Review Article International Ayurvedic Medical Journal ISSN:2320 5091

A REVIEW ON AYURVEDIC MANAGEMENT ON VENOMOUS SNAKE BITE Shweta Nidagundi1, Chaitra H2 P.G Scholar1, Associate professor2, P.G.Department of Agada Tantra, SDM college of Ayurveda, Hassan, Karnataka, India ABSTRACT Snake-bites are well-known medical emergencies in many parts of the world, especially in rural areas. Agricultural workers and children are the most affected. In India, snake bites take a heavy toll of human lives. India is reported to have the highest number of snake bites (81,000) and deaths (11,000) per year. Estimates of death due to snake bite range widely from 1,300- 50,000; hence there is a utmost need for the attention on snake bite treatment. The current annual need for the treatment of snake-bite envenoming amounts to 10 million vials of antivenins. Un- fortunately, the present worldwide production capacity is well below these needs and frequently leads to side effects. In view of limited presence of modern medical avenues in far flung areas, such are source needs to be harnessed, as herbals are cheap, acceptable and often at the disposal of victims. Ayurveda has its own way of approach in the management of snake bite poison, which has co-parlance with the concepts of current science. In the present article, an attempt is made to highlight the importance of classical remedial measures and special emphasis which helps in the management of snake bite poison. Keywords: Snakebite, Ayurveda, Sarpa Visha, Visha Chikitsa

INTRODUCTION There are nearly 3150 species of snake bites. India is reported to have the snakes in the world and around 600 species highest number of snake bites (81,000) and are venomous1. In India, out of the 216 spe- deaths (11,000) per year3. Estimates of death cies of snakes, 60 are considered poisonous2 due to snake bite range widely from 1,300- .Snakes are found on every continent except 50,000. According to Government of India Antarctica. The true global burden of snake data, there were 61,507 snake bites with bite is not known due to lack of standardized mortality of 1124 in 2006; 76,948 bites and reporting and underreporting. It is docu- 1359 deaths in 2007. A high mortality of mented that there are 54, 00,000 snake bites 50,000 deaths each year has also been pub- with 2, 50,000 envenomations and around lished4.Majority deaths are caused by cobra, 1,25,000 fatalities annually in the world. krait and vipers Most snake bites and fatalities occur in Asia, Fatality due to snake bite is due to wide spe- Southeast, and sub-Saharan Africa, with In- cies variation, shortage of anti-snake venom dia reporting the highest mortality due to (ASV), poor compliance with treatment pro-

How to cite this URL: Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite. International Ayurvedic medical Journal {online} 2016 {cited 2016 July} Available from: http://www.iamj.in/posts/images/upload/1284_1290.pdf Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite tocols, lack of public education and clear Darvikara Sarpa: Shyavata Of Mukha policy to deal with the problem. The reason ,Netra,Nakha, Mutra, Purisha And Tvak , being lack of experience in handling such Shiro Gourava, Sheeta Jwara, Nidra Nasha cases and non-compliance with the existing , Vijrimba, Sandigdhatva Of Vak (Irrelevant guidelines. Snake bite is a common medical Speech) , Acheshta ,Lala Srava And emergency, where timely treatment Phenagama, Kantha Guruguraya- Can reduce morbidity and mortality and na(Rumbling Sound) , Shushka Udgara And save precious human lives. Though National Other Lakshna Of Vata Protocol on Snake Bite Management formu- Mandali Sarpa: Saushma , Shosha ,Peeta lated by the Ministry of Health & Family lohita, Pruthu , visarpita, daha , ushna, Welfare, Government of India is in place kleda, kotha, vishiryatey , Peeta tha of besides the WHO Guidelines5. The modern mukha , danta etc,Trishna , Shrama health care facilities are not well equipped ,Bhrama Daha , Murcha , Jwara – tik- and there is shortage of ASV, emergency taasyata , Urdwa & Adho marga raktha drugs, ventilators etc thus necessitating a agama, Sheeta icha , Dhumako , Mada, trip to well-equipped tertiary care hospitals, Other Lakshna of Pitta . where treatment may be unaffordable due to Rajimantha Sarpa: Bite site –Snigdha , limited purchasing power of the rural vic- Sthira , Pichila, Shopha,Raktha- Sandra , tims. Thus, increasing the high mortality rate Shita & Pandu, Shirovyatha, Aru- and loss of crucial golden lives of humans. chi,Chardhi , Aalasya, Hrrillasa, Types of Sarpa Damsha: Madhurasyata Kantey Ghuru-Ghuru, According to Sushruta6 Kruchra- Uchvasa & Nishvasa, Nidra,Kasa, 1. Sarpita-deep punctured Panduta Of Nakha Etc, Anga Guruta And 2. Radita-superficial punctured with less Stamba ,Srava From Nasa,Akshi,Mukha, venom injected Romaharsha, Shwasa, Tama,Other Lakshna 3. Nirvisha-non poisonous Of Kapha According to Vagbhata7 Diagnosis: 1. Tundahata-stained by Saliva Vishahari Lehya11: 2. Vyalidha-one or two bite marks & no bleeding This Lehya is very useful in diagnosing 3. Vyalupta-one or two bite marks & bleed- venomous and non-venomous snake ing bites. 250gms of seeds of Luffa amara 4. Dashtaka-three marks accompanied with ground in the juice of about 500 betel tearing of muscles leaves should be tied in a cloth and hung 5. Dashtanipidita-four bitting marks on a hook. The juice flowing down is collected and an equal quantity of old Causes for Snakebite: Acharyas have neem oil is to be added. One-fifth quan- explained 8 reasons for Sarpa Damsha. tity (by weight) each of purified mercury They are Bhaya ,Krodha ,Aaharartha , Pada and purified sulphur is added to it, mixed sparsha ,Ati vishat ,Vairadhya ,Papa karma in a mortar and water is removed by , Deva-rishi-yama kopa8 . evaporation and kept in a glass jar. 50- Lakshana’s9, 10:

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Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite 100mg of Lehya spread on a betel leaf is Snake bite can be treated on the basis of given to the victim. 3 treatment modalities like If the victim tastes Amla Rasa then it is 1. Satwavajaya-Reassuring of the vic- to be bitten by Mandali Sarpa. Similar- tim who may be very anxious ly,Katu Rasa by Daarvikara Sarpa, 2. Daivavyapashraya-Chanting Mantra Madhura Rasa by Rajimantha Sarpa and 3. Yukthivyapashraya-Medication Kashaya Rasa then there is Slight en- Acharya Charaka has mentioned “Chatur- venomation . vimshati Upakramas” (24 treatment modali- Caution- This preparation itself is toxic. ties) in all cases of poisonings. Based on the If it was given, ripe fruit of Benincasa probable purpose of the treatment, these Hispida is to be used for the next 3-4 Upakramas can be applied. days. Table2 Chaturvimshati Upakramas12 Chikitsa: check entry of Eliminative Symptomatic Counteracting Pacifying poison in therapy therapy measures measures blood ArishtaBandhana RaktaMokshan Hrudayavaranam Mantra Anjana

Utkartanam Vamana SajnaSamsthapan Aushadha Lepa Nishpeedanam Virechan MrutaSanjeevan Prativisha Dhuma Cushanam Nasyam Leham Agni Upadhanam Parishekam Pradhamanam Avagaham Pratisaranam Mantra:Chakrapani prefers Mantra as of poison, the physician has to opt the foremost and par excellence Upakrama bandhana. among others, which nullifies the poison13. Charaka further say that, chanting Mantra is Material: Plota(cloth),Charmanta ,Mrudu a specific rhythm builds confidence in vic- Valka or any soft material. It should be tied tim and helps in relieving anxiety. They 4 Anguli above the site of bite. Neither too stimulate sympathetic nervous system tight nor too loose .Strengthen the peripheral blood vessels, Utkartanam(Incision): Poison does not ad- which helps in maintaining the normal blood vance after incision of bite like a tree after flow to the vital organs and it awakens the cutting its root i.e. spreading of poison can body's natural healing mechanisms14. be stopped. Arishta Bhandana(Ligature): Arishta Achushana(Sucking):The physician should means unfavorable/indication of death. suck the poison filling his mouth before with Bandhana means to stop. When the intensity Mruth,Bhasma, Agada Or Gomaya .This of the poison increases, it starts to combine method should be adopted especially on with the blood and gets spreaded all over the fleshy part body. Thus to prevent or stop the spreading 1286 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite Nishpeedanam(Compression):Expelling of Precaution: Avoid using Kanji. Kulatha, the poison by squeezing the area of bite Taila, Madhya etc so that Kapha does not where the incision is not advisable. It is just spread to whole body. like destroying of the seed before sprouting. Virechana(Purgation): It is done at the 2nd It should not be done if bite is on vital part stage, when Visha moves to the Pakvashaya. (Mrutyu) and joints (Angavikala). Indication: Koshta Daha and Ruja, Adhma- Avagaha(Immersion/dipping): It means the na, Mutrasangha,Purishsangha, Mutra Kri- affected part in a medicated Kwatha/Taila. chra, Pitha Vikara .If bite is below umbili- Agni (Cauterisation): It is Cauterising the cal region. site of bite with Suvarna, Loha etc and even After Virechana, Agadapana should be burning faggot (wooden). It is mainly indi- done. cated in Twak and Mamsagata Visha . It is Nasya(nasal medication): It should be done contraindicated in Mandali Sarpa. when Visha move to Shira Pradesha with, Rakthamokshna(Blood-letting):It is done Mula Swarasa of Bhandujiva, Bha- in case where bite site has become Vivar- rangi,Asita And Surasa. Or with Churna of na,Kathina,Shuna, And Ruja Yuktha. If it Pippali, Hingu, Vrichikali, Manashila, has spread to distance area Siravyadha Shirisha Bija, Apamarga, Lavana, blowen should be done. It is contraindicated in into the nose, restores consciousness. Bala, Vriddha, Garbhini . Indication: Shiro Gaurava-Vedana, Alasya, Selection of vein: The Veins around the site Hanusthambha, Galagraha, Manyasthmba of bite. In case of spread, veins at the end of Hridayavarana(protection of heart): Poi- Shakha/ in Lalata .If vein are not availa- son by its penetration property weakens the ble/visible due to Shotha than should go for heart,so in order to protect it, the patient Shrunga / Jaluka. And if blood does not should be made to drink Ghrita, Madhu, come, Pragharshana should be done with Majja, Dugdha, Shudha Gairika, Gomaya Churna of Trikatu, Gruhadhuma, Rajani, Rasa And Bhasma, Pakwa Ikshu Rasa, Kaka Panchalavana, Gorechana, Vartaka. Nishpidya Rasa, Chaga Raktha etc Features of Visha Raktha: Puti Gandha , SajnaSamsthapan(Resuscitation): This is a Chata-Chata Shabdha when put on fire. very important procedure which plays a vital Parisheka(Sprinkling): Should be done af- role in regaining the conscious state of an ter Rakthamokshana with Chandana and unconscious person. It follows, in case of Ushira. Sajna Nasha, Vivruthakshi, Griva Bhaghna Vamana(Emesis): During the first phase the Tikshna Pradhamana Nasya should be done. ingested poison should be eliminated by em- Siravyadha in Shakha and Lalata . Kruta esis, which means if the poison is in the Kakapada Vrana on Shira Pradesha than stomach emesis is indicated. keep Charma/ Mamsa or Charma Vriksha Indication: Amashaya, Kapha Prakopa, Kashaya/ Kalka Lepa .And also Small Damsha in Hemantha Ritu and if the bite is drums (Dundubhis) smeared with Agada above the umbilical region. Kapha Prakopa Lepa should be sounded around patient is due to Hridayavarana procedure accumu- also followed. After regain of consciousness lates Kapha in Hridaya causing Gaurava Vamana-Virechana should be done. ,Praseka and Hrillsa. 1287 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite MrutaSanjeevan(Revivation): This was Upadhana karma(medication on incised originated by Lord Brahma before the origi- scalp): This procedure includes incision on nation of Amruta. Sprikka, Plava ,Sthouneya scalp resembling Kakapada and 1 Bilva etc. are taken in same quantity& in fine quantityof paste of Charmakasha or Mamsa powder form to prepare pill named of Aja, Go, Mahisha, Kukkuta is applied Mritasanjivanaagad. Mritsanjivanaagad is over incision, which absorbes the poison used in the form of Nasya, Lepa, Dharana, present in the body. Dhumagrahan etc. Pradhamana(snuffing): It is followed After Aushadha(Medication):Using of different Upadhana Karma Pradhamana should be Aushadha in different condi- done with Katabi, Katuka And Katphala tion/complication. Churna Prativisha(antidote) : It should be given af- Pratisarana(Rubbing of agada churna): ter 5th Vega and before 7th Vega when Man- Done with Churna of Trikatu, Gruhadhuma, tra and Aushadha fails to cure.It is adminis- Haridra, tered after Suryodaya, and in Hemanta & Pancha Lavana, Brihati. Pravruth Ritu and in Grishma only in case Yukthivyapashraya: of emergency. It should not be administered The treatment modalities emphasized in in Varsha Ritu and Durdina. Should be giv- Ayurveda have a great significance and are en in the dose of 4-6-8 Yava in case of Sarpa valuable particularly in the remote areas, Visha . where there is a lack of medical facilities. It Anjana(collyrium): Devadaru, Shunti, has been specified by Charaka that “without Maricha, Pippali, Karavira Patra, Karanja, entering in the blood stream, poison cannot Nimba Pushpa, Tulsi, Aja Mutra is applied damage the tissues”15. Similar concepts have as collyrium which destroys the poison pre- been expressed by Vagbhata, who says that sent in eyes. “poison cannot damage the tissues without Indication: Shunakshi, Atinidra, Vivarna , entering into the blood. Even an atom of Vilochana. poison can spread all over the body along Lepa(paste):. Sheeta lepa should be done. It with blood and can damage the system”16. pacifies the poison like ceasing of the fire by Considering these, priority has been given sprinkling of water towards preventing the entry of poison in to Indication: Mada, Murcha, Vishada the systemic circulation. ,Hridrava. Special Treatment: Which are carried Dhuma(Smoking): Helps to clear off all out as Folklore treatment like, blocked Srotas due to which there will be 1. Oothu Chikitsa Swasa Avarodha. 2. Vishakallu Dhuma Agada: Tagara, Kushta, Ghrita, Oothu Chikitsa17: Three persons are made Sarpa Shirass, Shirisha Pushpa. This ellevi- to chew drugs like Dry ginger, Pipper ates all types of poison and edema and also nigrum, Root of Aristolochia indica, Cyclea check the entry of snakes in that place. peltata, Beetal leaf, Saussurea lappa (Kush- Lehyam(Linctus): It is generally used as ta) and blow the air from their mouths at the Anupana .It is given as a Combination of ears and vertex of the patient for 150 times. Madhu+Ghrita 1288 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite This relieves heaviness of head, somnolence poisoning effect. These drugs can be given and diplopia. It also prevents the develop- with various mode of administration like ment of pulmonary edema. Anjana (collyrium), Nasya(Nasal drop), Ka- Vishakallu18: A medicated stone with anti- kapada( scalp incision) etc poisoning properties to the affected area CONCLUSION: (snake bite). There are various logistic, marketing Drugs used: and economic issues with the production and 1. Pebblesb from the river 50gm supply of ASV.The other drawbacks with 2. Juice of Ocimum tenuiflorum, Aniso- ASV therapy are the adverse reactions rang- males malabarica, Leucas aspera, Pip- ing from early reactions (pruritus, urticaria) per bettle -20mleach and paste of San- to potentially fatal anaphylaxis. Few cases thanum album-50gm approximately. Method of preparation: The pebbles ground may also develop serum sickness. When we well and mixed with the said ingredients and compare both Ayurveda and Modern Medi- prepared in the form of paste .The paste cine with respect to this aspect, we find that covered with seven leaves of Aristolochia all these principles which are suggested by tagala. And placed on a rock and roasted modern medicine are already described in using the wood of Chukrasia tubularis, San- Ayurvedic Samhitas before thousands of talum album, Ocimum tenuiiforum and year. Modalities followed in Ayurveda are Camphor. The roasted material again paste based on scientific approach, it's the time of termite soil and soil content obtained need to apply see the realism of this treat- from the trees. The above materials are ment. This will definitely help to prove the again covered with the leaves of Aris- Ayurveda in emergency services also. Train- tolochia tagala and Aristolochia indica and ing of treating physicians and knowledge of then kept under a low fire. The dried mass protocols to deal with Snakebite cases kept in the ashes of cow dung cakes or dried REFERENCES leaves of cannabis sativa to maintain poten- 1. Vonk FJ, Jackson K, Doley R, Madaras cy of the stone F, Mirtschin PJ, et al. (2011)Snake ven- Mode of Administration: The stone is direct- om: From fieldwork to the clinic: Recent ly applied to the bitten part. It sticks there insights into snake biology, together and absorbs the venom from the wound. with new technology allowing high- Then Lord Shiva is propitiated by chanting throughput screening of venom, bring Mantras. When all the venom is absorbed new hope for drug discovery. Bioessays the stone falls away automatically. And it is 33:269-279. believed that, it can be used for 20 times. 2. Narvencar K (2006) Correlation between DISCUSSION: timing of ASV administration and com- Visha Chikitsa has been explained plications in snake bites. J Assoc Physi- since Vedas. By knowing the importances of cians India 54: 717-719 Visha Chikitsa for humans Acharyas have 3. Kasturiratne A, Wickremasinghe AR, de included this as one among Ashtanga Ayur- Silva N, Gunawardena NK, Pathmeswa- veda i.e Eight Folds of Ayurveda. Many ran A, et al. (2008) The global burden of medicines have been proved to have anti snakebite: a literature analysis and mod- elling based on regional estimates of en- 1289 www.iamj.in IAMJ: Volume 4; Issue 07; July- 2016

Shweta Nidagundi & Chaitra: Ha Review On Ayurvedic Management On Venomous Snake Bite venoming and deaths. PLoS Med 5: 11. Acharya J T. CharakaSamhitaby Ag- e218. nivesa revised by Charaka and Dri- 4. Warrell DA (2010) Epidemiology of dhabalawith Ayurveda Deepika com- snake-bite in South-East Asia Region. mentary of ChakrapaniDatta. Reprint ed. In: Warrell DA (ed.) Guidelines for the Varanasi (India): ChaukhambhaOrien- management of snakebite. New Delhi: talia; 2013.p-573 WHO regional office for Southeast Asia. 12. Chakrapani on charaka smahita,chikitsa 5. National snakebite management proto- sthana,23/35,Chaukhamba Surabharati col, India (2008). Prakashan, Varanasi, Reprint:2009 6. Acharya Y T. SushrutaSamhita of 13. Pratap G. Narayana prakash B, Suhas Sushruta with Nibhandhasangraha com- Shetty ; Critical Analysis of Mantra mentary of Dalhanacharya and Nyaya- Chikitsa, AYU,29(2),2008,pg.74 chandrikaPanjika of Sri Gayadasacharya 14. Chakrapani on charaka smahita,chikitsa on kalpastana. Reprinted ed. Varanasi sthana,23/40,Chaukhamba Surabharati (India): ChaukambhaSankritSansthan; Prakashan, Varanasi, Reprint:2009 2012.p. 571. 15. Paradakara HSS. AshtangaHrudayam 7. Sharma SP. Astangasamgraha of with SarvangaSundaram commentary VrddhaVagbata with Sasilekha Sanskrit ofArunadutta and Ayurveda Rasayana of commentary of Indu. 3rd ed. Varanasi Hemadri. Reprint 10th ed. Varana- (India): Chaukambha Sanskrit Series si(India): Chaukhambha Orientalia; Ofice;1988. p. 861 2005. p. 910. 8. Acharya Y T. SushrutaSamhita of 16. Namboodiri K Sushruta with Nibhandhasangraha com- C.Vishavaidyasarasamuchaya with mentary of Dalhanacharya and Nyaya- commentary of VMC Sankaran Nam- chandrikaPanjika of Sri Gayadasacharya boodiri.Thrissur:Ullannoor mana trust;P- on kalpastana. Reprinted ed. Varanasi 122 (India): Chaukambha Sankrit Sansthan; 17. http://siddhamedicares.blogspot.in/2011/ 2012.p. 573 08 9. Sharma SP. Astangasamgraha of CORRESPONDING AUTHOR VrddhaVagbata with Sasilekha Sanskrit Dr. Shweta Nidagundi commentary of Indu. 3rd ed. Varanasi 2nd year P.G Scholar (India): Chaukambha Sanskrit Series Sri Dharmasthala Manjunatheshwara Ofice;1988. p. 862 College of Ayurveda & Hospital, 10. Namboodiri K Hassan, Karnataka, India C.Vishavaidyasarasamuchaya with Email: [email protected] commentary of VMC Sankaran Nam- boodiri.Thrissur:Ullannoor mana trust; Source of Support: Nil Conflict of Interest: None Declared

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