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Darvekara sarpa and its contemaporary

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Darvekara sarpa and its contemaporary

  1. 1.  INTRODUCTION  PREVALENCE OF SNAKE BITE  CLASSIFICATION OF SARPA IN AYURVEDA  DARVEEKARA SARPA-IN DETAIL  TREATMENTS FOR DARVEEKARA SARPA DAMSHA.  YOGAAS  MODERN ASPECTS  DISCUSSION  CONCLUSION.
  2. 2.  The problem of poisons and their treatment has been coming since prehistoric times.  Information pertaining to the poison is available in Vedic literature. The word AGADA has referred several times in vedas.  Later AGADATANTRA was developed as one of the eight branches of Ayurveda that deals with diagnosis and treatment of poisons.
  3. 3. Mrityu is categorized into two in classics 1. KALA Mrityu : Natural 2. AKALA Mrityu : Unnatural The second category is also said to be AGANTUJA and may occur because of  Water - that is infected / polluted / contaminated  Agni - like fire accidents  Weapons  Stree / Visha Kanya - who is contaminated with STDs  VISHA – POISONING (Dalhana on Sushruta Sutra 34/6)
  4. 4. Among all these factors responsible for unnatural death VISHA is an important one. VISHA may be any substance that interferes normal physiology resulting in VISHADA Under different categories of Visha SARPA VISHA is an important factor that causes unnatural death.
  5. 5. As per the estimates of WHO; India has highest number of deaths due to snake bites in the world
  6. 6. Majority of the deaths are due to Delay / Lack in treatment, Unable to reach hospitals in time
  7. 7. It has been reported that, there are ONLY 52 VENOMOUS SNAKES out of 216 species in India. Yet, every year 50,000 Indians, mostly poor villagers, die in 250,000 incidents of snakebites (~20%). High incidences are noticed in the states of Tamil Nadu, West Bengal, Maharashtra, Uttar Pradesh, and Kerala.
  8. 8. SARPA DIVYA BHAUMA 80 Vasuki Etc. DARVIKARA MANDALI Rajimanta Vaikaranja 1226 22 10 Nirvisha 10
  9. 9.  Characteristic features to identify snakes,  symptoms of their poisoning,  management of poisoning etc.
  10. 10.  Saw-scaled viper ( Echis carinatus )  Russell’s viper ( Daboia russelii )  Common krait (bungarus caeruleus)  Indian cobra (Naja naja) Neurotoxic 20-30% 1 2 43 Majority of bites 70-80% hemotoxin / vasculotoxic
  11. 11.  तत्र दर्वीकरा- कृ ष्णसर्पो, महाकृ ष्ण, कृ ष्णोदर, स्र्वेत्कर्पोतो, महाकर्पोतो, बलाहको, महासर्पप, शङ्खकर्पोलो, लोहहताक्षो, गर्वेधुकः, र्पररसर्पपः,खण्डफ़न ्, ककु द्, र्पद्यो, महार्पद्यो, दर्पर्पुष्र्पो, दधधमुखः, र्पुण्डरीको, भ्रकु हिमुखो, वर्वष्ष्कर, र्पुष्र्पाभर्ककणो, धगररसर्पप, हृजुसर्पप, श्र्वेतोदरो, महाभशरा, अलगदप, आशीवर्वष इतत ! सु.सु.४/३४
  12. 12.  1. Krishna sarpa 10. Gavedhuk 19. Bhrakutimukh  2. Mahakrishn 11. Parisarpa 20. Vishkir  3. Krishnodar 12. Khandfan 21. Pushpabhikirn  4. Shwetkapot 13. Kakud 22. Girisarpa  5. Mahakapot 14. Padhya 23. Rijusarpa  6. Balahak 15. Mahapadya 24. Swetodar  7. Mahasarpa 16. Darbhpushp 25. Mahashira  8. Shankhkapal 17.Dadhimukh 26.Algard,Ashivish  9. Lohitaksh 18.Tundrik
  13. 13. रथाङ्गलाङ्गलच्छत्रस्वस्स्िकाङ्कु शधाररणः | ज्ञेयादवीकराःसरापः फणणनःशीघ्रगामिनः || सु.क.४/२२
  14. 14.  Hooded  Fast-moving  Having marks of wheel  Plough (हल,मण्डल)  Umbrella  Swastika (Auspicious cross)  Goad (अन्कु श)on the body.
  15. 15.  These snakes are … More poisonous during day time ...दर्वपकरास्िु िरुणा Darvikara are fatal in young stage of life. कोरयन््यननलःजन्िोः फणणनः सवप वविु All hooded (Darvekara) snakes aggravate Vata.
  16. 16. दर्वीकरवर्वषेण त्र्वङ्नयननखदशनर्वदनमूत्रर्पुरीषदंशकृ ष्णत्र्वं रौक्ष्यं भशरसो गौरर्वं सष्धधर्वेदना किीर्पृष्ठग्रीर्वादौबपल्यं जृम्र्णं र्वेर्पथुःस्र्वरार्वसादो घुघुपरको जडता शुष्कोद्गारः कासश्र्वासौ हहक्का र्वायोरूर्धर्वपगमनं शूलोद्र्वेष्िनं तृष्णा लालास्रार्वः फे नागमनं स्रोतोऽर्वरोधस्ताश्च र्वातर्वेदना र्र्वष्धत; सु.क.४/३७ Poisons of Darvikara causes Blackness in skin Eyes,Nails,Teeth,Face,Urine and place of bite, roughness, heaviness of head, pain in joints, dullness, dry eructation, cough, dyspnoea, hiccough, upward movement of Vayu, cramp due to pain, thirst, salivation, emitting froth, obstruction in channels and different types of vatika pain.
  17. 17. दर्वीकराणांप्रथमेर्वेगे वर्वषंशोणणतंदूषयतत,तत ् प्रदुष्िंकृ ष्णतामुर्पैतत,तेनकाष्ण्यं वर्पर्पीभलकार्पररसर्पपणभमर्वचाङ्गे र्र्वतत; द्वर्वतीये मांसं दूषयतत, तेनात्यथं कृ ष्णता शोफो ग्रधथयश्चाङ्गे र्र्वष्धत; तृतीयेमेदो दूषयतत, तेनदंशक्लेदः भशरोगौरर्वं स्र्वेदश्चक्षुग्रपहणं च; चतुथे कोष्ठमनुप्रवर्वश्यकफप्रधानाधदोषाधदूषयतत, तेन तधराप्रसेकसष्धधवर्वश्लेषार्र्वष्धत; र्पञ्चमेऽस्थीधयनुप्रवर्वशतत प्राणमष््नं च दूषयतत,तेन र्पर्वपर्ेदहहक्का दाहश्च र्र्वतत;षष्ठे मज्जानमनुप्रवर्वशततग्रहणीं चात्यथंदूषयतत,तेनगात्राणां गौरर्वमतीसारोहृत्र्पीडा मूर्च्ाप च र्र्वतत; सप्तमे शुक्रमनुप्रवर्वशतत चात्यथं कोर्पयततकफं च सूक्ष्मस्रोतोभ्यः प्रर्चयार्वयतत, तेन श्लेष्मर्वततपप्रादुर्ापर्वः किीर्पृष्ठर्ङ्गः सर्वपचेष्िावर्वघातो लालास्र्वेदयोरततप्रर्वृविरुर्च्र्वासतनरोधश्च र्र्वतत || सु.सु.४/३९
  18. 18. Vega Dushti Symptoms Prathama Rakhta Infects blood and manifests Paridaha (Burning sensation), कृ ष्णतामुर्पैतत (black discoloration) Dwitheeya Mamsa कृ ष्णाता शोफ़ो र्र्वष्धत (black discoloration of body parts), Tritheeya Meda Earlier symptoms & भशरोगौरर्वं दंसक्लेदः stiffness of eyes Chathurtha Kostha Pravesha कफ़प्रधान दोषदूषयतत Drowsiness Salivation Looseness of joint
  19. 19. Vega Dushti Symptoms Panchama Bones/asthi Vitiate prana and Agni Generalized pain, burning sensation, hiccough Shasta Majja Grahani Dushti (Impairs functions of GIT), Atisara (Diarrhea), Hritpida (Cardiac Arrest), Murcha (Unconscious), Sapthama Shukra Pain in flanks and lumbar Arrests all functions Respiratory arrest
  20. 20.  मधत्राररष्िोत्कतपन तनष्र्पीडनचूषणाष््न र्पररषेकाः ! अर्वगाह रक्तमोक्ष्ण र्वमनवर्वरेकोर्पधानातन !! ह्रुदयार्वरणाञ्जन नस्यधूमलेहौषधप्रशमनातन ! प्रततसारणं प्रततवर्वषं संज्ञासंस्थार्पनं लेर्पः !! मृतसञ्जीर्वनमेर्व च वर्वंशततरेते चतुभर्परधधकाः ! स्युरुर्पक्रमा यथा ये यत्र योज्याः श्रृणु तथा तान् !! च.धच. 23/25-27
  21. 21. TREATMENT MEASURE PROBABLE COMPARISON 1 Mantram Chanting Mantras 2 Arishta bandhanam Application of Tourniquet 3 Utkartanam Incision over the bite excluding vital points 4 Nishpeedanam Compression 5 Achushanam Sucking through the site 6 Agni Thermal cauterisation 7 Parishekam Sprinkling water 8 Avagaham Water bath 9 Rakta mokshana Blood letting 10 Vamana Emesis 11 Virekam Purgation 12 Upadhanam Medication on incised scalp 13 Hrudayavaranam Protection of heart 14 Anjanam Medicated collyrium
  22. 22. TREATMENT MEASURE PROBABLE COMPARISON 15 Nasya Medicated nasal insufflations 16 Dhumam Medicated smoking 17 Leham Medicated linctuses 18 Aushadham Anti-poisonous drugs 19 Pradhamanam Medicated snuffing 20 Pratisaranam Local applications 21 Prativisham Specific antidotes 22 Sajna Samstapanam Resuscitation 23 Lepam Application of Medicated pastes 24 Mruta Sanjeevanam Revivation
  23. 23.  Charaka emphasized NOT TO FOLLOW all these 24 UPAKRAMAS in all cases of poisonings.  A wise physician has to examine and decide justifiable procedures for specific condition.
  24. 24.  Different Upakramas may be helpful in different ways.  Are to be applied / used appropriately.  THESE MAY BE HELPFUL .. Example from 24 Upakramas  .. in restricting the entry of the poison into the systemic circulation Arista Bandhana, Utkartana, Chushana etc  .. to eliminate the poison form body Rakta Mokshana, Vamana, Virechana etc  .. to counteract the poisons (Anti-dot activity) Leha, Aushadha, Prativisha etc  .. as supportive / symptomatic measures Samjnasthapana, Mrita sanjivana etc  .. as topical applications Anjana, Pratisarana etc
  25. 25. मसन्दुवारक िूलानन रसेन स्वेन् रेषयिे ! िधुयुक्ि िोयिगद रानं दवीकृ िां र्वषे मसन्दुवारक िूलानन स्वेिा च गगररकणणपका !! रानं दर्वपकरे दष्टे नस्यं िधु सारकलि ! अ.स.उ.४२/२६-३० 1- Root of भसधदुर्वारक macerated in its own juice added with madhu for र्पान 2- Root of भसधदुर्वारक and swetha धगररकणणपका made into paste with water and consumed. 3- for नस्य the juice of कु ष्ठ with मधु can use. 4-In the case of black cobra bite,blood letting is done and paste of charti and nakuli applied 5-Drink prepared out of ghee, honey, manjishta, and griha-dhum
  26. 26. Vega Dushti Chikitsa Prathama Raka Dushti Raktamokshana by sira vedhana Dwitiya Mamsa Dushti Madhu, Ghrita and Yavagu Pana Tritiya Medo Dushti Teekshna Virechana, Yavagu Pana Chaturtha Kostha Pravesha Vamana, Yavagu Pana Panchama Asthi pravesha Sheetalopachara, Virechana, and Yavagu Pana Shashtha Majja Dushti Sheetalopachara, Virechana, and Yavagu Pana Saptama Shukra Dushti Tikshna anjana, nasya, kakpada shaped incision on the scalp and application of blood mixed flesh over the incision
  27. 27. लेरन योग  External application of HINGU, MARICHA, VACHA ground in the juice of KIMSUKA BARK on the bite mark subsides darvikara visha.  Lepa with tankana and grihadhooma ground in urine.  Lepana with paste of lasuna, maricha, ardraka and pippali ground in the juice of arkapatra.
  28. 28.  Internal administration of trikatu equal amount of pippali , maricha & sringavera with kanji or water nullifies all visha.  Intake of paste of Ashwagandha with pure water.  Mixed paste of guduchi and kola(piper cubeba).  Oral administration of shirisha flower and seed of arka and equal amount of vyosha is ground in arka kshira.
  29. 29.  Saindhava ground in the juice of tambula patra and dhatura patra is used as nasya in unconscious poisoned person.  Nasya with swarasa of tulasi & dronapushpi with maricha.  Nasya with hingu maricha & saindhav in human urine or tulasi swarasa.
  30. 30. िहागदा  Trivrt visalya, madhuka, haridra, daruharidra, rakta manjistha, aragvadha and the group of salts and trikatu-these should be powdered finely, mixed with honey and preserved in a horn.  This anti-poisonous formulation destroys poison used as intake.  This is known as MAHAGADA as it has great power.
  31. 31.  It is prepared by grinding the fine powder of vidanga,patha, triphala ajamoda, hingu, tagara, trikatu,chitraka and pancha lavana with honey into a fine paste and kept covering with the lid of same material
  32. 32. COMMON COBRA  The name "cobra" is short for cobra-de-capelo, which is uses for "snake with hood", or "hood-snake"  Zoological name- Naja naja  Latin name-naja tripudians  King cobra-राज नाग, राज सर्पप/ Naja bangarus ,Ohiophagus hannah  Common name- नाग(Hindi), Moorkan (Malayalam) Nagara Havu (Kannada)  Family - Elapidae  Venom- neurotoxic  Common cobras are usually brown or black in color  Hood is present. Dorsal aspect of hood may have monocellate or binocellate mark  Ventral surface of hood have two dark spot
  33. 33. Are Cobras aggressive?  Most cobras are shy, and will usually run and hide when people are around. The exception is King Cobra, who is aggressive and will rear up and stand his ground when confronted. What unique power do they have?  This is one of those supernatural cobra facts that Cobras are the only snake in the world that can spit their venom, and they are accurate up to about half their own length How powerful is their Venom? Cobras venom is not the strongest there is, but cobras can inject so much venom in a single bite that they can kill an elephant. Are they poisonous?  Cobras are not POISONOUS, they are VENOMOUS. This means that even though they have deadly venom in their sacs Are they great parents?  King Cobras are the only snake in the world that build a nest for their young, just like a bird, but on the ground!
  34. 34. Can they hear ?  Cobras can hear, although they sense sound through contact with the ground much better than humans. How old do they get?  Cobras typically live up to 20 years or more, when they’re in the wild. Do they eat their own?  King Cobras, known also as the Ohiophagus hannah, eat other snakes! The Latin word for “snake-eater” is ophiophagus. How Long are they?  King Cobras are the longest venomous snake in the world! The average male grows 18 feet long, and some have been known to grow more than 20 feet long.  All toxic snakes are venomous and not poisonous, well all of them except one The Asian is both poisonous and venomous
  35. 35.  The cobra is greatly respected and feared and has its own place in Hindu mythology as a powerful deity  The Hindu god SHIVA is often depicted with a cobra coiled around his neck  VISHNU is usually portrayed as reclining on the coiled body of ADISHESHA  Cobras are also worshipped during the Hindu festival of NAG PANCHAMI
  36. 36. Snakes by nature are timid and they bite humans, birds or other animals for the following reasons…  For food  By fear  Being touched by the feet  Accumulation of more venom  Anger  By hatred
  37. 37.  The Indian cobra's venom mainly contains a powerful post-synaptic neurotoxin and cardiotoxin  The venom acts on the synaptic gaps of the nerves, thereby paralyzing muscles, and in severe bites leading to respiratory failure or cardiac arrest.  The venom components include enzymes such as hyaluronidase that cause lysis and increase the spread of the venom.  The venom of cobra is mainly made up of proteins and polypeptides of neurotoxins and cardio-toxins
  38. 38. Snake Fatal dose Amount of venom injected per bite Fatal period Cobra 12mg of dried venom 200-300mg 20min to 6 hour Krait 6mg of dried venom 20-22mg Russel viper 15 mg of dried venom 150-200mg 1-2 days Saw scaled viper 8mg of dried venom 25 mg
  39. 39. Systemic features  Pre-paralytic stage - characterized by vomiting, headache, giddiness, weakness, lethargy  Paralytic stage –ptosis, opthalmoplegia, drowsiness, dysartheria, convulsion, bulbar paralysis, respiratory failure, coma, cardiac arrest, Local features  Symptoms start within 6-8 min  Sleepy , intoxicated  Nausea and vomiting  Fang marks  Burning pain, excessive salivation  Swelling and discoloration sometimes associated with some blisters.
  40. 40. Don’t  Cauterization should never be attempted in viper bites  Avoid alcohol for both internal and external use  Hot, chilli, sour , salt, oil, fruits , tubers, meat, fish, intercourse should be avoided Do  Site of bite is irrigated with water or ones own urine.  Assure the patient  Tourniquet is applied 2-3 inch above the bite mark  Poison is sucked out to minimize the poison level in the body  Never allow the patient to sleep  Cauterization only in the initial 1-2 min. poison gets neutralized at 100c
  41. 41.  Allaying the anxiety and fear  Prevention of spread of venom  Hospitalisation  Use of anti-venom and other anti toxic therapies  General measures
  42. 42. Blood  Complete blood count  Blood group and cross-matching  20 min whole blood clotting test(20 WBCT)  Blood gas analysis Liver  Liver function test Kidney  Kidney function test ECG  Chest x-ray
  43. 43. Most of the deaths are due to shock rather than poison. It is always advised to re-assure the patient by following points…  All the snakes are not poisonous  Poisons snakes are not fully charged  Even it is charged with poison, it cannot always inject lethal dose
  44. 44.  Keep the patient warm calm and restful  Non sedating, non salicylate analgesic (paracetamol) is the best  Broad, sterile, firm bandage on the area of the bite and on the limb  In the case of bite on the trunk, head or neck, firm pressure over the bitten area  If bite is on extremity, firm ligature is applied few inches above the site of the bite. The ligature is loosened for 90 sec once in every 10 min  Limb immobilizing to prevent spread of venom  Cross incision of 1cm long and 1/2cm deep over each mark is made and the blood and lymph are drained  Draining is continued until anti venom is administered
  45. 45.  Any interference with the bite wound may introduce absorption of venom and increase local bleeding  Washing increases the flow of venom into the system by stimulating the lymphatic system
  46. 46. Anti snake venom should not be administered as a routine measure. It should be carefully and selectively given as it leads serious allergic reactions Indications for antivenom administration are… 1) In coaguable blood 2) Spontaneous systemic bleeding 3) Hypotension 4) Neurotoxic or myotoxic features 5) Expanding local swelling 6) Tender regional lymph node
  47. 47.  Before administration the anti snake venom should be tested sub cutaneous as it produces serious anaphylactic reaction in sensitive persons DOSE  Cobra -5-20 ampoules  The anti venom powder is dissolved in distilled water or normal saline and administered in appropriate dose as infusion in 500 ml of normal saline at a rate of 15-20 drops per minute.  Flow should be completed in 1-2 hour so that further dose can be repeated, if required(every 6 hour)  It is useful if given within 4 hour of bite
  48. 48.  There is no absolute contraindication to ASV  ASV should not be used indiscriminately because it carries a risk of severe adverse reaction  Patients must be closely observed for at least 1 hour after starting IV antivenom so early anaphylactic shock can be detected
  49. 49.  Poisoning is usually accidental  Rarely homicidal or suicidal  Cattle are sometimes poisoned by snake venom
  50. 50.  Evidence of fang marks, local swelling, discoloration, blister formation, bleeding  Bleeding diathesis  Froth at mouth and nostrils  Pulmonary oedema  Congested organs  Cellulitis around the bite mark  Venous clots
  51. 51.  Immobilising and transporting snakebite victims to the hospital and prompt administration of anti-snake venom remain the best way to reduce morbidity and mortality.  It is also important to practice correct first aid measures, as otherwise they may cause more harm than good.
  52. 52.  Treatment modalities have their own significance in neutralizing the poison in different ways.  Chaturvimshati Upakramas can be used judiciously even in case of DARVEKARA Visha.  Application of Tourniquet also has certain limitations in case of DARVEKARA Visha (cobra poisoning) considering the danger of increasing the local effects of the necrotic venom.
  53. 53.  Evidences are available regarding the clinical efficacy or anti- venom activity of the formulations mentioned for the treatment of DARVEKARA Visha.  Though there is certain ambiguity in the approach as compared to modern medical science; the treatment modalities emphasized in Ayurveda have a great significance and are valuable particularly in remote areas, where medical facilities are meager.
  54. 54.  Charaka Samhita chikitsasthana  Sushruta Samhita kalpasthana  Ashtanga hrudaya Uttaratantra  Ashtanga Samgraha Uttaratantra  Review of forensic medicine & toxicology  Illustrated Agada Tantra  Vishavaidya Jyotsnika  Internet

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