Subconjunctival Hemorrhage (Arjuna) as an Iatrogenic Complication of Vamana Karma: A Comprehensive Case Report and Proposal for Ocular Fitness Screening

Abstract

Vamana Karma is a powerful bio-purificatory procedure in Ayurveda widely practiced for eliminating vitiated Kapha and associated Pitta. While generally safe when performed according to classical guidelines, the procedure generates acute temporary physiological strain that requires close monitoring. Subconjunctival hemorrhage (SCH), correlated with Arjuna in Ayurveda, is a microvascular complication that remains overlooked in routine pre-procedural screening. This case report presents a 32-year-old female with Urdhwaga Amlapitta who underwent Vamana Karma after clearing rigorous cardiovascular and respiratory fitness assessments. The procedure, executed using a Madanaphala-based Vamaka Yoga, achieved Avara Shuddhi. During Pradhana Karma, significant hemodynamic stress was noted, characterized by blood pressure rising from 110/81 mmHg to 119/90 mmHg and pulse rate from 87 to 99 bpm. Immediately post procedure, the patient developed painless, bilateral ocular redness with preserved visual acuity, diagnosed as subconjunctival hemorrhage (Arjuna). The complication was managed conservatively with topical ocular therapy and the hemorrhage completely resolved within 12 days without any visual impairment. This case highlights SCH as an iatrogenic occurrence precipitated by the intense Valsalva like pressure gradients generated during Vamana Karma. Given that classical texts acknowledged ocular vulnerability to Vamana, we strongly recommend incorporating a structured, baseline ocular fitness screening into standard pre Panchakarma assessment protocols to safeguard vulnerable microvasculature.