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| | === ''Vidhi Vimarsha'' === | | === ''Vidhi Vimarsha'' === |
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| − | Similes in historical origin:
| + | Work in Progress |
| − | As per the historical origin, the appearance of visha can be interpreted as follows. Deeptha teja denotes very strong nature of poison, chaturdamshtro denote the fangs of a snake, hari/ harith kesha (pingala varna kesha) depicting the colour of the venom which is straw coloured, analekshana denotes to the potency or taikshnya of the visha.
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| − | As the poison originates from water it becomes sticky like jaggery and when it comes in contact with water, it spreads fast in the body during the rainy season. However, the Agastya Nakshatra, the end of rainy season, counteracts the effects of this poison. Therefore, the effects of poison become milder after the rains are over. Similarly, poison becomes more virulent and persons afflicted with dushi visha become worse, during this season.
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| − | Gara visha (artificial poison):
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| − | The third category of poison that may affect the man is called samyogaja visha and it is said to be inducted deliberately to cause harm. Chakrapanidatta mentions two types in it. One is named as gara which is a combination of non poisonous substances and the second one is kritrima (artificial) which is a combination of poisonous substances.
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| − | The same things are mentioned by the other authors also with a little difference or without any sub classification in it. It was one of the major practices in olden days. Today the practitioners have a common opinion that it is only a psychological aspect of some disorders and no such toxin can be seen as such which acts as explained in gara. In Ashtanga Hridaya and Sushrutha Samhita, detailed symptomatology which can be clearly demarcated on the basis of those which are related to the body and those which affect the mind. In conditions like shopha (inflammation), udara (ascitis) and pleeha (spleenomegaly) show the involvement of the hepatic system predominantly and also metabolic disorders.
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| − | Properties and affects:
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| − | The ten gunas of visha with their impact on the doshas and the body are dealt in this section. Some gunas can be interpreted as follows: Sookshma guna has a property of vivarana i.e.; to spread which makes the rakta to spread all over and make the visha reach all over the body. Kapha and visha have the same origin from jala (water) and also the avyakta rasata leads to intrude into the anna rasa and spreads fast. Vyavayi vuna is responsible for the quick spreading of visha as like a drop of oil spreads on water surface. Taikshnya is responsible for marmaghna (..) effect. Basically marma is saumya in nature. The Vishada guna of visha makes it unsticky and there by not allowing getting it adhered at single place. The Teekshna guna of visha destroys it and causes the marmaghna effect. It is very difficult to keep a laghu dravya stagnant. It keeps on changing its form or function. So it becomes very difficult to treat visha that is laghu and constantly changing its site of action in the body. Sushruta has also attributed the effect of poisons corrosponding to its guna. The illustration is precise and understandable. (Su. K. 2/19-21)
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| − | Treatment modalities:
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| − | Visha is managed by the above said 24 fold treatment principles. Any of the above said methods can be implemented in the treatment. They can be classified in to two as per the usage. One is emergency management and the other is conservative and rasayana treatment. The procedures like mantra, arishta, utkartana, nishpeedana, aachooshana, agni, parisheka, avagaha, raktamokshana are all emergencies as they will arrest the spread of visha. The vamana, virechana, samjna sthapana (restoration of consciousness) etc are helpful in the removal of the absorbed poison. The set of treatments like prashamana (pacification), aushadha etc. are self explanatory. Mrita sanjeevana (restoring life in about to die or apprantly dead person) acts as a life saving and rasayana. To say, rasayana has an inverse relation with visha. This is told very clearly by Vagbhata while explaining the Ashtangas of Ayurveda. Rasayana comes next to visha in the chronology. Visha Chikitsa completes only after rasayana prayoga as it rejuvenates the damaged cells and tissues. The one which stands separate is kakapada chikitsa. It is a trump card management in visha chikitsa when all other treatments fail. In olden days of practice it was very much used by various vaidyas. Now it is restricted only to a limited area like Kerala. There are still some incidents of life saved by this procedure. Smilar references about the line of management in cases of poisoning can be cross referred in Sushruta Samhita & Ashtanga Samgraha (Su.K.5/3-4) (A.S.U. 42/8 & 42/19-23)
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| − | First aid or immediate treatment after bite:
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| − | Application of tourniquet should be to such an extent that the pressure exerted thereby should allow passing littlefinger underneath it and above the skin. It remains always a matter of debate whether to incise the bite site or not. One school of thought combat the procedure as there are chances of infection of the wound created thereby. It may also get worsen especially in cases of Viper bites as the open injuries get necrosed due to vasculotoxic effect of the venom ultimately results in amputation of the organ involved.
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| − | Chushana (sucking) may also be done after putting gomaya (dried cowdung) agada churnas, or bhasma in mouth. (A.H.U.36/46-47)
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| − | Agnikarma and its contraindications:
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| − | Agnikarma was performed with the help of shalaka (rod) made up of hema (gold) or lauha (iron). Nowadays a rod made up of pancha dhatu (mixture of five metals) is utilized for the purpose. The procedure is contra-indicated in mandali (viper) bites. (A.H.U.36/45)
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| − | Importance of protection of heart:
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| − | Hridayavarana (covering heart area with external local application of specific medicines) should be performed first before applying any treatment as it is the most vital organ in case of poisoning. Hridayavarana is to be done daily (Sushruta). It was specifically intended to the Kings as they were constantly under threat from various external factors. If done daily the person will not get affected by the poison. It has to be followed by vamana as the procedure causes kapha vriddhi i.e. shleshma upachaya. It is directed to administer ghrita, combination of ghrita and madhu (honey), or agada with ghrita. It is also indicated some other drugs like Gomaya Rasa (Juice of cow dung), Krishna Mrid (black soil) etc. (A.S.U.42/15-16) This is for what and how much what route of administration?
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| − | Stage wise treatment of poisoning:
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| − | It can be interpreted that the treatments mentioned are in chronological order and can be used as per the stage in which the patient has been brought to the Vaidya. As the complication is increased the treatment methodology has to be changed from simple local techniques to highly evolved methods like the Kaakapaada Chikitsa. It is mentioned in some of the Malayalam texts of toxicology that when Visha enters the body it starts hunting the Prana/life of the person and the chase begins where the Visha is after the Prana. It is the amount of poison and the strength of the person together with the rapidity of the action of the drugs given which decides the prognosis. There is also a concept called Visha Kala and Amritha Kala which says that there are 15 vital points in the body and the poison affected to any one of these points on the days as per the Tithi mentioned in the Indian calender decides the prognosis and the intensity of the treatment required. Similar is the concept of Kaalavanchana where the poison in its total virulence in the body is nullified by the treatment methods aptly adopted.
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| − | Mahagandhahasti agada: if it is not available now, why is it here?
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| − | This Agada is said to be very effective in all the modes of induction. It has the effect of Vishahara and at the same time it acts as a good prophylactic drug with a Rasayana property. The Agada is not available now and also not practised by any of the Visha Vaidyas in Kerala.
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| − | Various formulations:
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| − | The agada yogas help in managing the complications due to the sthavara visha. The Ashtanga Samgraha specifically mentions sixteen lakshanas as the upadravas of visha. If we see the above reference we can come across a few of the features like jwara, kasa, shwasa, hikka, swayathu. The drugs dealt above like nalada (Vetiveria zinzanioides), jeevaka (M. musifera), rishabhaka (Microstylis wallichii), bharangi (Clerodendrum serratum) are also effective in visha chikitsa which makes us understand that the selection of drug is an important factor in treating the complication in visha and the conventional drugs have to be replaced.
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| − | Ksharagada:
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| − | The site of affliction of Visha explains the site of action and the mode of action of the Agada. If we go through the indications of the Agada, we can easily come to a conclusion that the drug has a GIT level action (where there is Grathitha Kapha), very specifically in conditions of Garavisha with a Nidana and Samprapthi of the Udara (Dooshyodara) and Shotha. It also has a role in the management of disorders of the “Acute or chronic” pattern like Dooshivishaja origin.
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| − | Characteristics of poisonous food:
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| − | There are the methods to detect the poisons present in various foods provided. The characteristics of person giving poison and poisonous food are described in the text. It signifies the relevance of a good forensic lab to detect the toxicities in food. Probably this is the oldest reference we get regarding the forensic lab. Other than this we can get ample references regarding this in the Artha shastra of Kautilya. Simlar explanation is seen in Sushruta Samiha regarding the testing of food before consuming if suspected to be poisoned. (S.K. 1/28-33)
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| − | Identification and types of snakes:
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| − | Based on the appearance the poisonous snakes available in India, till date, can be characterised into 3 varieties- the ones with hood, the ones which possess rounded marks on their body and the ones with streaks on its body.
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| − | The hooded snakes include the Cobra and the King cobra, the ones with rounded marks include the vipers- different varieties of viper-Russels viper, pit vipers and saw scaled vipers and the ones with streaks includes the 2 varieties of krait- the common krait and banded krait.
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| − | Acharya Sushruta has explained other classification of snakes which includes the above three under Savisha variety, Nirvisha snakes and Vaikaranja or hybrid snakes (Su.Ka.4/9-10) He has further sub classified each of these 3 snakes into several varieties. (Su.Ka.4/34).
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| − | Darveekara snake – comparison: King cobra and cobra.
| + | === Glossary === |
| − | Cobra:
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| − | Spectacled cobra is the most common and found all throughout India. It is often seen in or near agricultural fields, human habitations and granaries in search of rats. It commonly moves during evenings and early mornings. It is in different shades of brown, yellow, grey or black. It is about 3- 7 ft in length.When provoked, the cobra will raise its forebody spread it as a hood and may hiss. Its distinctive mark is the spectacle on rear of the hood. Undersides of the hood are broad faint stripes, above these are 2 dark spots surrounded by white borders.
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| − | 4 species in genus Naja are found in India, all are hooded:
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| − | 1. Spectacled Cobra - Naja naja
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| − | 2. Monocled Cobra- Naja kaouthia:
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| − | 3. Central Asian Cobra- Naja oxiana
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| − | 4. Andaman Cobra- Naja sagittifera
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| − | King cobra: Ophiophagus hennah
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| − | It is common in Western Ghats. Its average length is 10 ft, max-15 ft. It is the longest venomous snake, stout bodied, black, grey, dark olive green or yellowish brown. It has white or yellowish cross bands over entire length of the body.
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| − | Mandali sarpa: Comparision- Russels viper, pit vipers, saw scaled vipers.
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| − | Russell’s viper:
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| − | Daboia russelli
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| − | Is the most beautiful of all snakes, average 3 ft. stout with 3 longitudinal series of conspicuous, large, brown or black oval marks on brown or yellowish brown body. Its head is flat, triangular with a ‘V’ shaped mark on it, pointed end towards the front. Its tail is short and thin. Its head is covered by small scales.
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| − | Saw scaled viper:
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| − | It is small and thin snake with 1-1.5 ft in length. Has a triangular head and possesses small scales on the top of head. Has a short and thin tail. Is brown/ brick red/ gray/sand coloured with zig-zag patterns on the back. Head has arrow shaped mark over it.
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| − | Pit vipers:
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| − | 20 species of pit vipers found in India all in Viperidae, different genus. They are so called because of pit located between nostril and eye.The membrane in the pit is extremely sensitive to heat- this helps the snake to locate its warm blooded prey even in pitch darkness. Usually found in forest areas and plantations.1-3.5 ft.Has a triangular head broader than the neck. All have vertical pupils. It is venomous, anyhow out of 20 species in India- fatalities less reported.
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| − | Rajiman Sarpa- Comparision- Common and Banded Krait:
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| − | Common Krait: Bungarus caeruleus:
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| − | This snake is seen in fields, jungle, in vicinity of human habitation, inside houses also. It is about 3-5ft. Steel blue, bluish grey, glossy black, brownish black with cross bands of narrow white colour. Fore body may sometimes be free from cross bands.Is nocturnal.Is shy in day, active at night.
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| − | Banded krait: Bungarus fasciatus
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| − | Has limited distribution in India. Found in south, west or north east India.Is about 5 ft.Its body is triangular in cross section with a prominent raised vertebral ridge.Uppermost row of scales on the back is very large and 6 sided.Moves in night.
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| − | Gender wise classification of snakes:
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| − | The gender wise classification of snakes is based on several features. The same is explained in Sushruta samhita.( Su.Sam.Ka.4/35).Presently the classification of a snake based on the sex can be made only after proper examination of the sex organs or by popping probing ( methods used to confirm the sex of a snake- ref: www.csus.edu/org/critters/CRITTERS/critters/gndrdetr.htm). Apart from this, the sexual dimorphism is also explained based on body size etc which stimulates the above mentioned description. (www.ncbi.nlm.nih.gov/pmc/articles/PMC1688872)
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| − | Godha:
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| − | The same description of godha has been explained in Ashtanga Hrudaya. (A.H.U.36/7). Though there is no such cross breed between a snake and a lizard, in the process of evolution, the snakes are derived from the lizards and both have several features in common. Some lizards can even spread out their upper neck stimulating a cobra or Darveekara Sarpa.(animals.pawnation.com/characteristics-lizards-snakes-have-8612.html) may be such varieties are explained as gaudheyaka.
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| − | Types of luta (spiders):
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| − | BROWN RECLUSE SPIDER: BLACK WIDOW SPIDER:
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| − | Loxosceles reclusa Latrodectus mactans
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| − | Current clinical practices:
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| − | Management of ingested poison:
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| − | Management of snake bite:
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| − | Management of insect bite:
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| − | Glossary:
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| | आध्भान ādhamānaṁ Distention of abdomen due to gas. | | आध्भान ādhamānaṁ Distention of abdomen due to gas. |
| | आरस्म ālasya Loss of enthusiasm, idleness , want of energy, apathetic, Reluctance to work or make an effort, laziness | | आरस्म ālasya Loss of enthusiasm, idleness , want of energy, apathetic, Reluctance to work or make an effort, laziness |