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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

<big>'''Abstract </big>'''

<big>'''Abstract </big>'''

<div style="text-align:justify;">

<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:

 

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.

 

'''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.  

  </div>

  </p>

''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]

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]] ===

=== Properties and affects ===

=== Properties and affects ===

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 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>

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. <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>

''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 ===

=== 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.<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>

''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 ===

#चुञ्चु

#चुञ्चु

#गोरोचना

#गोरोचना

==References==

==References==

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