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Int J Ayu Pharm Chem REVIEW ARTICLE www.ijapc.com e-ISSN 2350-0204 Critical Analysis of Vamana (Emesis) in Respiratory Disorder - A Review Vandana1*, Alok Kumar Srivastava2, Manab Jyoti Sharma3, Rakhi Nautiyal4, Shalinee Seepal5

1,3Dept of Panchkarma, Rishikul campus, UAU, Haridwar, India

2 Dept of Panchkarma, UAU, Dehradun, Haridwar, India 4Dept of Dravya Gun, Rishikul campus, UAU, Haridwar, India 5Dept of Prasuti and Stri rog Rishikul campus, UAU, Haridwar, India ABSTRACT Respiratory disease threatens as emerging public health crisis like Asthma, COPD,

Bronchiectasis, Idiopathic pulmonary fibrosis and lung cancer affect in worldwide, causing widespread5Dept of Prasutitantra&StriRog, morbidity and mortality Rishikul campus, rate. 100 UAU, millions Haridwar of, Indiapopulation in the world suffer from chronic respiratory diseases. 4 million people die prematurely from respiratory diseases each year. In modern Broncho dilators, Corticosteroids, Anti-IgE Antibodies are mainly used but not get much relief. In Panchakarma is most important part of the treatments. It is curative promotive, preventive, and rehabilitative therapy. Vamana (Emesis) is a first, major and strenuous procedure of Panchkarma. Procedure of Vamana karma in which dosha (toxin) are completely removed by upper channels i.e. mouth especially the Kaphaand Pitta dosha brought to Amashaya (stomach) from all over the body. During aggravated kaphadosha, it is best treatment which clear the toxins from the Respiratory tract and GIT. Vamana is mainly indicated in allergic condition like Bronchial asthma, COPD, Rhinitis, sinusitis etc. Vamana karma not only detoxifies the body in normal condition and disease stage but also provides nutrition, functioning, elasticity of lung tissue & gives natural immunity of the body. Vamana act as anti- histamine activity to washout the existing histamine from the respiratory system so Vamana is first treatment choice in respiratory disease.

KEYWORDS Respiratory disease, Panchkarma, Vamana, Kaphadosha, Asthma, COPD

Greentree Group Publishers Received 03/10/19 Accepted 12/02/2020 Published 10/03/2020 ______

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INTRODUCTION possible route for expelling Kapha doshas In the present era Respiratory disease is a in the form of Vamana Karma. So the very commonest disease that affects, removal of vitiated Kapha dosha from humanity globally like Asthma, COPD, Amasaya is the best way to treat a disease. idiopathic pulmonary fibrosis and lung According to Charaka that means cancer causing widespread mortality and purification of upper part of the body but morbidity. It is increasing due to poor according to Sharangadhar & hygiene, excessive air pollution, Bhavaprakash the word Vamanais used to industrialization, urbanization. As per the removal of “Apakwa ( undigest) Kapha& WHO, asthma and COPD will becomes the Pitta” forcibly the outside. Vamana karma third leading cause of death in world. 100 is indicated for elimination of kapha dosha millions of people suffer from chronic not only in disease states but also in healthy respiratory diseases, 4 million people die individuals in different states where the prematurely from respiratory diseases each kapha dosha is aggravated within normal year in world. Vamana procedure not only limits e.g. in vasanta ritu is best for doing detoxifies the body in normal condition and vamana karma because in this season disease stage but also provides nutrition & kaphadosha is predominant and easily functioning, elasticity of lung tissue & expelled out. So for this reason vamana develops natural immunity of the body. karma is specially indicated in Kaphaja 2 Vamana Karma is the first, major strenuous disorders, where kapha is predominant . procedure of Panchakarma. Vamana Disease review Modern – In the U.S. Karma means to induce vomiting or to approximately 6.8 million emergency expel out the vitiated toxins through oral department visits for respiratory disorders route, which is indicated for the purification for patients under the age of 18 years 3. of upward part of the body. The contents of Approximately 1 in 7 individuals are the stomach including Kapha & Pitta are affected by some form of chronic lung expelled out of body through oral route by disease, and most common disease is this process1. The important place of Kapha COPD in UK 4. In India deaths of people dosha is urdhwabhaga (upward) & caused by the two most chronic respiratory amasaya (stomach). General principle to diseases is COPD and asthma 5. Common force out utklishta doshas from the nearby respiratory disease causes are allergies, route, whereas the oral route is the nearest weak immunity, climatic conditions,

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extreme air pollution, exposure to excess prolonged expiration, wheeze, dyspnoea, smoke and poisonous material, chemicals, prolonged expiration which affects the dust, and pollen, Genetic reasons, Poor PranavahaSrotas9,10. Vata moving in the development of the lungs before birth , reverse order diffuse the channels (of vital nutritional as well as social deficiency, breath), afflicts the neck and head, and infections. Symptoms are breathlessness, stimulates Kapha to cause Margavarodha chest pain, cough with sputum. Nasal (blockage of respiratory passage) by congestion, Sore throat, watery rhinorrhea, producing broncho constriction. Vamana exhaustion6. Diagnosis by complete history liquefied the thick-sticky bronchial taking, physical examination, blood test, secretion and help in expectoration Chest X-ray, pulmonary function test. In (Removal of SamaKapha dosha)11. Where modern treatment are given the pranavayu which comes out of the Bronchodilators, Corticosteroids, Mast cell mouth suddenly with expectoration and stabilizers and Anti-IgE Antibodies, produces a loud voice called as cough12. Leukotriene receptor antagonists 7 but may Peenasais a disease of kaphavata have side effects and treated prominent dosha and situated in symptomatically. urdhjatrugatabhag (upward part) Disease review Ayurveda – In Ayurveda characterized by Kshavathu, Nasasrava, medicine may help to decrease the Nasanaha, Shirogourava etc. Acharya recurrence of the disease and improve Sushrutaused the term Apeenasato immunity of the body and check the described Peenasa. The sign and symptoms symptoms naturally. Here an important role of Peenasacan be corelated with Sinusitis of immunity in pranhara srotas as and Vamana is indicated in Peenasa rog13. respiratory disorder. According to Acc.to Ayurveda Vamana in Respiratory Ayurveda pathogenesis of asthma is a result disorder as a chikitsa - of abnormal interaction between vata and • Shwas- Tamak swasa corelated with kapha dosha. Vitiated vata dosha due to bronchial asthma on the basis of sign and obstruction by Kapha starts to move in all symptoms & etiopathogenesis. directions and disturb the channels of Tama - Oppression of chest, which is Pranvaha Srotasa, Annavaha srotasa and similar to broncho constriction felt by Udakavaha Srotasa which produce patients of asthma. dyspnea8. Tamaka shwasa is a type of shwasa roga and characterized by cough, ______

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Tamak shwas chikitsa – All guna, it causes instant digestion and described vamana are indicated in tamak initiates the movement after softening. Here shwas. tiksna guna separates the ready to go sticky Chikitsa – dosās in the channels. After the detachment • Charaksutra52/04 of dosa and mala from subtle and gross • |Charakchikitsa71/98 channels, these malarupi dosa are ready to • |Yogaratnakar come in to maha srotas. A proper snehana • Astanghridyachikitsa.0 and swedana procedure is helpful in this Kaphakaas - phenomenon. Due to oleation therapy, It is corelated with Bronchitis. dosās will be not remaining in the Srotas. Chikitsa– All Acharyas said Vamana Properties of Vamana drugs assist specific indicated in kaphajkaas stages of Vamana karma. Suksma property • Charakchikitsa81/801 of medicine allows penetration into minute • Astanghridyachikitsa channels. Downward movement of dosās • ratnakar from suksma to maha srotas helps to come Kaphajpratisaya- into Amasaya. The pressure gradient It is corelated with allergic rhinitis. developed by Anu-pravanabava of Chikitsa –Vamanain Kaphaja prtisaya medicine between Suksmaand maha srotas • Sustra Utartantra81/24 helps to maintain a flow from channels. • Yogratnakar Nasa rog chikitsa Due to the specialty of Vamana drugs • Astanghridya.chi.54/73 and mahabhuta dominant these accumulated dosas and malasin the DISCUSSION stomach move in the upward direction and ĀcharyaChraka mentioned a deep gets expelled out, result Vamana karma. conceptual mechanism of vamanadescribed This procedure facilitating the function of in the first chapter of kalpasthāna said that, Udānavāyu. Vāyudosa is responsible for the drugs which are having Usna, tiksna, the movement of muscles involved in suksma, vyavāyī, vikāsīguna, by their own Vamana. Agni mahābhūta or Pitta dosa can vīrya enters in to the heart with the help of be correlated with hormone or chemical dhamani it enters in to both types of srotas, trans-mediators of muscles and cells. suksma and sthūla, After entering in to the Initiation of muscular contraction by Agni all channels of the body due to Agneya mahābhūta and Usnaguna, followed by Vāyumahābhūta makes a forcible ______

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contraction of diaphragmatic and inter- sphincter, results in forcible elimination of costal muscles. Vyavāyī and gastric content. Stretch reflex and psychic Vikāsigunamake Vamanain faster pace. stimuli are also the factors which initiate the Due to the action of these gunas, drugs used sense of vomiting 15. in Vamana karma do not undergo digestion. Action of Vamana in respiratory disease All the drugs which possess emetic effect • Respiratory disorders are can not be used for Vamana karma. The kaphapradhanvyadhiand main specialty of Vamanadrugs is treatment of aggravated kapha is Anupravanabāva, which is discussed Vamana. above. Due to this, drugs are not deposited • Urhapradesh is main seat of kapha in the cells therefore not causing any dosh and Vamana karma is the complication. The Vamana drug goes to the treatment for kaphadosh. body in minutes and returns quickly after • Vamana cause histamine dialysis to exerting their effect at the site of action 14. washout the existing histamine from the Mechanism of Vomiting - respiratory system and also stabilize the In the mechanism of Vomiting, different histamine production mechanism. receptors are activated depending on the Vamana karma also reduces tolerance to cause of vomiting or cause of nausea. For stimulants which reflect restoration of the example- airway responsiveness. A small amount of 1. Dopamine receptors in the chemotactic histamine is formed continiously in the trigger zone (CTZ) in the fourth ventricle gastric mucosa either in response to acid in are stimulated by metabolic or drug causes the stomach or for other reasons. Histamine of nausea. is a necessary ‘cofactor’ exciting the 2. On the second way, gastric irritation significant acid secretion16. stimulates histamine receptor in the PRECAUTION DURING VAMANA vomiting centre via vagus nerve. KARMA IN RESPIRATORY Vomiting is a highly integrated and DISORDERS – complex reflex involving both autonomic Vamana karma should be avoided in the and somatic neural pathway. Synchronous serious ill patients or having complicated contraction of diaphragm, inter costal medical disorder such Rheumatic heart muscles and abdominal muscles raising the disease this is very serious disease because abdominal pressure, combined with it directly causes pulmonary edema. relaxation of the lower esophageal ______

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Contraindication- Bleeding disorders like Vamana procedure not only detoxifies the Haemetemesis, haemoptysis, epistaxis. body in normal condition and disease stage Vamana is strenuous process then better but also provides nutrition and elasticity of written consent should be taken. Although lung tissue & develops natural immunity of procedure is safe ,if done it in a scientific the body. manner & by experienced Vaidya, but still considering complications like Cardio Pulmonary arrest or Haemoptysis or Haemetamesis or Dehydration 17. Negative points of Vamana karma - The difficulty in performing Vamana is that the dosage and the procedure described in the text cannot be understood or followed perfectly. Vamana is very Vigorous Shodhana procedure causes weakness, weight loss, Sandhibandha, decrease in the Agni due to expulsion of Kapha, Pitta, Vata and Mala18. Due to this reason patient cannot tolerate any exertion. Neurogenic shock, electrolyte imbalance is very common occurs during Vamana procedure.

CONCLUSION Vamana is best treatment for the aggravated kaphadosha, which dislodges the toxins mainly from the Respiratory and GIT. Vamana therapy has important role in treating respiratory disorders not only symptomatically but also to cure the disease from root. It is the frontline choice of the treatment of the respiratory disorders caused by the aggravation of kapha.

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