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Line 1: + − + − + − − − <big>'''Abstract </big>''' − <div style="text-align:justify;"> − Among the Ashtangas, ''agada tantra'' (toxicology) stands separate in its concept, clinical approach, management and result. This is the only chapter which guides us in the management of poison and the conditions of poisoning. As we all know ''visha'' and ''visha chikitsa'' requires a special mention in any medical system. It is rightly justified by the following facts: − − Treatment of poisoning is an emergency and should be managed as a house on fire, earlier its extinguished, lesser the damage, and the result for the effort of ''vaidya'' is immediate when compared to the other disorders. This chapter deals with study of the poison, its origin and criterion of classification. The group of ''sthavara'' (poisons of plant origin, minerals and metal, poison of immobile origin or vegetable poison) and ''jangama'' (poisons of animal origin) are described. A special category called ''kritrima visha'' (artificial poison) with a significant role for a good physician in treating severe cases. ''Dushivisha'' (slow poisons) is explained in a sentence but, has lot of hidden meaning and is a treasure in innovating the treatment skills of a physician. Various treatment methods for the poisons and ''chaturvimshati upakrama'' (24 fold treatments) is a special contribution of Charak. Medicines as a single drug and as a combination are told as remedial measures and also as symptomatic treatments as per the requirement of condition are described. Together with this, ''jangama vishas'' (poison of animal origin) and specific approach for their management are very systematically mentioned. − − '''Keywords''': ''Agada, visha,'' toxins, poisons, ''dushi visha,'' slow poisons, snake bite, snake venoms, mosquito bite, antidotes, ''shanka visha'' (pseudo poison), ''gara visha'' (slow poisons), poisoning. − </div> − Line 31:
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Line 741: − + − + − ''Rakta dhatu'' is abode of ''visha'' (circulates ''visha'' all over the body) just like wind spreads the fire. With the help of ''pradeha'' (external application) and ''seka'' which are cooling in effect, blood gets coagulated thereby arresting the spread of poison. Due to the ''vega avastha'' of ''visha'' (different stages), patient suffers from ''mada'' (intoxication), ''murchha'' (fainting), ''vishada'' (depression), ''hridaya drava'' (palpitation) etc. Application of cooling therapies alleviates such complication. The patient should sufficiently ventilated till the occurrence of horripilation.[39-43]+ Line 776:
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{{#seo:
{{#seo:
|title=Visha Chikitsa
|title=Visha Chikitsa
|titlemode=append
|titlemode=append
|keywords=Agada, visha, toxins, poisons, dushi visha, slow poisons, snake bite, snake venoms, mosquito bite, antidotes, shanka visha (pseudo poison), gara visha (slow poisons)
|keywords=Agada, visha, toxins, poisons, dushi visha, slow poisons, snake bite, snake venoms, mosquito bite, antidotes, shanka visha (pseudo poison), gara visha (slow poisons),Ayurveda, Indian system of medicine, charak samhita.
|description=Chikitsa Sthana Chapter 23. Management of Visha (various types of poisoning)
|description=Chikitsa Sthana Chapter 23. Management of Visha (various types of poisoning)
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
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|image_alt=charak samhita
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<big>'''[[Chikitsa Sthana]] Chapter 23. Management of Visha (various types of poisoning) </big>'''
<big>'''[[Chikitsa Sthana]] Chapter 23. Management of Visha (various types of poisoning) </big>'''
{{Infobox
{{Infobox
|title = Visha Chikitsa
|title = Visha Chikitsa
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Gopikrishna,Bhatt S.,Binorkar S.
|label7 = Reviewer
|data7 = Binorkar S.
|label8 = Editors
|data8 = Binorkar S., Deole Y.S., Basisht G.
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.024 10.47468/CSNE.2020.e01.s06.024]
|header3 =
|header3 =
}}
}}
<big>'''Abstract </big>'''
<p style="text-align:justify;">Among the Ashtangas, ''agada tantra'' (toxicology) stands separate in its concept, clinical approach, management and result. This is the only chapter which guides us in the management of poison and the conditions of poisoning. As we all know ''visha'' and ''visha chikitsa'' requires a special mention in any medical system. It is rightly justified by the following facts:
<br/>
Treatment of poisoning is an emergency and should be managed as a house on fire, earlier its extinguished, lesser the damage, and the result for the effort of ''vaidya'' is immediate when compared to the other disorders. This chapter deals with study of the poison, its origin and criterion of classification. The group of ''sthavara'' (poisons of plant origin, minerals and metal, poison of immobile origin or vegetable poison) and ''jangama'' (poisons of animal origin) are described. A special category called ''kritrima visha'' (artificial poison) with a significant role for a good physician in treating severe cases. ''Dushivisha'' (slow poisons) is explained in a sentence but, has lot of hidden meaning and is a treasure in innovating the treatment skills of a physician. Various treatment methods for the poisons and ''chaturvimshati upakrama'' (24 fold treatments) is a special contribution of Charak. Medicines as a single drug and as a combination are told as remedial measures and also as symptomatic treatments as per the requirement of condition are described. Together with this, ''jangama vishas'' (poison of animal origin) and specific approach for their management are very systematically mentioned.
<br/>
'''Keywords''': ''Agada, visha,'' toxins, poisons, ''dushi visha,'' slow poisons, snake bite, snake venoms, mosquito bite, antidotes, ''shanka visha'' (pseudo poison), ''gara visha'' (slow poisons), poisoning.
</p>
== Introduction ==
== Introduction ==
Now we shall expound the chapter "Visha chikitsa"(Management of different types of poisoning). Thus said Lord Atreya.
Now we shall expound the chapter "Visha chikitsa"(Management of different types of poisoning). Thus said Lord Atreya.
Agnivesha, hear me carefully. Next I will explain about ''visha'' with the following aspects. ''Utpatti'' (origin), ''guna'' (properties), ''yoni'' (source), ''vegas'' (stages), ''lakshana'' (signs and symptoms) and ''chikitsa'' (therapeutic measures).[1-3]
Agnivesha, hear me carefully. Next I will explain about ''visha'' with the following aspects. ''Utpatti'' (origin), [[guna]] (properties), ''yoni'' (source), ''vegas'' (stages), ''lakshana'' (signs and symptoms) and ''chikitsa'' (therapeutic measures).[1-3]
=== History of origin of ''visha'' ===
=== History of origin of ''visha'' ===
In human beings, the effects of poisons are manifested in eight different stages as follows:
In human beings, the effects of poisons are manifested in eight different stages as follows:
*In the first stage, because of the vitiation of ''rasa'', the patient suffers from morbid thirst, unconsciousness, tingling sensation in teeth, salivation, vomiting and mental fatigue;
*In the first stage, because of the vitiation of [[rasa dhatu]], the patient suffers from morbid thirst, unconsciousness, tingling sensation in teeth, salivation, vomiting and mental fatigue;
*In the second stage, because of the vitiation of ''rakta'' the patient suffers from discoloration of the skin, giddiness, trembling; fainting, yawning, tingling sensation in the limbs and dyspnea.
*In the second stage, because of the vitiation of [[rakta dhatu]] the patient suffers from discoloration of the skin, giddiness, trembling; fainting, yawning, tingling sensation in the limbs and dyspnea.
*In the third stage, because of the vitiation of ''mamsa'', the patient suffers from ''mandala'' (skin rash), pruritus, edema and urticaria;
*In the third stage, because of the vitiation of [[mamsa dhatu]], the patient suffers from ''mandala'' (skin rash), pruritus, edema and urticaria;
*In the fourth stage, because of the vitiation of ''vayu'', etc., the patient suffers from vomiting, burning sensation, pain in the limbs, fainting, etc.;
*In the fourth stage, because of the vitiation of [[vayu]], etc., the patient suffers from vomiting, burning sensation, pain in the limbs, fainting, etc.;
*In the fifth stage, the patient suffers from blue-vision, or dark- vision, etc.;
*In the fifth stage, the patient suffers from blue-vision, or dark- vision, etc.;
*In the sixth stage, the patient suffers from hiccup.;
*In the sixth stage, the patient suffers from hiccup.;
</div></div>
</div></div>
''Laghu'' (lightness for digestion), ''ruksha'' (dryness), ''ashu'' (rapid), ''vishada'' (non sliminess), ''vyavayi'' (which pervades whole body before getting digested), ''tikshna'' (sharply acting), ''vikashi'' (causing looseness of joints by diminution of ''dhatus'')'', sukshma'' (subtleness), ''ushna'' (hot), and ''anirdeshya rasa'' (indistinct taste)- these are the ten properties of poison according to the expert ''vaidyas''.
''Laghu'' (lightness for digestion), ''ruksha'' (dryness), ''ashu'' (rapid), ''vishada'' (non sliminess), ''vyavayi'' (which pervades whole body before getting digested), ''tikshna'' (sharply acting), ''vikashi'' (causing looseness of joints by diminution of [[dhatu]])'', sukshma'' (subtleness), ''ushna'' (hot), and ''anirdeshya rasa'' (indistinct taste)- these are the ten properties of poison according to the expert ''vaidyas''.
Because of dryness property, ''vayu'' gets aggravated; due to hot property, ''pitta'' gets vitiated; subtleness leads to vitiation of ''rakta''; Due to ''avyakta rasa'' (indistinct taste), ''kapha'' is vitiated; due to rapidly acting, it quickly permeates through the nutrient fluid; ''vyavayi guna'' spreads it throughout the body instantaneously. ''Tikshna guna'' (sharply acting) property causes injury to ''marmas, vikashi guna'' results in death of the patient. Due to ''laghu guna'' it becomes difficult to manage therapeutically; because of ''vaishadya guna'', it pervades all over the body with ''doshas'' without any obstruction in circulation. Depending upon the location of ''doshas'' and ''prakriti'' of patient, ''visha'' produces several other complications. [24-27]
Because of dryness property, [[vayu]] gets aggravated; due to hot property, [[pitta]] gets vitiated; subtleness leads to vitiation of [[rakta]]; Due to ''[[Avyakta|avyakta]] rasa'' (indistinct taste), [[kapha]] is vitiated; due to rapidly acting, it quickly permeates through the nutrient fluid; vyavayi [[guna]] spreads it throughout the body instantaneously. Tikshna [[guna]] (sharply acting) property causes injury to marmas, vikashi [[guna]] results in death of the patient. Due to laghu [[guna]] it becomes difficult to manage therapeutically; because of vaishadya [[guna]], it pervades all over the body with [[dosha]] without any obstruction in circulation. Depending upon the location of [[dosha]] and [[prakriti]] of patient, ''visha'' produces several other complications. [24-27]
=== Clinical features as per site of ''dosha'' ===
=== Clinical features as per site of [[dosha]] ===
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<div class="mw-collapsible mw-collapsed">
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If ''visha'' is situated at ''vata sthana'' in a person having ''vatika prakriti'', then he suffers from ''trit'' (excessive thirst), ''moha'' (loss of consciousness), ''arati'' (dislikness for everything), ''moorchha'' (fainting), ''galagraha'' (obstruction in the throat), ''phena chhardi'' (vomitus containing froth). There will be less manifestation of signs and symptoms of ''kapha'' and ''pitta''.
If ''visha'' is situated at [[vata]] sthana in a person having vatika [[prakriti]], then he suffers from ''trit'' (excessive thirst), ''moha'' (loss of consciousness), ''arati'' (dislikness for everything), ''moorchha'' (fainting), ''galagraha'' (obstruction in the throat), ''phena chhardi'' (vomitus containing froth). There will be less manifestation of signs and symptoms of ''kapha'' and ''pitta''.
If the poison gets lodged in ''pitta sthana'' in a person having ''paittiika prakriti'' he will suffer from ''trit'' (excessive thirst), ''kasa'' (cough), ''jwara'' (fever), ''vamadhu'' (vomiting sensation), ''klama'' (mental fatigue), ''daha'' (burning sensation), ''tama'' (appearance of darkness), ''atisara'' (diarrhea). There will be less manifestation of signs and symptoms of ''kapha'' and ''vayu''.
If the poison gets lodged in [[pitta]] sthana in a person having paittiika [[prakriti]] he will suffer from ''trit'' (excessive thirst), ''kasa'' (cough), ''jwara'' (fever), ''vamadhu'' (vomiting sensation), ''klama'' (mental fatigue), ''daha'' (burning sensation), ''tama'' (appearance of darkness), ''atisara'' (diarrhea). There will be less manifestation of signs and symptoms of [[kapha]] and [[vayu]].
If the poison gets lodged in ''kapha sthana'' in a person having ''kapha prakriri'' then he will be suffering from ''shwasa'' (dyspnea), ''galagraha'' (obstruction of throat), ''kandu'' (itching), ''laala vamana'' (excessive salivation). There will be less manifestation of signs and symptoms of ''vayu'' and ''pitta''.[28-30]
If the poison gets lodged in [[kapha]] sthana in a person having [[kapha]] prakriri then he will be suffering from ''shwasa'' (dyspnea), ''galagraha'' (obstruction of throat), ''kandu'' (itching), ''laala vamana'' (excessive salivation). There will be less manifestation of signs and symptoms of [[vayu]] and [[pitta]].[28-30]
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</div></div>
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''Dushi-visha'' (a type of artificial poison) vitiates blood and produces symptoms like ''aru'' (eczema in the head), ''kitibha'' (psoriasis) and ''kotha'' (urticaria). This type of poison afflicts each one of the ''doshas'' and causes death of the patient.[31]
''Dushi-visha'' (a type of artificial poison) vitiates blood and produces symptoms like ''aru'' (eczema in the head), ''kitibha'' (psoriasis) and ''kotha'' (urticaria). This type of poison afflicts each one of the [[dosha]] and causes death of the patient.[31]
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#''Parisheka'' (affusion);
#''Parisheka'' (affusion);
#''Avagaha'' (bath with medicated water);
#''Avagaha'' (bath with medicated water);
#''Rakta-Mokshana'' (blood-letting);
#[[Raktamokshana]] (blood-letting);
#''Vamana'' (therapeutic emesis);
#[[Vamana]] (therapeutic emesis);
#''Virechana'' (therapeutic purgation);
#[[Virechana]] (therapeutic purgation);
#''Upadhana'' (application of medicine after making an incision over the scalp);
#''Upadhana'' (application of medicine after making an incision over the scalp);
#''Hridayavaram'' (giving medicines-to protect the heart);
#''Hridayavaram'' (giving medicines-to protect the heart);
#''Anjana'' (application of collyrium);
#''Anjana'' (application of collyrium);
#''Nasya'' (inhalation of medicated oil, etc.);
#[[Nasya]] (inhalation of medicated oil, etc.);
#''Dhuma'' (smoking therapy);
#''Dhuma'' (smoking therapy);
#''Leha'' (drugs in the form of linctus given for licking);
#''Leha'' (drugs in the form of linctus given for licking);
Thereafter bloodletting should be done with ''prachhana'' (scratching with the help of rough instruments), ''shringa'' (horn), ''jalauka'' (leech), or ''siravyadhana'' (venesection).
Thereafter bloodletting should be done with ''prachhana'' (scratching with the help of rough instruments), ''shringa'' (horn), ''jalauka'' (leech), or ''siravyadhana'' (venesection).
The blood vitiated by ''visha'' can cause vitiation of other ''dhatus'' there by resulting in death. Therefore blood does not come out of site of bite, then ''pragharshana'' (rubbing therapy) should be employed to cause the blood to flow out.
The blood vitiated by ''visha'' can cause vitiation of other [[dhatu]] there by resulting in death. Therefore blood does not come out of site of bite, then ''pragharshana'' (rubbing therapy) should be employed to cause the blood to flow out.
''Pragharshana'' done with the help of powdered ''trikatu'' (Zingiber officinale, Piper nigrum, Piper longum), ''grihadhooma, haridra'' (Curcuma longa), ''panchalavana'' (five varieties of salts) and ''varthaka''. Excessive bleeding can be treated with ''sheetalepa'' with the paste of ''vata'' (Ficus bengalensis), etc.
''Pragharshana'' done with the help of powdered ''trikatu'' (Zingiber officinale, Piper nigrum, Piper longum), ''grihadhooma, haridra'' (Curcuma longa), ''panchalavana'' (five varieties of salts) and ''varthaka''. Excessive bleeding can be treated with ''sheetalepa'' with the paste of [[vata]] (Ficus bengalensis), etc.
[[Rakta dhatu]] is abode of ''visha'' (circulates ''visha'' all over the body) just like wind spreads the fire. With the help of ''pradeha'' (external application) and ''seka'' which are cooling in effect, blood gets coagulated thereby arresting the spread of poison. Due to the ''vega avastha'' of ''visha'' (different stages), patient suffers from ''mada'' (intoxication), ''murchha'' (fainting), ''vishada'' (depression), ''hridaya drava'' (palpitation) etc. Application of cooling therapies alleviates such complication. The patient should sufficiently ventilated till the occurrence of horripilation.[39-43]
=== Benefits of first aid treatments ===
=== Benefits of first aid treatments ===
''Agnikarma'' (cauterization) causes burning of poison located in skin and flesh. ''Sravana'' (drugs used to cause exudation of liquid) helps in flowing out of poison from the blood.
''Agnikarma'' (cauterization) causes burning of poison located in skin and flesh. ''Sravana'' (drugs used to cause exudation of liquid) helps in flowing out of poison from the blood.
[[Vamana]] (emesis) helps in eliminating poison which has been taken orally. The second stage of poisoning [[virechana]] (purgation) places a definite role in eliminating the ''visha'' from the body. [45]
=== Treatment of second stage ===
=== Treatment of second stage ===
During the 4th stage, patient should be administered with juice of cow dung along with ''kapita rasa'', honey and ghee.
During the 4th stage, patient should be administered with juice of cow dung along with ''kapita rasa'', honey and ghee.
During the 5th stage, patient administered with ''aschothana, anjana'' and ''nasya'' with the juice of ''kakanda'' (Diospyros Montana or Strychnos nuxvomica) and ''shireesha'' (Albizzia procera).
During the 5th stage, patient administered with ''aschothana, anjana'' and [[nasya]] with the juice of ''kakanda'' (Diospyros Montana or Strychnos nuxvomica) and ''shireesha'' (Albizzia procera).
During the 6th stage, patient should be administered with ''samjnasthapana'' drugs (drugs for regaining the consciousness). For that patient should be given to drink ''gopitta'' (cows bile) mixed with ''rajani'' (Curcuma longa), ''manjishta'' (Rubia cordifolia), ''maricha'' (Piper nigrum) and ''pippali'' (Piper longum).
During the 6th stage, patient should be administered with ''samjnasthapana'' drugs (drugs for regaining the consciousness). For that patient should be given to drink ''gopitta'' (cows bile) mixed with ''rajani'' (Curcuma longa), ''manjishta'' (Rubia cordifolia), ''maricha'' (Piper nigrum) and ''pippali'' (Piper longum).
If inhaled, applied externally as an ointment, carried in the body as an amulet, smoked or kept in the house, it annihilates the afflictions by evil spirits, poisons, germs, ''alaksmi'' (inauspiciousness), ''karmana'' (black magic), ''mantra'' (incantations recited to inflict injury to others), fire, thunder-bolt and enemies. It counteracts the evil effects of bad dreams and ''stri-dosha'' (poisons secretly given by women). It prevents untimely death, fear of water and fear of thieves. It endows a person with wealth, food-grains and success in undertakings. It promotes auspiciousness, nourishment and longevity. This excellent recipe is called ''mrtasanjivana'' (recipe that helps in the revival of a dead person). Lord Brahma propounded this recipe prior to the discovery of ''amrita''(ambrosia).[54-60]
If inhaled, applied externally as an ointment, carried in the body as an amulet, smoked or kept in the house, it annihilates the afflictions by evil spirits, poisons, germs, ''alaksmi'' (inauspiciousness), ''karmana'' (black magic), ''mantra'' (incantations recited to inflict injury to others), fire, thunder-bolt and enemies. It counteracts the evil effects of bad dreams and ''stri-dosha'' (poisons secretly given by women). It prevents untimely death, fear of water and fear of thieves. It endows a person with wealth, food-grains and success in undertakings. It promotes auspiciousness, nourishment and longevity. This excellent recipe is called ''mrtasanjivana'' (recipe that helps in the revival of a dead person). Lord Brahma propounded this recipe prior to the discovery of ''amrita''(ambrosia).[54-60]
=== Principle of treatment as per site of ''dosha'' ===
=== Principle of treatment as per site of [[dosha]] ===
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''Dhamani bandha'' (application of tourniquet), ''avamarjana'' (eliminating the poison), and ''atmaraksha'' (protecting ourselves from the attack of evil spirits) should be done with the help of ''mantras''.
''Dhamani bandha'' (application of tourniquet), ''avamarjana'' (eliminating the poison), and ''atmaraksha'' (protecting ourselves from the attack of evil spirits) should be done with the help of ''mantras''.
The predominant site of ''dosha'' in whose place where ''visha'' lodged should be treated first.
The predominant site of [[dosha]] in whose place where ''visha'' lodged should be treated first.
If the ''visha'' is located in ''vata sthana'' (site of ''vata''),then the patient should be administered with ''swedana'' (fomentation therapy) and should be given to drink the paste of ''nata'' (Valeriana wallichii) and ''kushta'' (Saussurea lappa) mixed with curd.
If the ''visha'' is located in [[vata]] sthana (site of [[vata]]),then the patient should be administered with [[swedana]] (fomentation therapy) and should be given to drink the paste of ''nata'' (Valeriana wallichii) and ''kushta'' (Saussurea lappa) mixed with curd.
If the ''visha'' is located in ''pitta sthana'' (site of ''pitta''),then the patient should be administered with ghee, honey, milk and water to drink. He should also be given ''avagaha'' and ''parisheka'' (types of fomentation therapies).
If the ''visha'' is located in [[pitta]] sthana (site of [[pitta]]),then the patient should be administered with ghee, honey, milk and water to drink. He should also be given ''avagaha'' and ''parisheka'' (types of fomentation therapies).
If the ''visha'' is located in ''kapha sthana''(site of ''kapha''), then the patient should be administered with ''ksharagada, swedana'' (fomentation therapy) and ''siravydhana'' (bloodletting).
If the ''visha'' is located in [[kapha]] sthana(site of [[kapha]]), then the patient should be administered with ''ksharagada, [[swedana]] (fomentation therapy) and ''siravydhana'' (bloodletting).
If the ''visha'' is located in ''rakta sthana'' (site of ''rakta''), or if the patient is afflicted with ''dooshivisha'' then the patient should be administered with ''siravyadhana'' (bloodletting) and [[Panchakarma]] (five types of elimination therapies).
If the ''visha'' is located in ''rakta sthana'' (site of [[rakta dhatu]]), or if the patient is afflicted with ''dooshivisha'' then the patient should be administered with ''siravyadhana'' (bloodletting) and [[Panchakarma]] (five types of elimination therapies).
=== Treatment of obstruction by ''kapha'' and ''kakapada'' (incision in the shape of paw of crow) ===
=== Treatment of obstruction by [[kapha]] and ''kakapada'' (incision in the shape of paw of crow) ===
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When the channel of circulation of ''kapha'' gets vitiated by poison, then this causes obstruction in the channel because of which the movement of ''vayu'' gets obstructed. As a result of this, the patient breaths as if he is going to die very soon. If he is free from signs and symptoms of incurability, then incisions should be made on his scalp resembling the paw of the crow (''kakapada''), and one bilva (nearly 40 grams) of the paste of ''charmakasha'' (''saptala'' – Acacia concinna) should be applied over it. He may also be given ''pradhamana'' (a type of inhalation therapy in which the recipe in powder form is blown into the nostrils) with ''katabhi'' (Albizzia procera), ''katu'' (''shunti'' – Zingiber officinale, ''pippali'' – Piper longum and ''maricha'' – Piper nigrum) and ''katphala'' (Luffa cylindrica).
When the channel of circulation of [[kapha]] gets vitiated by poison, then this causes obstruction in the channel because of which the movement of [[vayu]] gets obstructed. As a result of this, the patient breaths as if he is going to die very soon. If he is free from signs and symptoms of incurability, then incisions should be made on his scalp resembling the paw of the crow (''kakapada''), and one bilva (nearly 40 grams) of the paste of ''charmakasha'' (''saptala'' – Acacia concinna) should be applied over it. He may also be given ''pradhamana'' (a type of inhalation therapy in which the recipe in powder form is blown into the nostrils) with ''katabhi'' (Albizzia procera), ''katu'' (''shunti'' – Zingiber officinale, ''pippali'' – Piper longum and ''maricha'' – Piper nigrum) and ''katphala'' (Luffa cylindrica).
Over the ''kakapada'' (incisions in the scalp), the meat of goat, cow, buffalo or cock should be applied which will absorb the poison from the body.[65-67]
Over the ''kakapada'' (incisions in the scalp), the meat of goat, cow, buffalo or cock should be applied which will absorb the poison from the body.[65-67]
=== ''Nasya'' and ''anjana'' administration ===
=== [[Nasya]] and ''anjana'' administration ===
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If there is obstruction to the nose, eyes (vision), ears, tongue and throat, then the patient should be given ''nasya'' (inhalation therapy) with the help of the paste of ''vartaku'' (Solanum melongena), ''bijapura'' (Citrus medica), ''jyotishmati'' (Celastrus paniculatus), etc.
If there is obstruction to the nose, eyes (vision), ears, tongue and throat, then the patient should be given [[nasya]] (inhalation therapy) with the help of the paste of ''vartaku'' (Solanum melongena), ''bijapura'' (Citrus medica), ''jyotishmati'' (Celastrus paniculatus), etc.
If there is obstruction to the eyes (vision), then the collyrium prepared of ''devadaru'' (Cedrus deodara), ''shunthi'' (Zingiber officinale), ''pippali'' (Piper longum) and ''maricha'' (Piper nigrum), ''haridra'' (Curcuma longa), ''karavira'' (Nerium indicum), ''karanja'' (Pongamia pinnata), ''nimba'' (Azadirechta indica) and ''surasa'' (Ocimum sanctum) by triturating with goat’s urine should be applied over the eyes.[68-69]
If there is obstruction to the eyes (vision), then the collyrium prepared of ''devadaru'' (Cedrus deodara), ''shunthi'' (Zingiber officinale), ''pippali'' (Piper longum) and ''maricha'' (Piper nigrum), ''haridra'' (Curcuma longa), ''karavira'' (Nerium indicum), ''karanja'' (Pongamia pinnata), ''nimba'' (Azadirechta indica) and ''surasa'' (Ocimum sanctum) by triturating with goat’s urine should be applied over the eyes.[68-69]
A poisoned garland loses its aroma and gets withered soon. It causes headache and horripilation. The poisoned fume causes stiffness in the channels of circulation and impairment of the functioning of the nose and eyes.
A poisoned garland loses its aroma and gets withered soon. It causes headache and horripilation. The poisoned fume causes stiffness in the channels of circulation and impairment of the functioning of the nose and eyes.
If the water of wells and ponds are poisoned, then the water becomes foul-smelling, dirty and discolored. Intake of this poisoned water causes edema, urticaria and pimples, and even death. If the poison has reached the stomach, then the physician in the beginning should administer emetic therapy. If the poisonous material is located in the skin, then ointments and fomentation therapy etc. should be administered. These therapeutic measures should be administered, keeping in view the nature of the ''doshas'' and the strength of the patient. [117-123]
If the water of wells and ponds are poisoned, then the water becomes foul-smelling, dirty and discolored. Intake of this poisoned water causes edema, urticaria and pimples, and even death. If the poison has reached the stomach, then the physician in the beginning should administer emetic therapy. If the poisonous material is located in the skin, then ointments and fomentation therapy etc. should be administered. These therapeutic measures should be administered, keeping in view the nature of the [[dosha]] and the strength of the patient. [117-123]
=== Description of snakes and poisoning ===
=== Description of snakes and poisoning ===
Let us now discuss on the various aspects of animal poisoning. At first, let us discuss on the various aspects of snakes and the special treatment of ailments caused by the snake-bite. [123]
Let us now discuss on the various aspects of animal poisoning. At first, let us discuss on the various aspects of snakes and the special treatment of ailments caused by the snake-bite. [123]
=== Types of snakes and their effect on ''dosha'' ===
=== Types of snakes and their effect on [[dosha]] ===
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Snakes are classified into three categories- ''darvikara, mandali'' and ''rajiman'' and they cause aggravation of ''vayu, pitta'' and ''kapha'' respectively.[124]
Snakes are classified into three categories- ''darvikara, mandali'' and ''rajiman'' and they cause aggravation of [[vayu]], [[pitta]] and [[kapha]] respectively.[124]
=== Identification of snakes ===
=== Identification of snakes ===
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The bite by the ''darvikara sarpa'' is characterized by minute fang marks, is black, there is absence of bleeding, swelling having the shape of back of a tortoise and it produces several disorders due to aggravation of ''vata''.[127]
The bite by the ''darvikara sarpa'' is characterized by minute fang marks, is black, there is absence of bleeding, swelling having the shape of back of a tortoise and it produces several disorders due to aggravation of [[vata]].[127]
=== Characteristics of ''mandali'' snake bite ===
=== Characteristics of ''mandali'' snake bite ===
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The fang marks due to the bite by ''mandali sarpa'' is deep, the wound is spread over a large surface area, associated with edema. There is yellowish discoloration at the site of bite and the exudates at the bite site are yellowish and bloody. They cause several other disorders due to aggravation of ''pitta''.[128]
The fang marks due to the bite by ''mandali sarpa'' is deep, the wound is spread over a large surface area, associated with edema. There is yellowish discoloration at the site of bite and the exudates at the bite site are yellowish and bloody. They cause several other disorders due to aggravation of [[pitta]].[128]
=== Characteristics of ''rajimana'' snake bite ===
=== Characteristics of ''rajimana'' snake bite ===
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The bite by the ''rajimana sarpa'' is characterized by a soft and stable edema.The bite site is unctuous and pale. The bloody exudates coming from the bite site is thick and several disorders due to aggravation of ''kapha'' are produced. [129]
The bite by the ''rajimana sarpa'' is characterized by a soft and stable edema.The bite site is unctuous and pale. The bloody exudates coming from the bite site is thick and several disorders due to aggravation of [[kapha]] are produced. [129]
=== Gender wise characteristics of snakes ===
=== Gender wise characteristics of snakes ===
The poison though situated in whole body is released by the snake when angry, but the same is not released due to hunger or fear.[164]
The poison though situated in whole body is released by the snake when angry, but the same is not released due to hunger or fear.[164]
=== ''Dosha'' dominance in insects poison ===
=== [[Dosha]] dominance in insects poison ===
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Poisons of crab and scorpion are predominant in ''vata'', those of ''keeta'' (insects) are predominant in ''vata'' and ''pitta'' and ''kanabha'' (hornets) etc. are predominant in ''kapha''.[165]
Poisons of crab and scorpion are predominant in [[vata]], those of ''keeta'' (insects) are predominant in [[vata]] and [[pitta]] and ''kanabha'' (hornets) etc. are predominant in [[kapha]].[165]
=== Treatment as per ''dosha'' dominance ===
=== Treatment as per [[dosha]] dominance ===
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Treatment is given with the measures having qualities contrary to those of the ''dosha'' exhibiting predominant symptoms.[166]
Treatment is given with the measures having qualities contrary to those of the [[dosha]] exhibiting predominant symptoms.[166]
=== Clinical effects of ''vata'' dominant ''visha'' ===
=== Clinical effects of [[vata]] dominant ''visha'' ===
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In ''vatika'' poisoning the symptoms are – cardiac pain, upward movement of ''vayu'', stiffness, dilatation of blood vessels, pain in the bone joints, giddiness, twisting and blackishness in the body.[167]
In ''vatika'' poisoning the symptoms are – cardiac pain, upward movement of [[vayu]], stiffness, dilatation of blood vessels, pain in the bone joints, giddiness, twisting and blackishness in the body.[167]
=== Clinical effects of ''pitta'' dominant ''visha'' ===
=== Clinical effects of ''pitta'' dominant ''visha'' ===
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Rabid dog bite: due to the vitiation of ''tridosha'' and aggravation of ''dhatus'' suffers from headache, salivation and drooped face. [175]
Rabid dog bite: due to the vitiation of tri[[dosha]] and aggravation of [[dhatu]] suffers from headache, salivation and drooped face. [175]
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Other such fierce animals too vitiate ''kapha'' and ''vata'' and cause cardiac pain, headache, fever, stiffness, thirst and fainting.[176]
Other such fierce animals too vitiate [[kapha]] and [[vata]] and cause cardiac pain, headache, fever, stiffness, thirst and fainting.[176]
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In poisoning of the ''mamsa dhatu'', roots of ''khadira'' (Acacia catechu), ''nimba'' (Azadiracta indica) and ''kutaja'' (Holarrhena antidysentrica) should be taken mixed with honey and along with water.[187]
In poisoning of the ''mamsa dhatu'', roots of ''khadira'' (Acacia catechu), ''nimba'' (Azadiracta indica) and ''kutaja'' (Holarrhena antidysentrica) should be taken mixed with honey and along with water.[187]
=== Treatment of poisonous effects in all ''dhatu'' ===
=== Treatment of poisonous effects in all [[dhatu]] ===
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In all types of poisoning, two types of ''bala'' (Sida cordifolia and Abutilon indicum), ''madhuka'' (Glycyrrhiza glabra), ''madhooka'' (Madhuca longifolia), and ''tagara'' (Valeneria wallichii) should be taken.[188]
In all types of poisoning, two types of ''bala'' (Sida cordifolia and Abutilon indicum), ''madhuka'' (Glycyrrhiza glabra), ''madhooka'' (Madhuca longifolia), and ''tagara'' (Valeneria wallichii) should be taken.[188]
=== Treatment of poisonous effects in ''kapha'' dominance ===
=== Treatment of poisonous effects in [[kapha]] dominance ===
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''Pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''yavakshara'' (Yavakshara (obtained by incinerating Hordeum vulgare) mixed with fresh ''navaneeta'' (butter) should be painted on the site if there is aggravation of ''kapha dosha''. [189]
''Pippali'' (Piper longum), ''shunthi'' (Zingiber officinale), ''yavakshara'' (Yavakshara (obtained by incinerating Hordeum vulgare) mixed with fresh ''navaneeta'' (butter) should be painted on the site if there is aggravation of [[kapha]] [[dosha]]. [189]
=== Various formulations ===
=== Various formulations ===
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All these anti-poison formulations may be used in chameleon poisoning according to ''dosha''.[208]
All these anti-poison formulations may be used in chameleon poisoning according to [[dosha]].[208]
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Moreover mostly the measures alleviating ''vata'' and ''pitta'' are prescribed.[211]
Moreover mostly the measures alleviating [[vata]] and [[pitta]] are prescribed.[211]
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*The action of animal poison is manly in lower gastrointestinal tract, while the action of plant poison is mainly in upper gastrointestinal tract. The clinical features are well differentiated in both cases. Therefore, the animal poison is used in treatment of poisoning by vegetable-poison and vice versa.
*The action of animal poison is manly in lower gastrointestinal tract, while the action of plant poison is mainly in upper gastrointestinal tract. The clinical features are well differentiated in both cases. Therefore, the animal poison is used in treatment of poisoning by vegetable-poison and vice versa.
*The effect of ''visha'' in humans can be assessed clinically in eight stages. The severity increases as per stage, finally leading to death.
*The effect of ''visha'' in humans can be assessed clinically in eight stages. The severity increases as per stage, finally leading to death.
*The poisonous effect depends upon site of ''dosha, prakriti'' of patient and nature of poison.
*The poisonous effect depends upon site of [[dosha]], [[Prakriti]] of patient and nature of poison.
*''Dushi-visha'' (a type of artificial poison) vitiates blood and produces symptoms like ''aru'' (eczema in the head), k''itibha'' (psoriasis) and ''kotha'' (urticaria). This type of poison afflicts all ''doshas'' and causes death of the patient.
*''Dushi-visha'' (a type of artificial poison) vitiates blood and produces symptoms like ''aru'' (eczema in the head), kitibha (psoriasis) and kotha (urticaria). This type of poison afflicts all ''doshas'' and causes death of the patient.
*Due to power of poison, vitiated blood transudes to obstruct srotas (channels) leading to death of the patient. If the poison is taken orally, it stays in heart ( generalized affect) and if the poison is transmitted by bite or from poisoned arrow (local affect), it gets lodged in the place of bite.
*Due to power of poison, vitiated blood transudes to obstruct srotas (channels) leading to death of the patient. If the poison is taken orally, it stays in heart ( generalized affect) and if the poison is transmitted by bite or from poisoned arrow (local affect), it gets lodged in the place of bite.
*Immediate treatment should be done to prevent spread of poison in the body through circulation. Application of tourniquet at the site of bite and suction are first measures.
*Immediate treatment should be done to prevent spread of poison in the body through circulation. Application of tourniquet at the site of bite and suction are first measures.
*''Rakta dhatu'' is abode of ''visha'' and circulates ''visha'' all over the body. Hence bloodletting shall be done in various modalities at site of bite.
*''Rakta dhatu'' is abode of ''visha'' and circulates ''visha'' all over the body. Hence bloodletting shall be done in various modalities at site of bite.
*The treatment shall be administered after assessment of stage of poisoning and condition of the patient.
*The treatment shall be administered after assessment of stage of poisoning and condition of the patient.
*The treatment of ''visha'' includes twenty four modalities that are categorized under emergency treatments and conservative treatments. viz. Recitation of mantras; ''Arishta'' (tying an amulet impregnated with ''mantra'' or tying a bandage above the place of bite); ''Utkartana'' (excision of the part afflicted with the poisonous bite); ''Nishpidana'' (squeezing out blood from the place of the bite); ''Chushana'' (sucking out the poison from the place of the bite); ''Agni'' (cauterization); ''Parisheka'' (affusion); ''Avagaha'' (bath with medicated water); ''Rakta-Mokshana'' (blood-letting); ''Vamana'' (therapeutic emesis); ''Virechana'' (therapeutic purgation); ''Upadhana'' (application of medicine after making an incision over the scalp); ''Hridayavaram'' (giving medicines-to protect the heart); ''Anjana'' (application of collyrium); ''Nasya'' (inhalation of medicated oil, etc.); ''Dhuma'' (smoking therapy); ''Leha'' (drugs in the form of linctus given for licking); ''Aushadha'' (administration of anti-toxic drugs or wearing as an amulet); ''Prashamana'' (sedatives); ''Pratisarana'' (application of alkalies); ''Prativisha'' (administration of poisons as medicines to counteract the original poison); ''Sanjna-samsthapana'' (administration of medicines for the restoration of consciousness); ''Lepa'' (application of medicines in the form of a paste or ointment); and ''Mrita-sanjivana'' (measures for the revival of life of an apparently dead person).
*The treatment of ''visha'' includes twenty four modalities that are categorized under emergency treatments and conservative treatments. viz. Recitation of mantras; ''Arishta'' (tying an amulet impregnated with ''mantra'' or tying a bandage above the place of bite); ''Utkartana'' (excision of the part afflicted with the poisonous bite); ''Nishpidana'' (squeezing out blood from the place of the bite); ''Chushana'' (sucking out the poison from the place of the bite); [[Agni]] (cauterization); ''Parisheka'' (affusion); ''Avagaha'' (bath with medicated water); ''Rakta-Mokshana'' (blood-letting); [[Vamana]] (therapeutic emesis); [[Virechana]] (therapeutic purgation); ''Upadhana'' (application of medicine after making an incision over the scalp); ''Hridayavaram'' (giving medicines-to protect the heart); ''Anjana'' (application of collyrium); ''Nasya'' (inhalation of medicated oil, etc.); ''Dhuma'' (smoking therapy); ''Leha'' (drugs in the form of linctus given for licking); ''Aushadha'' (administration of anti-toxic drugs or wearing as an amulet); ''Prashamana'' (sedatives); ''Pratisarana'' (application of alkalies); ''Prativisha'' (administration of poisons as medicines to counteract the original poison); ''Sanjna-samsthapana'' (administration of medicines for the restoration of consciousness); ''Lepa'' (application of medicines in the form of a paste or ointment); and ''Mrita-sanjivana'' (measures for the revival of life of an apparently dead person).
*''Dhamani bandha'' (application of tourniquet), ''avamarjana'' (eliminating the poison), and ''atmaraksha'' (protecting ourselves from the attack of evil spirits) should be done with the help of mantras. At first ''dosha'', where ''visha'' is lodged should be treated.
*''Dhamani bandha'' (application of tourniquet), ''avamarjana'' (eliminating the poison), and ''atmaraksha'' (protecting ourselves from the attack of evil spirits) should be done with the help of mantras. At first [[dosha]], where ''visha'' is lodged should be treated.
*If, ''visha'' is located in ''vata sthana'' then the patient should be administered with ''swedana'' (fomentation therapy) and should be given to drink the paste of ''nata'' (Valeriana wallichii) and ''kushta'' (Saussurea lappa) mixed with curd.
*If, ''visha'' is located in [[vata]] sthana then the patient should be administered with [[swedana]] (fomentation therapy) and should be given to drink the paste of ''nata'' (Valeriana wallichii) and ''kushta'' (Saussurea lappa) mixed with curd.
*If, ''visha'' is located in ''pitta sthana'' then the patient should be administered with ghee (clarified butter), honey, milk and water to drink. He should also be given ''avagaha'' and ''parisheka'' (types of fomentation therapies).
*If, ''visha'' is located in [[pitta]] sthana then the patient should be administered with ghee (clarified butter), honey, milk and water to drink. He should also be given ''avagaha'' and ''parisheka'' (types of fomentation therapies).
*If, ''visha'' is located in ''kapha sthana'' (chest region) then the patient should be administered with ''ksharagada'' (..), ''swedana'' (fomentation therapy) and ''siravydhana'' (bloodletting).
*If, ''visha'' is located in [[kapha]] sthana (chest region) then the patient should be administered with ''ksharagada'' (..), [[swedana]] (fomentation therapy) and ''siravydhana'' (bloodletting).
*If, ''visha'' is located in ''rakta sthana'' or if the patient is afflicted with ''dooshivisha'' (..) then the patient should be administered with ''siravyadhana'' (bloodletting) and [[Panchakarma]] (5 types of elimination therapies).
*If, ''visha'' is located in [[rakta]] sthana or if the patient is afflicted with ''dooshivisha'' (..) then the patient should be administered with ''siravyadhana'' (bloodletting) and [[Panchakarma]] (5 types of elimination therapies).
*Fumigation with herbs is useful in cleaning the atmosphere in home, things of daily use like bed, seats, cloths.
*Fumigation with herbs is useful in cleaning the atmosphere in home, things of daily use like bed, seats, cloths.
*If the poison has reached the stomach, then first principle is to administer emetic therapy. If the poisonous material is located in the skin, then ointments and fomentation therapy etc. should be administered. These therapeutic measures should be administered, keeping in view the nature of the ''doshas'' and the strength of the patient.
*If the poison has reached the stomach, then first principle is to administer emetic therapy. If the poisonous material is located in the skin, then ointments and fomentation therapy etc. should be administered. These therapeutic measures should be administered, keeping in view the nature of the [[dosha]] and the strength of the patient.
*Effect of poison gets aggravated in person who is afraid, drunken, weak and afflicted with heat, hunger and thirst and also if the body constitution and time are similar. Otherwise it has mild effect.
*Effect of poison gets aggravated in person who is afraid, drunken, weak and afflicted with heat, hunger and thirst and also if the body constitution and time are similar. Otherwise it has mild effect.
*Assessment of ''dosha'' dominance shall be done first for diagnosis. Then the poisoning cases shall be treated as per ''dosha'' dominance.
*Assessment of [[dosha]] dominance shall be done first for diagnosis. Then the poisoning cases shall be treated as per [[dosha]] dominance.
*The case of ''vatika'' poisoning, person should be treated with local application of ''khanda'', oil massage, fomentation with tubular method or ''pulaka'' (flesh) and bulk promoting regimens.
*The case of ''vatika'' poisoning, person should be treated with local application of ''khanda'', oil massage, fomentation with tubular method or ''pulaka'' (flesh) and bulk promoting regimens.
*''Paittika'' poisoning should be treated with very cold sprinkling and anointments.
*''Paittika'' poisoning should be treated with very cold sprinkling and anointments.
*''Kaphaja'' poisoning should be overcome with scraping, excision, fomentation and vomiting.
*[[Kapha]]ja poisoning should be overcome with scraping, excision, fomentation and vomiting.
*In poisoning with systemic symptoms, mostly the cold measures are adopted except in cases of ''vrishchika'' (scorpion) and ''ucchitinga'' (crab).
*In poisoning with systemic symptoms, mostly the cold measures are adopted except in cases of ''vrishchika'' (scorpion) and ''ucchitinga'' (crab).
=== Properties and affects ===
=== Properties and affects ===
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 corresponding to its ''guna''. The illustration is precise and understandable. (Su. K. 2/19-21)
The ten [[guna]] of ''visha'' with their impact on the [[dosha]] and the body are dealt in this section. Some [[guna]] 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|avyakta]] rasata'' leads to intrude into the ''anna rasa'' and spreads fast. Vyavayi [[guna]] 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 corresponding to its [[guna]]. The illustration is precise and understandable.<ref>Sushruta. Kalpa Sthana, Cha.2 Sthavaravishavijnaneeya Kalpa Adhyaya verse 3. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1 </ref>
=== Treatment modalities ===
=== Treatment modalities ===
''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)
''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. <ref>Sushruta. Kalpa Sthana, Cha.5 Sarpadashtavisha Chikitsitakalpa Adhyaya verse 3-4. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1</ref> <ref>Vagbhata, Ashtanga Sangraha, Uttara Sthana, 42, Sarpavishapratishedha Adhyaya. Verse 8 translated to English by Prof. Murthy KR, 9 th edition, Varanasi,Chaukhambha Orientalia Publisher, 2005; 229.</ref> <ref>Vagbhata, Ashtanga Sangraha, Uttara Sthana, 42, Sarpavishapratishedha Adhyaya. Verse 19-23 translated to English by Prof. Murthy KR, 9 th edition, Varanasi,Chaukhambha Orientalia Publisher, 2005; 229.</ref>
=== First aid or immediate treatment after bite ===
=== First aid or immediate treatment after bite ===
Application of tourniquet should be to such an extent that the pressure exerted thereby should allow the passing of the little finger 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.
Application of tourniquet should be to such an extent that the pressure exerted thereby should allow the passing of the little finger 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.
''Chushana'' (sucking) may also be done after putting ''gomaya'' (dried cowdung) ''agada churnas'', or ''bhasma'' in mouth. (A.H.U.36/46-47)
''Chushana'' (sucking) may also be done after putting ''gomaya'' (dried cowdung) ''agada churnas'', or ''bhasma'' in mouth.<ref>Vagbhata. Uttara Sthana, Cha.36 Sarpavishapratishedha Adhyaya verse 46-47. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>
=== ''Agnikarma'' and its contraindications ===
=== ''Agnikarma'' and its contraindications ===
''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)
''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. <ref>Vagbhata. Uttara Sthana, Cha.36 Sarpavishapratishedha Adhyaya verse 45. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref>
=== Importance of protection of heart ===
=== Importance of protection of heart ===
''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)
''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.<ref>Vagbhata, Ashtanga Sangraha, Uttara Sthana, 42, Sarpavishapratishedha Adhyaya. Verse 15-16 translated to English by Prof. Murthy KR, 9 th edition, Varanasi,Chaukhambha Orientalia Publisher, 2005; 229</ref>
=== Stage wise treatment of poisoning ===
=== Stage wise treatment of poisoning ===
=== ''Mahagandhahasti agada'' ===
=== ''Mahagandhahasti agada'' ===
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.
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.
=== Various formulations ===
=== Various formulations ===
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.
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. Similar explanation is seen in Sushruta Samiha regarding the testing of food before consuming if suspected to be poisoned. (S.K. 1/28-33)
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. Similar explanation is seen in Sushruta Samiha regarding the testing of food before consuming if suspected to be poisoned. <ref>Sushruta. Kalpa Sthana, Cha.1 Annapanaraksha Adhyaya verse 28-33. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>
=== Identification and types of snakes ===
=== Identification and types of snakes ===
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 two varieties of krait- the common krait and banded krait.
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 two varieties of krait- the common krait and banded krait.
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 three snakes into several varieties. (Su.Ka.4/34).
Acharya Sushruta has explained other classification of snakes which includes the above three under ''savisha'' variety, ''nirvisha'' snakes and ''vaikaranja'' or hybrid snakes<ref>Sushruta. Kalpa Sthana, Cha.4 Sarpadashtavishavijnaaneeya Adhyaya verse 9-10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. He has further sub classified each of these three snakes into several varieties.<ref>Sushruta. Kalpa Sthana, Cha.4 Sarpadashtavishavijnaaneeya Adhyaya verse 34. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>
==== ''Darveekara'' snake – comparison: King cobra and cobra ====
==== ''Darveekara'' snake – comparison: King cobra and cobra ====
==== Gender wise classification of snakes ====
==== Gender wise classification of snakes ====
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). Apart from this, the sexual dimorphism is also explained based on body size etc which stimulates the above mentioned description.
The gender wise classification of snakes is based on several features. The same is explained in Sushruta samhita.<ref>Sushruta. Kalpa Sthana, Cha.4 Sarpadashtavishavijnaaneeya Adhyaya verse 35 In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. 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). Apart from this, the sexual dimorphism is also explained based on body size etc which stimulates the above mentioned description.
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==== ''Godha'' (monitor) ====
==== ''Godha'' (monitor) ====
The same description of ''godha'' has been explained in Ashtanga Hridaya. (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''.
The same description of ''godha'' has been explained in Ashtanga Hridaya. <ref>Vagbhata. Uttara Sthana, Cha.36 Sarpavishapratishedha Adhyaya verse 7. In: Harishastri Paradkar Vaidya, Editors. Ashtanga Hridayam. 1st ed. Varanasi: Krishnadas Academy;2000.p.4.</ref> 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''.
=== Drugs to be identified ===
=== Drugs to be identified ===
#चुञ्चु
#चुञ्चु
#गोरोचना
#गोरोचना
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==References==
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