Your SlideShare is downloading. ×
  • Like
  • Save
Vamana ppt  dr .p.murali krishna
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Vamana ppt dr .p.murali krishna

  • 1,673 views
Published

 

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
1,673
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
1
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Vamana karma-concepts, application andcurrent researchDr . P. Murali Krishna,B.A.M.S (Gold medalist), M.D., Ph.D.Reader (PG), Dept of Pancha karmaS.V. Ayurvedic college & Hospital,Tirupati(AP). Email: mkparasar@yahoo.co.in
  • 2. Importance of Sodhana30-May-13Dr.P.Murali krishna, Tirupati.2-Ca.Su.16:20
  • 3. Pancha karmas(Bio-purification)30-May-13Dr.P.Murali krishna, Tirupati.31. Vamana (therapeutic emesis)2. Virecana (therapeutic purgation)3. Asthapana vasti (enema with primarilymedicated decoctions)4. Anuvasana vasti (enema with medicated oils)5. Sirovirecana (nasal instillations)
  • 4. Importance of sodhana30-May-13Dr.P.Murali krishna, Tirupati.4Ca.Su.16:16-19
  • 5. Purification of Body30-May-13Dr.P.Murali krishna, Tirupati.51. Trans membrane2. Trans dermal
  • 6. Trans membrane30-May-13Dr.P.Murali krishna, Tirupati.6Sodhana
  • 7. Trans Dermal Purification30-May-13Dr.P.Murali krishna, Tirupati.7 Bahya sneha Sweda Special treatments of Kerala
  • 8. Introduction30-May-13Dr.P.Murali krishna, Tirupati.8Panchakarma- Five therapies, sodhana in natureVamana & Virecana- Constitute first twokarmas: Urdhva & Adho sodhana respectively
  • 9. Vaman-Nirukthi30-May-13Dr.P.Murali krishna, Tirupati.9 Vam- Udgare, Yak-set Conveying the meaning, Marddane Charddane Nissarane Sarvanga abhishyanda
  • 10. Definition30-May-13Dr.P.Murali krishna, Tirupati.10Sa.Pu.Kh 4/Ch. Ka.1/
  • 11. Contd………30-May-13Dr.P.Murali krishna, Tirupati.11Vamana- expulsion of doshas from the upper routeVirecana- expulsion of the doshas from the lowerrouteAs they expel malas from the body,both are called Virecana
  • 12. Vamana30-May-13Dr.P.Murali krishna, Tirupati.12First Panchakarma Procedure Advisedin Human beingSu.Sa.10 & Ca.Sa.8
  • 13. Samyak Prayoga is the secret ofsuccess30-May-13Dr.P.Murali krishna, Tirupati.131. Selection of the patient2. Examination of the patient3. Collection of material required3. Selection of drugs4. Selection of Mathra(Dose)5. Vamana vidhi (procedure)Poorva karma (Praparatory)Pradhana Karma(prime treatment)Paschat karma (post treatmentmeasures)6. Observation of the patientCh. Su-15:4
  • 14. Yogya & Ayogya vicaran30-May-13Dr.P.Murali krishna, Tirupati.141. Vaman yogya (Inclusion criteria) patient shouldbe selected.2. Vamana Ayogya (Exclusion Criteria) PatientShould be Excluded
  • 15. Vamana - Indications30-May-13Dr.P.Murali krishna, Tirupati.15 Kapha Pitta samsrishta kapha Pitta or vata situated in Kaphasthana Commonly conducted in Kushta, Swasa,Unmada etc.
  • 16. Vamana indications30-May-13Dr.P.Murali krishna, Tirupati.16A.Hr.Su.18/1-3
  • 17. Contd…30-May-13Dr.P.Murali krishna, Tirupati.17 In Vasanta ritu As a purvakarma of Rasayana Irrespective of the rogibala in Visa, Gara, Ajirna,Viruddhahara sevana
  • 18. Common Indications(A.H.Su. 18)30-May-13Dr.P.Murali krishna, Tirupati.18 Navajwara(Acute fever) Atisara(Diarrhoea) Adhogataraktapitta(AnalUrethro,vaginalhaemorrhages) Rajayakshma Kushta(skin diseases) Prameha Apachi Granthi Sleepada(filariasis) Unmada(insanity) Kasa(cough) Swasa(Asthma) Hrillasa(nausea) Visarpa Sthanya dosa(lactationdisorders) Urdhwajatrugatarogas(diseases of head& neck)
  • 19. Indications of vamana karma30-May-13Dr.P.Murali krishna, Tirupati.19 Respiratory Digestive Skin miscellaneus
  • 20. Respiratory30-May-13Dr.P.Murali krishna, Tirupati.20 Pinasa (Rhinitis) Rajayakshma (? Pul.koch’s) Kasa (Bronchitis) Swasa ( Bronchial Asthma) Puti nasa (Chronic sinusitis) Kantha paka (URTI)
  • 21. DIGESTIVE30-May-13Dr.P.Murali krishna, Tirupati.21 Mandagni (dyspepsia) Vidagdajeerna (APD) Visucika Alasaka (gastro enteritis) Adhoga raktapitta (bleeding diathesis from lowerorifices) Aruci (anorexea) Atisara (diarrhoea) Hrillasa ( nausea) Mukha praseka ( water brash) Kaphaja arsas ( piles)
  • 22. Skin diseases30-May-13Dr.P.Murali krishna, Tirupati.22 Kitibha (psoriasis) Ekakushta Vicaricika ( Ch.Dermatitis) Kandu (pruritus) Vidradhi (abscess) Apachi (Cold abscess)
  • 23. miscellaneus30-May-13Dr.P.Murali krishna, Tirupati.23 Nava jwara (acute fever) Gala graha (pharyngitis) Sleepada (filarial lymphedema) Galaganda(Goitre) Unmada ( psychosis) Apasmara ( Seizure disorders) Chitta vibhrama (delusions) Granthi ( cystic lesions) Arbuda ( Neoplasms)
  • 24. Vamana-Contraindications30-May-13Dr.P.Murali krishna, Tirupati.24 By nature:pregnant, sukumara, rooksha, kshudhita, shokarta, krisha, bala, vriddha, durbala Diseased conditions like:Vataprakopa- Udavarta, Gulma, VatavyadhiMarmaja vyadhi- Hridroga, Mutragata, TimiraMaharoga- Arsas, Udara
  • 25. EXCLUDING CONDITIONS30-May-13Dr.P.Murali krishna, Tirupati.25 Cardiac problems like CAD, CHF & congenitalheart diseases Ascitis & Cirrhosis of liver Pleurisy Spleenomegaly Chronic diabetic with complications Hypertension very weak patients Cancer
  • 26. Contra indications of Vaman30-May-13Dr.P.Murali krishna, Tirupati.26A.Hr.Su.18:3-5
  • 27. Vaman Ayogya30-May-13Dr.P.Murali krishna, Tirupati.27Ca.Si.8:8
  • 28. Contra indications of vamana30-May-13Dr.P.Murali krishna, Tirupati.28 Children & Old aged Pregnant women Emaciated Durbala (weak) Asthapita/ Anuvasita(after vasti) Pipasita/kshudita/upavasita Bhara hata Vyayama prasakta chinta prasakta Parsva soola Krimi koshta Udavarta Asthila Pleeha dosa Mutraghat Gulma Udara Vata vyadhi Bhrama Karnasula Akshisula Bhrama Vata rogi
  • 29. Discriminatory use30-May-13Dr.P.Murali krishna, Tirupati.29Ca.Si.2:27
  • 30. Views of classics on use of Vaman inHridroga30-May-13Dr.P.Murali krishna, Tirupati.30 Caraka contra indicated vaman but left tothe discretion of physician(Ca.Si.2:24-27) Susruta & Vagbhata advocates vamankarma in all three hridrogas
  • 31. Classification30-May-13Dr.P.Murali krishna, Tirupati.31 Sadyovamana. Snehapurvaka vamanaMridu vamanaMadhyama vamanaTiksna vamana
  • 32. Examination of the patient30-May-13Dr.P.Murali krishna, Tirupati.32 Patient should be examined completely.(Vital datas like BP. Pulse, Temp. etc) Investigations.a) Blood sugar, b) Lipid profilec) SGPT, SGOT d) Blood urea &creatinined) CT, BT f) Haemogramg) Urine exam h) Stool exami) ECG j) X-Ray chest.
  • 33. Materials required:-30-May-13Dr.P.Murali krishna, Tirupati.33 Large Basin ------------------------- 1 Medium sized vessel ------------- 2 Steel tumblers (capacity-250ml) 2 Table spoon ----------------------- 2 Khalwa yanthra --------------------- 1 Stool ---------------------------------- 1 Chair with arm rest ----------------- 1 Cotton cloth--------------------------- 2 Hot water bath vessel ---------------1 Stove------------------------------------ 1
  • 34. Selection of drugs30-May-13Dr.P.Murali krishna, Tirupati.34
  • 35. Vamana dravyaThey can be classified as vamaka and vamanopagaVamanopaga30-May-13Dr.P.Murali krishna, Tirupati.35 Madhuka Ikshurasa Kovidara Sadapushpi Pratyak pushpi Madhu Ksheera Lavana
  • 36. 30-May-13Dr.P.Murali krishna, Tirupati.36 Vamanopagas like Madhu & Saindhava areused in all yogas- Kaphavilayana & Chedana According to dosaKapha- Katu, Tiksna, UsnaPittayukta- MadhuraVatayukta- Amla, Sasneha
  • 37. Quality of Vamana Dravyas30-May-13Dr.P.Murali krishna, Tirupati.37Su.Ci.33:7Asatmya (unsuitable)Beebhatsa (aversive)Durgandha (unpleasantsmell) smelling)Durdarsana (Ugly looking)
  • 38. Qualities of Vamana dravya30-May-13Dr.P.Murali krishna, Tirupati.38 Usna Tiksna Suksma Vyavayi Vikasi Sthula, Anu, sroto gatatwa Vishyandana, VicchindanaCa.Ka.1 : 5
  • 39. Contd…30-May-13Dr.P.Murali krishna, Tirupati.39In Caraka Samhita, 355 vamaka yogas and 6vamaka dravyas are explained - Madanaphala- All rogas Jimutaka- Jwara, Swasa Ikshvaku- Kasa, Visha, Jwara Dhamargava- Kapha, Amasayagata Vata Kutaja- Sukumara, Hridroga, Visarpa Kritavedana- Kusta, Pandu, Pliha
  • 40. Processing of Madanaphala30-May-13Dr.P.Murali krishna, Tirupati.40Fruits of Randia dumetorum
  • 41. Madana phala(Randia dumetorum•Administered in antarnakha mustipramana•It contains oleanolic acid3-/3-glucoside•It acts on GIT and CTZ•It is the drug of choice forasthapana vasti also30-May-13Dr.P.Murali krishna, Tirupati.41
  • 42. Ca.Ka.1:1330-May-13Dr.P.Murali krishna, Tirupati.42
  • 43. 30-May-13Dr.P.Murali krishna, Tirupati.43
  • 44. 30-May-13Dr.P.Murali krishna, Tirupati.44
  • 45. 30-May-13Dr.P.Murali krishna, Tirupati.45
  • 46. 30-May-13Dr.P.Murali krishna, Tirupati.46
  • 47. 30-May-13Dr.P.Murali krishna, Tirupati.47
  • 48. 30-May-13Dr.P.Murali krishna, Tirupati.48
  • 49. Vamana - Matranirnaya30-May-13Dr.P.Murali krishna, Tirupati.49 Varies according to vyadhibala, agnibala, kosta androgibala (Susruta) Madana pippali- Antarnakha Mushti or suitably(Caraka)
  • 50. Dose of vamana dravya30-May-13Dr.P.Murali krishna, Tirupati.50Uttama Madhyama & Kaneeyasi Matra forKwata-9, 6 & 3prasthaChurna, Kalka-3,2 & 1 palaSa . U. 3 : 14
  • 51. Vamana kala30-May-13Dr.P.Murali krishna, Tirupati.51 In Sadharana kala, preferably Vasanta In other seasons with artificially altering theatmosphere, if necessary[Atyayike punah karmani kamamritum vikalpyakritrimagunopadhanena…](Caraka) In an auspicious day and time In the morning, after proper digestion of previousday’s food
  • 52. Procedure of Vamana Karma30-May-13Dr.P.Murali krishna, Tirupati.521. Purva karma2. Pradhana karma3. Pascat karma
  • 53. Vamana - purvakarma30-May-13Dr.P.Murali krishna, Tirupati.53 Snehan- done for 3-7 days till samyaksnigdata is attained Swedan- in 2 days gap following snehan(Vagbhata)1 day gap after snehapana (others) Kaphotklesa kara ahara-Dadhi, Matsya, Masa - on the previousday of vamana
  • 54. 30-May-13Dr.P.Murali krishna, Tirupati.54A.H.Su.16:36-37
  • 55. Vamana- pradhanakarma30-May-13Dr.P.Murali krishna, Tirupati.55 Akantapana- Usually milk, sugarcane juiceetc. are given. But, can be done without it afterintake of yavagu added with ghrita Suitable yoga- usually a combination ofvamaka and vamanopaga dravyas is takenMadanaphala - 3-12 gVaca - 5-8 gYashtimadhu - 7.5 gSaindhava - 15 gMadhu - Q.S.
  • 56. Contd…30-May-13Dr.P.Murali krishna, Tirupati.56 After bath, patient sits on a comfortablechair of knee-height Suitable dravadrayas are given forakantapana Vamanousadhi is given after prayer Wait till 1 muhurta, expecting vegas
  • 57. 30-May-13Dr.P.Murali krishna, Tirupati.57A. H. Su.18
  • 58. Contd…..30-May-13Dr.P.Murali krishna, Tirupati.58A.H.Su.18:12-15
  • 59. Arundatta Kosta classification30-May-13Dr.P.Murali krishna, Tirupati.59 Arundatta - three special type of Kostha inrelation of Vamana. Dominance of Kapha -Mrudu Kostha for Vamana. Madhya Kapha - Madhya Kostha Slight Kapha in Kostha - Krura Kostha for Vamana.
  • 60. Contd…30-May-13Dr.P.Murali krishna, Tirupati.60 Observe:Swedapradurbhava- liquefaction of dosasRomaharsa- dislodging from their seatAdhmana- reaching kuksiHridayopamarda, hrillasa, asyasamsravana -upward movement
  • 61. 30-May-13Dr.P.Murali krishna, Tirupati.61Ca.Su.15:11
  • 62. Contd…30-May-13Dr.P.Murali krishna, Tirupati.62 Gently press flanks and abdomen Support patient’s forehead while vomiting Gently massage over his back in pratilomagati (upward direction) If vegas do not occur spontaneously, ask thepatient to stimulate vomiting withfingers, Erandanala etc.
  • 63. 30-May-13Dr.P.Murali krishna, Tirupati.63A.H.Su.18:19-20
  • 64. Vamana30-May-13Dr.P.Murali krishna, Tirupati.64
  • 65. vamana30-May-13Dr.P.Murali krishna, Tirupati.65
  • 66. vamana30-May-13Dr.P.Murali krishna, Tirupati.66
  • 67. Causes of Ayoga and Atiyoga30-May-13Dr.P.Murali krishna, Tirupati.67 Improper snehana i.e. internal oelation aswell as external application of snehana. Improper swedana. Insufficient kaphotklesana Selection of improper drug and dose , oldand less potency drug . Krura or Mridu Kostha. Tikshna or Mandagni. Strong body or weak body. Predominance of Ama.
  • 68. Vamana - ayoga laksana30-May-13Dr.P.Murali krishna, Tirupati.68
  • 69. Contd....30-May-13Dr.P.Murali krishna, Tirupati.69 Apravritti Adhopravritti Only medicine comes out Vega vibandha Arocaka, Adhmana, Kandu, Kota, Praseka, Sopha, Seetajwara etc.
  • 70. Management of Hinayoga30-May-13Dr.P.Murali krishna, Tirupati.70Heenavega- Pippali, Amalaki, Sarsapa,Lavanayukta Usnodaka given repeatedly
  • 71. Vamana - samyak yoga30-May-13Dr.P.Murali krishna, Tirupati.71
  • 72. Contd….30-May-13Dr.P.Murali krishna, Tirupati.72 Kale vegapravritti Evacuation of Sveda, Praseka, Oushadha, Kapha,Pitta, Vata in order Not much discomfort Stops automatically Swasthata, Manah prasada, Swarasuddhi, Laghuta
  • 73. Types of Suddhi30-May-13Dr.P.Murali krishna, Tirupati.73Assessment- 4 typesVaigiki- 4,6,8Antiki- pittantaManiki- 1, 1 &1/2, 2 prasthaLaingiki- sarva, madhya, alpa laksana
  • 74. Laingiki Suddhi30-May-13Dr.P.Murali krishna, Tirupati.74Elimination of Kapha, Pitta & VatarespectivelyHridaya ShuddhiParsva ShuddhiMurdha ShuddhiSrotas Shuddhi
  • 75. Contd..30-May-13Dr.P.Murali krishna, Tirupati.75 Laghuta Daurbalya Kantha Shuddhi Kapha Samsrava Yatha kala Ksudha & Pipasa Roga Samana
  • 76. 30-May-13Dr.P.Murali krishna, Tirupati.76Ca.Si.1:16Ca.Si.1:17
  • 77. Vamana - atiyoga lakshana30-May-13Dr.P.Murali krishna, Tirupati.77A.H.Su.18:26Ca.Si.1:17
  • 78. Atiyoga lakshana30-May-13Dr.P.Murali krishna, Tirupati.78 Phenila raktachandrikodgamana Swarakshaya, Daha, Kantasosha, Bhrama, Murcha, Sirahsula, Balahani, Agnihani Jeevashonita pravritti and marana may occur
  • 79. Vamana-pascat karma30-May-13Dr.P.Murali krishna, Tirupati. 79A.H.Su.18:27-28Ca.Su.15:14
  • 80. Pascat karma30-May-13Dr.P.Murali krishna, Tirupati.80 After samyak yoga, clean the limbs and face Rest for 1 muhurta kala Suitable dhumapana Tambula sevana Nivatagrihe sayana Snehokta acharavidhi Samsarjana krama (Ashtanga Sangraha)
  • 81. Samsarjana krama30-May-13Dr.P.Murali krishna, Tirupati.81
  • 82. samsarjana30-May-13Dr.P.Murali krishna, Tirupati.82 Means leaving or abandoning the diet restriction 2 types of samsarjana kramas- Peyadi krama &Tarpanadi krama Stabilizes agni that is diminished due to dosasodhana, gradually
  • 83. 30-May-13Dr.P.Murali krishna, Tirupati.83Ca.Su.15:16
  • 84. Peyadi krama30-May-13Dr.P.Murali krishna, Tirupati.84Following things are given for 3,2,1 annakalas inpravara, madhyama, avara sodhana respectively:PeyaVilepiAkrita yusaKrita yusaAkrita mamsarasaKrita mamsarasa
  • 85. Samsarjana kramdiet Pravara madhyama avarapeya 3 2 1vilepi 3 2 1Akrita yusha 1 1 1Krita yusha 2 1Akrita mamsa rasa 1 1 14Krita mansa ras 1121830-May-13Dr.P.Murali krishna, Tirupati.85
  • 86. Samsarjana krama•Peya:-easily digestible carbohydrate in liquid form•Vilepi:- easily digestible carbohydrate in semisolidform•Akritha Yusha:- easily digestible plant protein insemisolid form•Kritha yusha :- easily digestible plant protein withsaturated fat in semisolid form•Akritha mamsa rasa:- animal protein•Kritha mamsa rasa:- animal protein with saturatedfatty acids30-May-13Dr.P.Murali krishna, Tirupati.86
  • 87. Effects of Samsarjana krama•Restores the physiology of digestion•Restores mucosal barrier•Habituates the three important nutrientsviz.carbohydrates, proteins and fats in anorder30-May-13Dr.P.Murali krishna, Tirupati.87
  • 88. Tarpanadi krama30-May-13Dr.P.Murali krishna, Tirupati.88A. H.18
  • 89. Tarpana indications30-May-13Dr.P.Murali krishna, Tirupati.89 Indicated in alpa sodhana of pitta & kapha,madyapa and in vatapitta pradhanya Peya- svaccha tarpanaVilepi- ghana tarpana (Chakrapani)1. annakala: lajasaktu2. annakala: jeerna salyodana3. annakala: mamsarasa (Arunadatta)
  • 90. Things to do After the samyakVamana30-May-13Dr.P.Murali krishna, Tirupati.90Ca.Su.15:15
  • 91. Observation of the patient30-May-13Dr.P.Murali krishna, Tirupati.91
  • 92. Vaman vyapathCa.Si.6:29-3030-May-13Dr.P.Murali krishna, Tirupati.92
  • 93. Vyapath –Susruta quotes30-May-13Dr.P.Murali krishna, Tirupati.93Su.Ci.34:3
  • 94. Vyapath30-May-13Dr.P.Murali krishna, Tirupati.94 Adhmana(Bloating) Kanta karsanam Srava Hrithgraha Gatragraha Jeevadana Vibhramsam Sthambha Upadrava Klama
  • 95. Common vyapaths & Management30-May-13Dr.P.Murali krishna, Tirupati.95 Bloody streaks along with bouts – Lajatarpanawith sita Feeble pulse, giddiness, collapse-Sidhamakaradhwajam with honey and betel juice Exhaustion- Laja, ksheera, Manda, tendercoconut water.
  • 96. Vamana kalpa in different disease30-May-13Dr.P.Murali krishna, Tirupati.96 Jwara-Thathrotklishte samuthklishte kaphaprayechale maleSahrillasa praseka annadwesha kasavishucikeSadyo bhuktasya sanjathe jware sameviseshathaVamanam vamanarhasya
  • 97. Contd…….30-May-13Dr.P.Murali krishna, Tirupati.97 Uthklishta doshas are present in amasaya Sneha-sweda not required or done in littleintensity Yoga- Pippali, kalinga, Madhuka, Saindhava &Madhu
  • 98. Contd…….30-May-13Dr.P.Murali krishna, Tirupati.98 Swasa-Snehasweda done until swasavega subsides Uthkleshahara- Dadhi etc which provokesnocturnal attacks are avoided Yoga- Pippali, Saindhava & Kshoudram- vataavirodhi
  • 99. Kushtam30-May-13Dr.P.Murali krishna, Tirupati.99 Done in uthklishta doshavastha and inurdhwadehasrita kushta Yoga- Kutaja, Madana, YashtiPatola, nimba kasaya
  • 100. Vaman in Ayurveda30-May-13Dr.P.Murali krishna, Tirupati.100Usna, Tiksna, Suksma, Vyavayi, Vikasioushadhi reach Hridaya by their veeryamoves through dhamanis into sarvashareeraOushnya- vishyandana of doshasanghataTaikshnya- vicchindana of doshasanghataReach amashaya & propelled out by Udana vayudue to Agni, Vayubhoota & oordhvabhagaprabhava
  • 101. 30-May-13Dr.P.Murali krishna, Tirupati.101Ca.Ka. 1:5
  • 102. Physiology of vomiting30-May-13Dr.P.Murali krishna, Tirupati.102Vomiting is produced by a series of co-ordinatechanges in GI activity and respiratory movements.Salivation-sharp and deep inspiration-increasein intra-abdominal pressure-contraction ofabdominal muscles-closure of epiglottis andsoft palate-forcible contraction of stomachpylorus-relaxation of fundus,cardiacsphincter and esophagus.
  • 103. 30-May-13Dr.P.Murali krishna, Tirupati.103
  • 104. VOMITINGPATHWAYSIpecac syrup 30-May-13Dr.P.Murali krishna, Tirupati.104
  • 105. The Physiology of Vomiting30-May-13Dr.P.Murali krishna, Tirupati.105 The Chemoreceptor Trigger Zone (CTZ) and Vomiting Center(VC) are regions within the brain When stimulated these regions initiate the vomiting reflex Different causes of nausea and vomiting stimulate theseregions in different ways
  • 106. Causes of Nausea and Vomiting: MotionSickness30-May-13Dr.P.Murali krishna, Tirupati.106The visual and vestibular systems send mixed messages tothe VC, inducing the vomiting reflexVCVomiting Reflexvisualinputvestibularinput(balance)
  • 107. Mechanisms of Chemotherapy-inducednausea and vomiting (CINV)30-May-13Dr.P.Murali krishna, Tirupati.107 Central mechanism Chemotherapeutic agent activates thechemoreceptor trigger zone (CTZ) Activated CTZ invokes release of variousneurotransmitters, which stimulate vomiting center Peripheral mechanism Chemotherapeutic agent causes irritation anddamage to gastrointestinal (GI) mucosa, resulting inthe release of neurotransmitters Activated receptors send signals to vomiting centervia vagal afferentsBerger AM et al. In: Cancer: Principles and Practice of Oncology. 6th ed.Lippincott Williams & Wilkins; 2001:2869–2880.
  • 108. Vamana karma30-May-13Dr.P.Murali krishna, Tirupati.108 Drugs act on* vomiting centre of medulla* CTZ ( Chemo-receptor Trigger Zone)* gastric mucosa* gag reflex
  • 109. Vomiting center30-May-13Dr.P.Murali krishna, Tirupati.109 It is located in the dorso-lateral border of the reticularformation of the medulla. It consists of1. N .tractus solitarius2. Parvicellular reticular formation3. Visceral & motor nuclei
  • 110. Vomiting center30-May-13Dr.P.Murali krishna, Tirupati.110Excitatory inputs from1. Nerve endings of vagal sensory fibers inthe GI tract2.Labyrinths via vestibular nuclei3.Higher centers in the cortex4.CTZ5.Intra cranial pressure receptors
  • 111. Chemo-receptor Trigger Zone30-May-13Dr.P.Murali krishna, Tirupati.1111. It is located in the area postrema on the ivventricle2. Blood brain barrier is poorly developed in CTZhence it is readily accessible to emeticsubstances in the general circulation
  • 112. Drugs acting on GIT30-May-13Dr.P.Murali krishna, Tirupati.112Activate entero chromaffin cells in the mucosa ofthe GIT causing the cells to secrete serotoninwhich acts on the 5 HT3 receptors at the nerveendings of the vagal sensory fibers.The afferent fibers transmit the excitation to the N.Tractus solitarius , which in turn activates thevomiting center
  • 113. Vamana karma - research30-May-13Dr.P.Murali krishna, Tirupati.113 Vomitus contains abundant muco polysaccharides Small quantities of sterco bilinogen Histamine also seen
  • 114. mucins30-May-13Dr.P.Murali krishna, Tirupati.114Mucins are very high molecular weight glycoproteins secreted by mucosae or some exo crineglands in to the lumen of the respiratorytract, gastro intestinal & reproductive tracts.Intestinal mucins are produced by Goblet cells &entero cytes
  • 115. VAMANAMECHANISM OF ACTION30-May-13Dr.P.Murali krishna, Tirupati.115Vamana karma occurs at three different levelsin this mechanism.A- Activation of emesis.B- Stimulation of vomiting centre.C- Actual motor response through motornerves.
  • 116. Activation of emesis.30-May-13Dr.P.Murali krishna, Tirupati.116 Vomiting starts in the stomach or upper GIT when it is fullof contents (Akanthapana during Vamana. It becomes overdistended and over excitable) Reflex from gastric mucosa. This excited stage stimulatesboth Sympathetics & Vagal afferents
  • 117. Stimulation of vomiting centre30-May-13Dr.P.Murali krishna, Tirupati.117 Central emesis- By stimulating the vomiting centresituated in Medulla Reflex emesis- irritation of the gastric mucosastimulates the Vomiting centre through Vagus andsympathetic pathwaysProbably both actions can be seen with thevamanoushadhi
  • 118. Contd…30-May-13Dr.P.Murali krishna, Tirupati.118 Vomiting is coordinated by the brain stem –effected by neuromuscular responses in thegut, pharynx and thoraco abdominal wall Somatic and visceral muscles – stereotypicresponses Inspiratory thoracic and abdominal wallmuscles contract – raised intra thoracic &intra abdominal pressure Larynx moves up, reduced gastric tone andperistalsis along with increased tone ofduodenum – conditions that inhibit gastricemptying, promote vomiting
  • 119. 30-May-13Dr.P.Murali krishna, Tirupati.119 Administration of certain drugs (which havevamaka prabhava) may stimulate chemoreceptortrigger zone - bilateral vomiting centre in themedulla. Emesis is provoked by several psychic stimuli orby noxious thoughts
  • 120. Actual motor response through motornerves30-May-13Dr.P.Murali krishna, Tirupati.120 Vagal and sympathetic afferents –bilateralvomiting centre (tractus solitarius near vagusnucleus) Automatic motor impulses – Transmitted by5,7,9,10,12th cranial nerves to upper GIT andthrough spinal nerves to diaphragm andabdominal muscles
  • 121. SEQUENTIAL ANALYSIS30-May-13Dr.P.Murali krishna, Tirupati.121 OUSHADA VEERYA ( SENSORY STIMULI- neuron or vascularpath) HRIDAYA ( SHIRAS - ? VOMITING CENTER) SAREERA DOSA VISYANDANA,SVEDA,LOMAHARSA,KUKSHISAMADMAPANA(PARASYMPATHETIC ACTION) HRILLASA, ASYA SRAVANA ( NAUSEA) UDANA ACTION VAMANA ( VOMITING )
  • 122. Pharmaco dynamics ofVamanLiquifidies thedoshas ortoxinsDoshas or toxins detachedfrom dhatus(Chedan BhedanDoshas or toxicmicrofined (Anupravanabhavat)Asajjannamiti –NakwachidapiSanghagachhatiAgni,VayuRomaharshaAdhmanaHrillasaA o rti c a rte ryP u lm o n ary ve in sL eft atriu mL eft co ro n a ry arte ryA n te rio rin te rve n tri cu la r a rte ryGre a t c a rd ia cvei nDe sc e n di ng a o rtaA n te rio rc ard ia c ve in sIn fe rio rven a c a vaRig h t ve ntri cl eRig h t c o ro n arya rte ryRig h t a triu mP u lm o n ary ve in sS u pe ri o rven a c a vaP u lm o n ary arte ryFatHEARTVyavahi vikasiAdministration of drug30-May-13Dr.P.Murali krishna, Tirupati.122
  • 123. Benefit of Vamana30-May-13Dr.P.Murali krishna, Tirupati.123 Efficacy is compared to the destruction of theleaves, fruit, flowers by severing the root of atree Also to the destruction of the budding paddyby drying the water
  • 124. 30-May-13Dr.P.Murali krishna, Tirupati.124