Madatyaya Chikitsa: Difference between revisions

Line 2,934:

=== ''Vidhi Vimarsha'' ===

==== ''Sura'' and its varieties in present era ====

Sura, is the liquor prepared with shalidhanya which is nutritionally superior type of rice grain. Sura, if consumed as per the standard directives of limited consumption, leads to pleasure; otherwise it leads to the undesirable conditions like hangover, intoxication and the state of unconsciousness.

Depending upon the methods of preparation followed alcoholic drinks are of different types like sura, madhu and maitreya. The term sautramani has two meanings in different contexts, the former emphasizes the use of alcohol for the purpose of oblation, while the later as sacrificial Soma2.

The advice to use utensils made up of gold and silver for serving liquor is due to their property of being highly non-reactive. In present era metals have been replaced by glass, which is also an inert substance to serve liquor. The principle is to serve liquor in utensils made up of inert substances.

==== Qualities of good liquor ====

The liquor consumption must be in optimal amount suitable to individual’s body constitution and should not cause vitiation of dosha.

Good liquor is prepared from multiple ingredients of varied qualities which have diverse actions to help regulate the three doshas and prevent their vitiation, which may occur in case of use of single ingredient. Sushruta mentioned that the increase or decrease of the dosha is mainly influenced by the ingredients (dravya) of liquor. Therefore, manufacturing liquor with multi-component of varied quality substances will help to maintain state of homoestasis.

Features of intoxication:Hangovers are a frequent, though unpleasant, experience among people who drink to intoxication. Multiple possible factors to cause hangover state by liquor have been investigated, and evidence suggests that hangover symptoms depend upon its effects on urine production, the state of gastrointestinal tract, blood sugar concentrations, sleep patterns, and biological rhythms. In addition, researchers postulate that effects related to alcohol withdrawal depend upon, alcohol metabolism, biologically active non alcohol compounds in beverages; the use of other drugs; certain personality traits; and a family history of alcoholism may contribute to the hangover conditionas shown in table 2 below.

Table 1: Symptoms of hangover:

Class of Symptoms Type

Constitutional Fatigue, weakness, and thirst

Pain Headache and muscle aches

Gastrointestinal Nausea, vomiting, and stomach pain

Sleep and biological rhythms Decreased sleep, decreased REM, and increased slow-wave sleep

Sensory Vertigo and sensitivity to light and sound

Cognitive Decreased attention and concentration

Mood Depression, anxiety, and irritability

Sympathetic hyperactivity Tremor, sweating, and increased pulse and systolic BP

Table 2: Possible Contributing Factors to Hangover3

Direct effects of alcohol

• Dehydration

• Electrolyte imbalance

• Gastrointestinal disturbances

• Low blood sugar

• Sleep and biological rhythm disturbances

Alcohol withdrawal

Alcohol metabolism (i.e., acetaldehyde toxicity)

Non-alcohol effects

• Compounds other than alcohol in beverages, especially methanol

• Use of other drugs, especially nicotine

• Personality type

• Family history for alcoholism

Table 3: Dubowski’s stages of Alcoholic influence

BAC gms/100ml Stages of Alcoholic Influence Clinical Signs /Symptoms

0.01 to 0.05 Subclinical Influence / effects usually not appearent or obvious

Behaviour nearly normal by ordinary observation

Impairment detectable by special tests

0.03 to 0.12 Euphoria Mild Euphoria, Socialbility, Talkativeness

Increased self confidence, Decreased inhibitions

Diminished attention, Judgement and control

Some sensory motor impairment

Slowed information processing

Loss of efficiency in critical performance tests

0.09 to 0.25 Excitement Emotional instability, Loss of critical judgement

Impairment of perception, memory and comprehension

Decreased sensory response, Increased rection time

Reduced visual acuty and peripheral vision& slow glare recovery

Sensory motor incoordination, Impaired Balance

Slurred speech, Vomitting, Drowsiness

0.18 to 0.30 Confusion Disorientation, Confusion, Vertigo, Dysphoria

Exagarated emotional states, (fear, rage, grief etc.)

Disturbances of vision (Diplopia) & 0f color, form, motion & dimensions

Increased pain threeshold

Increased muscular incoordination, staggering gait and ataxia

Apathy, Lethargy

0.25 to 0.40 Stupor General inertia, approaching loss of motor functions

Markedly decreased response to stimuli

Marked muscular incoordination, inability to stand or walk

Vomiting, incontinence of urine and feces

Impaired conciousness, sleep or stupor

0.35 to 0.50 Coma Complete unconciousness, Coma, Anesthesia

Depressed or abolished reflexes

Subnormal temperature

Impairement of circulation and respiration

Possible death

0.45 + Death Death from respiratory arrest

Role of olfaction in intoxication:

Alcoholic beverages provoke massive orthonasal and retronasal stimulations (Bragulat et al., 2008) which constitute strong appetitive cues (Bienkowski et al., 2004) and might be involved in causing alcohol-dependence as they rapidly lead to conditioned alcohol-seeking behaviors (Pautassi et al., 2009). Olfactory stimulations elicit strong drinking desires (Schneider et al., 2001), this olfactory craving being even stronger than those provoked by visual–auditory cues, particularly during withdrawal (Kareken et al., 2004; Little et al., 2005) and thus being potentially involved in relapse.

The olfactory system relates to cognitive and emotional brain regions, and exploring olfaction might improve the understanding of emotional-cognitive deficits in alcohol- dependence (up to now explore with visio–auditory stimulations). Olfaction is indeed directly connected with limbic (Soudry et al., 2011) and fronto-temporal regions (Rolls, 2004).

The orbitofrontal cortex is a crucial area in this perspective, being simultaneously involved in emotional, executive, and olfactory processing (Rolls, 2008). Strong correlations between olfactory and cognitive abilities have been shown (Purdon, 1998; Schu- bert et al., 2008; Sohrabi et al., 2012), underlining their common cerebral basis. Olfaction thus constitutes an interesting way to renew the exploration of emotional-executive deficits in alcohol-dependence.

In view of the above research; the consumption of liquor in pleasent atmosphere, with perfumes, esscense and garlands has a reason to avoid false stimulation of olfactory nerve and to maintain the consciousness during and after liquor intake.

The intention of using perfumes etc is based upon the understanding of its effect on olfaction and there by on the cerebral functions; which otherwise termed as gandha-jnyana, meaning knowledge of olfaction. The most preferred aromas will help maintaining the psycho-neuro axis well in control and it prevents the intoxicating effects on human body.

Factors affecting addictive behaviour: Addictive behavior associated with alcoholism is characterized by compulsive preoccupation with obtaining alcohol, loss of control over consumption, and development of tolerance and dependence, as well as impaired social and occupational functioning. Like other addictive disorders, alcoholism is characterized by chronic vulnerability to relapse after cessation of drinking.

More recently, increasing attention has been directed toward the understanding of neurobiological and environmental factors in susceptibility to relapse5.

The BAC’s showed in the following tables are the maximum attainable concentrations for a specific amount of alcohol consumed.

Table 4: Factors determining maximum BAC:

The calculations are based on Widmark’s Formula:

A = Amount of alcohol measured in grams

P = Mass of the individual in kilograms

C = Blood Alcohol Concentration in gram/100ml

R = Distribution Factor (f=0.7 =0.6)

10 = Conversion Factor from g/1000 ml to g/100ml

A = P x C x R x 10

In a fat person the r-factor will be less than in a muscular one. Theoretically a fat person with the same mass as a muscular one will become more intoxicated on the same amount of alcohol consumed over the same period. (alcohol is not fat soluble but water soluble)

The given blood alcohol concentration is a reflection of the minimum alcohol that was absorbed in the gut.

It does not reflect the:

a) Alcohol remaining in the

b) Alcohol already metabolized

c) Alcohol excreted in the urine and still in the bladder

d) Alcohol perspired

e) Alcohol exhaled

Alcoholism jointly leads to olfactory and memory source impairment and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggests that olfaction could become a reliable cognitive marker in psychiatric disorders6.

Table 5: ICD classification

ICD 11 – Alcohol

Y91 categories in ICD-10:

Evidence of alcohol involvement determined by level of intoxication

Y91.0

Mild alcohol intoxication

Smell of alcohol on breath, slight behavioural disturbance in functions and responses, or slight difficulty in coordination

Y91.1

Moderate alcohol intoxication

Smell of alcohol on breath, moderate behavioural disturbance in functions and responses, or

Moderate difficulty in coordination

Y91.2

Severe alcohol intoxication

Severe disturbances in functions and responses, severe difficulty in coordination, or impaired ability to cooperate

Y91.3

Very severe alcohol intoxication

Very severe disturbance in functions and responses, very severe difficulty in coordination, or loss of ability to cooperate

Y91.4

Alcohol involvement, not otherwise specified

Suspected alcohol involvemen

Effects of alcohol:

Alcohol consumption can interfere with the function of all parts of the gastrointestinal tract. Acute alcohol ingestion induces changes in the motility of the esophagus and stomach that favor gastro-esophageal reflux and, probably, the development of reflux esophagitis.

Alcohol abuse may lead to damage of the gastric mucosa, including hemorrhagic lesions. Beverages with low alcohol content stimulate gastric acid secretion, whereas beverages with high alcohol content do not. In the small intestine, alcohol inhibits the absorption of numerous nutrients. The importance of these absorption disorders for the development of nutritional disturbances in alcoholics, however, is unclear. In alcoholics with other digestive disorders (e.g., advanced liver disease or impaired pancreatic function), impaired digestion likely is more significant. Acute alcohol consumption also damages the mucosa in the upper region of the small intestine and may even lead to the destruction of the tips of the villi.

Qualities of different types of liquors and uses:

The Ashtang Hridaya has elaborated peculiarities of liquor prepared by various sources. The superiority though has been mentioned; the liquor prepared by respective components have specific qualities, which can be considered therapeutically important.

Table 6: Types of liquors Name of liquor Main Quality Indication Correlation

Sura Snehani (Unctous) Gulma, Udara, Arsha, Grahani, Lactating, Diuretic Tumor, Ascitis, Hemorrhoids, Colitis and digestive disorders

Varuni Agile, Sharp, Hridya Shool, Kasa, Vomitting, Asthma, Vibandha, Adhmana, Peenasa Gasric erosions, Cough, Bloating, Rhinitis,

Baibhitaki Agile, Pathya Wounds, Anemia, Skin diseases

Yava-sura Guru, Arid, Vishtambhi

Mardwika Sweet, Sara, Lekhana, not to hot Anemia, Meha, Worms All types of Urine disorders

Kharjura Vatala, Guru

Sharkara Sweet, Hridya, Agile

Gaudika Tarpana, Deepana Diuresis, Laxative

Seedhu Stimulates Vata, Pitta Obesity, Anasarca, Ascitis, Hemorrhoids

Madhwasava Chhedana Meha, Peenas, Kasa Urinary disorders, Rhinitis, Cough

Shuktam Utkledi, Hot, sharp, Sour, Palatable, Laxative, Cool on touch Anemia, Visual disorders, Worms

Time needed to absorb and metabolize different amounts of alcohol:

Factors such as food intake and its constituent profile, gender and age have been reported to influence the kinetics of alcohol absorption and metabolism.

It is widely accepted that the rate of alcohol absorption can be decreased by consuming food along with the alcoholic drink. The rate at which alcohol is absorbed depends on how quickly the stomach empties its contents into the intestine.

The higher the dietary fat content, the more time this emptying will require and the longer the process of absorption will take.

One study found that subjects who drank alcohol after a meal that included fat, protein, and carbohydrates, absorbed the alcohol about three times more slowly than when they consumed alcohol on an empty stomach. Ref???

Role of fructose and carbohydrates in alcohol absorption:

Rogers et al, showed that carbohydrates significantly increased the rate of alcohol metabolism in fasting humans while protein and fat failed to show the same effect. In this context it is interesting to mention that for a long time (prior to controlled scientific interventions) a common nonscientific experience existed claiming that consumption of honey may shorten the period of alcohol intoxication (honey is an excellent rich source of nutritional fructose). The honey significantly increased blood alcohol disappearance and elimination rates by 32.4 and 28.6 percent, respectively, and reduced the intoxication time (that is, the time taken to attain zero blood alcohol level) and its degree (the peak blood alcohol level) by 30 and 4.4 percent.

Fructose, also known as “fruit Sugar”, is naturally-occurring, is characterized by “clean” non-lingering sweet taste. Fructose is highly soluble, and is characterized by a Relative Sweetening Value (RSV) of 1.1-1.7 (where sucrose = 1.0), depending on temperature and pH.

With regards to the possible mechanism by which fructose accelerates ethanol metabolism, a literature review indicates a possible shift in the metabolism of fructose in the presence of alcohol. This shift has been linked to the production in the liver of NAD+ which facilitates alcohol oxidation. Therefore, in the presence of alcohol, the metabolism of fructose in the liver is diverted from NAD+ to NADH requiring pathways, which in turn generates the NAD+ needed for alcohol oxidation9.

Treatment of acute alcoholism: ??

Treatment of chronic alcoholism: ??

Refrences:

1. Charaka Samhita; Chaukhamba, Bhagwan Das, R K Sharma

2. Charaka Samhita; Chaukhamba, Bhagwan Das, Sharma

3. Alcohol Health and Research World; Mechanisms and Mediators; Robert swift, Dena Davidson; page 54-60

4. Frontiers in Psychology; Olfaction in alcohol dependence: a neglected yet promising research field; Maurage et al; Jan 2014, Vol.4. Article 1007

5. Journal of Neurosciences, May 1, 2002, 22(9), 3332-3337; Behavioural Neurobiology of Alcohol addiction; Weiss and Porrino

6. Journal of Plosone; August 2011, Vol.6, Issue 8; Olfactory Impairment Is Correlated with Confabulation in Alcoholism: Towards a Multimodal Testing of Orbito-frontal Cortex

Pierre Maurage et al

7. Alcohol Health and Research World; Alcohol’s role in Gastrointestinal disorders; Chirstian Bode & J. Christian Bode

8. Biological Psychology, Vol. 88, Issue 1; Sep 2011. 28-36; Chemosensory event-related potentials in alcoholism: A specific impairment for olfactory function; Maurage et al

9. Agro Food Industry hi tech Sep-Oct2009, Vol. 20 No.5; Fructose and its effect on alcohol elimination from blood following alcohol consumption; Fernando Schved

10. Charak Sutrasthana 1/ 44.

11. Sushrut sutrasthana 2:

Gunaha ye ukta dravyeshu sharireshu api te tathaI

sthana vriddhi kshayah tasmad dehino dravyahetukaII

12. Ashtang Hridaya Sutrasthana 11/37-38 commentary by Arundatta

13. Ashtang Hridaya Chilitsasthana 7 Madatyayachikitsa – Hemadri & Arundatta

14. Alcohol, the body and health effects; The Alcohol Advisory Council, NZ

Index 1:

Verse no. Name as per Charaka Lattin name Useful Part Rasa

23 Yava

23 Godhum Triticum sativum Phal

23 Marich Piper nigrum Phal

111 Matulung Celastrus paniculatus Willd Beeja

111 Aadrak Zingiber officinale Swaras

121 Bijpurak Citrus medica Linn Phal

121 Vrukshamla Garcinia indica Chois Phal

121 Kol Zizyphus jujuba Lam Phal

121 Dadim Punica granatum Linn Phal-Twak, Moola-twak

121 Yawani Hyoscyamus niger Linn Beeja

121 Hapusha Juniperus communis Linn Phal

121 Ajjaji Cuminum cyminum Linn Phal

121 Shrungwer

125 Godhum

126 Mash Phaseolus mungo Linn Phal

127 Marich

127 Adrak

127 Dadim

128 Marich

128 Adrak

129 Dadim

129 Panchmul

130 Dhanya Coriandrum sativum Linn Phal

130 Nagar Zingiber officinale Roscoe Moola

136 Kharjur Phoenix sylvestris Roxb Phal

136 Mrudhwika Vitis vinifera Linn Phal

136 Parushak Grewia asiatica Linn Phal

137 Mardik

138 Shalishashtik Oryza sativa Linn Phal

139 Patol Trichosanthes dioics Roxb Patra, Mool

139 Mudag Phaseolus aureus Roxb Beej, phal

139 Dadim

139 Aamlak Phyllanthus emblica Linn Phal

140 Draksha

140 Aamlak

140 Kharjur

140 Parushak

145 Guduchi Tinosphora cardifolia Panchang

145 Bhadramusta Cyperus rotundus Linn Kand

145 Patol

145 Nagar

146 Draksha

149 Parushak

149 Pilu Salvadora persica Linn patra, beeja, Moola

150 Musta Cyperus scariosus R.Br kanda

150 Dadim

150 Laja

151 Kol

151 Dadim

151 Vrukshamla

151 Churika Tamarindus indica Linn phal, beeja, patra, pushpa

153 Padam Prunus puddum Roxb Kashtha

153 Utpal Saussurea lappa, Mool Katu, madhur, tikta

153 Chandan Santalum album, Linn Kashthasar Tikta

155 Chandan

156 Kumud Nymphaea alba, Linn moola, pushap

156 Utpal

156 Chandan

159 Phalini Callicarpa macrophylla vahl phul, patra

159 Sevya Andropogon muricatus Retz Moola Tikta, madhur

159 Lodhra Symplocos racemosa, Roxb Twaka Kashay

159 Ambu

Index 2:

(www.alcoholservices-ateam.org)

Work in Progress

@@ Line 2,934: / Line 2,934: @@
 === ''Vidhi Vimarsha'' ===
+==== ''Sura'' and its varieties in present era ====
+Sura, is the liquor prepared with shalidhanya which is nutritionally superior type of rice grain. Sura, if consumed as per the standard directives of limited consumption, leads to pleasure; otherwise it leads to the undesirable conditions like hangover, intoxication and the state of unconsciousness.
+Depending upon the methods of preparation followed alcoholic drinks are of different types like sura, madhu and maitreya. The term sautramani has two meanings in different contexts, the former emphasizes the use of alcohol for the purpose of oblation, while the later as sacrificial Soma2.
+The advice to use utensils made up of gold and silver for serving liquor is due to their property of being highly non-reactive. In present era metals have been replaced by glass, which is also an inert substance to serve liquor. The principle is to serve liquor in utensils made up of inert substances.
+==== Qualities of good liquor ====
+The liquor consumption must be in optimal amount suitable to individual’s body constitution and should not cause vitiation of dosha.
+Good liquor is prepared from multiple ingredients of varied qualities which have diverse actions to help regulate the three doshas and prevent their vitiation, which may occur in case of use of single ingredient. Sushruta mentioned that the increase or decrease of the dosha is mainly influenced by the ingredients (dravya) of liquor. Therefore, manufacturing liquor with multi-component of varied quality substances will help to maintain state of homoestasis.
+Features of intoxication:Hangovers are a frequent, though unpleasant, experience among people who drink to intoxication. Multiple possible factors to cause hangover state by liquor have been investigated, and  evidence suggests that hangover symptoms depend upon its effects on urine production, the state of gastrointestinal tract, blood sugar concentrations, sleep patterns, and biological rhythms. In addition, researchers postulate that effects related to alcohol withdrawal depend upon, alcohol metabolism, biologically active non alcohol compounds in beverages; the use of other drugs; certain personality traits; and a family history of alcoholism may contribute to the hangover conditionas shown in table 2 below.
+Table 1: Symptoms of hangover:
+Class of Symptoms 			Type
+Constitutional 				Fatigue, weakness, and thirst
+Pain 					Headache and muscle aches
+Gastrointestinal 			Nausea, vomiting, and stomach pain
+Sleep and biological rhythms	Decreased sleep, decreased REM, and increased slow-wave sleep
+Sensory 				Vertigo and sensitivity to light and sound
+Cognitive 				Decreased attention and concentration
+Mood 					Depression, anxiety, and irritability
+Sympathetic hyperactivity 		Tremor, sweating, and increased pulse and systolic BP
+Table 2: Possible Contributing Factors to Hangover3
+Direct effects of alcohol
+• Dehydration
+• Electrolyte imbalance
+• Gastrointestinal disturbances
+• Low blood sugar
+• Sleep and biological rhythm disturbances
+Alcohol withdrawal
+Alcohol metabolism (i.e., acetaldehyde toxicity)
+Non-alcohol effects
+• Compounds other than alcohol in beverages, especially methanol
+• Use of other drugs, especially nicotine
+• Personality type
+• Family history for alcoholism
+Table 3: Dubowski’s stages of Alcoholic influence
+BAC gms/100ml	Stages of Alcoholic Influence	Clinical Signs /Symptoms
+.01 to 0.05	Subclinical	Influence / effects usually not appearent or obvious
+ 	 	Behaviour nearly normal by ordinary observation
+ 	 	Impairment detectable by special tests
+.03 to 0.12	Euphoria	Mild Euphoria, Socialbility, Talkativeness
+ 	 	Increased self confidence, Decreased inhibitions
+ 	 	Diminished attention, Judgement and control
+ 	 	Some sensory motor impairment
+ 	 	Slowed information processing
+ 	 	Loss of efficiency in critical performance tests
+.09 to 0.25	Excitement	Emotional instability, Loss of critical judgement
+ 	 	Impairment of perception, memory and comprehension
+ 	 	Decreased sensory response, Increased rection time
+ 	 	Reduced visual acuty and peripheral vision& slow glare recovery
+ 	 	Sensory motor incoordination, Impaired Balance
+ 	 	Slurred speech, Vomitting, Drowsiness
+.18 to 0.30	Confusion	Disorientation, Confusion, Vertigo, Dysphoria
+ 	 	Exagarated emotional states, (fear, rage, grief etc.)
+ 	 	Disturbances of vision (Diplopia) & 0f color, form, motion & dimensions
+ 	 	Increased pain threeshold
+ 	 	Increased muscular incoordination, staggering gait and ataxia
+ 	 	Apathy, Lethargy
+.25 to 0.40	Stupor	General inertia, approaching loss of motor functions
+ 	 	Markedly decreased response to stimuli
+ 	 	Marked muscular incoordination, inability to stand or walk
+ 	 	Vomiting, incontinence of urine and feces
+ 	 	Impaired conciousness, sleep or stupor
+.35 to 0.50	Coma	Complete unconciousness, Coma, Anesthesia
+ 	 	Depressed or abolished reflexes
+ 	 	Subnormal temperature
+ 	 	Impairement of circulation and respiration
+ 	 	Possible death
+.45 +	Death	Death from respiratory arrest
+Role of olfaction in intoxication:
+Alcoholic beverages provoke massive orthonasal and retronasal stimulations (Bragulat et al., 2008) which constitute strong appetitive cues (Bienkowski et al., 2004) and might be involved in causing alcohol-dependence as they rapidly lead to conditioned alcohol-seeking behaviors (Pautassi et al., 2009). Olfactory stimulations elicit strong drinking desires (Schneider et al., 2001), this olfactory craving being even stronger than those provoked by visual–auditory cues, particularly during withdrawal (Kareken et al., 2004; Little et al., 2005) and thus being potentially involved in relapse.
+The olfactory system relates to cognitive and emotional brain regions, and exploring olfaction might improve the understanding of emotional-cognitive deficits in alcohol- dependence (up to now explore with visio–auditory stimulations). Olfaction is indeed directly connected with limbic (Soudry et al., 2011) and fronto-temporal regions (Rolls, 2004).
+The orbitofrontal cortex is a crucial area in this perspective, being simultaneously involved in emotional, executive, and olfactory processing (Rolls, 2008). Strong correlations between olfactory and cognitive abilities have been shown (Purdon, 1998; Schu- bert et al., 2008; Sohrabi et al., 2012), underlining their common cerebral basis. Olfaction thus constitutes an interesting way to renew the exploration of emotional-executive deficits in alcohol-dependence.
+In view of the above research; the consumption of liquor in pleasent atmosphere, with perfumes, esscense and garlands has a reason to avoid false stimulation of olfactory nerve and to maintain the consciousness during and after liquor intake.
+The intention of using perfumes etc is based upon the understanding of its effect on olfaction and there by on the cerebral functions; which otherwise termed as gandha-jnyana, meaning knowledge of olfaction. The most preferred aromas will help maintaining the psycho-neuro axis well in control and it prevents the intoxicating effects on human body.
+Factors affecting addictive behaviour: Addictive behavior associated with alcoholism is characterized by compulsive preoccupation with obtaining alcohol, loss of control over consumption, and development of tolerance and dependence, as well as impaired social and occupational functioning. Like other addictive disorders, alcoholism is characterized by chronic vulnerability to relapse after cessation of drinking.
+More recently, increasing attention has been directed toward the understanding of neurobiological and environmental factors in susceptibility to relapse5.
+The BAC’s showed in the following tables are the maximum attainable concentrations for a specific amount of alcohol consumed.
+Table 4: Factors determining maximum BAC:
+The calculations are based on Widmark’s Formula:
+A = Amount of alcohol measured in grams
+P = Mass of the individual in kilograms
+C = Blood Alcohol Concentration in gram/100ml
+R = Distribution Factor (f=0.7 =0.6)
+= Conversion Factor from g/1000 ml to g/100ml
+A = P x C x R x 10
+In a fat person the r-factor will be less than in a muscular one. Theoretically a fat person with the same mass as a muscular one will become more intoxicated on the same amount of alcohol consumed over the same period. (alcohol is not fat soluble but water soluble)
+The given blood alcohol concentration is a reflection of the minimum alcohol that was absorbed in the gut.
+It does not reflect the:
+a) Alcohol remaining in the
+b) Alcohol already metabolized
+c) Alcohol excreted in the urine and still in the bladder
+d) Alcohol perspired
+e) Alcohol exhaled
+Alcoholism jointly leads to olfactory and memory source impairment and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggests that olfaction could become a reliable cognitive marker in psychiatric disorders6.
+Table 5: ICD classification
+ICD 11 – Alcohol
+Y91 categories in ICD-10:
+Evidence of alcohol involvement determined by level of intoxication
+Y91.0
+Mild alcohol intoxication
+Smell of alcohol on breath, slight behavioural disturbance in functions and responses, or slight difficulty in coordination
+Y91.1
+Moderate alcohol intoxication
+Smell of alcohol on breath, moderate behavioural disturbance in functions and responses, or
+Moderate difficulty in coordination
+Y91.2
+Severe alcohol intoxication
+Severe disturbances in functions and responses, severe difficulty in coordination, or impaired ability to cooperate
+Y91.3
+Very severe alcohol intoxication
+Very severe disturbance in functions and responses, very severe difficulty in coordination, or loss of ability to cooperate
+Y91.4
+Alcohol involvement, not otherwise specified
+Suspected alcohol involvemen
+Effects of alcohol:
+Alcohol consumption can interfere with the function of all parts of the gastrointestinal tract. Acute alcohol ingestion induces changes in the motility of the esophagus and stomach that favor gastro-esophageal reflux and, probably, the development of reflux esophagitis.
+Alcohol abuse may lead to damage of the gastric mucosa, including hemorrhagic lesions. Beverages with low alcohol content stimulate gastric acid secretion, whereas beverages with high alcohol content do not. In the small intestine, alcohol inhibits the absorption of numerous nutrients. The importance of these absorption disorders for the development of nutritional disturbances in alcoholics, however, is unclear. In alcoholics with other digestive disorders (e.g., advanced liver disease or impaired pancreatic function), impaired digestion likely is more significant. Acute alcohol consumption also damages the mucosa in the upper region of the small intestine and may even lead to the destruction of the tips of the villi.
+Qualities of different types of liquors and uses:
+The Ashtang Hridaya has elaborated peculiarities of liquor prepared by various sources. The superiority though has been mentioned; the liquor prepared by respective components have specific qualities, which can be considered therapeutically important.
+Table 6: Types of liquors Name of liquor	Main Quality	Indication	Correlation
+Sura	Snehani (Unctous)	Gulma, Udara, Arsha, Grahani, Lactating, Diuretic	Tumor, Ascitis, Hemorrhoids, Colitis and digestive disorders
+Varuni	Agile, Sharp, Hridya	Shool, Kasa, Vomitting, Asthma, Vibandha, Adhmana, Peenasa	Gasric erosions, Cough, Bloating, Rhinitis,
+Baibhitaki	Agile, Pathya	Wounds, Anemia, Skin diseases
+Yava-sura	Guru, Arid, Vishtambhi
+Mardwika	Sweet, Sara, Lekhana, not to hot	Anemia, Meha, Worms	All types of Urine disorders
+Kharjura	Vatala, Guru
+Sharkara	Sweet, Hridya, Agile
+Gaudika	Tarpana, Deepana	Diuresis, Laxative
+Seedhu	Stimulates Vata, Pitta 	Obesity, Anasarca, Ascitis, Hemorrhoids
+Madhwasava	Chhedana	Meha, Peenas, Kasa	Urinary disorders, Rhinitis, Cough
+Shuktam	Utkledi, Hot, sharp, Sour, Palatable, Laxative, Cool on touch	Anemia, Visual disorders, Worms
+Time needed to absorb and metabolize different amounts of alcohol:
+Factors such as food intake and its constituent profile, gender and age have been reported to influence the kinetics of alcohol absorption and metabolism.
+It is widely accepted that the rate of alcohol absorption can be decreased by consuming food along with the alcoholic drink. The rate at which alcohol is absorbed depends on how quickly the stomach empties its contents into the intestine.
+The higher the dietary fat content, the more time this emptying will require and the longer the process of absorption will take.
+One study found that subjects who drank alcohol after a meal that included fat, protein, and carbohydrates, absorbed the alcohol about three times more slowly than when they consumed alcohol on an empty stomach. Ref???
+Role of fructose and carbohydrates in alcohol absorption:
+Rogers et al, showed that carbohydrates significantly increased the rate of alcohol metabolism in fasting humans while protein and fat failed to show the same effect. In this context it is interesting to mention that for a long time (prior to controlled scientific interventions) a common nonscientific experience existed claiming that consumption of honey may shorten the period of alcohol intoxication (honey is an excellent rich source of nutritional fructose). The honey significantly increased blood alcohol disappearance and elimination rates by 32.4 and 28.6 percent, respectively, and reduced the intoxication time (that is, the time taken to attain zero blood alcohol level) and its degree (the peak blood alcohol level) by 30 and 4.4 percent.
+Fructose, also known as “fruit Sugar”, is naturally-occurring, is characterized by “clean” non-lingering sweet taste.  Fructose is highly soluble, and is characterized by a Relative Sweetening Value (RSV) of 1.1-1.7 (where sucrose = 1.0), depending on temperature and pH.
+With regards to the possible mechanism by which fructose accelerates ethanol metabolism, a literature review indicates a possible shift in the metabolism of fructose in the presence of alcohol. This shift has been linked to the production in the liver of NAD+ which facilitates alcohol oxidation. Therefore, in the presence of alcohol, the metabolism of fructose in the liver is diverted from NAD+ to NADH requiring pathways, which in turn generates the NAD+ needed for alcohol oxidation9.
+Treatment of acute alcoholism: ??
+Treatment of chronic alcoholism: ??
+Refrences:
+.	Charaka Samhita; Chaukhamba, Bhagwan Das, R K Sharma
+.	Charaka Samhita; Chaukhamba, Bhagwan Das, Sharma
+.	Alcohol Health and Research World; Mechanisms and Mediators; Robert swift, Dena   Davidson; page 54-60
+.	Frontiers in Psychology; Olfaction in alcohol dependence: a neglected yet promising research field; Maurage et al; Jan 2014, Vol.4. Article 1007
+.	Journal of Neurosciences, May 1, 2002, 22(9), 3332-3337; Behavioural Neurobiology of Alcohol addiction; Weiss and Porrino
+.	Journal of Plosone; August 2011, Vol.6, Issue 8; Olfactory Impairment Is Correlated with Confabulation in Alcoholism: Towards a Multimodal Testing of Orbito-frontal Cortex
+Pierre Maurage et al
+.	Alcohol Health and Research World; Alcohol’s role in Gastrointestinal disorders; Chirstian Bode & J. Christian Bode
+.	Biological Psychology, Vol. 88, Issue 1; Sep 2011. 28-36; Chemosensory event-related potentials in alcoholism: A specific impairment for olfactory function; Maurage et al
+.	Agro Food Industry hi tech Sep-Oct2009, Vol. 20 No.5; Fructose and its effect on alcohol elimination from blood following alcohol consumption; Fernando Schved
+.	Charak Sutrasthana 1/ 44.
+.	Sushrut sutrasthana 2:
+Gunaha ye ukta dravyeshu sharireshu api te tathaI
+sthana vriddhi kshayah tasmad dehino dravyahetukaII
+.	Ashtang Hridaya Sutrasthana 11/37-38 commentary by Arundatta
+.	Ashtang Hridaya Chilitsasthana 7 Madatyayachikitsa – Hemadri & Arundatta
+.	Alcohol, the body and health effects; The Alcohol Advisory Council, NZ
+Index 1:
+Verse no.	Name as per Charaka	Lattin name 	Useful Part	Rasa
+	Yava
+	Godhum	Triticum sativum	Phal
+	Marich	Piper nigrum	Phal
+	Matulung	Celastrus paniculatus Willd	Beeja
+	Aadrak	Zingiber officinale	Swaras
+	Bijpurak	Citrus medica Linn	Phal
+	Vrukshamla	Garcinia indica Chois	Phal
+	Kol	Zizyphus jujuba Lam	Phal
+	Dadim	Punica granatum Linn	Phal-Twak, Moola-twak
+	Yawani	Hyoscyamus niger Linn	Beeja
+	Hapusha	Juniperus communis Linn	Phal
+	Ajjaji	Cuminum cyminum Linn	Phal
+	Shrungwer
+	Godhum
+	Mash	Phaseolus mungo Linn	Phal
+	Marich
+	Adrak
+	Dadim
+	Marich
+	Adrak
+	Dadim
+	Panchmul
+	Dhanya	Coriandrum sativum Linn	Phal
+	Nagar	Zingiber officinale Roscoe	Moola
+	Kharjur	Phoenix sylvestris Roxb	Phal
+	Mrudhwika	Vitis vinifera Linn	Phal
+	Parushak	Grewia asiatica Linn	Phal
+	Mardik
+	Shalishashtik	Oryza sativa Linn	Phal
+	Patol	Trichosanthes dioics Roxb	Patra, Mool
+	Mudag	Phaseolus aureus Roxb	Beej, phal
+	Dadim
+	Aamlak	Phyllanthus emblica Linn	Phal
+	Draksha
+	Aamlak
+	Kharjur
+	Parushak
+	Guduchi	Tinosphora cardifolia	Panchang
+	Bhadramusta	Cyperus rotundus Linn	Kand
+	Patol
+	Nagar
+	Draksha
+	Parushak
+	Pilu	Salvadora persica Linn	patra, beeja, Moola
+	Musta	Cyperus scariosus R.Br	kanda
+	Dadim
+	Laja
+	Kol
+	Dadim
+	Vrukshamla
+	Churika	Tamarindus indica Linn	phal, beeja, patra, pushpa
+	Padam	Prunus puddum Roxb	Kashtha
+	Utpal	Saussurea lappa, 	Mool	Katu, madhur, tikta
+	Chandan	Santalum album, Linn	Kashthasar	Tikta
+	Chandan
+	Kumud	Nymphaea alba, Linn	moola, pushap
+	Utpal
+	Chandan
+	Phalini	Callicarpa macrophylla vahl	phul, patra
+	Sevya	Andropogon muricatus Retz	Moola	Tikta, madhur
+	Lodhra	Symplocos racemosa, Roxb	Twaka	Kashay
+	Ambu
+Index 2:
+(www.alcoholservices-ateam.org)
 Work in Progress