. This imbalance leads to tissue damage and ultimately causes diseases.

Ayurveda is the science of life as interpreted by Acharyas for human well being. Its primary objective is to maintain the health of healthy individuals and to cure the diseases of the sick [3]. To achieve this primary goal and maintain the health of healthy individuals, Acharyas have recommended dinacharya, rutucharya, rasayan chikitsa, and shodhan karma (body purification processes), including vaman in vasant rutu, virechan in sharad rutu, and basti karma in varsha rutu [4].

The ultimate aim of shodhan karmas is to purify the body, which means cleaning the body. The swasthya (health) of a person is defined as the balance of doshas in the body. Out of the six rutus mentioned in classical texts, during hemant and shishir rutu, there is an accumulation of kapha dosha due to our seasonal regimen. In vasant rutu, this accumulated kapha dosha gets converted into Prakopawastha (aggravation) at its own site [5]. Approximately, this season comes from mid-March to mid-May [6]. In the Sushrut Samhita, Acharya Sushrut has mentioned that when the roots of a tree are cut, the flowers, fruits and branches are also destroyed; in the same way, kapha vyadhis is destroyed by eliminating kapha dosha through Vamankarma [7].

The vamanchikitsa planned in vasant rutu is called VasantikVaman. During vasant rutu, due to the natural prakopa of kapha dosha, individuals may suffer from agnimandya (symptoms of kapha vriddhi). Agnimandya is the root cause of all diseases [8]. The treatment for kapha vriddhi requires either deepan chikitsa or Shodhan chikitsa, depending on the individual’s constitution. VasantikVamanchikitsa is recommended for all to maintain their health by eliminating kapha dosha from the body.

There are many research publications that provide evidence for the free radical scavenging properties of various herbs, such as Allium sativum, Curcuma longa, and Triphala, as well as, Rasaushadhi preparations like Aogyavardhini Rasa [9-13]. Rasayanchikitsa, as mentioned in Ayurveda, functions as antioxidant therapy. Broadly, Ayurveda describes two types of therapy: Shamanchikitsa (pacification of dosha) and Shodhanchikitsa. Rasayanchikitsa is a part of Shamanchikitsa and has been found to be effective in managing oxidative stress. However, it is worth exploring whether internal cleansing through Shodhan karma during appropriate periods can help decrease oxidative stress. There is a need for research in this area.

Considering this fact, the present research was planned with the objective of evaluating the efficacy of VasantikVamana karma on free radicals, specifically MDA, and antioxidant SOD levels as markers of oxidative stress in healthy volunteers, compared to a non interventional control group.

Materials and Methods

The present randomised controlled study was conducted in the Department of Kriyasharir, Mahatma Mahatma Gandhi Ayurved College, Hospital, and Research Centre in Salod (H), a constituent college of Datta Meghe Institute of Higher Education and Research, Deemed to be University, Wardha, Maharastra, India, from March to April 2023, during the Vasant Rutu season. The study was approved by the Institutional Ethical Committee, with letter number MGACHRC/IEC/May 2022/478 dated 23/05/2022.

Inclusion criteria: Healthy subjects who are not suffering from any physical or psychological problems and have not taken any medications for any reason in the past six months, aged between 20 years and 40 years, and willing to participate in the study were included in the study.

Exclusion criteria: Subjects who were on any medication for physical or psychological problems and those contraindicated for Vamankarma were excluded.

Sample size: The sample size selected for the pilot study was 15 participants in each group.

Study Procedure

A group of healthy individuals was sensitised regarding the procedure and benefits of VasantikVamankarma. After sensitisation, volunteers who provided written consent for participation in the study were enrolled. All volunteers were assessed for Prakriti, Agni, Koshtha, and underwent a comprehensive systemic examination as part of routine care for the intervention of Panchakarma. These volunteers were then randomly divided into two groups, group A and group B, by a computerised randomisation method during the enrollment process.

Group A served as a non interventional group, which was only monitored for adherence to instructions and maintenance of their regular lifestyle.

Group B served as the interventional group. This group received the intervention of Vasantik Vaman.

All participants in both groups were instructed to avoid smoking, alcohol consumption, physical and mental stress and radiation, as these factors could exacerbate oxidative stress. The study was designed as a single-blind study, with the researcher unaware of the allocation of participants to their respective groups. The intervention was administered under the supervision of the Kayachikitsa department. Volunteers were examined and enrolled for the project in the Kayachikitsa Outpatient Department (OPD).

Intervention:Vamana karma is a procedure in which aggravated doshas are eliminated through the oral route [14]. The procedure is divided into three phases: Purvakarma, Pradhankarma and Paschatkarma. In the Vamana procedure, primarily Kapha and Pitta doshas from the entire body are brought into the Aamashaya (stomach) with the help of Purvakarma. These doshas are then eliminated through the mouth by inducing emesis with the administration of Vamak Dravyas. To pacify the remaining doshas and restore the capacity of digestive power (agni), Paschatkarma is required. According to the protocol, volunteers registered for VasantikVaman were examined, and healthy individuals meeting the specified criteria were selected and enrolled in the study after providing their written consent.

Procedure of Vasantik Vaman: This Vamana karma was conducted in the Vasant Rutu, hence it is referred to as VasantikVaman.

Purvakarma [Table/Fig-1]: Before starting Snehapan as Poorvakarma, Deepan and Pachan were administered using Chitrakadi Vati, with each participant taking 1 tablet of 250 mg twice a day before meals for three days. This was helpful for Agnideepan (enhancing digestive power) prior to beginning Snehapan [15,16]. After the Deepan and Pachan phases, all participants underwent AbhyantarSnehapan (internal oleation) for five days, tailored according to their Agni (digestive capacity) and Koshtha (quality of the alimentary canal’s internal oiling). The Snehapan began with a dose of 30 mL of Goghrit in the morning on an empty stomach, accompanied by lukewarm water. All volunteers were advised to drink lukewarm water until the sneha was digested and they felt hungry. The following day, the dose was increased as follows: 60 mL on the 2nd day, 90 mL on the 3rd day, 120 mL on the 4th day, and 150 mL on the 5th day, until the symptoms of Samyak SnigdhaLakshanas (indicating the completion of internal oiling) appeared. All enrolled volunteers exhibited Samyak SnigdhaLakshanas within five days. On the 9th day, all participants underwent Bahya Snehakarma with Til Tail Abhyanga and Bashpapeti Swedan. They were instructed to consume Kaphotkleshaka Ahar the day before Vamana. On the 10th day, prior to VamanKarma, Sarvang Snehan and Swedan were performed.

Consolidated Standards of Reporting Trials (CONSORT) flow chart.

Pradhanakarma [Table/Fig-1]: In the morning at 7:30 AM, after bowel evacuation and Sarvang Snehan Swedan, all participants were seated. Each volunteer was asked to drink milk until full (akanthpan), and after 5-10 minutes, Vamak Yoga, consisting of Madanphala Yog (Madanphalachoorna + Vachachoorna + Saindhava + honey), was administered [12]. Participants were then observed for Vaman Vegas. All underwent Pittant Samyak Vaman with 6 to 7 Vegas.

Pashchatkarma [Table/Fig-1]: After Samyak Vamana, all participants were given Dhumapan and instructed to take rest. They were advised to avoid loud speaking, overeating, excessive walking, prolonged sitting, anger and daytime sleeping, among other things [17]. The Sansarjana Krama was prescribed to help restore the strength of Agni with the aid of a proper dietary schedule. This plan was based on the type of purification achieved by the volunteers.

On the first day after Vamana, they were instructed to consume Peyadi Samsarjana Krama, which consists of thin rice gruel without spices and fat, once a day. On the second day, they were to have thick rice gruel without spices and fat twice a day. On the third day, they were allowed rice and liquid soup made of green gram and rice without spices and fat, twice a day in moderate quantities. On the fourth day, they were provided liquid soup made of green gram and rice with spices and fat, twice a day in moderate quantities. From the fifth day onward, a normal diet was introduced. No one developed any Vyapad, complications, or any untoward effects during or after the Vamana procedure.

Assessment criteria: Both groups were assessed for oxidative stress before and after the intervention period [Table/Fig-2].

Parameters assessment protocol for both the groups.

DayAssessmentGroup A(Non interventional)Group B(Intervention of vaman)
0th dayMDA and SOD levelsDoneDone
1st to 14th dayOnly monitoredIntervention of Vaman, including Purva, Pradhan and Paschatkarm
15th dayDoneDone

Specific parameters for assessment of oxidative stress:

SOD levels were assessed using the method described by Marklund S and Marklund in 1974 [18].

MDA levels were measured using the Thiobarbituric Acid method [19,20].

MDA and SOD levels are commonly recognised as markers of oxidative stress [21]. The plasma level of MDA in normal volunteers ranges from 0.18-2.87 ng/mL [22], whereas SOD levels in a healthy adult group range from 0.40-4.99 U/L [23].

Statistical Analysis

Statistical analysis was performed using descriptive and inferential statistics, including Student’s paired and unpaired t-tests. The software used for the analysis was SigmaStat version 3.2, and a p-value of less than 0.05 was considered statistically significant.

Results

A total of 30 volunteers were selected, with 15 volunteers in each group. In group A, 8 (53.33%) were males and 7 (46.66%) were female. In group B, 7 (46.66%) were males and 8 (53.33%) were females. The mean±SD age of the volunteers involved in the study was 21.23±0.37 years [Table/Fig-3].

Age and gender-wise distribution of research participants.

ParametersGroup A(n=15)Group B(n=15)Total
Gender, n (%)
Male8 (53.33)7 (46.66)15 (50)
Female7 (46.66)8 (53.33)15 (50)
Age (years)
19-2110717
22-245813
25-40000
Mean±SD20.86±0.3721.6±0.37

Both the groups were assessed for oxidative stress markers SOD level and MDA level pre and postperiod of intervention


Before intervention the SOD levels in both groups were almost at same level. In group B the SOD level after intervention of VasantikVaman was significantly high. On using paired t-test the difference observed in between two periods was statistically highly significant (p-value!<0.001). In a group A, the difference between pre and postperiod was not statistically significant (p-value=0.951). Before intervention the MDA levels in both groups were almost at same level. In Group B the MDA level after intervention of Vasantik Vaman was declined. On using paired t-test the difference observed i.e. declination of MDA levels inpost intervention of Vamana karma group was statistically highly significant (p-value<0.001). In a group A, the difference between pre and postperiod was not statistically significant (p-value=0.551) [Table/Fig-4,5].

Comparison of pre and post-intervention SOD levels and MDA levels in both the groups.

VariablesSODMDA
Mean±SDStd. error meanMean±SDStd. error mean
PretestGroup A1.819±0.5680.1471.969±0.8340.215
Group B1.626±0.3450.08922.058±0.8230.212
Post-testGroup A1.803±0.7840.2022.265±0.9540.246
Group B3.318±0.5710.1470.247±0.1450.212

Descriptive statistics


Student’s paired t-test for intragroup comparison of SOD and MDA level.

Assessment parameterGroupPaired differencesTdfp-value
Mean values95% confidence interval of the difference
MeanStd. deviationStd. error meanLowerUpper
SODGroup A(Non interventional)0.01580.9750.252-0.5240.5560.0626140.951
Group B(Intervention of Vaman)-1.6920.7060.182-2.083-1.300-9.27614<0.001*
MDAGroup A(Non interventional)1.9690.5680.147-0.4040.2250.612-0.08970.551
Group B(Intervention of Vaman)2.2651.0180.2631.4542.5827.6752.018<0.001*

*The p-value <0.05 was considered statistically significant


Student’s unpaired t-test for intergroup comparison of SOD and MDA levels.

Assessment parameterTestt-test for equality of means
Mean values95% confidence interval of the difference
tdfp-valueMean differenceStd. error differenceLowerUpper
SODPretest1.122280.2720.1930.055-0.1590.544
Post-test-6.04728<0.001*-1.5150.0578-2.028-1.002
MDAPretest-0.665280.511-0.2300.0120.9380.478
Post-test5.25328<0.001*1.3440.1010.8201.868

When both the groups compared with student’s unpaired t-test; it showed there was no statistically significant difference in SOD levels at pre intervention period in between two groups (p-value=0.272, NS). Both groups were at same level. It showed statistically significant difference in post-interventional SOD levels of both groups. VasantikVaman intervention group showed good improvement in SOD levels after VasantikVaman intervention (p-value≤0.001). When both the groups compared with student’s unpaired t-test; it showed there was no statistically significant difference in SOD levels at the pre-intervention period between the two groups (p-value=0.272); both groups were at the same level. There was a statistically significant difference in post-intervention SOD levels between the two groups. The VasantikVaman intervention group showed a significant improvement in SOD levels after the intervention (p-value<0.001).

When both groups were compared using Student’s unpaired t-test, there was no statistically significant difference in MDA levels at the pre-intervention period between the two groups (p-value=0.511); both groups were at the same level. There was a statistically significant difference in post-intervention MDA levels between the two groups. The VasantikVaman intervention group showed a significant decrease in MDA levels after the intervention (p-value<0.001) [Table/Fig-6].

Discussion

VasantikVamana karma is a bio-purification process recommended for both healthy and diseased individuals. In healthy persons, it is suggested to maintain the body’s health through detoxification. During the Vasant (spring) season, the recommended procedure for detoxification is VasantikVaman. The qualitative assessment of detoxification can be evaluated by examining the symptoms related to the vriddhi (increment) and kshaya (decrement) of Kapha dosha. Gupta B et al., observed quantitative measurements of physiological and biochemical changes after VasantikVamana karma across different parameters and found it to be very effective in decreasing cholesterol and Triglyceride (TG) levels [24]. These lipids are considered toxic substances in the body. Vamana karma corrects the malproduction of such lipids and restores them to an equilibrium state [25].

The Yakrit (liver), which is the site of pitta and controls lipid formation, is directly affected by Vamana karma, which corrects the metabolic processes of lipid formation and excretion. Free radicals formed during oxidative processes act as toxins for the body by damaging cell membranes. This destruction of cell membranes localises aggravated doshas, leading to the creation of diseases. To mitigate this type of damage, antioxidants are employed. Antioxidants prevent free radical-induced tissue damage by inhibiting the formation of radicals, scavenging them, or promoting their decomposition [26].

The use of antioxidants, i.e., rasayan, is part of shamanchikitsa (palliative treatment). Numerous studies have been conducted to demonstrate the role of rasayan dravyas (herbal preparations) in preventing free radicals by measuring MDA levels and improving SOD levels as antioxidants. However, to date, no studies have been conducted to examine the effect of shodhanchikitsa (purification therapy) on oxidative stress markers. The present pilot study was conducted with healthy volunteers to assess the efficacy of VasantikVamana karma. The results indicated a statistically significant reduction in MDA levels and a significant increase in SOD levels in the interventional group compared to a non interventional group.

The present study findings are supported by a single case study conducted by Shukla A and Bhatted S, which reported that Vamana showed a significant reduction in MDA levels, a free radical, and a significant increase in SOD and Glutathione Reductase (GSH), thereby demonstrating the potent action of the procedure in reducing oxidative stress [27]. A study by Neeta S et al., on VamanKarma followed by Rasayan Karma in Akalaj Jara (premature ageing) noted positive effects on the premature graying of hair, skin wrinkling, and overall ageing after the administration of Vaman followed by Rasayanchikitsa [28]. Free radicals are responsible for the premature ageing process, and the observed effects in the current study were the cumulative results of Shodhan and Shamanchikitsa.

The present study examined the effects of rutu shodhanchikitsa on free radicals and the body’s self-generated antioxidants.

Limitation(s)

The study was conducted exclusively on VasantikVaman and involved healthy volunteers. It should be planned for individuals with diseases.

Conclusion(s)

The present study concluded that Vamana karma, as advised by Acharyas during Vasant Rutu, is effective in decreasing toxins in the body and improving antioxidant levels in healthy individuals. As a bio-purification process, VasantikVamana karma has been shown to be highly efficacious compared to a non interventional group in detoxifying the body. The interventional group exhibited a significant decrease in MDA levels and an increase in SOD levels, indicating improved antioxidant activity. To further support its efficacy as a detoxification process, it is recommended that Vamana karma be conducted in healthy individuals to maintain health; however, this should be evaluated in a larger sample size. Similarly, the efficacy of SharadikVirechankarma and Basti during Varsha Rutu also needs to be assessed.

Both the groups were assessed for oxidative stress markers SOD level and MDA level pre and postperiod of interventionDescriptive statistics*The p-value <0.05 was considered statistically significant

Author Declaration:

    Financial or Other Competing Interests: None

    Was Ethics Committee Approval obtained for this study? Yes

    Was informed consent obtained from the subjects involved in the study? Yes

    For any images presented appropriate consent has been obtained from the subjects. NA

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ETYMOLOGY:

Author Origin

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