AGADA TANTRA & VYAVAHARA AYURVEDA
Deals with various natural and artificial toxic substances and poisons in detail along with their antedotes , the signs and symptoms and also the management of poisoning resulting from the bites of snakes, insects, spiders, rodents etc as well as from the combinations of various other poisons &fatal doses of various poisons. Deals also with medicine in relation to the law, legal aspects of medical ethics and standards. This discipline finds a parallel in the modern discipline of Toxicology & forensic medicine.
Agada tantra or toxicology is a branch of Ashtang Ayurveda, which includes the science of poisons. The tradition of Agada tantra practice is very ancient. It originated from the school of toxicology, which was founded and run by Kashyapa, also known as Vriddhakashyapa, the great saint and medical practioner. The students of the Kashyapa School of toxicology later became royal vaidyas (doctors) in various kingdoms and were meant to protect the members of the royal families from being poisoned. They were at times also used to administer poison to their king’s enemies. Even now the traditional practice of toxicology is done by different families of Vishavaidyas (poison doctors) who claim to be specialists in toxicology in various parts of Indian subcontinent.
Damstra or Visha chikitsa, as the Aganda Tantra is popularly known, deals with various methods of cleaning the poisons out of the body as well as recommends antidotes for particular poisons. It deals with a wide range of natural toxins originating from wild lives like animals, birds, insects etc., plants including herbs (belladonna, aconite etc.), vegetables, minerals (leads, mercury, arsenal etc.) and artificial poisons prepared from poisonous drugs. This branch also deals with air and water pollution, which are basically the causes of various dangerous epidemics.
There are two types of poisons that have been described in the Agada tantra- the Natural poisons and the Artificial poisons. The natural poisons are classified as inanimate (Sthaavara) and animate (Jangama). Inanimate poisons or the Staavara comprise of poisons that have plant origin and toxic minerals, metals or metal ores that are found inside the earth. Animate poisons or Jangama consist of the venoms of animals like snakes, scorpions, worms, insects etc. Artificial poisons are the invented poisons which are prepared by combining different kinds of animate and inanimate poisons.
Apart from the above mentioned poisons, the three samhitas described about this branch of toxicology, also include the description and disadvantages of food of opposite qualities, drugs and food causing chronic poisoning symptoms. There are also descriptions of certain poisons that are used as medicines after proper processing and quantification, precious stones like diamond, ruby and poisonous minerals like lead and mercury are few of them. This branch of Ayurveda also has information regarding fatal doses of various poisons.
Poison (Visha) is defined as any substance that gains entry into the body (exogenous) or formed in it (endogenous) that is capable of endangering life or that can impair health. Knowledge of the origin, development and toxicity manifestation of accumulated poisons and suitable remedial measures are an integral part of health. Present food habits, life style and mental attitudes etc, are entirely different from the past. The basic essentials of a healthy life such as air, food and water are all polluted and the resultant hazards paint a gloomy picture for the generations to come. The greatest gift we can offer to the new generation is a clean world.
Ayurveda states that health and disease are caused by the right and wrong foods respectively. Elaborate descriptions regarding the food and drinks fit for continuous use, foods that can be taken occasionally and foods to be strictly avoided are detailed in texts (A.H.Su.7 & 8). There is a misconception that Ayurveda advocates only vegetarian foods, Non-vegetarian foods are also advised in health and certain diseases. The beneficial and therapeutic effects of the meat of animals, birds and fish are also given in detail while describing similar effects of cereals, pulses and vegetables. (Asht`aanga Hridaya Sootrasthaana Chapter.6) The qualities and therapeutic effects of potable liquids such as rain water, river water, water contained in ponds and wells; cold water, warm water, water previously boiled and maintained at room temperature etc are also given in A.H.Su.7. Similarly, the qualities of milks in general, cows milk, buffalos milk, goats milk, breast milk, elephants milk, curds, buttermilk, sour buttermilk, butter, clarified butter, sugarcane juice, jaggery sugar candy and honey are also included in the same chapter. Qualities of edible oils such as sesame oil, mustard oil, margosa oil etc and the therapeutic effects of Castor oil are also described; Animal fats are included in certain oils used externally and at times, internally.
The right food and the wrong food vary from person to person. Based on Dosha_s / humors, humans are divided into three main groups. The physical appearance likes and dislikes mental attitudes of all these groups are given in detail in chapter 3 of Asht`aanga Hridaya S`haareera Sthaana. Predominance of elements such as air, fire and water gives rise to three basic natures termed Vaata, Pitta and Kapha. We commonly see and admixture of all the three natures in diseased and healthy individuals alike. The right food, drinks and habits vary in each of these groups and therefore medicines also vary.
Endogenous toxic manifestations are caused mainly by ingestion of the wrong and incompatible food, inhalation of polluted air and staying in unhealthy surroundings. The food regimens are to be altered or readjusted depending upon the seasons. Elimination of accumulated metabolic wastes is absolutely essential for the maintenance of health in Ayurveda.
Exogenous toxic manifestations are caused by factors outside the body and based on their nature, are broadly classified as in inanimate (Sthaavara) and animate (Jangama) poisons.
The main channels of elimination of toxic metabolites in the body are through feces, urine, sweat and breath. When these excretory channels are blocked there is an accumulation of materials unwanted or harmful to the body that results in a wide range of toxic manifestations ranging from headache to death. Therefore, the basic principle of treatment is to open up these channels of elimination whereby the wastes are eliminated, paving way for the normalization of the functions of the body.
The primary classification of poison is a) natural (Akritrima) b) artificial (Kritrima). Natural poisons are again classified as Inanimate (Sthaavara or static) and animate (Jangama or mobile). Some authors also include concocted poison (prepared by combining natural and artificial poisons). This third type, in general is termed Gara. Some non-poisonous substances become poisonous by virtue of the mere combination and these are also included in Gara. Some foods having diametrically opposing actions on the physiological system become incompatible with the body and give rise to toxicity manifestations, usually in the long run. They are also considered similar to Gara by some authors.
Natural poisons are divided into inanimate (Sthaavara) and animate (Jangama). Inanimate poisons include poisons of plant origin and toxic minerals, metals / metal ores in their natural form embedded in the earth. Animate poisons include venoms of the living such as venoms of reptiles, scorpions, worms, insects etc.
The substrata of natural inanimate poisons are ten viz. root, leaves, fruits, flower, bark, latex, heartwood, resins, toxic minerals and tuber. (S.K. 2/4)
Animate poisons have a wider substrata base. They are sixteen viz. sight, breath, teeth / fangs, nails, urine, feces, semen, saliva, menstrual blood, pincers, anal region, beak bones, bile, hair and a dead body.
Artificial Poisons (Gara):
Artificial poison, also termed concocted poison is prepared by the combinations of various animate and inanimate poisons. They contain parts of insect, blood of animals, fecal matter, ashes of different toxic herbs of opposing actions, toxic minerals and poisons of low potency. (A.H.U.35/49)
Charaka the well-known physician describes two types of artificial poisons. One is composed of non-poisonous matter given in combination. Separately nontoxic these act as poisons when ingested in a combined form. Toxic materials of animate and inanimate origin are combined to prepare the second type. This can be termed `true` Gara. Gara and true Gara metabolize very slowly. The ill effects are not initially so grave, but only a menace. In the long run, both are fatal. (C.Chi.23/14).
TOXIC MANIFESTATIONS OF INANIMATE POISONS:
Root poisons cause a sense of constriction, the patient utters nonsense and becomes unconscious.
Leaf toxins cause a sense of binding, or wringing pain of organs, yawning and breathing disorders.
Fruit poisons produce vomiting anorexia and edema of testicles.
Poisonous flowers precipitate flatulence, vomiting and finally, the patient becomes unconscious.
Skin (bark), heartwood and mineral poisons cause halitosis, dryness and roughness of mouth, headache and catarrhal inflammation.
Latex poisons cause frothy discharge from the mouth heaviness of tongue followed by incoherent speech and catharsis.
Mineral and metal toxins cause burning sensation for the palate, chest pain and coma (S.K. 2/10)
Finally the patient goes into coma.
Charaka summarizes the ill effects of animate poisons as lethargy, lassitude, horripilation, burning sensation, purulent lesions and diarrhea (C.Chi.23/15)
PROPERTIES OF POISONS:
Dryness (Rooksha Gun`a) vitiates Vaata. Pitta and blood are vitiated by the property of heat.
Too much sharpness (Taakshn`ya) affects the brain causing madness to varying degrees. Vital points of the body both structural and functional (Marma); are shattered. Minuteness (Soukshmya) permits free entry of poisons to the remote sites of the body causing derangement. Speed (Aas`hutva) eats away at the roots of life spreads without proper digestion (Vyavaayee) and affects the basic structure (Prakriti) of the victim, muscle relaxant effect (Vikaashitva) reduces humors, tissues (Dhaatu) and wastes are expelled through the natural orifices of the body (Mala) and debilitates their functions in preserving the integrity of the body. Clarity (Vais`hadya) facilitates unopposed entry of poison to the minutest orifices of the body and aids its spread lightness (Laghutva makes it indigestible and inaccessible for biotransformation and indigestibility (Avipaakitva) makes its elimination difficult as, it is not metabolized naturally (S.K.2/17).
Thus all the properties mentioned above act in unison to trouble the patient for a prolonged period (S.K.2/21).
Poisons first vitiate blood, and then vitiate the humors Kapha, Pitta and Vaata in sequence along with their substrata, proceed to the heart and become fatal (A.H.U.35/9-10).
All properties of poison are fast acting. These results in the vitiation of all humors that render the latter from performing natural functions attributed to them. Biotransformation is one function of the humors and adverse affection of this function precipitates retention of toxins in the body and their elimination is blocked. The vital centers regulating respiration, cardiac functions, vasomotor tone etc. get enveloped due to the deranged Kapha and the patient becomes comatose. Life remains hidden in his body but his sensory and motor functions are apparently absent. The physicians duty is to melt off the Kapha, blanketing the vital force of life, and if he fails to do so death is sure to intervene. (S. K.3/23-25).
In snakebites, the venom is retained in the spot for 100 seconds. Combined with Vaata, it reaches the forehead and then the eyes. Thereafter, it spreads to tissues like a drop of oil placed on the surface of water. (Prayoga Samuchchaya P.33). The tissues (Dhaatu_s) in this context are skin, blood, muscles, fatty tissue, and bone and reproductive tissue. Thereafter, the poison spreads to the six plexus (Chakra) Moolaadhaara, Svaadhisht`haana, Man`ipooraka, Anaahata and Vis`huddhi. (Functional vital points, described by some as nerve plexus also. Further details are obtainable in Yoga.)
The Poison then spreads from Aadnyaa Chakra to Brahma Randhra. The life force is always one step ahead of poison during the whole process and in this desperate flight. The life force reaches a point in the head (brain) termed as Karantaka. Within 13 days, this point also succumbs and death supervenes. This is the usual process. If the potency of poison is high and the strength of life force is weak, the patient may die earlier also.
Concept of Phases and Interphases (Vega & Vegaantara):
A membrane separates each of the seven tissues. Traversing each membrane the poison creates a phase to do its worst. The Dhaatu_s are Rasa, Rakta, Maamsa, Meda, Asthi Majjaa and S`hukra. They are contained in cisterns bordered by membranes (Kalaa). Poison, in its effort to spread through the tissues breaks, the membranes and enters the tissue. Situated in the tissue, the poison precipitates certain symptoms. (S.K.4/43)
During the process of spread, poison takes sometime to gain entry from the earlier Dhaatu to the latter. This period is termed as Vegaantara, is relatively symptom free. Vaata is the Dosha facilitating the movement. Some authors specify substrates occupied by poison during Vega. Some give only the number and Vega_s. The majority accepts seven Vega_s. Symptoms present during phases of inanimate and animate poisons differ, and also the treatment. Phases with reference to inanimate poison are given below (A.H.U. 35/9-15)
I. Black color of tongue, stiffness, disorientation (startling), vomiting, lethargy and unconsciousness.
II. Shivering, sweating, burning sensation, throat pain poisons reaches stomach (Aamaas`haya) and precipitate chest pain.
III. Dryness of palate, intense stomachache, eyes edematous green shaded, with reduced response to reflexes, poison reaches the intestines, causes griping, hiccup and Borborygmus, cough.
IV. Heaviness of head
V. Salivation, change of body color, splitting pain of joints, vitiation of all humor and severe pain of the colon
VI. Severe diarrhea and unconsciousness
VII. Causes spasmodic flexion of spine involving shoulder, dorsum and sacral region, spasm, convulsion and death.
Phases with reference to animate (snake) poison (Su. K. 4/42):
While elaborating on snake poison, Sus`hruta, the learned physician states symptoms bases on tissues / different systems / organs of the body. Only the phases of Cobra poisoning are discussed here:
I. Vitiates blood, blood turns black, body turns black hyperaesthesia.
II. Vitiates flesh intensification of black / blue color of the body; edema, nodular swellings all over the body.
III. Vitiates fatty tissue [Medas], oozing of serum from the bite, heaviness of head, absence of sweating, immobility of eyes.
IV. Enters gut, [Kosht`ha] and causes predominant vitiation of Kapha causing lethargy, salivation and disability of joints.
V. Enters Bone, vitiates Praan`a (a faction of the humor Vaata and digestive system splitting pain of joints hiccup and generalized burning sensation.
VI. Enters reproductive tissue (S`hukra) vitiates a faction of Vaata based on the heart (Vyaana) secretes mucous material (Kapha) from micro-Orifices, wick like mucus secretion from nose, salivation, profuse sweating, cessation of breath, coma and death. (A.S.K. 4/40)
Charaka consolidates the definition of poison. The origin of poison was from water. It aggravates during the rainy season and its ill effects are reduced by irrigation with water, it resembles fire (Sage Vyaasa describes the origin of fire from water Abdayoni) in its capacity to spread fast, it has eight phases ten properties and 24 treatments. (C.Chi 23/6)
Like solid Jaggery liquefying during the rainy season, poisons also spread during rain showing their full potency. When the rain ends, the Sharada (autumn) season follows, the star Canopus (Agastya) raises and reduces the potency of poison. (C. Chi 23/8)
The spread of animate poison is downwards and that of inanimate poison is upwards. Toxins of inanimate origin are and antidote for poison from fangs and vice-versa (C.Chi. 23/17)
METHOD OF SPREAD OF POISON AND MODE OF DEATH:
Poison, gaining entry into the body vitiates blood, Kapha. Pitta and Vaata including their substrates and cisterns placed proximally and distally in the body. Afterwards it reaches the heart and spreads along the circulatory system to ending the death of the victim (A.H.U. 35/9-10)
When poison is located in Vaata, symptoms of vitiation of the humor predominate, followed by minimal vitiation of other humors; Similarly presence of poison in Pitta produces symptoms of vitiation of Pitta. Predominant symptoms of vitiation of Kapha are observed when poison is located in Kapha. (C.Chi.23/27-30)
By vitiating each humor, the poison robs a man of his life. (C.Chi. 23/31)
In venomous bites and wounds from poisoned arrows, the poison is restricted to the site; but when the poison is ingested, it damages the functions of blood, blocks the vessels, lodges in the heart and kills the victim (C.Chi. 23/33).
Classification of snakes, symptoms of envenomation and treatment forms a major chunk of Ayurvedic toxicology.
Sus`hruta classifies snakes under two main heads, celestial (Divya) and terrestrial (Bhauma). Pathology and treatment with respect to the celestial snakes are not mentioned. They are worshipped. Terrestrial snakes are classified as follows:
Terrestrial snakes (Bhauma Sarpa)
Cobra (Darveekara) 26 types
Viper (Man`d`ali) 22 types
Krait (Raajila) 10 types
Non-poisonous (Nirvisha) 12 types
Mixed type (Vaikaranja or Vyantara) 3 types
Admixed type originating from mixed types (Citra / Vaikaranjotbhava) 7 types.
Another classification is based on the caste of the snake akin to the for castes in classical Indian society viz. Braahman`a, Kshatriya, Vais`ya and Kshudra appearances of these snakes are detailed in S.K. 4/23-26
Based on sex snakes are classified into three:
Female (Stree) and
Eunuch (Napumsaka) (A.S.U.41).
Based on age snakes are classified as:
Adolescent (Tarun`a) and
Depending upon the status of the female they are classified into two viz. Pregnant (Garbhin`ee) and newly delivered (Sootaa) (A.S.U 41)
CAUSES OF SNAKEBITE
Bites happen when snakes mistake part of the body as food; when frightened; when stamped over; when venom in their sac has accumulated; when angered, due to their vile nature, as revenge and when incited by gods, sages, or the God of death (Yama). Gravity of bite increases in an ascending order.
Classification of snakebite
Five types of bites are described in Ashtaan`ga Hridaya. (A.H.U.36/11-13):
Saliva of snake present, no bite marks (Tund`a Aahata)
One or two fang marks, no bleeding Vyaaleedha
One or two fang marks with bleeding Vyaalupta
Three fang marks with oozing of blood, muscle puncture (Dasht`aka)
Four fang marks, muscle penetrated, puncture of blood vessel (vein) as in the case of intravenous injection. (Dasht`anipeedita)
The first two are non-poisonous and the last three venomous. Sus`hruta classifies bites into three, highly poisonous types (Sarpita) Reticulate (Radita) and non-poisonous (Nirvisha)
Charaka describes the snakes four fangs left lower (Vaamaadhara), left upper (Vaamottara), these right lower (Dakshinaadhara), right upper (Dakshinottara) and these upper fangs are more powerful. Color of fangs and body spot bitten and quantity of venom contained in each fang is given below: –
Left lower white 1 drop left upper yellow 2 drops
Right lower red 3 drops right upper black 4 drops
Jyotsnika (chapter 3/8-11) mentions four fangs viz. Karaalee.
Maakaree, Kaalaraatree and Yamadootikaa. Bites by Karaalee and Yamadootikaa are near fatal.
SYMPTOMS OF VENOMOUS BITE:
Pricking pain, itching, edema, pain, burning sensation and solidification of bitten part are the characteristic features of venomous bite. Absence of these symptoms indicates a non-venomous bite.
The venom of cobra is pungent (Kat`u Rasa) and rough (Rooksha Gun`a). It vitiates Vaata; potency of venom is increased in the young snakes and during the rainy season. Venom of viper is sour and hot in potency. It vitiates Pitta, potency of venom increases in middle age and in the cold season. Venom of krait is sweet and is cold in potency. It vitiates Kapha. Potency of venom is increased in old age of the snake and in the summer season.
Insect Poisoning (Keet`a Visha):
Insects (Keet`a_s) are classified and treated based on their ability to vitiate humors. In Ashtaan`ga Hridaya, it is stated that in insect bite or sting, predominant vitiation is of Vaata and Pitta. (A.H.U. 37/16) Sush`ruta differs from this opinion stating that insect poison is slow acting and hence not capable of vitiating Pitta. As the main vitiation is of Vaata and Kapha sudation is permitted. The generally accepted line of treatment in poisons is cold (S`heeta), but in insect poisoning the cold therapy will aggravate vitiation of Kapha and it is contra-indicated (S.K.6/26), (S.K. 3/29)
Scorpion Poisoning (Vrishchika Visha):
Based on the strength of venom, scorpions are classified into mildly poisonous (Manda), medium-poisonous [Madhya], and highly poisonous (Mahaavisha). The venom, spreading upwards from the site of sting very fast, returns and remains at the sting spot. Predominant vitiation is of Vaata (A.H.U. 37/6).
Spider Poisoning (Lootaa Visha):
There are several small and large varieties of spiders. General symptoms of poisoning, development of lesion and appearance of symptoms for the first seven days are given in the texts. Severe spider poisoning is fatal. The classification and treatment is based on the vitiation of humors (A.H.U. 37/47) and the potency of the venom. Dress and articles of daily used contaminated by spiders also cause toxic manifestations (A.H.U. 37/65) Symptoms subside within twenty-one days. If they persist, treatment should be changed.
Rat Poisoning (Mooshika Visha):
Rats semen is said to be the substrate of poison and the main vitiation is of Kapha. Burning, bloodletting, external application of medicines, administration of emetics purgatives, nasal medication collyrium (eye medication) etc. are employed in its treatment. It is stated that residual rat poison, if not eliminated, will flare up during cloudy days (A.H.U. 38/33). Contamination of water and rats urine gives rise to infections.
Rabies (Alarka Visha):
The vitiated Kapha of fox, jackal, dog and other Quadrupeds block the sensory nerves causing characteristic symptoms of madness. Bitten by these animals, one becomes mad as the poison progresses. Preparation containing thorn apple (Dattoora) Alangium (Sarapunkhaa) in the form of a cake was given to patients to generate madness before its natural onset. The detailed process is given in Sus`hruta Kalpa 7/51-56. Development of symptoms simulating madness in the normal course of the disease is fatal. Bite should be cauterized with hot ghee or metal. Local application of medicines, purgatives mixed with the latex of Mandaara (Arka-Calotropis gigantean) and consumption of antidotes are indicated.
Other minor poisoning:
Wasp, bees, flies, insect, lizards, leeches, centipedes, frog, beetle, mosquito, etc. can be sources of minor poisoning. Symptoms and treatment are given in S.K.8.
Denatured poison (Doosheevisha):
Attenuated or denatured poisons function as latent toxins in the body. One who suffers from latent poison (Dooshee Visha) will have loose motion, his complexion will be altered, his mouth will emit foul smell, his olfactory and gustatory senses will be impaired and he will suffer from unquenchable thirst. Slurring and broken speech, vomiting, sorrow and sudden bouts of unconsciousness are also seen. He will suffer from symptoms of chronic Ascites (Dooshyodara), (detailed in A.H.Ni.12/20-21)caused by Vitiation of all humors. (S.K.2/27).
Situated in the stomach (Aamaas`haya) denatured poison vitiates Kapha and Vaata, in intestines (Pakvaas`haya) it precipitates diseases originating from the vitiation of Vaata and Pitta. His hairs will fall off, body will be emaciated and he appears like a bird with its feathers and wings clipped off. (S.K.12/28).
A deeper entry of latent toxins into tissues result in their derangement and subsequent diseases. The ill effects increase when the season is cold and windy. On cloudy days, the sun also aggravates the symptoms. (S.K.2/29). If the above condition is also neglected, he suffers from anorexia and instead of providing satiation, food precipitates intoxication Urticaria, deterioration of tissues, unconsciousness, edema of the extremities, intense thirst, vomiting, diarrhea, Ascites, irregular fever and loss of body color demarcate this stage (S.K.2/30)
Advancing further, it causes flatulence, impaired functions of reproductive tissue, stammering and insanity. Widespread skin lesions are also seen (S.K.2/32)
The following factors cause aggravation of the above symptoms and therefore it is termed Dooshee Visha. S.K.2/33)
Dusht`a Des`ha – wet lands (Anoopa Des`ha)
Dusht`a Kaala – cold winds, cloudy days
Dusht`a Anna – stale food, alcohol, sesame oil, horse gram etc.
Divaasvapana – sleeping during day
The patient should be subjected to sudation, after which induction of emesis (Vamana) and catharsis (Virechana) will have to be done. The purpose of sudation is to bring the Latent humors situated in Dhaatu_s to alimentary tract (Kosht`ha). Once brought to the gut they can be eliminated through the mouth or anus by the induction of emesis or purgation. (A.H.U.34/38)
Dooshee Vishaaree Agada (A.H.U. C.35 / 38-39) finely powdered and mixed with an excess quantity of honey is to be consumed.
Concocted Poison [Gara]:
Concocted poison is artificial poison. Different parts of the body of insects, blood, menstrual blood, urine Faeces etc of human and animal origin, medicines having diametrically opposing action on the same physiological system, ashes (Bhasma_s) of metallic and mineral origin containing toxic material and poisons of low potency are mixed together in the composition of Gara (A.H.U. 35/49)
While prescribing medicines one should take sufficient care to see that the medicines are compatibles. Coupling medicines having hot (Ushn`a) and cold (S`heeta) potency, mixing an anti-diarrhea drug with a cathartic, mixing of a weight reducing agent with nourishing ghee etc, are against the basic principles of this science, It is stated that incompatible food can be equated with poison or Gara. Incompatible medicines also can be considered under the above group.
MOTIVE AND MODE OF ADMINISTRATION
Females infatuated by the male used to give him concocted poisons in order to seduce him to be her husband. It was also used to poison a king as per the direction of spies of enemy; concocted poisons mixed with food were given to the king with the help of workers in the royal kitchen. Lust, vanity etc. may also be other motives. (A.H.U.35/48).
Loss of weight, anemia, – anorexia, cough, breathing disorders, fever, narcolepsy, depression, Ascitis, Hepatomegaly, Splenomegaly, feeble or husky voice, flatulence, debility, lethargy, edema, slimming of arms and legs, wasting disorders etc. are the effects of the slow acting poison. In the second stage somatic symptoms give way to psychic disorders. In dreams he visualizes fox, cat, mongoose; ferocious animals, monkey, dry ponds or wells, dry climbers (plant) etc. Fair complexioned people mistake their color for dark and vice versa. He may be obsessed that his nose and face have ceased to exist.
The patient suffers such or more severe afflictions of the body and mind. Unless treated immediately he awaits an impending doom. (A.H.U.35/50-54)
Induction of emesis by suitable emetics, consumption of compatible (Pathya) food and drinks and medication with gold is the desire line of treatment (A.H.U.35/55)
To the enemy a king and his soldiers poisoned food, water, air, land, grass, and fumes etc. of the enemy territory. (Todays pollution presents a similar picture). Methods to identify the poisoning and a process of such purification are described in S.K.3 Symptoms of wounds caused by a poisoned arrows and treatment are given in A.H.U.35/40-44
Sus`ruta, Samhitaa, Kalpa Sthaana chapter 1, discusses ancient methods of poisoning the king or enemies. The elementary portions of criminology and body language are given in the chapter under the head How to identify the person who have poisoned the food of the king.
Methods to identify poisoned food drinks, dishes, vegetables, cereal soup, fruits, tooth brush, tongue cleaner, oils applied externally, astringent liquids used to remove oil, comb, water for bathing, perfumes applied externally such as sandalwood paste etc, garlands dress materials, armor, ornaments, footwear, bangles, bed and foot rest are discussed in detail.
Medicated oils used as nasal drops; eye drops, eardrops, fumigating materials etc. are likely to be poisoned. Methods to identify them are also included in the chapter. The treatment is also given.
The king used to travel on a horse or an elephant. Application on the dorsum of these animals with a view to harm the king was usual in those days. Symptoms of these poisoned animals and the rider and the treatment is also mentioned.
FEATURES OF POLLUTED AIR WATER AND LAND:
Characteristic features of polluted air, water, land, poisoned grass, fumes, smoke etc. and methods of purification using herbal remedies and processes for purification are given in detail in Sus`hruta Samhitaa, Kalpasthaana Chapter 3.
Toxic Dame (Visha Kanyaa)
Toxic or venomous substances were given to females from childhood and the doses were increased gradually as age advances. At the time of puberty, they were saturated with poison. They were used to seduce the enemy king. Ways to identify such toxic dames are given in the text. (S.K.1/6 commentary of D`alhan`a). Her sweat, touch, contact kiss etc. were harmful and sexual was an invitation to death. Today the slow poisoned horse serum is used to prepare antivenin.
TREATMENT OF POISON IN GENERAL:
Treatment is based on the involved humors. Charaka describes 24 methods of therapy. Treatment is also done based on stages and symptoms (C.Chi. 23/35-37)
Twenty four specific treatment of poisons (Visha) as detailed by Charaka are as follows:
Chanting of Mantra_s Mantra
Local blood letting by incising Utkartana
Application of pressure to drain the venom Nishpeed`ana
Immersion bath Avagaaha
Blood letting Raktamokshan`a S.K.5/34
Vomitting Vamana Ref S.K. 5/34
Purging Vireka S.K. 5/38
Application of medicine on head After incision: Upaadhaana S.K.5/42-45
Administration of ghee to protect heart Hridayaavaran`a Ch Chi 23/46-50
Collyrium Eye medication Anjana S.K. 5/39
Nasal medication Nasya S.K. 5/40
Medicated Fumigation Dhoopa / Dhooma
Consumption of Medicated jam Leha
Removal of residual poison Prashamana
Dusting of medicated powder Pratisaaran`a
Antivenom/antitoxinPrativisha(A.H.U. Vishopayogeeyam Ch.48)
Medicines to bring back senses Sadnyasamsthaapana
Application of medicated paste Lepa
Revival of the apparently dead Mr. Tasan Jeevana
The treatment or administration of toxic antidotes (Prativisha) is based on the opposing action of animate and inanimate poisons. In root poisoning, snake venom is used as an antidote and in certain severe snake/scorpion poisoning; plant poisons are used externally or internally. When the fifth phase is over and seventh phase is about to supervene, toxic antidotes are administered. This mode of treatment is resorted to under dire circumstances when Mantra_s and other life saving measures fail.
In snakebite and plant toxicity treatments, sixteen complications are to be anticipated. These are described along with treatment in Asht`aanga Samgraha Uttaratantra Ch 47.
Breathing difficulty (S`hvaasa)
Tenderness of bladder (Basti Ruk)
Necrotic Ulcer (Pootidamshatvam)
Hemorrhage (Rakta Sraava)
Toxic Neruropathy (Vishaaneela)
When the weak are subjected to blood letting, when the patient consumes excess of dry food or due to the specific nature of the venom, Vaata gets vitiated giving rise to insanity, epilepsy, mental derangement, convulsive disorders etc. The treatment should be medicated enema (Basti), insufflations of medicated powder into the nose (Pradhamana), Nasal medication (Nasya) and Collyrium (Anjana) A.S.U Ch 47.
As mentioned earlier, the treatment is to open up the excretory channels. One common finding in a large number of skin lesions such as weeping eczema, itching, falling of hair due to inflammatory lesion of hair follicles etc. There is chronic constipation and persistent urinary tract infections. Susceptibility to infections is frequent. To relieve the patient from these disorders, administration of Pat`olakat`urohinyaadi Kashaaya and / or Punarnavaadi Kashaaya is given. As result solid wastes are purged out enhancing the secretion of urine expel liquid soluble wastes. However, there are toxins in the systems that are fat/lipid soluble. Here the elimination process is more complicated. Unction or Snehapaana is a process where ascending doses of medicated clarified butter or Ghrita is given to the patient for seven consecutive days. The dose is adjusted in such away that on the seventh day the patient consumes no food but only medicated clarified butter and a very small quantity of water. Thus his system gets saturated with lipids and toxins that have affinity to fat, which gets absorbed in the ghee. One or two days later the patient is subjected to sudation whereby the fats containing toxins are brought to the gut. Purgatives such as medicated castor oil, Avipattikara Choorn`a, Trivruta Leha etc are given to induce purgation. Alternatively, emetics are also given when the site of vitiated humor is in the upper part of the gut. But these treatments are aimed to expel the ghee introduced into the system. This purification process relieves chronic skin disorders such as Psoriasis, Ayurvedically a combination of Sidhma and Dadru. In obstinate cases, repeated cleansing as detailed above is required. Medicated ghee such as Tiktaka or Mahaatiktaka is usually used in this process.
Allergic disorders encompassing the respiratory system, skin, and gastro intestinal systems etc are directed very frequently in clinical practice. Respiratory disorders arise due to exposure to direct freeze from ceiling or table fans while traveling on the side seats of vehicles such as buses and trains. Exposure of the head to atmosphere during winter season, taking bath when sweating has not subsided naturally, taking oil baths, exposure of head to sun etc can precipitate respiratory allergies such as bronchial asthma, sneezing, stuffy nose, running eyes, sinusitis, unilateral or bilateral headache. A low level of hemoglobin and a deficient Vitamin C level are contributory factors. Consumption of an excess quantity of milk rich in lipid content, consumption of eggs, constipation and a hypersensitive or irritable mental temperament are usually associated with this condition. Ayurveda advises that the diet should be changed as and when he seasons change. Periodic cleansing of the body by purgation at least thrice in a year is a must and the common ma, due to reasons that are obvious, does not heed this advice.
Preventing the patient from taking head baths, administration of Kashaayas such as Dasamoolakatutrayaadi, Pathyaashadangam etc, consumption of powders that contain Turmeric, restricting oils that are medicated or plain on the head, covering the head with cotton or woolen garments, relieving the anxiety of the patient with some sedatives or anti-anxiety preparations etc works well to restore the health of the patient.
Dry eczema and wet eczema are treated differently. The former variety responds well to unction and external applications of oil. However, in the presence of fever, administration of clarified butter or external applications are contra indicated. In the presence of edema, diuretics are the first option. Unction should be followed with purgation periodically. Prolonged administration of medicated clarified butter should be followed with regular monitoring of Blood pressure, especially in the elderly.
Weeping skin lesions are treated with administration of cleansing Kashaayas such as Padoolammlad, Padolakaturohinyaadi or Aargvadhaadi. Here also periodic purging may be necessary. When the vitiated humors are almost cleared from the system, the residual vitiation is stagnated with Kashaayas such as Thikthaka or Mahaathikthaka. When the weeping stops and the lesion becomes dry, pain may be caused due to stretching of the skin. Here only external application of oils is required.
Fungal infections of the skin are best relieved with the administration of mediated coconut oil preparations. Sesame oil may aggravate certain fungal lesions, Rubbing of powders also are to be done with caution as some powders may burn the upper strata of the skin or may cause blister formation.
Dandruff is not only the problem of adolescence; it is seen to affect all age groups. Predominance is more among the affluent society who consume fats and oils in excess, sweat a lot and neglect hair care.
Moisture and dirt retained in between the fingers can give rise to infections, cracking of the skin, painful or burning inflammatory lesions. Allergy to detergent powders also presents a similar picture. Keeping the feet, dry, application of medicated oils, cleaning the affected part with green gram powder usually clears these lesions. However, chronic lesions may require purging. Allergic lesions caused by synthetic or leather footwear are also treated along the same lines.
Weeping skin lesions of infants are very common the clinics. The vitiated blood of the mother can give rise to a number of clinical manifestations in infants. Here the treatment is aimed to purify the blood of the mother if the infant is breast-fed. Her diet is adjusted to curb all non-vegetarian food; especially fish, Cathartics and diuretics are administered to the mother. The drugs freely cross the milk barrier and the therapeutic effect is achieved within three to four weeks.
Certain types of Vitiligo with duration less than a year are seen to respond to drugs like Psoralia Cordifolia. Internal administration and/ or external applications may be required. In obstinate cases, medicines are given to expel intestinal parasites.
Charma is a skin lesion where the skin surface is blackened and roughened, presenting the appearance of an elephants skin. The lesion may itchy, hairs fall off and scaling off may present bleeding. Washing the affected area with ones own urine twice or thrice a day, local application of medicated oils that scrape off the skin and occasionally, internal medicines give good results.
Insect bites are treated with local application of Vilwaadi pill in water; scorpion bites are treated with external application of pills that contain compounds of arsenic.
Snakebite treatment is a major topic and a large number of raw and prepared drugs are essential. Symptomatic treatment is given in mild to extreme cases. Clinical manifestations of Cobra, Viper and Krait venoms are treated differently. Details are given in Sus`ruta Samhita Kalpasthaanam Ch3 & 4
It is evident that elimination of toxins and poisons from the system is a must for a healthy life. The natural efforts of the body to excrete toxins through routes of elimination such as urine, Faeces, sweat etc should be complimented by the use of right food at the right time. Any blockade or insufficiency of the excretory apparatus and process builds up toxins in the body and gives rise to diseases. The significance of seasonal and periodic cleansing should never be underestimated.
The humors (Dosha) balanced, tissues (Dhaatu_s) structurally and functionally normal, good appetite reflecting perfect digestive process, ability to distinguish tastes (Rasa), normal functioning of sensory and motor organs, mind and body synchronized these qualities denote one who has been detoxified S.K. 6/32.
Medical jurisprudence is a branch of medicine that involves the study and application of medical knowledge in the legal field. Because modern medicine is a legal creation and medico-legal cases involving death, rape, paternity etc. require a medical practitioner to produce evidence and appear as an expert witness, these two fields have traditionally been inter-dependent.
Forensic medicine is a narrower field that involves collection and analysis of medical evidence (samples) to produce objective information for use in the legal system.
Medical jurisprudence is concerned with a broad range of medical, legal and ethical issues, as well as human rights and rights of individuals.
Physicians have a duty to act in their patients best interest and can be charged in a court of law if they fail to do so. On the other hand, a physician may be required to act in the interest of third parties if his patient is a danger to others. Failure to do so may lead to legal action against the physician.
States have been known to ask physicians engage in torture of individuals or examine and identify individuals who can endure torture. In such circumstances physicians must choose whether to disobey the authorities even at the risk of harm to themselves.
Physicians assess injured individuals and the degree of impairment they cause. This allows courts to determine and award damages.
They may also be required to assess the mental status of accused persons and whether they are fit to stand trial. They may also determine whether an individual is of sound mind and capable of getting into a binding contract with another party.
They are also required to perform an autopsy to determine the cause or time of death where this is not clear.
Medical jurisprudence includes:
questions of the legal and ethical duties of physicians;
questions affecting the civil rights of individuals with respect to medicine; and medicolegal assessment of injuries to the person.
Under the second heading there are many aspects, including (but not limited to):
(a) questions of competence or sanity in civil or criminal proceedings;
(b) questions of competence of minors in matters affecting their own health; and
(c) questions of lawful fitness or safety to drive a motor vehicle, pilot an aeroplane, use scuba gear, play certain sports, or to join certain occupations.
Under the third heading, there are also many aspects, including (but not limited to):
(a) assessment of illness or injuries that may be work-related (see workers’ compensation or occupational safety and health) or otherwise compensable;
(b) assessment of injuries of minors that may relate to neglect or abuse; and
(c) certification of death or else the assessment of possible causes of death — this is the incorrect, narrow meaning of forensic medicine as commonly understood.