आध्मानं परिकर्तिश्च स्रावो हृद्गात्रयोर्ग्रहः|
जीवादानं सविभ्रंशः स्तम्भः सोपद्रवः क्लमः||
अयोगादतियोगाच्च दशैता व्यापदो मताः|
प्रेष्यभैषज्यवैद्यानां वैगुण्यादातुरस्य च||                    (Cha. Si. 6/29-30)

The ten cardinal complications arising out of improper administration of emesis and purgation are Aādhmāna (distension of abdomen), Parikartikā (fissure in ano), Srāva (excess discharge), Hṛt-graha (congestion in cardiac region), Gātra-graha (body stiffness), Jīvādāna (bleeding), Vibhraṃśa (prolapse of rectum), Stambha (body stiffness), Upadrava (complications), Klama (fatigue without excertion).

The above complications arise out of either under activity or excessive activity of the drug because of the following:

• Preṣya – Vaiguṇya(incompetency of the attendant)
• Bhaiṣajya – Vaiguṇya(incompetency of drug)
• Vaidya – Vaiguṇya(incompetency of physician)
• Ātura – Vaiguṇya(incompetency of the patient)

वैद्यातुरनिमित्तं वमनं विरेचनं च पञ्चदशधा व्यापद्यते |तत्र वमनस्याधो गतिरूर्ध्वं विरेचनस्येति पृथक्; सामान्यमुभयोः- सावशेषौषधत्वं, जीर्णौषधत्वं, हीनदोषापहृतत्वं, वातशूलम्, अयोगो,अतियोगो, जीवादानम्, आध्मानं, परिकर्तिका, परिस्रावः, प्रवाहिका, हृदयोपसरणं, विबन्ध, अङ्गप्रग्रह इति ||                                                                                                                                                                                                                         (Su. Chi. 34/3)

Fifteen  different  kinds  of Vyāpats  may  result  from  an  injudicious  use  of  emetics and  purgatives  owing  to  the  ignorance  of  the  physician or  of  the  patient.  Of  these  fifteen,  the  upward  coursing in  cases of  purgatives  and  the  downward  coursing  in  cases of  emetics  are  peculiar  to  each  of  them  respectively. The  fourteen  other  remaining Vyāpats are common  to  both.  They  are  SāvaseṣaAuṣadhatva (continuance  of  the  drug  in  the  stomach),  JīrṇaAuṣadhatva  (complete  digestion  of  the  medicine),  HīnaDoṣaApahṛtatva  (insufficient  elimination  of  the  Doṣas from  the  system)  AdhikaDoṣaApahṛtatva  (excessive elimination  of  the  Doṣas  from  the  system),  VātaSūla (pain due to Vāta), Ayoga  (insufficient  dosage),  Atiyoga (over  dosage),  Jivādāna  (vomiting blood),  Ādhmāna (distention of abdomen),  Parikartikā  (cutting  pain  in  the  anus.), Parisrāva  (oozing  out  of  stools),  Pravāhika(  (diarrhoea), Hṛdayopasarana  (rising  of  the  Doṣas  towards  the heart)  and  Vibandha  (constipation)

प्रतिकूला गतिः पाको ग्रथितत्वं सगौरवम्|
दोषोत्क्लेशो भृशाध्मानं परिकर्त्तः परिस्रवः|
प्रवाहिका हृद्ग्रहणं सर्वगात्रपरिग्रहः|
सह धातुस्रवेणैताः द्वादशोक्ताः ससाधनाः| (Ash. San. Ka 3/21)

ĀcāryaVagbhata explained overall 12 Vamana Vyāpat (complications). Out of these, Grathitatva, Gaurava, Doshotklesa, Dhatu Srāvavypaths are mentoned only by Vagbhata Ācārya.

Vamana AyogaandAtiyogaVyāpatexplainedbyĀcāryaCaraka

AccordingtoĀcāryaCaraka,VyāpatsmaybecausedduetoVamanaAyogaandAtiyoga.

Vamana AyogaVyāpat

श्लेष्मोत्क्लिष्टेनदुर्गन्धमहृद्यमतिवाबहु|
विरेचनमजीर्णेचपीतमूर्ध्वंप्रवर्तते||३२||
क्षुधार्तमृदुकोष्ठाभ्यांस्वल्पोत्क्लिष्टकफेनवा|
तीक्ष्णंपीतंस्थितंक्षुब्धंवमनंस्याद्विरेचनम्||
प्रातिलोम्येनदोषाणांहरणात्तेह्यकृत्स्नशः|
अयोगसञ्ज्ञे,कृच्छ्रेणयातिदोषोनवाऽल्पशः||                       (Cha. Si. 6/33-34)

The medicines administered for Virecana, in a patient with aggravated and excited status of Kapha, will act as Vāmaka, if the medicine is having bad smell, the drug not being wholesome, large quantity of medicine, intake of medicine before the previous meal is digested

The medicines administered for Vamana will cause Virecana under the following conditions, Vamana isperformed on an individual who is hungry, an individual with MṛduKoṣṭha, an individual with littleincreaseofKapha,ifthemedicineisTīkṣṇa(penetrating/potent),ifthemedicineisreminentandagitating

Whether in Vamana or Virecana, if the medicines work in opposite, it is termed Ayoga or inadequate action. It is also called the same, if Doṣās are not eliminated or eliminated with difficulty.

अस्निग्धास्विन्नदेहस्यरूक्षस्यानवमौषधम्|
दोषानुत्क्लिश्यनिर्हर्तुमशक्तंजनयेद्गदान्||
विभ्रंशंश्वयथुंहिक्कांतमसोदर्शनंभृशम्|
पिण्डिकोद्वेष्टनंकण्डूमूर्वोःसादंविवर्णताम्               (Cha. Si. 6/38-39)

Ayoga happens when Asnigdha (under-oleated) and Asvinna (under-sudated) person with Rūkṣa nature ofthebody, is administered a recipe, which is stored for long duration. Here,the drug is unable to remove Doṣās from the body by creating doṣā-Utkleśa. Such a condition will lead to symptoms like Vibhramśa (virechana oushadha will lead to Vamana and vice versa), swelling, hiccups, black-out, cramps in calf muscle, itching, fainting and discoloration.

स्निग्धस्विन्नस्यचात्यल्पंदीप्ताग्नेर्जीर्णमौषधम्|

शीतैर्वास्तब्धमामेवादोषानुत्क्लिश्यनाहरेत्||

तानेवजनयेद्रोगानयोगःसर्वएवसः|

विज्ञायमतिमांस्तत्रयथोक्तांकारयेत्क्रियाम्||

तंतैललवणाभ्यक्तंस्विन्नंप्रस्तरसङ्करैः|

पाययेतपुनर्जीर्णेसमूत्रैर्वानिरूहयेत्||

निरूढंचरसैर्धान्वैर्भोजयित्वाऽनुवासयेत्|

फलमागधिकादारुसिद्धतैलेनमात्रया||

स्निग्धंवातहरैःस्नेहैःपुनस्तीक्ष्णेनशोधयेत्|

नचातितीक्ष्णेनततोह्यतियोगस्तुजायते||                              (Cha. Si. 6/40-44)

Ayoga happens in conditions such as administration of sub-optimal dose of medicine even after proper Sneha-Sveda and quick digestion of medicine happens due to increased Agni.

If there is Āma Doṣa, the medicine for Vamana will not work in the desired manner. The case is similar also with Virecana drugs.

Because of the above mentioned causes, the earlier mentioned conditions like Vibhramśa will happen. These come under Ayoga. The intelligent physician must understand the same and treat accordingly.

VamanaAyogaVyāpatmanagement

Taila (oil) processed with Lavana(salt) has to be applied and made to undergo Prastaraand Saṅkarakind ofsudation.   Once     the     medicine     for Vamana or Virecana must     be     administered     again     or else Kaṣāya Basti (decoction enema) with cow’s urine has to be done. After the administration of Kaṣāya Basti, food with meats of animals of arid regions (Jāngala Maṃsa Rasa) should be taken and should be followed by administration of Sneha Basti (oilenema).

Sneha basti can be done  by  oil  processed  with Madana(Randiadumetorum), Pippali(Piperlongum), Devadāru(Cedrus deodara), in proper dose. Once adequate oleation happens, elimination must be done with a recipe containing Tīkṣṇa drugs. However, the medicines that are Ati-Tīkṣṇa should not be given,as it may result in Atiyoga.

VamanaAtiyogaVyāpatandmanagement

अतितीक्ष्णंक्षुधार्तस्यमृदुकोष्ठस्यभेषजम्|

हृत्वाऽऽशुविट्पित्तकफान्धातून्विस्रावयेद्द्रवान्||४५||

बलस्वरक्षयंदाहंकण्ठशोषंभ्रमंतृषाम्|

कुर्याच्चमधुरैस्तत्रशेषमौषधमुल्लिखेत्||४६||

वमनेतुविरेकःस्याद्विरेकेवमनंपुनः |

परिषेकावगाहाद्यैःसुशीतैःस्तम्भयेच्चतत्||४७||

कषायमधुरैःशीतैरन्नपानौषधैस्तथा|

रक्तपित्तातिसारघ्नैर्दाहज्वरहरैरपि||४८||

अञ्जनंचन्दनोशीरमज्जासृक्शर्करोदकम्|

लाजचूर्णैःपिबेन्मन्थमतियोगहरंपरम्||४९||

शुङ्गाभिर्वावटादीनांसिद्धांपेयांसमाक्षिकाम्|

वर्चःसाङ्ग्राहिकैःसिद्धंक्षीरंभोज्यंचदापयेत्||५०||

जाङ्गलैर्वारसैर्भोज्यंपिच्छाबस्तिश्चशस्यते|

मधुरैरनुवास्यश्चसिद्धेनक्षीरसर्पिषा||५१||                              (Cha. Si. 6/ 45-50)

When a patient who is with MṛduKoṣṭha, who is affected with hunger, is provided with an exceedinglystrongVamanaorVirecana,itresultsinthequickeliminationofnotonlythefaecalmatter,PittaandKapha,but also the Drava-Dhātu (liquid content of the body). Consequently, there will be sudden depression of strength and voice, dryness of throat, giddiness and thirst. In such a condition, it is preferable to eliminate the residual drug in the Koṣṭha using the drugs of Madhura Gaṇa(mentioned in sweet category).

If Ati -Yoga happens like this during attempting Vamana, the residual Doṣās are eliminated by initiating a Virecana and vice-versa.

Stambhana can be done by providing cold irrigation (Pariṣeka) and tub bath (Avagāha), providing foods, drinks and medicine which are Śīta (cold), Kaṣāya (astrigent)and Madhura (sweet)rasa and following appropriate regimens prescribed for Rakta-Pitta, Atisāra, Dāha and Jvara.

वमनस्यातियोगेतुशीताम्बुपरिषेचितः|

पिबेत्कफहरैर्मन्थंसघृतक्षौद्रशर्करम्||

सोद्गारायांभृशंवम्यांमूर्च्छायांधान्यमुस्तयोः|

समधूकाञ्जनंचूर्णंलेहयेन्मधुसंयुतम्||

वमतोऽन्तःप्रविष्टायांजिह्वायांकवलग्रहाः|

स्निग्धाम्ललवणैर्हृद्यैर्यूषक्षीररसैर्हिताः||

फलान्यम्लानिखादेयुस्तस्यचान्येऽग्रतोनराः|

निःसृतांतुतिलद्राक्षाकल्कलिप्तांप्रवेशयेत्||

वाग्ग्रहानिलरोगेषुघृतमांसोपसाधिताम्|

यवागूंतनुकांदद्यात्स्नेहस्वेदौचबुद्धिमान्||                             (Cha. Si. 6/52-56)

In Atiyoga of Vamana, the whole body irrigation must be done with cold water. Mantha must be preparedwithghee, honey and sugar.

IfAtiyogahappenswithbelchingandfainting,powderedDhānyaka(Coriandumsativum),Musta(Cyonodondactylon),Rasānjana (Berberisaristata) etc. addedwith honeycan belicked.

If due to excessive Vamana, his tongue goes inside, a vegetable soup milk or meat soup which are preparedby incorporating unctuous, salty, sour and pleasant ingredients can be used for gargling. Eating sour fruitsinfrontof him by others will also behelpful.

Ifthetonguecomesout,apasteofTila (sesame)andDrāksha(grapes)canbeappliedoveritandcanbemadeto moveout.

If there is problem in speech or other disorders of Vāta, he can be given a porridge made of ghee and meatjuice.Theintelligentphysician thenmust do Snehana (oleation)and Svedana(sudation).

Dhūmapāna(Inhalation of medicated smoke)

योगेन तु खल्वेनं छर्दितवन्तमभिसमीक्ष्य सुप्रक्षालितपाणिपादास्यं मुहूर्तमाश्वास्य, स्नैहिकवैरेचनिकोपशमनीयानां धूमानामन्यतमं सामर्थ्यतः पाययित्वा, पुनरेवोदकमुपस्पर्शयेत्||उपस्पृष्टोदकं चैनं निवातमागारमनुप्रवेश्य संवेश्य चानुशिष्यात्                                                                                                                        (Cha.Su. 15/14)

According to ĀcāryaCaraka after Samyak Vamana patient is advised to wash mouth, hands, feet and then rest for 1 Muhūrta. Afterwards patient is advised to Dhūmapāna (inhale the smoke) ie according to the condition physician can administer Snaihika, Vairecanika or UpaśamanīyaDhūmapāna.

वमनानन्तरं स्रोतोविलग्नकफहरणार्थं धूमपानमत्रोक्तम्| वातप्रकृतौ स्नैहिकं, कफपित्तप्रकृतावुत्क्लिष्टदोषे च वैरेचनिकं, समदोषप्रकृतावुपशमनीयं प्रायोगिकं स्वस्थवृत्तिकमित्यर्थः |

(Su.Chi. 33/11, Dalhana Commentary)