VATSANABHA: an AGADA PERSPECTIVE Dr Amala Jyothi1, Dr Aruna Naga1, Dr Rajalakshmi R1, Dr Ashwinikumar S Bharati2 1PG Scholar, 2Professor, Dept
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Review Article International Ayurvedic Medical Journal ISSN:2320 5091 VATSANABHA: AN AGADA PERSPECTIVE Dr Amala Jyothi1, Dr Aruna Naga1, Dr Rajalakshmi R1, Dr Ashwinikumar S Bharati2 1PG Scholar, 2Professor, Dept. of Agada Tantra, SDM College of Ayurveda Hassan, Karnataka, India ABSTRACT Ayurveda is the science of life that is widely practiced in India. It uses medicine pre- pared from plants, animals, and mineral origin. All the three sources of drugs can be divided under poisonous and nonpoisonous category. Vatsanabha is one such plant which is considered the most toxic plant in the world, hence listed out under Visha varga. It is the only Mahavisha which still identified and available. But if administered after proper Shodhana acts as Ra- sayana. Shodhana or purification is the process which involves the purification as well as re- duction in the levels of toxic principles thus removing the untoward effects the drug produces. The present review is designed to extensively discuss and understand the plant, its toxic effects, management and the medico-legal aspects involved. Keywords: Ayurveda, Vatsanabha, Toxicity, Detoxification, Management, Medico-legal as- pects INTRODUCTION ga[6]. The objective of this study is to review Vatsanabha or Mahavisha, Aconitum ferox the state of knowledge of the drug as such is a species of monk’s hood from the family along with its toxic effects on various sys- Ranunculaceae is a deciduous perennial with tems, its shodhana and medico-legal im- tall and erect stems crowned by racemes of portance. large eye catching blue, purple, white zygo- Toxic constituents: morphic flowers with numerous stamens. [1] The tuber of Vatsanabha contains 0.4–0.8% Vatsanabha is also identified as Vatsanaga, diterpene alkaloids and the concentration of Ksweda, Visa and Amrita.[2] As the synonym aconite in the fresh plant is between 0.3% reveals, this toxic plant can also be useful as and 2.0% in tubers and 0.2% and 1.2% in Amrita. The root of this plant is extremely the leaves. The highest concentration of ac- poisonous but useful in the treatment of var- onite is found in the winter. The major alka- ious diseases such as fever, rheumatoid ar- loids are aconitine, pseudaconitine, thritis, sciatica, hypertension and also act as bikhaconitine, diacetyl pseudaconitine, a Rasayana after Shodhana[3-5]. Classically, aconine, picro-aconine, veratry pseudaco- Charaka has categorized Vatsanabha under nitine, chamaconitine, veratryl gama acon- Sthavara Visha, Susruta under Kanda Visha ine, and di-Ac–Y-aconitine.[7]. and Kaiyadeva nighantu under Visha Var- Necessity of Shodhana: How to cite this URL: Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective. International Ayurvedic medical Journal {online} 2016 {cited 2016 July} Available from: http://www.iamj.in/posts/images/upload/1235_1241.pdf Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective Impure or impurely purified Vatsnabha if cotic effect; its pollen causes pain and swell- administered in any form will cause Daha ing in the eyes. It imparts a sensation of tin- (acute burning sensation) all over the body. gling & numbness to the tongue, lips & It may also cause Murcha (Syncope), mouth when chewed.[9] Hrutrodana (cardiac arrest) which may usu- Toxic symptoms [10-12] ally lead to Mrutyu (death) of patient [8]. Use Susruta enumerates the toxic symptoms as of Vatsnabha in higher dose may also lead Greeva stambha (neck stiffness) and peeta to toxicity and death. vinmootra netrata (yellowish discoloration All parts of the plants are poisonous. Tuber of feces, urine and eyes). is chiefly used as a poison. Leaves handled Rasa Vagbhata enumerated Ashta vegas or rubbed on the skin, produces tingling and (eight stages) of poisoning as: numbness. The odor of the plant has a nar- Stage Symptom 1st Twak vikara (skin changes) 2nd Vepathu (tremors) 3rd Daaha (burning all over the body) 4th Vikrtavastha (deformities) 5th Phenodgama (froth from mouth) 6th Skanda bhanga (drooping of shoulders) 7th Jadata (comatose) 8th Marana (death) Externally, when applied to mucous mem- dilatation of pupil[finally dilated] and Di- branes or to the skin for any length of time, plopia or impaired vision. aconite first stimulates and then depresses CVS Symptoms include slow, feeble and the ends of the sensory nerves, producing irregular pulse, fall in BP, Respiration which respectively tingling, numbness, and local at first is rapid and then slow, labored and anesthesia. shallow. Skin may become cold and damp It acts as both Neurotoxic and Cardiotoxic. and temperature will be usually sub normal. Generally symptoms occur immediately or Mode of Action [13]: within minutes of ingestion. Patient experi- Its major alkaloid aconitine has the chemical ences Bitter-sweet taste in the mouth fol- formula C34H47NO11, and is soluble in chlo- lowed by severe burning and tingling sensa- roform or benzene, slightly in alcohol or tion of lips, tongue, mouth & throat, which ether, and only very slightly in water. is again followed by numbness & anesthe- Aconitine can interact with the voltage- sia, Nausea, salivation, difficulty in swal- dependent sodium-ion channels, which are lowing, Pain in abdomen, vomiting and later proteins in the cell membranes of excitable tingling of the whole body. tissues, such as cardiac and skeletal muscles CNS Symptoms include Vertigo, Restless- and neurons. These proteins are highly se- ness, Difficulty in speech; Great prostration, lective for sodium-ions. They open very fast Pain and weakness of muscles associated to depolarize the cell membrane potential, with twitching and spasm, Contraction and causing the upstroke of an action potential. 1236 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016 Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective Normally, the sodium channels close very • Aconitine nitrate: 4mg rapidly, but the depolarization of the mem- Fatal Period [15]: brane potential causes the opening (activa- • Usually 1-5 hrs tion) of potassium channels and potassium- • Doses below Lethal Dose : produce efflux, which results in repolarization of the alarming symptoms immediately membrane potential. • Non-fatal cases: numbness & tingling In short Aconitine increases the permeability sensation persist of excitable membrane for sodium ions and Recovery Period [16]: prolong the sodium influx during the action Recovery time is dependent on amount of potential as a consequence sensible nerve intoxication. Mildly intoxicated patients ending and motor endplates are first activat- may take 1–2 days while patients with car- ed but later blocked. diovascular complications may take 7–9 Fatal dose[14]: days to recover. • Indian aconite root: 1.3-2gm Cause of death [17]: • Tincture: 5ml Death may be due to Respiratory failure or • Liniment: 1ml Ventricular fibrillation. • Pure aconitine: 2mg Shodhana: Sl No. Process Media Duration 01 Swedana [18,19] Aja dugdha 3 days 02 Sthapana Gomootra 3 days Aatapa shoshana [22,21,22,23] 03 Swedana[24] Go dugdha 3 days 04 Sthapana Gomootra 3 days Aatapa shoshana Tankana Bhavana [25] Changes occurring during Shodhana: dhana by both Gomootra and Godugdha Though treatment with cow urine, cow milk, makes Aconite devoid of cardiac and neuro– or cow dung is the traditional method of muscular toxic effects without affecting its Shodhana, it may not be feasible or accepta- antipyretic activity.[35] Soaking and boiling ble to all. After Shodhana process, the total during processing or decoction preparation alkaloid content decreases,[26] but the con- will hydrolyze aconite alkaloids into less tents of less toxic substances such as acon- toxic and non-toxic derivatives. ine, hypoaconine, and benzylhypoaconine The results of the toxicity study suggested increases [27,28] possibly due to conversion that after Ayurvedic Shodhana process, TLC of the toxic aconitine into aconine or hy- studies have shown that pseudoaconitine and drolysis of the alkaloids to their respective aconitine were converted into far less toxic amino alcohols after Shodhana process[29,30]. substances veratroyl pseudoaconine and It has been reported that Gomootra converts benzoylaconine respectively. Aconite to a compound with cardiac stimu- Management: lant property, whereas, raw Aconite showed According to Rasa Vagbhata, Upto 5th ve- cardiac depressant properties.[31,32,33,34] Sho- ga management is possible. First vamana 1237 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016 Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective (vomiting) shall be induced using Ajak- internally by mistake. Inhalation of the dust sheera followed by Lepa, Kwatha or Anjana while powdering of root has caused toxic of Vishaghna gana. symptoms. If toxic symptoms is appears due to over Used of aconite as suicidal and homicidal dose of formulation contains aconitum or poisoning is common in India, where aco- usage of improper / without purification of nite is given along with betel leaf to mask its Vatsanabha in that condition Tankana taste. Aconitine added in Indian liquors to bhasma along with Ghee is given[36]. Com- increase the intoxicating effect, and causes bination of honey, ghee and bark of Arjun poisonous symptoms followed occasionally (Terminalia arjuna) is also used as antidote. by death. In rare cases, aconite root has been Whenever Vatsanabha is used in any formu- used as an abortifacient. Root of aconite is lation, Tankana bhasma (borax calx) is also occasionally used as cattle poison. Roots of used in the formulation to counteract the aconite are used as an arrow poison. toxic effect of Vatsnabha and hence there Identification [41]: will be no toxic effects[37]. Elimination of aconitine is mainly in the Use of Emetics or Gastric lavage with a so- urine and is best tested by acidifying it with lution containing animal charcoal, tannic diluted acetic acid. Traces have also been acid or milk is advised. Immediate attention found in the saliva, sweat and bile. should be given to vital organs. There Vatsanabha: An Ideal Homicide [42]? should be close monitoring of BP & cardiac Aconitine is extremely unstable and is de- rhythm.