Article

Induced vomiting: A therapeutic option

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Abstract

Vomiting, the basic protective reflexes against ingested toxins, or result from underlying diseases such as inevitable medication side effect or anatomic obstruction, however, in some situations, induced vomiting may be a therapeutic option as reported in bulimia nervosa as a weight control measure. Besides that, many types of researches demonstrate that induced vomiting for treating disease does not have serious negative effects. To well understand the therapeutic effect of induced vomiting, the paper firstly describe the anatomy of brain structures containing the vomiting reflex, including chemoreceptor trigger zone, vomiting center and the specific signal deliver process. Moreover, cardiovascular and respiratory functions changes are essential to the generation of vomiting. Furthermore, the brain-gut connections may play an important role in the vomiting reflex, its bidirectional interaction can be perturbed leading to acute physiological repercussions. In addition to that, vagal afferent activation is also indispensable. Effect of emesis can achieve via vagal fibers in variable methods. Additionally, induced vomiting can change the gastrointestinal homeostasis as well which lead to a recovery of the stomach’s function. Finally, this work will briefly illustrate the procedure of induced vomiting, as well as the side effects of induced vomiting and the corresponding control strategies. According to the known acknowledge about the induced vomiting as mentioned above, we draw a conclusion that induced vomiting may be a therapeutic option.

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... It receives inputs from the GI tract, vestibular system, CTZ, and higher cortical centers (Willems et al., 1986). Once activated, the VC coordinates the physical act of vomiting by sending signals to muscles in the GI tract, diaphragm, and abdominal wall (Chai et al., 2016). During emesis, the abdominal muscles undergo a retrograde contraction while the lower esophageal sphincter relaxes, facilitating the expulsion of stomach contents through the oral cavity and inducing retching. ...
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Emesis, or vomiting, is a reflex involving the forceful expulsion of stomach contents, often triggered by various physiological and psychological factors. The current study was conducted to evaluate the antiemetic properties of ascorbic acid (AA) using both in vivo and in silico approaches. In this study, emesis was triggered in chicks by administering copper sulfate pentahydrate (CuSO 4 ⋅5H 2 O) orally. AA was given orally at 25, 50 and 100 mg/kg and compared with reference drugs domperidone (7 mg/kg), ondansetron (5 mg/kg), and with a vehicle negative control. We also performed in silico study to investigate the potential interactions of AA with D2 and 5HT 3 receptors and assess its toxicity. Results showed that AA, particularly at 100 mg/kg, significantly delayed the onset of retching (73.75 ± 8.13 seconds) and reduced retch frequency (15.00 ± 3.36 times) over a 10 min period, with enhanced efficacy when combined with standard antiemetics. Docking studies revealed favorable binding affinity (− 5.3 and − 5.4 kcal/mol, respectively) and greater hydrogen bond (HB) interactions between AA and both receptors, suggesting a dual antagonistic mechanism. Also displayed favorable toxicological profile. This study underscores the potential of AA as an effective and safe antiemetic agent, warranting further investigation into its therapeutic application.
... Emesis is a physiological protective mechanism that helps to remove ingested noxious or harmful material from the gastrointestinal tract. 1 In dogs, induced emesis is often the first step of decontamination after the ingestion of potentially toxic substances or foreign objects. [2][3][4][5][6] The systemic absorption of toxic substances can be markedly reduced with timely use of appropriate emetics. ...
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Objective To study the safety and effectiveness of consecutively administered ropinirole and apomorphine (both dopamine 2‐like receptor agonists) for emesis induction in dogs. Design Prospective, crossover study design. Setting Institutional animal research facility. Animals Six healthy male purpose‐bred Beagle dogs. Interventions Each dog received 4 treatments: (1) apomorphine infusion (21 μg/kg) over 30 minutes + ropinirole eye drops (3.75 mg/m²); (2) ropinirole infusion (108 μg/m²) over 30 minutes + apomorphine SC (100 μg/kg); (3) apomorphine SC (100 μg/kg) + ropinirole eye drops (7.5 mg/m²) after 30 minutes; and (4) ropinirole eye drops (7.5 mg/m²) + apomorphine SC (100 μg/kg) after 30 minutes. Infusions were administered via a catheter instrumented in the cephalic vein. Eye drops and SC injections were administered as described in the product inserts. Blood samples were taken for ropinirole and apomorphine concentration analysis before dosing and periodically following administrations. The washout period between the treatments was 5–7 days. Measurements and Main Results Number of vomits and clinical signs were recorded. Alertness and heart rate were monitored in conjunction with blood sampling. The average number of vomits varied between 4.3 and 8.8 (range 1–16) following treatments. Signs of nausea, vomiting, and lethargy were seen in all individuals without significant differences between treatments. Moderate to marked, transient increase in heart rates was detected in all treatments. Infrequent noted side effects included ocular hyperemia, blepharospasms, and muscle tremors. Prior treatment with apomorphine significantly decreased the absorption of ropinirole eye drops. Conclusions The safety and efficacy profiles of this experimental study support that ropinirole and apomorphine could be administered consecutively in cases where the treatment using 1 substance has resulted in an incomplete evacuation of the stomach contents, and the attending veterinarian considers the use of a different agent to have benefits that outweigh the risks.
... In the modern biomedical approach, emesis sits on a subtle border between being considered either a problem or a solution: gastric lavage, for example, is used only in cases of severe and acute poisoning, and neither as a prevention tool, nor as a "cure" for chronic poisoning. It is noteworthy to mention, however, the role of emesis as a key protective reflex of the body which involves multiple systems, including the respiratory, gastrointestinal, and abdominal muscles, and which can serve as a potential therapeutic option (Chai et al., 2016). ...
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i>Aristolochia didyma (Yawar Panga) and other Aristolochia species are used as traditional herbal remedies with potent emetic properties. Scientific data for such Yawar Panga species, however, are scarce in the literature. The aim of this study was to describe the use of Yawar Panga within the context of the therapeutic community Takiwasi, in which the plant is used as part of the protocol for the rehabilitation of individuals with drug addiction. Fieldwork with experts in the administration of Yawar Panga at Takiwasi Center, as well as a retrospective qualitative analysis of experiences with this plant remedy in a residential inpatient population were performed. In-silico analysis of the main constituents of A. didyma as represented in the literature was completed in order to identify its putative pharmacological targets. The therapists interviewed consider Yawar Panga to be the most potent purga at Takiwasi and consider it especially useful in attenuating addiction withdrawal syndrome. From the patient’s perspective, this plant induces strong physical effects, and commonly precipitates effects in the oneiric and emotional dimensions. GABA B seems to be the receptor involved in the emesis induced by the phytochemicals contained in this plant species. Despite some relevant concerns related to the safety of the genus Aristolochia in modern western pharmacopoeias, some species, including A. didyma , are routinely used in the context of traditional herbal medicine in the Peruvian Amazon. Further phyto-pharmacological investigations would be helpful to elaborate this species’ medical utility, especially within the context of addiction treatment.
... Por lo tanto, se puede afirmar que la emesis y la purga se encuentran en una frontera sutil entre ser consideradas problemas o soluciones. En este sentido, es de notable interés mencionar cómo la emesis es un reflejo protector clave, que involucra múltiples sistemas del cuerpo humano, incluidos los músculos respiratorios, gastrointestinales y abdominales, y hay estudios que muestran que también sirve como una posible opción terapéutica, especialmente frente a la ingestión de toxinas alimentarias y el ataque de migraña [19]. Por otro lado, la misma práctica de vomitar, como mencionado anteriormente, es un aspecto importante de la medicina tradicional amazónica, donde las plantas eméticas se utilizan con fines depurativos no solo para restaurar la salud sino también para mantenerla. ...
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En varias cosmologías indígenas de América del Sur, el origen de la enfermedad es reconducido a la acción de espíritus dañinos o a la presencia de objetos o espíritus en el cuerpo de la persona. El vómito sirve entonces para evacuar a las entidades intrusas, librando el cuerpo de la enfermedad. Además, este proceso de limpieza es necesario para limpiar las interferencias inducidas por “malas energías” y así poder establecer un contacto con los espíritus vegetales que son aliados en la curación. La noción de purificación del cuerpo es central y condiciona las buenas relaciones con el mundo invisible y los no-humanos. Se observa entonces que el uso de la ayahuasca como purga no es limitado a fines curativos. Los cazadores indígenas, por ejemplo, pueden usar plantas eméticas como la misma ayahuasca para limpiarse de los malos espíritus en su cuerpo y, a través de los efectos psicoactivos, pueden visitar el mundo espiritual para negociar con los animales del bosque que la caza sea exitosa.
... The contemporary understanding of neural structures and circuits involved in this response proceeds from pioneering studies of Borison and Wang in the 1940s and 1950s [18][19][20][21]. Currently, four known sensory pathways induce vomiting and nausea [22][23][24][25][26][27][28][29]. These four routes are afferent signals which come from outside stimuli indicating the brain what they are sensing, and they are extended to the nucleus of the solitary tract (Nucleus Tractus Solitarii, NTS) through (1) caudal rhombencephalon in GI vagal afferent fibers, (2) area postrema, (3) vestibular nuclei, (4) and forebrain, as shown in Fig. (1) [30,31]. ...
Article
An important group of anti-emetic drugs used in the treatment of nausea and vomiting after chemotherapy contains an indole moiety in their structures, working as 5-hydroxytryptamine type 3 serotonin receptor antagonist (5-HT3). This revision is focused on compounds bearing an indole core that present a 5-HT3 receptor antagonist activity that has been successfully used as anti-emetic drugs, reducing chemotherapy adverse secondary effects during cancer treatment. Their synthesis, biological activities, and some outstanding characteristics are discussed, affording a general outlook towards the development of more efficient anti-emetic drugs.
... This is promising for the process of becoming conscious of the reasons behind addictive behaviors, an aspect considered relevant within a rehabilitation protocol (Hamill et al. 2019). With regards to the physical effect, it is worth mentioning the relation between the emetic action and neurophysiology, which is mostly through brain-gut connection by the vagal fiber activation (Chai, Jiang, and Li 2016); vomiting can be therefore considered a detoxifying procedure not only at a physical but also at a psycho-emotional level. This could be particularly relevant within a treatment for drug addiction as also mentioned in previous findings (Berlowitz et al. 2018). ...
Article
Takiwasi is a therapeutic community for the treatment of Substance Use Disorders (SUDs) that combines traditional Amazonian medicine (TAM) with modern psychotherapy. One of the plant medicines from TAM used in this protocol is purgahuasca. It is a decoction of the vine Banisteriopsis caapi alone, whose use is traditional among the Awajún and other ethnic groups in Peru. The research began with a field trip to Awajún territory to explore the indigenous use of purgahuasca as an initiation rite. Then, analysis of its application was conducted in the clinical context of Takiwasi. Open-ended and semi-structured interviews with Awajún informants and Takiwasi’s therapeutic staff were performed and analyzed following the narrative methodological approach. Further clinical data on the ingestion of purgahuasca by Takiwasi’s SUD patients were obtained from the internal repository. These indicate that 359 (92.1%) patients reported having had the so-called mareación (dizziness), 299 (76.7%) experienced physical sensations, and 208 (53.3%) had visions. These effects can be related to the psychoactivity of β-Carbolines alkaloids from B. caapi, a medicinal plant that seems to have potential benefits also for SUD, especially giving a key contribution to the patients’ therapeutic process of becoming aware of the personal reasons behind addictive behaviors.
... Las purgas son sesiones rituales de ingesta de varios tipos de plantas vomitivas o eméticas con fines desintoxicantes y depurativos. La inducción del vómito como opción terapéutica ha sido observada también en contextos ajenos a la MTA (9). En el caso de Takiwasi las plantas utilizadas en estas sesiones suelen considerarse activas a nivel de limpieza física y también de limpieza emocional y espiritual, ya que cada una de ellas actúa en una zona somática precisa que tiene su correspondencia simbólica. ...
Article
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El Centro Takiwasi es una comunidad terapéutica única en su género por la integración de psicoterapia y medicina moderna con el uso de prácticas derivadas de la Medicina Tradicional Amazónica (MTA). El eje central e innovador es el uso terapéutico de plantas medicinales con efectos psicosomáticos sobre el individuo, en sesiones rituales o en un contexto de aislamiento comúnmente llamado dieta. El objetivo principal de este trabajo es describir: los medicamentos naturales utilizados; el perfil sociodemográfico de los usuarios; el acompañamiento en el proceso de integración de las ceremonias rituales de Ayahuasca.
Article
Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.
Article
The herbal preparation ayahuasca has been an important part of ritual and healing practices, deployed to access invisible worlds in several indigenous groups in the Amazon basin and among mestizo populations of South America. The preparation is usually known to be composed of two main plants, Banisteriopsis caapi and Psychotria viridis, which produce both hallucinogenic and potent purging and emetic effects; currently, these are considered its major pharmacological activities. In recent decades, the psychoactive and visionary effect of ayahuasca has been highly sought after by the shamanic tourism community, which led to the popularization of ayahuasca use globally and to a cultural distancing from its traditional cosmological meanings, including that of purging and emesis. Further, the field of ethnobotany and ethnopharmacology has also produced relatively limited data linking the phytochemical diversity of ayahuasca with the different degrees of its purging and emetic versus psychoactive effects. Similarly, scientific interest has also principally addressed the psychological and mental health effects of ayahuasca, overlooking the cultural and pharmacological importance of the purging and emetic activity. The aim of this review is therefore to shed light on the understudied purging and emetic effect of ayahuasca herbal preparation. It firstly focuses on reviewing the cultural relevance of emesis and purging in the context of Amazonian traditions. Secondly, on the basis of the main known phytochemicals described in the ayahuasca formula, a comprehensive pharmacological evaluation of their emetic and purging properties is presented.
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The medicinal plant diet is a healing process used in traditional Amazonian medicine (TAM), and it is poorly described within the scientific literature. This work analyzes the experience of seven participants in this therapy performed at the Takiwasi Center in Peru. Semistructured interviews were performed before and after treatment, documenting participants’ motivation, psychological experience, and perceived personal changes (physically, psychologically, socially, and spiritually), as well as the role played by each medicinal plant. All the interviews were recorded, transcribed, and analyzed using interpretative phenomenological analysis. Reasons to participate in the plant diet included self-discovery, personal development, interest in plant medicine, and professional realization. The experience was perceived as intense and allowed participants to experience self-acceptance, self-discovery, mental balance, rest, cleansing, and connection with nature. Three months after the experience, participants felt physical changes (n = 6), psychological changes (n = 7), social changes (n = 5), and spiritual changes (n = 5).
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