Review Article International Ayurvedic Medical Journal ISSN:2320 5091

VATSANABHA: AN PERSPECTIVE Dr Amala Jyothi1, Dr Aruna Naga1, Dr Rajalakshmi R1, Dr Ashwinikumar S Bharati2 1PG Scholar, 2Professor, Dept. of Agada , SDM College of Hassan, Karnataka, ABSTRACT Ayurveda is the science of life that is widely practiced in India. It uses medicine pre- pared from , animals, and mineral origin. All the three sources of drugs can be divided under poisonous and nonpoisonous category. Vatsanabha is one such 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 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, 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- 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 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

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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. Maintenance of body heat is essen- stroyed by putrefactive process. Hence it is tial and use of inotropic therapy in cases of often difficult to detect it after its death. It is hypotension. In cases of bradycardia, admin- also decomposed by an alkali. Wood ashes, istration of 1mg atropine is indicated. For which are often added to a vomit, destroy cardiac arrhythmias, 50ml of 0.1 percent aconite owing to the presence of an alkali. Novocain given intravenously, in a slow CONCLUSION: manner is useful. Oxygen & artificial respi- Vatsnabha (Aconitum ferox) is categorized ration maybe resorted to, if necessary. Glu- under the sthavara visha (plant origin) while cose saline maybe administered intravenous- Aconite is a Greek word which means arrow ly to combat collapse [38]. poison referring to the then use of the plant. Post Mortem Appearance [39]: As our Acharyas have clearly mentioned, Post-mortem appearances are not character- even a strong poison can become an excel- istic. Fragments of root may be found in the lent medicine if administered properly; on stomach contents. Mucus membrane of the other hand even the most useful medi- stomach and small intestines may be con- cine act as a poison if not handled correctly. gested and inflamed. The bronchial tree Vatsnabha is highly toxic in nature even shows frothy mucus. then it is used as a medicine after purifica- Medico-legal Importance [40]: tion and in therapeutic dose. Accidental poisoning is not rare as aconite Active constituents of many plant drugs may root is often consumed after mistaking it for exert severe toxic effect at high concentra- horse radish root. Tincture has been swal- tions. The purification processes are basical- lowed in overdoses and liniment is taken ly intended to reduce the toxicity level to a 1238 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective body sustainable limit and to reduce the tox- lations: Traditional views and their ref- ic constituents to some extent or by potenti- erences. Spatula DD 2011;1:233‑44. ating their chemical transformation to non- 6. Dr.Shastry J.L.N.,Dravyaguna vijnana, toxic or relatively less toxic substances by Vol 2,Chukhambha Orientaliya, varana- enhancing their biological efficacy. si, Ed.1st, 2004, pg no 2. Pharmacologically, it improves digestion, 7. www.ncbi.nim.nih.gov- Overdose effect relieves coldness, nutritive. It is used in the of aconite containing Ayurvedic Medi- treatment of vision problems, night blind- cine (‘Mahashankha Vati’) byAshok ness, eyes infections, inflammation, otitis Kumar Panda and Saroj Kumar Debnath and headache. It is useful in treatment of 8. Pandit Kashinath Shastry, Rasatarangini, sciatica and backache. It is also used as anti- Motilala Banarasidas, Delhi, dote for poisoning due to jangama visha Ed,11,1979, peg no 651. (animal origin poison). 9. Modi′s Medical Jurisprudence and Toxi- Due to some properties like Ashukaritwa, cology, 23rd edition, Lexis Nexis But- Ushna, Teekshna vish dravya get spread rap- terworths; 2005 page no. 468 idly in the body. So for the quick action of 10. Shastri Ambikadatta, editors, medicines many Ayurvedic formulations Sushrutsamhita-klp., Chukhambha San- contain these vishadravyas like Vatsanabha skrit Sansthan, Varanasi, Reprint 2000, as their ingredient. By utilizing these proper- Pg No .565 ties of vishadravyas medicines can be made 11. Dr.Shastry J.L.N.,Dravyaguna vijnana, more effective. In spite of being a Ma- Vol 2,Chukhambha Orientaliya, varana- havisha, it is a basic ingredient of various si, Ed.1st, 2004, pg no 15. ayurvedic formulations which thus proves 12. Modi′s Medical Jurisprudence and Toxi- its synonym Amrita. cology, 23rd edition, Lexis Nexis But- REFERENCES: terworths; 2005 page no. 469 1. Dr.Shastry J.L.N.,Dravyaguna vijnana, 13. From Wikipedia, the free encyclopedia, Vol 2,Chukhambha Orientaliya, varana- en.wikipedia.org/wiki/Aconitine. si, Ed.1st, 2004, pg no 9. 14. Modi′s Medical Jurisprudence and Toxi- 2. Pandit Kashinath Shastry, Rasa- cology, 23rd edition, Lexis Nexis But- tarangini, Motilala Banarasidas, Delhi, terworths; 2005 page no. 469 Ed,11,1979, peg no 651. 15. Modi′s Medical Jurisprudence and Toxi- 3. Ffrench G. Aconitine‑induced cardiac cology, 23rd edition, Lexis Nexis But- arrhythmia. Br Heart J 1958;20:140‑2. terworths; 2005 page no. 469 4. Makino T, Kato K, Mizukami H. Pro- 16. Modi′s Medical Jurisprudence and Toxi- cessed aconite root prevents cold‑stress‑ cology, 23rd edition, Lexis Nexis But- induced hypothermia and immuno ‑ terworths; 2005 page no. 469 17. Modi′s Medical Jurisprudence and Toxi- suppression in mice. Biol Pharm Bull cology, 23rd edition, Lexis Nexis But- 2009;32:1741‑8. terworths; 2005 page no. 469 5. 19. Rastogi S. A review of aconite (Vatsanabha) usage in Ayurvedic formu-

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Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective 18. Mishra GS. Àyurveda Prakash. New 29. Handa KL, Chopra IC, Kohli JD, Singh Delhi, India: Chaukhamba Surabharati K. Mitigation of aconite; a preliminary Academy; 2007. p. 490‑5. note. Indian J Med Res 1951;39:89‑98. 19. Shastri K. Sadananda Sharma: Rasa Ta- 30. Parikh KM, Doshi VJ, Salunkhe UB, rangini. 11th ed. New Delhi: Motilal Ba- Dhanvate AA. Authentication of detoxi- narasidas; 2012. p. 651‑52. fication process used in traditional Indi- 20. Sastri A. Vagbhattacharya: Rasaratna an medicine. Int HorticSoc Acta Hortic Samuchchaya. 6th ed. Varanasi: Chau- 1996;426:57‑4 khamba Sanskrit Series Office; 1978. p. 31. Rastogi S. A review of aconite 590. (Vatsanabha) usage in Ayurvedic formu- 21. Mishra GS. Àyurveda Prakash. New lations: Traditional views and their ref- Delhi, India: Chaukhamba Surabharati erences. Spatula DD 2011;1:233‑44. Academy; 2007. p. 490‑5. 32. Singh LB. Poisonous (Visa) Plants in 22. Mishra BS. Yogaratnakara. Varanasi: Ayurveda. 2nd ed. Va- Choukambha Prakashana; 2010.p. 167‑ ransai:Chaukhamba Sanskrit Bhawan; 9. 2003 23. Shastri K. Sadananda Sharma: Rasa Ta- 33. Paul A. Effects of Avurvedic shodhana rangini. 11th ed. New Delhi: Motilal Ba- (processing) on dried tuberous Aconite narasidas; 2012. p. 651‑52. (Aconitum napellus Linn.) root. Indones 24. Mishra GS. Àyurveda Prakash. New J Pharm 2013;24:40‑6. Delhi, India: Chaukhamba Surabharati 34. Tai YT, But PP, Young K, Lau CP. Car- Academy; 2007. p. 490‑5. diotoxicity after accidental herb‑induced 25. Shastri AD. Govind Das: Bhaisja aconite poisoning. Lancet Ratanavali. Varanasi: Chaukhambha 1992;340:1254‑6. Sanskrit Samsthan; 2008. p. 155. 35. Sarkar PK, Prajapati PK, Shukla VJ, 26. Sarkar PK, Prajapati PK, Shukla VJ, Ravishanka B. Evaluation of effect of Ravishanka B. Evaluation of effect of Shodhana process on pharmacological Shodhana process on pharmacological activities of aconite. Indian J Pharm activities of aconite. Indian J Pharm Educ Res 2012;46:243‑7. Educ Res 2012;46:243‑7. 36. Sastri, Sri Vagbhattachary’s Rasaratna 27. Singh LB. Poisonous (Visa) Plants in Samuchchaya, 6th ed. Varanasi: Chau- Ayurveda. 2nd ed. Va- khambha Sanskrit series office; 1978 ransai:Chaukhamba Sanskrit Bhawan; 37. Dr.Shastry J.L.N.,Dravyaguna vijnana, 2003 Vol 2,Chukhambha Orientaliya, varana- 28. Deore SL, Moon KV, Khadabadi SS, si, Ed.1st, 2004, pg no 16. Deokate UA, Baviskar BA. Evaluation 38. Modi′s Medical Jurisprudence and Toxi- of toxicity of ‘Vatsanabha’ (Aconitum cology, 23rd edition, Lexis Nexis But- ferox, Ranunculaceae) Before and After terworths; 2005 page no. 470 Shodhana. J Young Pharm 2013;5:3‑6. 39. Modi′s Medical Jurisprudence and Toxi- cology, 23rd edition, Lexis Nexis But- terworths; 2005 page no. 470 1240 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Dr Amala Jyothi Et Al: Vatsanabha: An Agada Perspective 40. Modi′s Medical Jurisprudence and Toxi- cology, 23rd edition, Lexis Nexis But- CORRESPONDING AUTHOR terworths; 2005 page no. 470 Dr Amala Jyothi 41. Modi′s Medical Jurisprudence and Toxi- PG Scholar cology, 23rd edition, Lexis Nexis But- Dept. of Agada Tantra, terworths; 2005 page no. 470 SDM College of Ayurveda Hassan, Karna- 42. Modi′s Medical Jurisprudence and Toxi- taka, India. cology, 23rd edition, Lexis Nexis But- Email: [email protected] terworths; 2005 page no. 470 Source of Support: Nil Conflict of Interest: None Declared

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