Emesis

Meaning of Emesis:

Emesis means expulsion of malas or dosas through the oral route via vomiting. Emetic substances are used to induce vomiting for detoxification of the abdomen.

Link with Seasons:

It can be done throughout the year, but it should be avoided in severe winter and extreme summer.

Correct timing of the day to perform emesis:

It should be done in the morning (that is the time when Kapha is active). The procedure is also best done on an empty stomach. This is why it should be done in the morning and is also the reason why on the previous night dinner should be taken early on and should be light and easily digestible.¹

If someone is feeling excessively hungry before emesis, the following things can be consumed by them¹:

• Warm Milk
• Rice gruel mixed with ghee
• Sugarcane juice
• Soup of meat

Link with Doshas:

Emesis is considered the best procedure for elimination of Kapha. It can also be used as a treatment for Pitta disorders.

Uses:

• Congestion in the lungs causing cough
• Bronchial asthma
• Fever due to Kapha
• Tonsillitis, cold, inflammation of the nose and sinus
• Pus formation in the nose, mouth, lips and ears
• Nausea, loss of appetite, indigestion
• Diarrhea
• Diseases due to obesity, anemia
• Dermatitis, boils, other skin diseases
• Urinary disorders
• Excessive sleeping, drowsiness
• Epilepsy and insanity

Pre-emesis Measures:

The measures that need to be taken before emesis include measures to aggravate Kapha in the body.

• 1 day before emesis, oleation and fomentation therapy is done on the chest and back. The objective of this is to liquify Kapha.
• Kapha increasing diet with adequate salt is taken one day before the therapy.
• Oleation therapy is especially mandatory for this type of treatment.¹

Medicinal Emetic substances as used in most Panchkarma centres¹:

The following substances are taken in the given proportion, soaked in warm water and grinded on a stone to make a thick paste.

• Emetic Nut or Madana Phala - 2 tsp
• Vacha - ½ tsp
• Pippali - 1 tsp
• Rock salt - ½ tsp
• Honey - 1 tsp - acts as a catalyst

Method used when herbal medicinal emetic substances are used¹:

The Posture:  Sit on legs with folded knees or on a chair of knee-height.

• Sit in the recommended posture and drink 4-5 glasses of milk very fast. The quantity depends on you feel full after drinking the milk.
• After one feels full, drink another glass of milk which has 1 tsp of the medicated paste mixed in it.
• Soon you would start vomiting. If not, then try putting your own fingers down the throat.
• After you are done vomiting, rinse your mouth with warm water and wash your face warm water to feel fresh.
• Repeat this whole process without giving excess breaks in between. 
• Stop when you see the signs of completion. 
• Usually, 10-15 vomits might occur. 
• In this process, liquids other than milk that can be used are - soup of meat or wine.
• During the process, the person undergoing the procedure needs to be supported on the forehead, shoulders and abdomen. Massage might be required to be done on the back in the process. 
• Overall, the dosage of the medicine should be distributed in 5-6 glasses of milk.

Emetic substances (other than the medicated herbs paste discussed above):

Taste of the substances used for emesis in link with different doshas:

• In case of Kapha provocation: Pungent, penetrating and hot potency substances are used.
• In case of Pitta provocation: Sweet and cold potency substances are used.
• In case of Kapha and Vata provocation: Sweet, salty, sour and hot potency substances are used.

Examples of some of the substances used are:

• Rock salt and honey
• Liquorice root
• Margosa
• Bitter sponge guard 
• Bitter bottle guard
• Long pepper
• Cardamom
• Bitter oleander

The substances used for emesis are used in the form of decoction. 

Method:

The Posture:  Sit on legs with folded knees or on a chair of knee-height while drinking the decoction.

Dosage of the decoction: 

• High dose: 7 litres
• Medium dose: 4.5 litres
• Low dose:  1.5 litres

After drinking the decoction while sitting in the recommended posture, one will start feeling nauseated. 

As soon as one feels nauseated, they should use their middle and index finger or a smooth castor twig to rub the tongue in order to induce vomiting.

The number of vomits is in the range of 4 to 8 generally. 

Signs that show that the process of emesis is complete¹:

• The vomit will become frothy, and there will be no mucous visible in the vomit
• The sound being produced in the process of vomiting will increase.
• Yellowish colour bile will become visible.

When to stop the procedure before the completion of the process¹:

• In case someone is feeling excessively weak during the process

Signs visible when vomiting is about to begin in the process¹:

• Sweating starts - It implies that toxins deep in the tissues are melting.
• Horripilation (that is, body hair stand stiff) - Toxins have started moving out of these tissues.
• Abdominal Distention - Toxins start accumulating in the alimentary tract.
• Excess Salivation - Toxins have started moving up
• All these signs often happen in quick succession and might not always be obviously visible because of the same.

Post-emesis Measures:

The measures that need to be taken after emesis include:

• Do Dhuma Pana in order to help clear the mucous accumulated in eyes, ears, nose and throat in the process of emesis.¹
• Take a warm shower after the completion of the process.¹
• Diet to be taken when hungry: food which is light, warm and lubricating - vegetable soup, boiled rice and green gram.
• Rest after the process, sleep even if it is the daytime.¹

The measures to be followed for a few days after emesis are:

• Avoid cold drinks and cool substances.
• Do not do any strenuous physical exercise, coitus and control your anger.
• No exposure to too much sun or wind or cold or rain or even pollution.¹
• Day sleeping should not be done, except on the day of emesis itself.¹
• Do not suppress any natural urges like thirst, hunger etc.¹
• Do not overeat and eat meals at proper time.
• Do not speak loudly.

Should not be done in the following cases:

• Childhood, old age, debility
• Emaciation, hunger
• Heart patients
• Those having cavities in lungs
• Bleeding from upper body channels
• During menstruation or pregnancy
• While in grief
• Those having fear or difficulty in vomiting
• Those with dry body constitution
• Those suffering from jaundice, worm infestation
• In case of Vata-related disorders
• Those suffering from loss of speech¹
• Those having abdominal tumours or enlargement of abdomen¹
• Those with pulsating headaches¹
• In case of reverse peristalsis¹
• Burning sensations in the chest¹
• Those who have been recently administered with enema¹
• Enlargement of prostate¹

If someone is suffering from any of these above along with Kapha aggravation, emesis can be done in mild form.

Emesis though is strictly prohibited in childhood, debility, in fragile and fearful people.

How to measure the success of emesis:

• Body feels light, fresh and energetic.
• Lightness is felt in heart, throat, head and the whole body.
• One might feel some tightness in the chest, despite the lightness in whole body.¹

Other visible benefits of emesis¹:

• Depression reduces. There will be a sense of calmness in mind.
• There will be a decrease in feelings of heaviness and congestion.
• Sense organs will get better.
• Digestion will improve.
• Many other Kapha related disorders will go away.
• Pain in the body will be reduced.

Complications visible when the process of emesis is overdone¹:

• In case of dehydration
• Colour of the vomiting changes from yellow to green to finally red
• Inflammation of throat
• Burning sensation in throat
• Fainting
• Weakness of body 
• Darkness near eyes along with giddiness
• Various Vata disorders
• Insomnia
• Pain in heart
• If overdone despite these signs, it can even result in death.

Complications visible when the process of emesis is left incomplete¹:

• There is still heaviness and dullness in the body.
• Itching sensation might be felt on the skin.
• Feverish feeling
• Channels would be left impure.
• Only medicine will be expelled in the vomit.

What to do if things are better but full benefits are not experienced¹:

• The procedure can be repeated after proper preparations after 15 days.

Should Emesis be done by fully healthy person?¹:

• The simple answer is no, except in emergency cases.
• Emesis is one of the procedures in Ayurveda which is not recommended for healthy people. It is only done in the cases of Kapha aggravation.

Emergency cases when Emesis might be induced¹:

In these cases, emesis can be down without the preparatory procedures.

• In case of intake of poison
• If incompatible foods are taken
• Indigestion resulting in body feeling sluggish
• Bleeding from any openings in downward part of the body (such as rectal bleeding, bloody urine, bleeding from vagina other than menstruation etc.)
• In case of chronic diarrhoea

References:

Primary Source: Acharya Balkrishna: A Practical Approach to The Science of Ayurveda - A Comprehensive Guide for Healthy Living - Chapter - Treatment Methods 

1. School of Ayurveda and Panchkarma - Lectures and Notes