1.
Vamana karma-
concepts, application and
current research
Dr . P. Murali Krishna,
B.A.M.S (Gold medalist), M.D., Ph.D.
Reader (PG), Dept of Pancha karma
S.V. Ayurvedic college & Hospital,
Tirupati(AP). Email: mkparasar@yahoo.co.in

2.
Importance of Sodhana
30-May-13Dr.P.Murali krishna, Tirupati.2
-Ca.Su.16:20

3.
Pancha karmas(Bio-purification)
30-May-13Dr.P.Murali krishna, Tirupati.3
1. Vamana (therapeutic emesis)
2. Virecana (therapeutic purgation)
3. Asthapana vasti (enema with primarily
medicated decoctions)
4. Anuvasana vasti (enema with medicated oils)
5. Sirovirecana (nasal instillations)

4.
Importance of sodhana
30-May-13Dr.P.Murali krishna, Tirupati.4
Ca.Su.16:16-19

5.
Purification of Body
30-May-13Dr.P.Murali krishna, Tirupati.5
1. Trans membrane
2. Trans dermal

6.
Trans membrane
30-May-13Dr.P.Murali krishna, Tirupati.6
Sodhana

7.
Trans Dermal Purification
30-May-13Dr.P.Murali krishna, Tirupati.7
 Bahya sneha
 Sweda
 Special treatments of Kerala

8.
Introduction
30-May-13Dr.P.Murali krishna, Tirupati.8
Panchakarma- Five therapies, sodhana in nature
Vamana & Virecana- Constitute first two
karmas: Urdhva & Adho sodhana respectively

9.
Vaman-Nirukthi
30-May-13Dr.P.Murali krishna, Tirupati.9
 Vam- Udgare, Yak-set
 Conveying the meaning,
 Marddane
 Charddane
 Nissarane
 Sarvanga abhishyanda

10.
Definition
30-May-13Dr.P.Murali krishna, Tirupati.10
Sa.Pu.Kh 4/
Ch. Ka.1/

11.
Contd………
30-May-13Dr.P.Murali krishna, Tirupati.11
Vamana- expulsion of doshas from the upper route
Virecana- expulsion of the doshas from the lower
route
As they expel malas from the body,
both are called Virecana

12.
Vamana
30-May-13Dr.P.Murali krishna, Tirupati.12
First Panchakarma Procedure Advised
in Human being
Su.Sa.10 & Ca.Sa.8

13.
Samyak Prayoga is the secret of
success
30-May-13Dr.P.Murali krishna, Tirupati.13
1. Selection of the patient
2. Examination of the patient
3. Collection of material required
3. Selection of drugs
4. Selection of Mathra(Dose)
5. Vamana vidhi (procedure)
Poorva karma (Praparatory)
Pradhana Karma(prime treatment)
Paschat karma (post treatment
measures)
6. Observation of the patient
Ch. Su-
15:4

14.
Yogya & Ayogya vicaran
30-May-13Dr.P.Murali krishna, Tirupati.14
1. Vaman yogya (Inclusion criteria) patient should
be selected.
2. Vamana Ayogya (Exclusion Criteria) Patient
Should be Excluded

15.
Vamana - Indications
30-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 indications
30-May-13Dr.P.Murali krishna, Tirupati.16
A.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)
 Adhogata
raktapitta(Anal
Urethro,vaginal
haemorrhages)
 Rajayakshma
 Kushta(skin diseases)
 Prameha
 Apachi
 Granthi
 Sleepada(filariasis)
 Unmada(insanity)
 Kasa(cough)
 Swasa(Asthma)
 Hrillasa(nausea)
 Visarpa
 Sthanya dosa(lactation
disorders)
 Urdhwajatrugata
rogas(diseases of head
& neck)

19.
Indications of vamana karma
30-May-13Dr.P.Murali krishna, Tirupati.19
 Respiratory
 Digestive
 Skin
 miscellaneus

20.
Respiratory
30-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.
DIGESTIVE
30-May-13Dr.P.Murali krishna, Tirupati.21
 Mandagni (dyspepsia)
 Vidagdajeerna (APD)
 Visucika
 Alasaka (gastro enteritis)
 Adhoga raktapitta (bleeding diathesis from lower
orifices)
 Aruci (anorexea)
 Atisara (diarrhoea)
 Hrillasa ( nausea)
 Mukha praseka ( water brash)
 Kaphaja arsas ( piles)

22.
Skin diseases
30-May-13Dr.P.Murali krishna, Tirupati.22
 Kitibha (psoriasis)
 Ekakushta
 Vicaricika ( Ch.Dermatitis)
 Kandu (pruritus)
 Vidradhi (abscess)
 Apachi (Cold abscess)

23.
miscellaneus
30-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-Contraindications
30-May-13Dr.P.Murali krishna, Tirupati.24
 By nature:
pregnant, sukumara, rooksha, kshudhita, shokart
a, krisha, bala, vriddha, durbala
 Diseased conditions like:
Vataprakopa- Udavarta, Gulma, Vatavyadhi
Marmaja vyadhi- Hridroga, Mutragata, Timira
Maharoga- Arsas, Udara

25.
EXCLUDING CONDITIONS
30-May-13Dr.P.Murali krishna, Tirupati.25
 Cardiac problems like CAD, CHF & congenital
heart diseases
 Ascitis & Cirrhosis of liver
 Pleurisy
 Spleenomegaly
 Chronic diabetic with complications
 Hypertension
 very weak patients
 Cancer

26.
Contra indications of Vaman
30-May-13Dr.P.Murali krishna, Tirupati.26
A.Hr.Su.18:3-5

27.
Vaman Ayogya
30-May-13Dr.P.Murali krishna, Tirupati.27
Ca.Si.8:
8

28.
Contra indications of vamana
30-May-13Dr.P.Murali krishna, Tirupati.28
 Children & Old aged
 Pregnant women
 Emaciated
 Durbala (weak)
 Asthapita/ Anuvasita
(after vasti)
 Pipasita/kshudita/upa
vasita
 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 use
30-May-13Dr.P.Murali krishna, Tirupati.29
Ca.Si.2:2
7

30.
Views of classics on use of Vaman in
Hridroga
30-May-13Dr.P.Murali krishna, Tirupati.30
 Caraka contra indicated vaman but left to
the discretion of physician(Ca.Si.2:24-27)
 Susruta & Vagbhata advocates vaman
karma in all three hridrogas

31.
Classification
30-May-13Dr.P.Murali krishna, Tirupati.31
 Sadyovamana.
 Snehapurvaka vamana
Mridu vamana
Madhyama vamana
Tiksna vamana

32.
Examination of the patient
30-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 profile
c) SGPT, SGOT d) Blood urea &
creatinine
d) CT, BT f) Haemogram
g) Urine exam h) Stool exam
i) 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 drugs
30-May-13Dr.P.Murali krishna, Tirupati.34

35.
Vamana dravya
They can be classified as vamaka and vamanopaga
Vamanopaga
30-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 are
used in all yogas- Kaphavilayana & Chedana
 According to dosa
Kapha- Katu, Tiksna, Usna
Pittayukta- Madhura
Vatayukta- Amla, Sasneha

37.
Quality of Vamana Dravyas
30-May-13Dr.P.Murali krishna, Tirupati.37
Su.Ci.33:
7
Asatmya (unsuitable)
Beebhatsa (aversive)
Durgandha (unpleasant
smell) smelling)
Durdarsana (Ugly looking)

38.
Qualities of Vamana dravya
30-May-13Dr.P.Murali krishna, Tirupati.38
 Usna
 Tiksna
 Suksma
 Vyavayi
 Vikasi
 Sthula, Anu, sroto gatatwa
 Vishyandana, Vicchindana
Ca.Ka.1 : 5

39.
Contd…
30-May-13Dr.P.Murali krishna, Tirupati.39
In Caraka Samhita, 355 vamaka yogas and 6
vamaka 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 Madanaphala
30-May-13Dr.P.Murali krishna, Tirupati.40
Fruits of Randia dumetorum

41.
Madana phala(Randia dumetorum
•Administered in antarnakha musti
pramana
•It contains oleanolic acid3-/3-
glucoside
•It acts on GIT and CTZ
•It is the drug of choice for
asthapana vasti also
30-May-13Dr.P.Murali krishna, Tirupati.41

42.
Ca.Ka.1:13
30-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 - Matranirnaya
30-May-13Dr.P.Murali krishna, Tirupati.49
 Varies according to vyadhibala, agnibala, kosta and
rogibala (Susruta)
 Madana pippali- Antarnakha Mushti or suitably
(Caraka)

50.
Dose of vamana dravya
30-May-13Dr.P.Murali krishna, Tirupati.50
Uttama Madhyama & Kaneeyasi Matra for
Kwata-9, 6 & 3prastha
Churna, Kalka-3,2 & 1 pala
Sa . U. 3 : 14

51.
Vamana kala
30-May-13Dr.P.Murali krishna, Tirupati.51
 In Sadharana kala, preferably Vasanta
 In other seasons with artificially altering the
atmosphere, if necessary
[Atyayike punah karmani kamamritum vikalpya
kritrimagunopadhanena…]
(Caraka)
 In an auspicious day and time
 In the morning, after proper digestion of previous
day’s food

52.
Procedure of Vamana Karma
30-May-13Dr.P.Murali krishna, Tirupati.52
1. Purva karma
2. Pradhana karma
3. Pascat karma

53.
Vamana - purvakarma
30-May-13Dr.P.Murali krishna, Tirupati.53
 Snehan- done for 3-7 days till samyak
snigdata is attained
 Swedan- in 2 days gap following snehan
(Vagbhata)
1 day gap after snehapana (others)
 Kaphotklesa kara ahara-
Dadhi, Matsya, Masa - on the previous
day of vamana

54.
30-May-13Dr.P.Murali krishna, Tirupati.54
A.H.Su.16:36-37

55.
Vamana- pradhanakarma
30-May-13Dr.P.Murali krishna, Tirupati.55
 Akantapana- Usually milk, sugarcane juice
etc. are given. But, can be done without it after
intake of yavagu added with ghrita
 Suitable yoga- usually a combination of
vamaka and vamanopaga dravyas is taken
Madanaphala - 3-12 g
Vaca - 5-8 g
Yashtimadhu - 7.5 g
Saindhava - 15 g
Madhu - Q.S.

56.
Contd…
30-May-13Dr.P.Murali krishna, Tirupati.56
 After bath, patient sits on a comfortable
chair of knee-height
 Suitable dravadrayas are given for
akantapana
 Vamanousadhi is given after prayer
 Wait till 1 muhurta, expecting vegas

57.
30-May-13Dr.P.Murali krishna, Tirupati.57
A. H. Su.18

58.
Contd…..
30-May-13Dr.P.Murali krishna, Tirupati.58
A.H.Su.18:12-15

59.
Arundatta Kosta classification
30-May-13Dr.P.Murali krishna, Tirupati.59
 Arundatta - three special type of Kostha in
relation 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 dosas
Romaharsa- dislodging from their seat
Adhmana- reaching kuksi
Hridayopamarda, hrillasa, asyasamsravana -
upward movement

61.
30-May-13Dr.P.Murali krishna, Tirupati.61
Ca.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 pratiloma
gati (upward direction)
 If vegas do not occur spontaneously, ask the
patient to stimulate vomiting with
fingers, Erandanala etc.

63.
30-May-13Dr.P.Murali krishna, Tirupati.63
A.H.Su.18:19-20

64.
Vamana
30-May-13Dr.P.Murali krishna, Tirupati.64

65.
vamana
30-May-13Dr.P.Murali krishna, Tirupati.65

66.
vamana
30-May-13Dr.P.Murali krishna, Tirupati.66

67.
Causes of Ayoga and Atiyoga
30-May-13Dr.P.Murali krishna, Tirupati.67
 Improper snehana i.e. internal oelation as
well as external application of snehana.
 Improper swedana.
 Insufficient kaphotklesana
 Selection of improper drug and dose , old
and less potency drug .
 Krura or Mridu Kostha.
 Tikshna or Mandagni.
 Strong body or weak body.
 Predominance of Ama.

68.
Vamana - ayoga laksana
30-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, Se
etajwara etc.

70.
Management of Hinayoga
30-May-13Dr.P.Murali krishna, Tirupati.70
Heenavega- Pippali, Amalaki, Sarsapa,
Lavanayukta Usnodaka given repeatedly

71.
Vamana - samyak yoga
30-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 Suddhi
30-May-13Dr.P.Murali krishna, Tirupati.73
Assessment- 4 types
Vaigiki- 4,6,8
Antiki- pittanta
Maniki- 1, 1 &1/2, 2 prastha
Laingiki- sarva, madhya, alpa laksana

74.
Laingiki Suddhi
30-May-13Dr.P.Murali krishna, Tirupati.74
Elimination of Kapha, Pitta & Vata
respectively
Hridaya Shuddhi
Parsva Shuddhi
Murdha Shuddhi
Srotas 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.76
Ca.Si.1:16
Ca.Si.1:17

77.
Vamana - atiyoga lakshana
30-May-13Dr.P.Murali krishna, Tirupati.77
A.H.Su.18:26
Ca.Si.1:17

78.
Atiyoga lakshana
30-May-13Dr.P.Murali krishna, Tirupati.78
 Phenila raktachandrikodgamana
 Swarakshaya, Daha, Kantasosha, Bhrama, Murcha, Si
rahsula, Balahani, Agnihani
 Jeevashonita pravritti and marana may occur

79.
Vamana-pascat karma
30-May-13Dr.P.Murali krishna, Tirupati. 79
A.H.Su.18:27-28
Ca.Su.15:14

80.
Pascat karma
30-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 krama
30-May-13Dr.P.Murali krishna, Tirupati.81

82.
samsarjana
30-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 dosa
sodhana, gradually

83.
30-May-13Dr.P.Murali krishna, Tirupati.83
Ca.Su.15:16

84.
Peyadi krama
30-May-13Dr.P.Murali krishna, Tirupati.84
Following things are given for 3,2,1 annakalas in
pravara, madhyama, avara sodhana respectively:
Peya
Vilepi
Akrita yusa
Krita yusa
Akrita mamsarasa
Krita mamsarasa

85.
Samsarjana kram
diet Pravara madhyama avara
peya 3 2 1
vilepi 3 2 1
Akrita yusha 1 1 1
Krita yusha 2 1
Akrita mamsa rasa 1 1 1
4
Krita mansa ras 1
12
1
8
30-May-13Dr.P.Murali krishna, Tirupati.85

86.
Samsarjana krama
•Peya:-easily digestible carbohydrate in liquid form
•Vilepi:- easily digestible carbohydrate in semisolid
form
•Akritha Yusha:- easily digestible plant protein in
semisolid form
•Kritha yusha :- easily digestible plant protein with
saturated fat in semisolid form
•Akritha mamsa rasa:- animal protein
•Kritha mamsa rasa:- animal protein with saturated
fatty acids
30-May-13Dr.P.Murali krishna, Tirupati.86

87.
Effects of Samsarjana krama
•Restores the physiology of digestion
•Restores mucosal barrier
•Habituates the three important nutrients
viz.carbohydrates, proteins and fats in an
order
30-May-13Dr.P.Murali krishna, Tirupati.87

88.
Tarpanadi krama
30-May-13Dr.P.Murali krishna, Tirupati.88
A. H.18

89.
Tarpana indications
30-May-13Dr.P.Murali krishna, Tirupati.89
 Indicated in alpa sodhana of pitta & kapha,
madyapa and in vatapitta pradhanya
 Peya- svaccha tarpana
Vilepi- ghana tarpana (Chakrapani)
1. annakala: lajasaktu
2. annakala: jeerna salyodana
3. annakala: mamsarasa (Arunadatta)

90.
Things to do After the samyak
Vamana
30-May-13Dr.P.Murali krishna, Tirupati.90
Ca.Su.15:15

91.
Observation of the patient
30-May-13Dr.P.Murali krishna, Tirupati.91

92.
Vaman vyapath
Ca.Si.6:29-30
30-May-13Dr.P.Murali krishna, Tirupati.92

93.
Vyapath –Susruta quotes
30-May-13Dr.P.Murali krishna, Tirupati.93
Su.Ci.34:3

94.
Vyapath
30-May-13Dr.P.Murali krishna, Tirupati.94
 Adhmana(Bloating)
 Kanta karsanam
 Srava
 Hrithgraha
 Gatragraha
 Jeevadana
 Vibhramsam
 Sthambha
 Upadrava
 Klama

95.
Common vyapaths & Management
30-May-13Dr.P.Murali krishna, Tirupati.95
 Bloody streaks along with bouts – Lajatarpana
with sita
 Feeble pulse, giddiness, collapse-
Sidhamakaradhwajam with honey and betel juice
 Exhaustion- Laja, ksheera, Manda, tender
coconut water.

96.
Vamana kalpa in different disease
30-May-13Dr.P.Murali krishna, Tirupati.96
 Jwara-
Thathrotklishte samuthklishte kaphapraye
chale male
Sahrillasa praseka annadwesha kasa
vishucike
Sadyo bhuktasya sanjathe jware same
viseshatha
Vamanam vamanarhasya

97.
Contd…….
30-May-13Dr.P.Murali krishna, Tirupati.97
 Uthklishta doshas are present in amasaya
 Sneha-sweda not required or done in little
intensity
 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 provokes
nocturnal attacks are avoided
 Yoga- Pippali, Saindhava & Kshoudram- vata
avirodhi

99.
Kushtam
30-May-13Dr.P.Murali krishna, Tirupati.99
 Done in uthklishta doshavastha and in
urdhwadehasrita kushta
 Yoga- Kutaja, Madana, Yashti
Patola, nimba kasaya

100.
Vaman in Ayurveda
30-May-13Dr.P.Murali krishna, Tirupati.100
Usna, Tiksna, Suksma, Vyavayi, Vikasi
oushadhi reach Hridaya by their veerya
moves through dhamanis into sarvashareera
Oushnya- vishyandana of doshasanghata
Taikshnya- vicchindana of doshasanghata
Reach amashaya & propelled out by Udana vayu
due to Agni, Vayubhoota & oordhvabhaga
prabhava

101.
30-May-13Dr.P.Murali krishna, Tirupati.101
Ca.Ka. 1:5

102.
Physiology of vomiting
30-May-13Dr.P.Murali krishna, Tirupati.102
Vomiting is produced by a series of co-ordinate
changes in GI activity and respiratory movements.
Salivation-sharp and deep inspiration-increase
in intra-abdominal pressure-contraction of
abdominal muscles-closure of epiglottis and
soft palate-forcible contraction of stomach
pylorus-relaxation of fundus,cardiac
sphincter and esophagus.

103.
30-May-13Dr.P.Murali krishna, Tirupati.103

104.
VOMITING
PATHWAYS
Ipecac syrup 30-May-13Dr.P.Murali krishna, Tirupati.104

105.
The Physiology of Vomiting
30-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 these
regions in different ways

106.
Causes of Nausea and Vomiting: Motion
Sickness
30-May-13Dr.P.Murali krishna, Tirupati.106
The visual and vestibular systems send mixed messages to
the VC, inducing the vomiting reflex
VC
Vomiting Reflex
visual
input
vestibular
input
(balance)

107.
Mechanisms of Chemotherapy-induced
nausea and vomiting (CINV)
30-May-13Dr.P.Murali krishna, Tirupati.107
 Central mechanism
 Chemotherapeutic agent activates the
chemoreceptor trigger zone (CTZ)
 Activated CTZ invokes release of various
neurotransmitters, which stimulate vomiting center
 Peripheral mechanism
 Chemotherapeutic agent causes irritation and
damage to gastrointestinal (GI) mucosa, resulting in
the release of neurotransmitters
 Activated receptors send signals to vomiting center
via vagal afferents
Berger AM et al. In: Cancer: Principles and Practice of Oncology. 6th ed.
Lippincott Williams & Wilkins; 2001:2869–2880.

108.
Vamana karma
30-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 center
30-May-13Dr.P.Murali krishna, Tirupati.109
 It is located in the dorso-lateral border of the reticular
formation of the medulla.
 It consists of
1. N .tractus solitarius
2. Parvicellular reticular formation
3. Visceral & motor nuclei

110.
Vomiting center
30-May-13Dr.P.Murali krishna, Tirupati.110
Excitatory inputs from
1. Nerve endings of vagal sensory fibers in
the GI tract
2.Labyrinths via vestibular nuclei
3.Higher centers in the cortex
4.CTZ
5.Intra cranial pressure receptors

111.
Chemo-receptor Trigger Zone
30-May-13Dr.P.Murali krishna, Tirupati.111
1. It is located in the area postrema on the iv
ventricle
2. Blood brain barrier is poorly developed in CTZ
hence it is readily accessible to emetic
substances in the general circulation

112.
Drugs acting on GIT
30-May-13Dr.P.Murali krishna, Tirupati.112
Activate entero chromaffin cells in the mucosa of
the GIT causing the cells to secrete serotonin
which acts on the 5 HT3 receptors at the nerve
endings of the vagal sensory fibers.
The afferent fibers transmit the excitation to the N.
Tractus solitarius , which in turn activates the
vomiting center

113.
Vamana karma - research
30-May-13Dr.P.Murali krishna, Tirupati.113
 Vomitus contains abundant muco poly
saccharides
 Small quantities of sterco bilinogen
 Histamine also seen

114.
mucins
30-May-13Dr.P.Murali krishna, Tirupati.114
Mucins are very high molecular weight glyco
proteins secreted by mucosae or some exo crine
glands in to the lumen of the respiratory
tract, gastro intestinal & reproductive tracts.
Intestinal mucins are produced by Goblet cells &
entero cytes

115.
VAMANA
MECHANISM OF ACTION
30-May-13Dr.P.Murali krishna, Tirupati.115
Vamana karma occurs at three different levels
in this mechanism.
A- Activation of emesis.
B- Stimulation of vomiting centre.
C- Actual motor response through motor
nerves.

116.
Activation of emesis.
30-May-13Dr.P.Murali krishna, Tirupati.116
 Vomiting starts in the stomach or upper GIT when it is full
of contents (Akanthapana during Vamana. It becomes over
distended and over excitable)
 Reflex from gastric mucosa. This excited stage stimulates
both Sympathetics & Vagal afferents

117.
Stimulation of vomiting centre
30-May-13Dr.P.Murali krishna, Tirupati.117
 Central emesis- By stimulating the vomiting centre
situated in Medulla
 Reflex emesis- irritation of the gastric mucosa
stimulates the Vomiting centre through Vagus and
sympathetic pathways
Probably both actions can be seen with the
vamanoushadhi

118.
Contd…
30-May-13Dr.P.Murali krishna, Tirupati.118
 Vomiting is coordinated by the brain stem –
effected by neuromuscular responses in the
gut, pharynx and thoraco abdominal wall
 Somatic and visceral muscles – stereotypic
responses
 Inspiratory thoracic and abdominal wall
muscles contract – raised intra thoracic &
intra abdominal pressure
 Larynx moves up, reduced gastric tone and
peristalsis along with increased tone of
duodenum – conditions that inhibit gastric
emptying, promote vomiting

119.
30-May-13Dr.P.Murali krishna, Tirupati.119
 Administration of certain drugs (which have
vamaka prabhava) may stimulate chemoreceptor
trigger zone - bilateral vomiting centre in the
medulla.
 Emesis is provoked by several psychic stimuli or
by noxious thoughts

120.
Actual motor response through motor
nerves
30-May-13Dr.P.Murali krishna, Tirupati.120
 Vagal and sympathetic afferents –bilateral
vomiting centre (tractus solitarius near vagus
nucleus)
 Automatic motor impulses – Transmitted by
5,7,9,10,12th cranial nerves to upper GIT and
through spinal nerves to diaphragm and
abdominal muscles

121.
SEQUENTIAL ANALYSIS
30-May-13Dr.P.Murali krishna, Tirupati.121
 OUSHADA
 VEERYA ( SENSORY STIMULI- neuron or vascular
path)
 HRIDAYA ( SHIRAS - ? VOMITING CENTER)
 SAREERA DOSA VISYANDANA
,SVEDA,LOMAHARSA,KUKSHISAMADMAPANA
(PARASYMPATHETIC ACTION)
 HRILLASA, ASYA SRAVANA ( NAUSEA)
 UDANA ACTION
 VAMANA ( VOMITING )

122.
Pharmaco dynamics of
Vaman
Liquifidies the
doshas or
toxins
Doshas or toxins detached
from dhatus
(Chedan Bhedan
Doshas or toxic
microfined (Anupravana
bhavat)
Asajjannamiti –
Nakwachidapi
Sanghagachhati
Agni,Vayu
Roma
harshaAdhmana
Hrillasa
A o rti c a rte ry
P u lm o n ary ve in s
L eft atriu m
L eft co ro n a ry arte ry
A n te rio r
in te rve n tri cu la r a rte ry
Gre a t c a rd ia c
vei n
De sc e n di ng a o rta
A n te rio r
c ard ia c ve in s
In fe rio r
ven a c a va
Rig h t ve ntri cl e
Rig h t c o ro n ary
a rte ry
Rig h t a triu m
P u lm o n ary ve in s
S u pe ri o r
ven a c a va
P u lm o n ary arte ry
Fat
HEART
Vyavahi vikasiAdministration of drug
30-May-13Dr.P.Murali krishna, Tirupati.122

123.
Benefit of Vamana
30-May-13Dr.P.Murali krishna, Tirupati.123
 Efficacy is compared to the destruction of the
leaves, fruit, flowers by severing the root of a
tree
 Also to the destruction of the budding paddy
by drying the water

124.
30-May-13Dr.P.Murali krishna, Tirupati.124