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Background: Emesis gravidarum is a common obstetrical problem affecting 50–80% of pregnant women during their first trimester which begins in the morning and frequently continues throughout the day; considered as one of the Vyakta Garbha Lakshana in Ayurveda. If it is not treated effectively in time; it may lead to complications in pregnancy affecting the quality of life and thus the pregnancy outcome. Objective: To evaluate the clinical effectiveness of Bilwa-Lajadi syrup in emesis gravidarum. Material and methods: A single arm open labeled clinical trial was conducted on 30 participants fulfilling the inclusion criteria from OPD and IPD of Prasuti Tantra Evam StreeRoga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan and administered with Bilwa-Lajadi Syrup 20 ml per day in two divided doses, empty stomach before food for 30 days with followed up every 15 days during treatment and 15 days after completion of trial period. Results: The drug showed statistically significant effect in reducing the frequency of vomiting per day, quantity of vomitus, aversion to smell, nausea and anorexia, altered content of vomitus, improved appetite, imparted lightness of body and increased haemoglobin gm%. Conclusion: Thus, early medication with Bilwa-Lajadi syrup and following dietetic regimen played a vital role in relieving the symptoms of emesis gravidarum.