SNAKE BITE MANAGEMENT IN AYURVEDA WITH SPECIAL REFERENCE TO KERALIYA VISHA CHIKITSA
1 1Dr.GopikrishnaS.,Dr.MeghaKS.
ABSTRACT
WHO
toWHOwithafrequencyof83,000bites perannumwith11,000deaths.ThemostoftheenvenomationwasbyRussell'sViperfollowedbyKraitsandCobras.SnakebitesareconsideredasamajorhealthprobleminNorthKerala,amongbites,Humpnosedpitvipercasesarerelativelymoreandtheineffectivenessoftheantivenomagainstitsbiteworsentheproblem.Highest numberofcaseswasreportedfromKozhikode(1,125)followedbyKannurandPalakkadandleastnumberofcasesinIdukki.AgadTantradealswithalmostallpossibilitiesofpoisoningespeciallysnakebitemanagement.Keralahasdevelopeditsownsnakebitemanagementprotocolsbywidelypracticingvishavaidyasatthattime andrecordedinKeraliyavishachikitsagranthas Theyhadintroducedspecialtreatmentmodalitieslikeoothchikitsa,talam,Tukkudharaetc.Thisreviewdetailssuch specialtreatmentmodalitiesmentionedinVishavaidyaJyotsnikaandPrayogaSamuchayawithspecialreferencetoDarvikaravishachikitsa.
KEYWORDS:Keraliyavishachikitsa,Sarpavishachikitsa,Darvikaravishachikitsa.
Introduction: Acharya has pinpointed the minute details about the symptomatic changes occurring in an envenomation case in accordance with the passage of time throughtheconceptofvishavega Vegaiscalculatedasthetimetakenbyvishato spread from one dhatu to next dhatu Symptoms produced by visha in each dhatu is quite different and by noticing these symptoms physician can easily understandthepathwayofvishaandcangivetreatmentsattheearliesttoprevent its spread into next deeper dhatus. So faster acting medicines and treatments havegivenprimeimportanceinthecontextofSarpavishachikitsa.Keraladueto its geographical peculiarities encountered envenomation more than any other placeswhichnecessitatedthephysiciantogetexpertisedin visha chikitsa.Thus theydevelopedtheirowntreatmentprotocolsusinglocallyavailablemedicines. InbriefsnakebitemanagementinAyurvedacanbeclassifiedunderthese4headings:
1) Sadyakaraniyainsarpavisha
2) Samanyachikitsaofsarpavisha
3) Viseshachikitsaofsarpavisha
4) Upadravachikitsa
Sadyakaraniyainsarpavisha: The first aid management was explained by all textbooks except Gauthamiya kashayapasamhita BhrihatrayisandVishavaidyajyotsnikahasmentionedsimilarmeasuresandoneexceptionisthat Vishavaidyajyostnika hasnotmentioned Aristabandana Andallthetextbooksstatestheimportanceof sadya karaneeya chikitsaupayasbysayingthatthevishawillremainonlyfor100matraatthebite 1 site. (Gauthameeya kashayapa samhita states it as 500 matra) All textbooks hasmentioned Hridayavaranam butin vishavaidya jyotsnika termhasnotmentionedbutseveralghritayogashavementionedwhichcanbetakeninthisregard.
TableNo.1: Bhrihatrayi's
References Procedures
Charaka 2Samhita Venika bandana – nispeedana – acushana – raktamokshana –seeta pradeha and seka
Susrutha 3Samhita Aristabandana – dahana –acushana – raktamokshana –Agada lepanam – parisekam
Astanga 4sangraha Utkartana – bite the snake / stone – application of karnamala – aristabandana with mantra – nispeedana – acushana –Agada lepanam – sechanam – raktamokshana - seethalepa and sekha- hridayavaranm – Vamana
VishavaidyaJyotsnika:
Importanceofmantraishighlighted.Firstaidmeasuresarementionedinthatprimarily asked to bite the snake itself for regaining the confidence of patient. Application of srothramala and dahanam with lohadi is indicated. Therafter jaladhara and dhatugata visha chikitsa is mentioned which is same as that of Prayogasammuchayam.
Prayogasammuchaya:
Theforemostprocedurementionedinthisbookistobitethesnakeitself,whichis meant to increase our confidence / manobalam frighteneing will cause vatavridhi which further causes spread of visha into deeper tissues.After that, application of srothramala as said in ashtanga hridya is mentioned here also. First measure to be adopted is raktamokshana and after that dahana karma is indicated.The dahana karma is contraindicated in mandala damsa Dahana is followedby parisekham.Here jaladhara isindicated. Dhara helpsinreducing the peripheral circulation, thereby reduces spread of venom. In contrast to classical texts, aristabandana is said to be done after these procedures Aristabandana should be done above 4 angula , triangular in shape with two knotsandsamesimilieexplainedbySusruthaAcharyahasquotedhereinorderto signify the usage of aristabandana Thus the chapter sadhyodashta chikitsa 5 comprisesofmeasureswhichcheckthespreadofvenom
6 Jaladhara :
Keraleeyavishachikitsagranthasas afirstaidmeasureandwaspractisingwith much importance. It is said to maintain a continuous flow of water as dhara Seetha Parisekham / dhara helpstodecrease pitta prakopa andalsodecreases therateofperipheralcirculation byVasoconstrictionand therebyretardingthe spreadofvisha
TableNo.2:Comparisonoffirstaidmanagement
Measures
Bite the same snake or stone or stick etc immediately
Ch. Sa Su. Sa As. San VVJ Pra.sa KK
û û û ü ü ü ü
Bite site smeared with sputum or ear wax û ü ü ü ü ü
Arista bandana ü ü ü û ü ü Utkartana ü ü ü ü ü ü Nispidana û ü ü ü ü ü Cusana ü ü ü ü ü ü Agni ü ü ü ü ü ü Parisheka ü ü ü ü ü ü Siravedha ü ü ü ü ü ü Hridayavaranam ü ü ü ü ü ü
Vamana ü ü ü û û ü Jaladhara û û ü ü ü ü
Samanyachikitsa:
General treatment includes both Mantra and Aushadha Prayoga. Bhrihatryai explainsthegeneralsnakebitemanagementindifferentway Charaka acharya explains24treatmentmodalitieswhichincludesbothemergencyandconserva7 torymanagement Theconditionofthepatientdecidesthetreatmentprocedure
andyoga(medicinalformulation)tobeused.
1) Mantra 2) Arishta(tourniquet) 3) Utkartana(incision) 4) Nishpeedana(applicationofpressurearoundbite) 5) Chooshana(suction) 6) Agni(cauterization) 7) Parisekha(washing) 8) Avagaha(immersioninwater) 9) Rakthamokshana(bloodletting) 10) Vamana(inductionofemesis) 11) Virechana(inductionofpurgation) 12) Upadhana(applicationoffleshoveranincisiononhead) 13) Hridayavarana(protectingheartwithmedicaments) 14) Anjana (application of medicaments on lower palpebral conjunctiva) 15) Nasya(intranasaldrugadministration) 16) Dhooma(inhalationofmedicatedsmoke) 17) Leha(oraladministrationofsemisolidmedication) 18) Oushadha(administrationofdrugs) 19) Prasamana(medicationforsuppressionofsymptoms) 20) Prathisarana(stimulationofsecretion) 21) Prathivisha(useofantidotes) 22) Samnjasthapana(restorationandstabilizationofsenses) 23) Lepa(applicationofmedicineinpasteform) 24) Mruthasanjeevana(restorationoflifeindead)
Eventhough Charaka Acharya hasexplained mantra prayoga itisnotdetailed. Susrutha samhita and astanga sangraha detailsabouttheimportanceof mantra prayogabutitdoesn'tincludehowmantraprayogahastobeperformed.
Samanaya chikitsa: Additional treatment modalities in keraleeya visha granthas:
1) Uttu 2) Talam 3) Tukkudhara 4) VelaPrayoga 5) Karuprayoga
8 Uttu :
ThetreatmentprocedurehasmentionedinYogaratnakaraasphuthkarachikitsa. Thewidespreaduseofthattreatmentprocedureisseenamong keraleeya traditional vishachikitsa practitioner's as UTTU chikitsa. The references can been seeninallkeraleeyavishagranthas
Visha residinginfirstthree dhatus ( twak, rakta and mamsa)eliminatedbythe treatmentprocedurecalled'uttuchikitsa”.Itisaprocedureofblowingmedicated airintobothearsandatmoordhaby3personsatatimeupto150times.Forchewingdrugs;sunti,dushsparsha, marichaandvishavegaismentionedandallthese 4drugstobetakeninequalquantity
9 Talam :
Applicationofmedicinesinvertexistermedastalam Itiswidelypractisedtreatment procedure among Keraleeya Visha Vaidya's it is considered to be a best measuretocheckthespreadof visha intodeeper dhatus.Itisusuallyappliedas soonasthepatientapproachesthephysician.Itisadvisedtochangethemedicine applied on the vertex for every 1 ½ - 2 hr gap and continued till the treatment stops.
10
Tukkudhara :
Incaseofpoisoning,swellingwithpainandlocalriseoftemperatureandprickingpainisconsideredasindicationof dhara (VVJ).Incaseofextremeswelling tukkudharaisindicated.JalaDharawithspecializedpot(tukkupatra)isconsideredastukkudhara.Another opinionof Dhara with eswaramooli isalsoseenin this contest. In VVJ, Nimbapatra, parasitic plant grown on karaskara vriksha (karaskarathinpullunni),chandana,eswaramooli,kumariswarasa,kusmanda, erandapatra,withjalaisindicatedforcontinuousdharaoverbitesite.Itrelieves swelling and helps to reduce the complications of bite (especially storny hard edemaandvesicobullouslesionformation).
In neelakandeeyam,itisadvisedtodo dhara with1½ para jala (37.32l)witha pothangedjustabovethebitesitewithahole,throughwhich dhara jala comes andthispotshouldbefilledwithnimbapatra.Dharashouldbecontinuedfor1½ hours.Speciallymentioneddrugsfor tukku dhara includes visanika, arkapatra, nimbapatra, kuppamanjal, karanjapatra, erandapatra Swarasa of leaves of theseplantscanbeusedinsteadofjalaintukkudhara
11 VelaPrayoga : Keraleeya visha grantha's has given much importance to the plant Gyndandropsisgynandra. VelaPrayogaisexplainedin kalavanjam, panchama paricheda of prayoga Sammuchaya It is advised to give this drug along with other drugs. The yogas mentioned for lehya, ghrita, taila and gulika should include1part vela (samoolam )andalsoindicatedfor nasya , anjana andexternalapplicationincaseofbleedingfromhairfollicles.
12 Karuprayogam : Isanadditionalmethodappliedincaseofseverenonrespondingcases. Ametal rod(copper/gold),shapedsimilarto dhatura pushpham formales6 angula in guda marga andapply paradam andforfemales8 angula through yoni margam andapply1 panattukkam paradam Karuprayogam isconsideredtobethebest kalavanjanayogaduetomedicolegalissuesitsusewasdeclinedevenatthetime of pra. Sam A yoga named as Narma Prayoga (kalavanjanam chapter of panchamaparicheda)wasconsideredasbestkaruprayogaatthattime.
TableNo.3:Important yogas mentionedin keraleeya visha granthas
References Gulika Kashaya andGhrita Lehya
Pra.Sa 13 Vilwadi gulika Mrutasanjeevani 14gulika Jivaraksha 15gulika Hinguvadi 16gulika Tarunabhaskaram 17gulika 18 Pavitra vatakam Mrutunjaya 19gulika
KK Vishavilwadi 29gulika Vilwadi gulika
Pangthiprasoonadi 20ghritam 21 Neelidaladi ghritam 22 Durva ghritam Amukkuravayambadi 23kashayam Mustarammachadi 24Kashaya Nalpamaram kwatha 25 with pippali Neelikaranjadi 26kashayam
27 Vishahari lehya Garalaghna 28 rasayana
Neelimooladi 30lehyam Palasakshara 31lehyam
TableNo.4:Importantyogasforexternalapplication
References Nasya Anjana Dhara Lepam and taila
Pra.Sa Bhringaraja swarasa Saindhava in tamboola and dhatura patra swarasa
Purana maricha anjana Garudanjan 32 am 33Churnaraja
Kottam 34tagaradi Ghrita saindhava 35dhara Nimbaneelika ranja parisheka (trimoorthi 36yoga)
Sigrupunarnavadi 37 Paranthyadi 38tailam
KK Dasabeeja 39anjana
TableNo.5:Commonlypractisingyogasfrom Visha Vaidya jyotsnika
Yogas Internal Nasyam Anjana External
Iswaramoola + sunti
Aswagandha in water
Trikatu in amla jala
Neelimoola in water
Lasuna + maricham + Hingu + sunti + pippali in Arka ksheera
Sireeshapuspha +hingu + trikatu in arka ksheera
Guduchi + maricham + chandana + ushira
sireeshapanchangam
Maricham + surasa swarasa + dronapusphi swarasa
Bhringaraja swarasa with maricham 3) Hingu + maricham + saindhava in Naramootra 4) Lasuna + hingu in chandanavari 5) Katakabeeja nasyam
1) Arkapatram + hingu 2) Iswaramooli + sunti 3) Palasa swarasa + maricham + hingu 4) Agaradhooma + tankana 5) Neelimoola in water 6) Karanjamoola + maricham
Vegas Susrutha samhita Astangasangraha
st1 vega Raktamokshana
Raktamokshana and madhusarpi agadapana
nd2 vega Vamanam Madhu + sarpi agadam Vamana and agadapanam
rd3 vega Anjanam & Nasyam Nasya and anjana
th4 vega Vamanam & yavagu Vamana, yavagau pana
th5 vega Seetopacharam Vamanam with teekshana dravya Tikshna Virechana
th6 vega Seetopacharam Vamanam with teekshana dravya Tikshna Virechana
th7 vega Tikshna Anjanam Avapeedana Nasyam Apply blood rich flesh on kakapada shaped incision on scalp
Vamana, yavagau pana and sheetopachara
Vamana, yavagau pana and sheetopachara
Teekshana anjana and nasyam, kakapada chikitsa
Table No. 7: Darvikara vishavega chikitsa in keraleeya vishagranthas
Vega 40 Prayoga sammuchaya
st1 vega Siravedham
nd2 vega Siravedham + internally Maricha + ghritham
rd3 vega Chandhana + ushira as seethakashayam for internal administration
th4 vega Kashayam with Tanduleeyakam + aswagandha
th5 vega Siravedham of 5 veins teekshna nasyam
th6 vega Bhringaraja swarasa nasyam
th7 vega Teekshna nasya and anjana
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Table No. 6: Visesha chikitsa : Darveekara visha vega chikitsa