Vomiting is the oral expulsion of upper gastrointestinal contents resulting from contractions of the gut and thoraco-abdominal wall musculature. Vomiting is coordinated by the centres in brain and is effected by neuromuscular responses in the gut, pharynx and thoracoabdominal wall.

The causes of vomiting are diverse and include gastritis, indigestion, gastrointestinal infection, worm infestation, obstruction in the gastrointestinal tract, inflammatory diseases of abdominal organs, myocardial infarction, raised intracranial pressure, motion sickness, pregnancy, uraemia, drugs, acute hepatitis and liver failure and may be psychogenic.

Psychogenic vomiting without any gastrointestinal cause is seen in persons suffering from anxiety and it usually occurs in the morning on awakening. Early morning vomiting is a frequent symptom in hypersensitive pregnant women in early pregnancy. This type of vomiting rarely occurs in the later part of the day. Water brash (regurgitation of stomach juices into the mouth), nausea, loss of appetite, salty taste in the mouth, etc. are the common associated symptoms of vomiting resulting from gastrointestinal causes. These symptoms do not accompany vomiting of psychogenic origin. By and large, this type of vomiting is a short-lived symptom and manageable with diet regulation and simple medication. Acute vomiting causes dehydration, fluid and electrolyte imbalance. Weight loss may result from chronic vomiting.

Ascertaining the cause of vomiting is essential so as to rule out serious illnesses. However, irrespective of the cause and nature of vomiting, it is always important to treat this symptom to prevent fluid and electrolyte imbalance in the body system and untoward effects on the functioning of vital organs.

Judicious use of simple home remedies such as cardamom (Ela) is effective in successful management of vomiting and should be resorted to, in case proper medical care is not readily available.

Ela [Elettaria cardamomum (Linn.) Maton]

Ela (Cardamom) is one of the common spices found in almost every Indian kitchen and is known for its medicinal properties in traditional medicine. It is a stout large perennial herb that grows naturally and also cultivated in many parts of south India at elevations from 750 to 1500 metres. Ela seeds are used for aromatic and appetizing property in various food preparations and for chewing alone or along with other aromatic spices as a mouth freshener and appetizer. It is an effective home remedy for many common ailments of the digestive system. Many Ayurvedic formulations described in classical literature have powdered Ela seeds as one of the ingredients. Powder of cardamom seeds alone is specifically indicated for the treatment of symptoms resulting from excess heat or acidity in the body system. Easy accessibility, cost effectiveness, long history of safe use, palatable taste and small dose are attributes that make this formulation a simple but ideal home remedy for first-hand management of common ailments like vomiting, loss of appetite, indigestion, gastric irritation, nausea, burning sensation, thirst, giddiness, burning urination, bad smell from mouth, etc. This herbal drug is described as Sukshmaila in the Ayurvedic Pharmacopoeia of India1 and is widely used by the people in self-health-care. Eladi powder described in ancient classical Ayurvedic texts is a popular formulation made of Ela seeds and other herbal ingredients for the management of different kinds of vomiting.

Composition

Ela powder consists of finely powdered seeds of dried fruits of cardamom.

English name	Cardamom
Latin name	Elettaria cardamomum (Linn.) Maton
Family	Zingiberaceae
Parts used	Seeds

Main chemical constituents

Essential oils (α-terpineol, myrcene, etc.).

Quality standards

The Ayurvedic Pharmacopoeia of India provides quality standards of Ela seeds based on the following physical constants:

Foreign matter	Nil
Total ash	Not more than 6%
Acid-insoluble ash	Not more than 4%
Alcohol-soluble extractives	Not less than 2%
Water-soluble extractives	Not less than 10%
Volatile oils	Not less than 4%

Method of preparation

• (1) Not more than one-year-old dried cardamom fruits with adequate aroma are taken in as much quantity as is required for making powder for medicinal use. Remove dust and any other foreign matter and the outer skin of the fruits before grinding the seeds to make powder. About 10 grams of seeds are sufficient for a treatment period of seven to 10 days.
• (2) Grind the seeds in a clean grinder or mortar to make a fine powder and filter it through a metallic sieve. It is difficult to make powder, if the seeds are not properly dried due to presence of high moisture content. The powder should not be filtered through coarse cloth as it absorbs the essential oil, which contains aromatic and bio-active chemical constituents.
• (3) Seed powder is then kept in a dry air-tight small bottle, away from direct sunlight where the temperature normally does not exceed average room temperature. Keeping the powder in hot surroundings should be avoided as it facilitates loss of volatile content leading to reduced therapeutic potency.

Dosage form

Brownish powder with strongly aromatic odour and characteristic taste. The powder can be filled into capsules.

Therapeutic properties

• (1) Ela has cooling, anti-emetic, stimulant, carminative, digestive, stomachic and appetizing properties.
• (2) Pharmacological studies have proven Ela seeds to have antiinflammatory, analgesic, anti-spasmodic, anti-microbial and anti-fungal properties.

Dose and mode of administration

• (1) Seed powder of Ela (Cardamom) is recommended in a dose of 250 milligrams to 500 milligrams (about 3-4 pinches), for adults and 60-120 mg for children, two to three times a day with a little warm water or any soft, sweet syrup, e.g. honey. It is advisable to consume the powder on an empty stomach or half-an-hour before eating meals.
• (2) The best way to consume Ela powder for control of vomiting is to swallow it with a small amount of water or syrup. Intake with a large amount of water or any other liquid should be avoided.
• (3) In cases of vomiting due to indigestion, gastritis, pregnancy and high levels of blood urea in kidney failure, it is advisable to administer concoction of Ela powder in small frequent doses for fast absorption of the medicine.
• (4) Concoction is prepared by putting half to one teaspoonful (2.5 to 5 grams) of Ela powder in 30 milliliters of warm water and kept as such for 30 minutes and then it is filtered on getting cooled. Infusion is given in the dose of 5 to 10 milliliters (one to two teaspoonfuls) at regular intervals and is to be consumed the same day.

Indications and uses

Nausea, vomiting, gastritis, indigestion, anorexia, excessive thirst, giddiness and bad taste of mouth.

Precautions and safety aspects

• (1) Traditionally, cardamom seeds are regarded as safe owing to their use as a home remedy and a common spice in various food items and beverages. No adverse effect and toxicity is reported in the literature. However, there are reports that cardamom seeds can trigger gallstone colic and hence not recommended for self-medication in patients with gallstones.
• (2) Patients with vomiting as a major symptom should take small meals in liquid or semi-solid forms made of soft easily digestible materials. Overeating, irregular eating and heavy, fiber-rich and spicy foods should be avoided.
• (3) Fresh concoction of cardamom seeds as described above should be used if the patient does not find seed powder palatable.
• (4) Strenuous work, anxiety and stress should be avoided for successful management of vomiting. Adequate bed rest and sleep at proper time help a lot to enhance the effect of medication.
• (5) Medical advice should be sought if vomiting is drastic and is not controlled with Ela powder and the patient’s condition deteriorates rapidly. The underlying cause of vomiting must be properly treated with suitable medication.
• (6) Mere symptomatic relief of vomiting should not be attempted, if the condition gets severe and non-responsive to self-medication with Ela powder and similar other home remedies.
• (7) Medication with Ela powder should be restricted to mild to moderate vomiting mainly resulting from gastrointestinal causes and pregnancy. Specific treatment of the underlying cause is required in kidney failure, cancer of stomach, worm infestation, brain tumour and psychogenic vomiting.
• (8) Ela powder is safe during pregnancy and for breast-fed children.

References

• (1) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 101-102.
• (2) Shastri AD. Bhaishajyaratnavali. 19th ed. Varanasi: Chaukhambha Prakashana. 2008. p. 490.
• (3) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 101.
• (4) India, Ministry of Health and Family Welfare. The Ayurvedic pharmacopoeia of India. Part I. Vol. I. New Delhi: Department of Indian Systems of Medicine & Homeopathy, 2001. p. 102.
• (5) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda and Siddha, 2002. p. 392.
• (6) Sharma PC, Yelne MB, Dennis TJ. Database on medicinal plants used in Ayurveda. Vol. 5. New Delhi: Central Council for Research in Ayurveda and Siddha, 2002. p. 393.

Further reading

• (1) Chopra RN, Nayar SL, Chopra IC. Glossary of Indian medicinal plants. New Delhi: Publications and Information Directorate, Council for Scientific and Industrial Research, 1986.
• (2) Chunekar KC. Bhavaprakasha Nighantu. Vol. 2. Varanasi: Chaukhambha Bharati, 1982.
• (3) Warrier PK et al. eds. Indian medicinal plants. Madras: Orient Longman Ltd., 1995.
• (4) Khare CP. Indian medicinal plants. New Delhi: Springer (India) Private Limited, 2007.
• (5) Kirtikar KR, Basu BD. Indian medicinal plants. Vol. IV. Allahabad: LM Basu, 1989.
• (6) Kurup PNV, Ramadas VNK, Joshi P. Handbook of medicinal plants. New Delhi: Central Council for Research in Ayurveda and Siddha, 1979.
• (7) Sharma PV. Classical uses of medicinal plants. Varanasi: Chaukhambha Vishvabharati, 1996.
• (8) Sharma PV. Dravyaguna Vijnana. Vol. II. Varanasi: Chaukhamba Bharati Academy, 2001.

Source: Traditional Herbal Remedies for Primary Health Care - WHO