Changes

Drugs for emesis which are ''ushna'' (hot), ''tikshna'' (sharp/penetrating),''sukshma'' (subtle), ''vyavayi'' (pervading), and ''vikashi'' (loosening), by virtue of their own potency (''swa viryena''), reach the heart and circulate throughout the body through vessels. It liquefies the mass of impurities by its ''agneya'' nature (dominance of ''agni mahabhuta'') and due to ''tikshna guna''(penetrating property) separate the adhered ''doshas'' situated in gross and subtle channels of the entire body. Consequently the separated mass floating in the oleated body like honey kept in a fat smeared vessel reaches the stomach because of its nature to move through subtle channels (''anumarga sancharitwat'') and to flow towards gastrointestinal tract (''koshta gamanonmukhatwam''). Because of the predominance of ''agni'' and ''vayu mahabhutas'' in these drugs, their specific action (''prabhava'') to move upwards and ''udana vata'', the morbid matter gets expelled through the upward tract (mouth)<ref>Ram karan Sharma and Vaidya Bhagwan Dash, Caraka Samhita, Vol VI, Kalpasthana, Chap 1, shlok no.5, edition 2nd 2005,Chaukhamba Sanskrit Series Office, Varanasi, pp. 8,9</ref>.   

Drugs for emesis which are ''ushna'' (hot), ''tikshna'' (sharp/penetrating),''sukshma'' (subtle), ''vyavayi'' (pervading), and ''vikashi'' (loosening), by virtue of their own potency (''swa viryena''), reach the heart and circulate throughout the body through vessels. It liquefies the mass of impurities by its ''agneya'' nature (dominance of ''agni mahabhuta'') and due to ''tikshna guna''(penetrating property) separate the adhered ''doshas'' situated in gross and subtle channels of the entire body. Consequently the separated mass floating in the oleated body like honey kept in a fat smeared vessel reaches the stomach because of its nature to move through subtle channels (''anumarga sancharitwat'') and to flow towards gastrointestinal tract (''koshta gamanonmukhatwam''). Because of the predominance of ''agni'' and ''vayu mahabhutas'' in these drugs, their specific action (''prabhava'') to move upwards and ''udana vata'', the morbid matter gets expelled through the upward tract (mouth)<ref>Ram karan Sharma and Vaidya Bhagwan Dash, Caraka Samhita, Vol VI, Kalpasthana, Chap 1, shlok no.5, edition 2nd 2005,Chaukhamba Sanskrit Series Office, Varanasi, pp. 8,9</ref>.   

Vomiting is a complex process that consists of a pre-ejection phase (gastric relaxation and retro peristalsis), retching (rhythmic action of respiratory muscles preceding vomiting and consisting of contraction of abdominal and intercostals muscles and diaphragm against a closed glottis), and ejection (intense contraction of abdominal muscles and relaxation of the upper oesophageal sphincter). The process appeared to be coordinated by a central emesis centre in the lateral reticular formation of the mid brain-stem adjacent to both the chemoreceptor trigger zone (CTZ) in the area postrema at the bottom of the fourth ventricle and the solitary tract nucleus (STN). The lack of blood-brain barrier allows the CTZ to monitor blood and cerebrospinal fluid constantly for toxic substances and to relay information to the emesis centre to trigger nausea and vomiting. The emesis centre also receives information from the gut, principally by the vagus nerve (via the STN) but also by splanchnic afferents via the spinal cord. The CTZ has high concentrations of receptors for serotonin (5-HT3), dopamine (D2), and opioids; the STN is rich in receptors for enkephalin, histamine, and Ach, and also contains 5-HT3 receptors.In the emetic response fundus and body of stomach, eosophageal sphincter and esophagus relax, while duodenum and pyloric stomach contract in a retrograde manner. Rhythmic contractions of diaphragm and abdominal muscles then compress the stomach and evacuate its contents via mouth[4].

Vomiting is a complex process that consists of a pre-ejection phase (gastric relaxation and retro peristalsis), retching (rhythmic action of respiratory muscles preceding vomiting and consisting of contraction of abdominal and intercostals muscles and diaphragm against a closed glottis), and ejection (intense contraction of abdominal muscles and relaxation of the upper oesophageal sphincter). The process appeared to be coordinated by a central emesis centre in the lateral reticular formation of the mid brain-stem adjacent to both the chemoreceptor trigger zone (CTZ) in the area postrema at the bottom of the fourth ventricle and the solitary tract nucleus (STN). The lack of blood-brain barrier allows the CTZ to monitor blood and cerebrospinal fluid constantly for toxic substances and to relay information to the emesis centre to trigger nausea and vomiting. The emesis centre also receives information from the gut, principally by the vagus nerve (via the STN) but also by splanchnic afferents via the spinal cord. The CTZ has high concentrations of receptors for serotonin (5-HT3), dopamine (D2), and opioids; the STN is rich in receptors for enkephalin, histamine, and Ach, and also contains 5-HT3 receptors.In the emetic response fundus and body of stomach, eosophageal sphincter and esophagus relax, while duodenum and pyloric stomach contract in a retrograde manner. Rhythmic contractions of diaphragm and abdominal muscles then compress the stomach and evacuate its contents via mouth<ref>K D Tripathi, Essentials of Clinical Pharmacology, 6th edition, Jaypee Brothers Medical Publishers, 639.</ref>.

Administration of drugs in emetic or purgative therapies and rest of the [[Panchakarma]] procedures, complication arising out of their improper administration and their successful management dealt in [[Siddhi Sthana]] (section on successful administration of therapeutic measures) in detail. Indications and contraindications of emetic and purgative therapies are described by preceptor in [[Siddhi Sthana]] (Chap.2/8-13) [5]. Appearance of ''pitta'' at the end of emesis and ''kapha'' at the end of purgation though described under signs of proper elimination, Chakrapani opines that they may occur in inappropriate purification (''asamyakshudhhi''). Therefore additionally associated signs like emaciation (''karshya''), weakness (''daurbalya'') and lightness of the body (''laghavata'') only indicate appropriate purification.

Administration of drugs in emetic or purgative therapies and rest of the [[Panchakarma]] procedures, complication arising out of their improper administration and their successful management dealt in [[Siddhi Sthana]] (section on successful administration of therapeutic measures) in detail. Indications and contraindications of emetic and purgative therapies are described by preceptor in [[Siddhi Sthana]] (Chap.2/8-13) [5]. Appearance of ''pitta'' at the end of emesis and ''kapha'' at the end of purgation though described under signs of proper elimination, Chakrapani opines that they may occur in inappropriate purification (''asamyakshudhhi''). Therefore additionally associated signs like emaciation (''karshya''), weakness (''daurbalya'') and lightness of the body (''laghavata'') only indicate appropriate purification.