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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>'''
 
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<big>'''Abstract </big>'''
 
<big>'''Abstract </big>'''
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<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:
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:
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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.
 
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.
 
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'''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.  
 
'''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.  
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''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''.
 
''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 [[dosha]] without any obstruction in circulation. Depending upon the location of [[dosha]] and [[prakriti]] of patient, ''visha'' produces several other complications. [24-27]
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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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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]
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=== Treatment of poisonous effects in ''kapha'' dominance ===
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=== 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]
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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]
    
=== Various formulations ===
 
=== Various formulations ===
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All these anti-poison formulations may be used in chameleon poisoning according to ''dosha''.[208]
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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]
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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.  
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*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.
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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 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).
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*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.  
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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. 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.  
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*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).  
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*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).  
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*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).
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*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.
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*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.  
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*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.
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*[[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).
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=== Properties and affects ===
 
=== 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 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>
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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 ===
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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. <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>
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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. <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 ===
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=== Importance of protection of heart ===
 
=== 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.<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>
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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.<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 ===
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=== ''Mahagandhahasti agada'' ===
 
=== ''Mahagandhahasti agada'' ===
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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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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 ===
 
=== Various formulations ===
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#चुञ्चु
 
#चुञ्चु
 
#गोरोचना
 
#गोरोचना
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==References==
 
==References==
 
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