VISHA

Visha chikitsa or Agadatantra (Ayurvedic toxicology) is one among the eight clinical branches of Ayurveda. This branch is also known as Vishatantra, Vishagaravairodhika prasamana, and Damshtra chikitsa.

“Kayabalagrahordhvanga shalyadamshtrajaravrishan

Ashtavangani tasyahuchikitsa yeshu samshritha” 10

It deals with the bites of snakes, insects, spiders, scorpions, rats, etc., their diagnosis, treatment, and the signs and symptoms of accidental and purposeful ingestion of poisons including KritrimaVisha (artificial poison) Gara (concocted poison) and Dushivisha

(denatured poison).

“Agadatantram nama sarpakeetaloothamooshikadi dashta Visha vyanjanartham

Vividha Visha samyoga upashamanartham cha”11

Derivation

The word Agadatantra is derived from the two words “Agad” and “Tantra”. ‘Agad’ is derived from the word ‘Gada’. The word ‘Gada’ has two meanings, one is a disease and the other is poison. Agada means anything that cures poison or gives freedom from disease.

Agadatantra is thus the system of knowledge for eliminating poison(Visha).12

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VISHA: An overview

Derivation [13][14]

 The word ‘Visha’ is derived from the Sanskrit root word “vish” means ‘that which

flows easily, ‘vyapane’.

 Another derivation is ‘Visha viprayoge’ which shows the capacity of Visha to

derange the body and mind

Definition

“Jagat Vishannam tam drishtva tena asou Visha samnjita” 15

The substance which causes sadness to the world is called Visha.

“Vishada jananatwat Visham ithyabideeyate” 16

That which cause Vishada (depression) even for the devatas is called Visha.

Mythological origin of Visha:

According to Charaka Samhita

When the Gods and demons churned the ocean of milk to obtain ambrosia, a frightening creature emerged from the ocean which caused melancholy (Vishada) for the whole universe, and hence it was called Visha. Brahma subdued the being and instituted it in some animate and inanimate things. Hence, they became poisonous. By further churning of the ocean, ambrosia was obtained17. This myth indicates that:

1. Goodness and evil are products of brainstorming

2. Ambrosia can be attained by purification of a toxic substance.

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3. Ambrosia and toxin are different forms of the same substance. The impure form is Visha and the pure form is ambrosia.

“Visham pranaharam thacha yukthiyuktham rasayanam” 18

According to Susruta Samhita19

While creating the universe Brahma was attacked by a demon, Kaitabha. Brahma got angry and from his face emerged a fierce being that burnt the demon. Even after killing the demon, the being was growing. Brahma instituted the fierce being in some animate and inanimate objects. Thus, these objects became poisonous. Plants like Vatsanabha and animals like snakes are examples of inanimate and animate poisonous things, respectively. This mythological description implies the following:

1. Fiery nature of Visha

2. Fatality of poison

3. Anger being the first fatal poison hazardous to the universe

Classification

According to Susruta20 and Keraleeya Visha chikitsa21, Visha is classified as

 Sthavaram (Inanimate) &

 Jangamam (Animate)

According to Charaka22, Visha is classified into

 Sthavaram

 Jangamam &

 Samyogajam

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Samyogajam is again classified as

 Gara (NirVisha dravya samyogaja Visham) &

 Kritrima (SaVisha dravya samyogaja Visham)

Here Dushivisha is considered as a part of Sthavara and Jangama Visha.

According to Vagbhata23, Visha can be classified into

 KritrimaVisha (Garavisha) &

 AkritrimaVisha

AkritrimaVisha is again classified as

 Sthavara and

 Jangama.

According to Bhavaprakasa24 and Madhava Nidana25, Visha is classified as

 Sthavaram &

 Jangamam

Visha adhishtanas:

There are 10 Sthavara Visha adhistanas and 16 Jangama Visha adhishtanas explained in the classics

Sthavara Visha adhishtana:

Sthavara Visha (vegetable and mineral poisons) has ten abodes specifically. They are:

Table no.1: Sthavara Visha adhishtana26

Root (moola)

Leaf (patra)

Fruit (phala)

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Flower (pushpa)

Bark (twak)

Sap (ksheera)

Heartwood or pith (sara)

Exudates or gum (niryasa)

Mineral ores (dhatu)

Rhizomes or tubers (kandha)

Jangama Visha adhishtana:

Seats of Jangama Visha are sixteen. They are:

Table no. 2: Jangama Visha adhishtana27

Visha adhishtana Example

Drishti (sight) Celestial serpents

Nishvasa (breathing) Celestial serpents

Sparsha (Touch) Loota

Damshtra (Canine Terrestrial serpents, cats, dogs, monkeys, frogs, lootha,

teeth) paka matsya, snail, etc.

Mukha (mouth or teeth) Cats, dogs, monkeys, frogs.

Nakha (nails or claws) Cats, dogs, monkeys, frogs, paka matsya, snail, lootha,

etc.

Asthi (bone) Varati fish

Mootra (urine) Cipita, picchitaka, kasha, vasika, Sarshapika, loota,

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Citrasiras etc.

Pureesha (excreta) Cipita, picchitaka, kasha, vasika, loota, Sarshapika, etc.

Shukra (semen) Mouse, Loota, etc.

Aarthava (menstrual Loota

blood)

Laala (saliva) Loota

Sooka (hair, bristle, Vriscika, Vishabhara, varaatika, uccitinga, sea scorpion.

sting)

Pitta (bile) Sakuli fish, rakta raaji, varati fish.

Roma (hair) Loota

Shava (Dead body) Snake, insects

Gara Visha 28

Artificial poison, known as gara Visha is prepared by the combination of various animate and in-animate poisons. They contain parts of insects, the blood of animals, fecal matter, ashes of different toxic herbs of opposing properties, toxic minerals, and poisons of low potency. Charaka describes two types of artificial poisons. One is composed of non- poisonous matter given in combination. Separately nontoxic, these act as poison when ingested in the mixed form. The second type is prepared by combining toxic materials. This can be termed true gara. In the long run, both are fatal.

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Visha gunas (properties of Visha)

There are 10 gunas for Visha. Most Aacharyas share almost similar opinions regarding the properties of Visha, except in few aspects such as the taste or rasa of Visha. The opinions are as cited below:

Table no. 3: Visha gunas according to Brihattrayi

Sl.no Susruta Acharya29 Caraka Acharya30 Vagbhata Acharya31

1 Teekshna Teekshna Teekshna

2 Ushna Ushna Ushna

3 Rooksha Rooksha Rooksha

4 Visada Visada Visada

5 Sookshma Sookshma Sookshma

6 Vyavaayi Vyavaayi Vyavaayi

7 Aashukari Aashukari Aashukari

8 Vikaashi Vikaashi Vikaashi

9 Laghu Laghu Laghu

10 Apaaki Anirdesya rasa Avyaktarasa

11 - - Apaaki

Visha karma

Each of the above - said property of Visha is held responsible for unique karma or action expressed by Visha. Different Acharyas have different opinions about the karmas done by each property of Visha. The opinion of Brihattrayi regarding the karma of Visha gunas is listed in the table below.

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Table no. 4: Visha karma according to Acharya Susruta32

Property Actions

Teekshna Affects brain functions, deranges vital points (Marma)

Ushna Vitiates pitta and rakta

Rooksha Vitiates vaayu

Visada Does not stick anywhere

Sookshma Enters vital organs

Vyavaayi Easily absorbed and spread all over the body

Aasukaari Kills fast

Vikaashi Damages doshas, malaas and dhaatus

Laghu Difficult to treat as it can spread without digestion

Apaaki Difficult to eliminate from the body by purgation or emesis

Table no. 5: Visha karma according to Acharya Caraka33

Property Actions

Teekshna Destroys vital points (marma)

Ushna Aggravates pitta

Rooksha Aggravates vaayu

Visada Become difficult to locate

Sookshma Vitiates rakta

Vyavaayi Easily spreads throughout the body

Asukari Quickly permeates through annarasa

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Vikaashi Causes death

Laghu Difficult to treat

Anirdesha rasa Aggravates kapha

Table no. 6: Visha karma according to Acharya Vriddha Vagbhata31

Property Karma

Teekshna Aggravates pitta and rakta

Ushna Aggravates pitta and rakta

Rooksha Aggravates vaayu

Vishada Spread without obstruction

Sookshma Enters dosha, dhatu, mala and vital organs

Vyavaayi Enters dosha, dhatu, mala and vital organs

Asukari Kills quickly

Vikashi Causes delusions, fainting, disjoins vital points (marma)

Laghu Difficult to treat

Avyakta rasa Aggravates kapha

Apaaki Does not undergo digestion

Visha Sampraapti 34

The Visha as soon as it enters the body affects the blood. It then vitiates the rest of the sapta dhatus, and finally affects the hridaya which is the ojo sthana and results in death. After entering the rakta, Visha quickly spreads all over the body and reaches the hridaya. It also obstructs the various srothas such as the praanavaha srothas, affecting the normal functioning

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of the prana, the samna vaha and ceshta vaha srothas, resulting in losing the control of the mind and body functions and causing various disorders.

When Visha predominantly affects vata, symptoms of vitiation of vatadosha are expressed, followed by minimal vitiation of other two doshas. Similarly, presence of Visha in pittasthana produces symptoms of vitiation of pitta. Predominant symptoms of vitiation of kapha dosha are observed when the Visha is localised on kapha sthana.

Concept of Phases and Inter-phases

The sapta dhatus are rasa, raktha, mamsa, meda, asthi, majja, shukla. They are contained in cisterns bordered by membranes (kalaa). Poison, in its course of spreading through tissues, breaks the membranes, and enters the tissue.

Situated in the tissues, poison manifests certain symptoms. During the process of spreading, the poison takes some time to gain entry from the former dhatu to the later. This period termed as veganthara is relatively symptom-free. Vata is the dosha facilitating the movement35.

Some authors specify substrates occupied by poison during vega, some give only the number and symptoms, others simply give symptoms. Differences exist in the number of vegas.

Seven vegas are accepted by the majority but sage punarvasu states that they are eight36.

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Table no. 7: Differences of opinion about phases and inter-phases in Visha

According to According to According to According to According to

Punarvasu37 Nagnajit38 Videhapathi39 Alambayana40 Dhanwantari41

1.Rasa- 1.Raktha 1.Fainting 1.Raktha 1.Raktha

Vomiting, salivation

2.Raktha- 2.Edema 2.Severe chest 2.Maamsa 2.Mamsa

Creeping pain sensation, tremor, yawning

3.Maamsa- 3.Creeping 3.Headache 3.Vasa 3.Vasa

Urticaria, sensation wheals and inflammation

4.Dosha- 4.Fever, 4.Vata Kopa 4.Snayu 4.Koshta

Symptoms unconsciousness based on the vitiated humor

5.Visual 5.Pale tongue, 5.Hiccough 5.Asthi 5.Asthi hallucinations dry mouth

6.Hiccup 6.Chest pain 6.Splitting pain 6.Majja 6.Majja

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of Marmas

7.Drooping of 7.Death 7.Doubt 7.Sukla 7.Shukla shoulder whether patient

is live or not

8.Death

Symptoms presented during phases and treatment of inanimate and animate poisons differ.

Table no. 8: Vegas of inanimate poisoning42

1.The Black colour of tongue, stiffness, vomiting, lethargy, and unconsciousness

2. Shivering, sweating, burning sensation, throat pain- poison reaches the stomach and precipitates chest pain

3. Dryness of palate, intense stomachache, edematous eyes, reduced responses to reflexes- poison reaches intestines, causes griping, hiccough, and cough

4.Heaviness of head

5.Salivation, change of body colour, splitting pain of joints, severe pain of colon

6.Severe diarrhea and unconsciousness

7.Spasmodic flexion of spine, spasm, convulsion, and death

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Vegas regarding animate poison

Table no.9: Symptoms of vegas in Darvikara Visha43

1.Vitiates raktha, blood turns black, the body turns black, hyperesthesia

2.Vitiates mamsa, intensification of the black colour of body, edema

3.Vitiates medas, the heaviness of head, immobility of eyes

4.Enters koshta and causes vitiation of kapha, causing salivation, lethargy, and disability of joints

5.Enters asthi, vitiates prana and digestive system, splitting pain of joints, hiccup and burning sensation

6.Enters majja and vitiates grahani, causes heaviness of the body, chest pain, and unconsciousness

7.Enters sukla vitiates vyana vata, wicks like mucous secretion from nose, salivation, profuse sweating, coma, and death.

Charaka consolidates the definition of Visha. The origin of Visha was from water, it aggravates during the rainy season, its ill effects are reduced by irrigation with water, it resembles the fire in its capacity to spread fast, it has eight phases, ten properties, and 24 treatments44. Like solid jaggery liquefying during the rainy season, poisons also spread during rain showing their full potency. When the rain ends, the Agasthya star rises and reduces the potency of the poison. The spread of animate poison is downward and that of inanimate poison is upwards. Poison from fangs is cured by toxins of inanimate origin and vice versa.

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Visha in Puranas

Agni purana mentions the types of Visha, their symptoms, and the treatment for poisoning.

Garuda purana deals Visha in more detail. The branch of knowledge poisons and the corresponding treatment is explained in Garuda Purana45.

In Varahapurana, Visha is the name of a mountain situated in lake Maanasa. Natyasastra represents Visha by throwing out of hands and feet and the effect of poison will lead to quivering actions of different body parts. The first stage is the thinness of the body, the second tremor, the third a burning sensation, the fourth a hiccup, the fifth froth in the mouth, the sixth breaking of the neck, seventh paralysis, and the eighth death.

Visha in Sanskrit classics

In Malavikagnimitram, the creation of Kaalidasa, there is a scene wherein, the vidooshaka is bitten by a snake. Inorder to relieve him of the ill-effects of snakebite, the treatment process is prescribed. The treatment process is called ‘Kumbhipakam’. Malavika is also compared to the hidden treasure guarded by serpents, stating that Malavika was under the strict watch of queen Dharini which suggests man’s dependence on even the poisonous snake for guarding his wealth46. Bhagavathajjukam is a Sanskrit drama belonging to the early centuries of the

Christian era. The hero-in of the play is a victim of snakebite. A physician is brought to cure her. The effects of snakebite in the patient is described and the medicines for cure are also mentioned.

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Vishakanya

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 poisons. They were used to seduce the enemy king. Ways to identify such toxic dames are given in the text47. Kalki purana says that Vishakanyas can kill a person by looking at them and mentions about a Vishakanya Sulochana, wife of Chitragreeva48. Vishakanyas would kill the targets by seducing them after giving poisoned alcohol49. In Mudrarakshasa, a Sanskrit play by Vishakhadatta, a Vishakanya was sent by Nanda’s minister Amatyarakshasa to kill

Chandragupta Maurya but Chanakya diverted them to kill Parvatak.50

Snakes and Gods

Lord Shiva’s neck is decorated with Naga, Vasuki. Mahavishnu lies on the Naga, Srikrishna performs dance atop the mahasarpa, Kaaliya and saved the people. Vasuki, the serpent was chosen as rope for churning Palazhi and during samudra madhana, came the deadliest poison, Halahala. Lord Shiva out of compassion decided to swallow it but he assured goddess Parvati that he will not die of the poison when she got frightened. Hence, he stored the poison in this kanta and thus became ’Neelakanta’ with a blue throat. Other gods like

Ganapathi, Durga, Kaali also have stories related to the snake. Naga is an important aspect in

Jyotisha, related to Rahu and Ayilya nakshatra. In Yoga sastra, kundalini is also a sarpa.

There are two festive days in a year dedicated to snake worship. They are Naga panchami and Anantha chathurdashi, in July and September respectively51. Naga panchami is celebrated in memory of a devotee of Naga who regained her father bitten by cobra from

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death to life by the blessings of Naga. According to ancient literature, there are nine Nagas and it is believed that one who chants or meditates the name and form of these snakes will be free from the fear of snake venom and will be victorious.

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HISTORY OF VISHACHIKITSA IN INDIA

Toxicology started right from the prehistoric era when man lived in caves of forests. Reptiles originated nearly 240 million years ago, but man was born nearly about 4 million years back.

Various poisonous reptiles were one of his main problems to tackle.

Acharya Kasyapa is considered to be the expounder of Indian toxicology; Dalhana,

Chakrapani, and Srikantha quote him. Some commentators quote from Alambayana tantra,

Usana Samhitha, and Latyayana Samhitha, but the originals are lost.52

Vedic period.

The history of Ayurvedic toxicology can be traced back to Vedic period. In Rigveda, ‘Ahi’ means a snake, and Indra, the king of gods defeated ‘Ahi vritasura’. This may refer to a king named ‘Vritasura’ chief of a sect of Naga people who worshiped serpents. In olden times mainly there were two types of worship, Solar worship, and Serpent worship. The Aryans who worshiped the sun would have invaded and defeated the Dravidian sect who worshiped serpents. In Yajurveda and Atharvaveda, mantras to overcome injuries caused by snakes are mentioned.53

Purana period

The Epics, Ramayana, and Mahabharata contain references about powerful remedies for snakebite management. In Mahabharata, there is an instance when a serpent called

‘Thakshaka’ bit a tree and turned it to ashes in front of Maharshi Kasyapa. The sage caused the resurrection of the tree with the power of mantra. Penance and mantras were very much utilized for treating snake bites in ancient times. Mantras or hymns will not be effective if done without penance.

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Samhita Period

Charaka Samhita has a chapter for Vishachikitsa in Chikitsa sthaana. The Chaturvimshati upakramas54 explained by Charaka for Vishachikitsa are:

Table no. 10: Chaturvimshati upakramas

Mantra (Chanting hymns) Hrdayavarana (Protection of hridaya)

Arishta bandhana (Tourniquet application) Anjana (Collyrium)

Uthkarthana (Incision) Nasya (Nasal instillation)

Nishpeedana (Squeezing) Dhoopa (Fumigation)

Achushana (Sucking) Leha (Linctus)

Agni (Cauterization) Aushadha (Medicine)

Parisheka (Sprinkling) Prashamana (Pacifying measure)

Avagaha (Immersion bath) Prathisarana (Rubbing)

Rakthamoshana (Bloodletting) PrathiVisha (Antidote)

Vamana (Emesis) Sanjastapanam (Regaining consciousness)

Virechana (Purgation) Lepa (Ointments)

Upadhana (Applying medicine over incised Mrthasanjivani (Revival) scalp)

MANTRA

Mantras are truth and penance delivered for the removal of Visha. Mantra chikitsa is said to be the best treatment. So, it is the first line of treatment in Chathurvimshathi Upakrama.55

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ARISHTA BANDHANA

Arishta bandhana is one of the emergency lines of treatment for Visha. It prevents the spreading of the poison. If the Visha has not spread from the site of the bite, then arista bandhana should be done 4 angula above the bite site.56 Two types of tourniquet applications are mentioned in classics namely, without mantra by rajju (rope), etc, and with mantra.

Materials used for tourniquet application- cloth, the soft skin of animals can be used. The bandhana should be based on the Desha. It should not be too tight or too loose. Tourniquet application restricts lymphatic flow and not blood. Once venom enters the body it reaches the vital parts either through lymphatic/venous drainage. The hydrostatic pressure in venomous capillaries and the lymphatic channel is about 20mm/Hg, wherein larger venous vessels it is about 100mm/Hg. But the arterial pressure average is 120 mm/Hg. So, the effort can be made to slow down the lymphatic and venous drainage and not to obstruct the arterial supply as a result spreading of poison all over the body can be prevented.

UTHKARTHANA

It is the method of incision of the site of the bite. According to Vagbhata, Visha will remain

100 matra kaala (blinking of the eye is considered as one matra kala) in the bite site. Then it spreads into circulation. One should go for utkartana karma during this period.57

NISHPEEDANA

It is the method of expelling the poison by squeezing the area of the bite. It is contraindicated in Marma (vital parts) and Sandhi (joints). If it is done in marma sthana it will cause death, in joints, it will cause deformity of joints.58

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ACHUSHANA

It is the method of sucking the poison from the site of the bite. According to Acharya

Charaka, the mouth should be filled with Yava curna, before sucking.59 It removes blood mixed with Visha from the bite site. Acharya Susrutha explained to suck the Visha by filling the mouth with cloth.60

AGNI KARMA

It is indicated in Twak-Mamsagatha Visha61 (Poison in skin & muscles). Dalhana opines that in viper bite agnikarma is contraindicated, it causes pitta aggravation and leads to the quick spread of poison. Materials used for agnikarma are metals and cloth.62 In modern medicine, it is known as Cauterization. It destroys affected tissues and minimizes infection.63

PARISHEKA

It is the method of sprinkling medicated decoction over the site of the bite. The decoction prepared by Chandana and Usheera is used for parisheka. Visha vega is prevented by using cold decoction.64 Condensation of blood helps to pacify the intensity of poison. Appropriate irrigation of the bite will decrease the rate of absorption of the poison. The cold character of drug helps in reduction of further infection in the wound; contraction of blood vessels, prevent further spread of poison.65

AVAGAHA

Avagaha means immersion or dipping the affected part in the medicated decoction or oil.

RAKTHAMOKSHANA

Once the Visha enters the body, Rakthamokshana is said to be the prime treatment.66 In cases of snake bite, the physician should puncture the vein in the upper or lower limbs and

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forehead region. By this Visha will be eliminated from the body with blood and saves the life of the person.

VAMANA

It is the method of inducing vomiting. In Visha chikitsa, mainly sadhyo vamana should be done.

VIRECHANA

It is the method of inducing purgation. It is indicated in burning sensation, pain, and obstruction of urine in pitta prakrithi person.67

UPADHANA

Upadhana is a special procedure in which medicine is applied over the incised scalp.

HRIDAYAVARANA

Hridayavarana is the method of protection of Hridaya by using certain medicines.

Teekshnata of Visha causes the karshana of hridaya. So, for the protection of Heart,

Hridayaavarana is to be done.68 Madhu (Honey) Supakva ikshu rasa (sugarcane juice) Majja

(Bone marrow) Gairika (Red ochre) Sarpi (Ghee) Panchagavya Raktha of chaga (goat’s blood) Dadhi (curd) Water and decoction help in dilution; ghee, curd, panchagavya having demulcent action gives a protective covering.

ANJANA

It is indicated in Shoonakshikuta (Swelling in the orbital margin), Nidrarta (Excessive sleep), Vivarna avila lochana (Discoloured and turbid eyes), Vivarnam pasyathi (perception of various colours).69

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NASYA

It is the instillation of medicine in the nostrils. If poison enters the head, Nasya is said to be mainline of treatment.70

DHOOPANA

It is the procedure; wherein medicated smoke is used for fumigation and this helps to nullify the adverse effects of the poison.

LEHA

It is the preparation of medicine in the linctus form. Lehyas are used, to prevent the drying of the throat, palate by Visha.71

AUSHADA

Internal medicine for the treatment of Visha is explained.

PRASHAMANA

After elimination therapy, some doshas will remain in the body. To remove this, prashamana is to be done.

PRATHISARANA

It is a method by applying and rubbing with powders. It is indicated in Raktamokshana when blood fails to come out.72

PRATHIVISHA

Substances used to treat poison is named as Prativisha. It is indicated if the Visha vega in between 5th and 7th vega. Sthavara Visha is like kaphaja guna, so its direction is upward.

Jangama Visha is like pittaja guna, so its direction is downward. The guna of sthavara and jangama Visha are opposite to each other. Hence it is Prativisha to each other and it nullifies the effect of Visha.73

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SAMJNASTHAPANAM

It is the method of regaining consciousness. In 6th Visha vega samjnasthapana chikitsa is to be done. It is attained by pana of gopitta along with Haridra, Manjishta, Maricha, and Pippali churna.74

LEPA

It is the method of applying medicated paste at the site of the bite. If a pitta prakrithi person suffers from thirst, unconsciousness, then sheethala lepa should be done. After

Raktamokshana for the removal of residual poison, lepa should be applied at the site of bite.75

MRITHASANJEEVANI

Just as amrita gives life even to the dead person, in the same way Mrithasanjeevani can be used in all cases of Visha. Charaka explains a formulation named Mrithasanjeevani agada which is in the form of gutika. This cures all types of Visha.76

In Susruta Samhita, Acharya has dedicated a separate part ‘Kalpasthana’ exclusively for toxicology. It discusses how kings were poisoned by enemies through food, garlands, clothes during the war, and the methods to combat it. He classifies poison into two groups, i.e. plant origin (sthavara Visha) and animal origin (jangama Visha) and studies their symptoms and treatments separately. In sthavara Visha, he explains the different parts of plants having toxicity; their symptoms and differences are also explained in detail. In jangama Visha, the distinction between the serpents, characteristics of their fang marks, their features, etc are explained. Apart from snakes, symptoms, and treatment for the poisons from scorpions, tarantula, spider, etc are described. In one chapter, there are formulations, which describe

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methods like beating the drum smeared with medicated paste, to purify the air. Then it studies the poisons of rodents and rabies; in the chapter Kita kalpa, the symptoms and treatment for wasp bite, etc are mentioned.77

Kashyapa samhita is incompletely available now. The portions quoted by Dalhana,

Chakrapani and Sreekandadatha indicate that the original text contained much more.

Alambayana samhita, written by Alambayana is not available now. Dalhana quotes some of the portions of the text.

Usana samhita is a textbook of toxicology. Kautilya explains postmortem examinations and toxicology based on this book.

Sanaka samhita is very ancient and was translated into Greek.

Laatyayana samhita and Brihaspathi samhita are some other Sanskrit texts on Ayurvedic toxicology which were said to have existed but are not available now.

Sangraha period

Ashtanga sangraha classically describes toxicology. This text is a compilation of Susruta samhita and Charaka samhita. It describes remarkably effective medicines such as Vilwadi gulika and Dashanga agada.78

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HISTORY OF AYURVEDA IN KERALA

Studies and researches are still going on about the original inhabitants of Kerala. The rich flora and fauna and the life of aborigines give a clue regarding the life of people in the pre- historic period. Some scholars opine that this part of south India was linked to the African continent by some group of Islands. It is believed that at one stage the Dravidians conquered them. The natural layout of Kerala with the Arabian Sea on the west and the Western Ghats on the east warded off invasions from outside; These circumstances impelled it to make relations with the distant regions by sea route. Dravidians had established contacts with places like Egypt, Arabia, Iran, etc. from the ancient days itself using water transport. This resulted in the different customs, habits, and culture of this state. It has been liberal to alien cultures and religions.

The land from Tirupati to Kanyakumari was once known as Centamilnatu. A general view is that Malayalam and Tamil share their origin from a common source. There had been interactions between the Aryan and Dravidian literature even before the inception of

Centamil literature. Either as a tradition of the Maurya period or as science which developed in south India or as inherited with changes from north-India, the rural medical practice of south India had a close connection with the ancient Indian medical system. This must have had different application methods. Later, the Ayurveda system itself had local variations and methods of application.

The Siddha tradition of Tamil Nadu and certain treatment systems of Kerala are examples that lead to such a presumption. Apart from the differences in principles and practices, it must be examined as to how Ayurveda knowledge reached here. There is no direct evidence

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for that. But the inscriptions in certain caves and rocks give meaningful though distant indications in this direction. Scripts and writings came to south India during this period of caves.79 The direct possibility is that these caves were built for Jain monks. Hence it must be these monks who popularized this north Indian knowledge here.

There is documentary evidence that there were Siddha groups and the acharyas among them wrote medical books for the benefit of the people. During the Middle ages, the Jain and

Buddhist settlements became centers of medical learning. Jains studied Tamil and wrote books in Tamil. The period up to AD 600-850 (Pallava period) shows that medical education was not isolated but rather institutionalized. By 11th and 12th century Saiva and Vaishnava muts were centers of learning also. At some of those centers, Charaka Samhita and

Ashtanga Hridaya were being taught. These developments in Tamil Nadu during Chozha period are important in the study of the history of medical education in Kerala. There are references to show that people went to Tamil Nadu to study medical classics80.

Vaidya grahas began to appear in Kerala by the middle ages. This led to the popularization of medical practice and its diversity. During this period, many medical centers came up attached to the temples. This throws light on the social aspects of the medical facilities at temples. It was meant for a particular class of people and not for the public system hence it gradually shrinked. Maybe there was a facility for the common man outside the temple premises as Ezhavas and Velans had adopted the medical practice as their vocation. They had also established gurukulas during the rule of Swaroopas ranging from 12th to 19th century AD. The literary works of the period have many interesting references to medical education.

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Tamil Nadu followed Charaka tradition and Kerala that of Ashtanga Hridaya and Vagbhata who was from Kerala. This would point to the origin and development of a Kerala tradition in Ayurveda. It could cross the barriers of caste and community and become available to all.

There is a difference of opinion regarding the beginning of Sanskrit influence in Kerala.

Some scholars say that the most powerful upsurge of Sanskrit must have been during the fifth, sixth, and seventh centuries but certain evidence shows signs of much early influences.81

Ancient Sanskrit texts describe Kerala as a land guarded by the sea and the mountain ranges.

An examination of the social structure, family, modes of worship, customs, and other characteristics reveals the inclination of the people of Kerala towards pre-Aryan traditions.

Due to the overseas connections of Kerala, before the arrival of Aryan civilization, there already existed a civilization that was capable enough not only in welcoming the new ones but also in making some contributions to it.

In general, ‘Ayurveda’ refers to the classical texts of Charaka and Susrutha. They reached

Kerala with the advent of Sanskrit or by its influence among Keralites. But certain features of Ayurveda in Kerala like treatment methods, drugs used, etc show certain distinct characteristics from that of Charaka and Susrutha samhitha. According to N.V.K. Varier, there is a strong reason to believe that some indigenous systems of healing prevailed here before the advent of Sanskrit and Ayurvedic works. This popular, indigenous system along with the classical method contributed much to the development of Ayurveda in Kerala.81 The formulations, mode of treatments that are popularly used by the physicians of Kerala today for common ailments especially toxicity are indications of a well -developed medical system

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that was in existence. There are numerous formulations and modalities of treatment in the

Kerala tradition that cannot be found in Charaka, Susruta, or Vagbhata.82

It is the analysis against the background of society that makes the history of any branch of knowledge meaningful. It was with the unprecedented growth of caste system against the background of a priest controlled feudal system of authority over land that the gap between thought and action widened. Intellectual leadership deviated from the straight path to take refuge in the mantra-tantra mystique and hence sciences became stagnant. In south India where the caste hierarchy, landlordism, and invasions arrived much late, the old traditions survived a little longer.83

In Kerala, medical practice never remained a monopoly of any class. Along with the

Brahmin families who studied the Veda, many Ezhava families studied Sanskrit works in - depth and practiced the science down the generations. The social nature of the medical profession before the arrival of Sanskrit can be understood from the numerous numbers of depressed classes and families who followed medical practice as their family profession.

Velan and Mannan were the classes that practiced medicine and nursing related to midwifery as their profession. Panikkan and Gulikan castes were handling pediatrics and Kuruppan in marma chikitsa. Many families followed toxicology, ophthalmology, pediatrics, etc. as their traditional profession. Tolakapya, the famous grammatical work of sangha period does not include the medical profession under the six professions prescribed for Brahmins, but it refers to the caste Velan and their rituals.84 All these facts conclude that there was a widespread social foundation for medical practice in Kerala before the arrival of Aryans. By the influence of Aryan culture and Sanskrit, changes might have come about which was

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closely followed by Sanskrit and would have merged with the old system of medicine that was prevailing then. The local system must have influenced the structure and content of

Ayurveda and helped in its further progress in Kerala.

Buddhism in India contributed much to the spread of Ayurveda. Ayurveda took its roots in all countries where Asoka sent his missionaries for propagating Buddhism. Ayurveda spread along with Buddhism to Ceylon, China, the Southeast Asian countries, Tibet, Central Asia, and even, according to some, Egypt. It was the period that Ayurveda reached the zenith of its glory; Courses in all branches of Ayurveda were offered in Taxila. In Sri Lanka, kings of

Buddhist traditions were experts in medicine also. It is believed that the Non-Brahmins learned Visha chikitsa and Ayurveda from Buddhist monks.85 We have enough shreds of evidences from the inscriptions on Ashoka sthambha for the widespread influence of

Buddhism in Kerala. Sreemoolasthana, Sabarimala, and many old and damaged temples at different parts of the state are solid reminisces of Buddhist tradition according to V.M.

Kuttikrishna Menon.86 He assumes that snake worship might have started from Buddhist influence in Kerala. Snake worship is a major aspect of the Buddhist tradition. We can see structures of snakes above almost all Buddha idols (Fig. 54). Snake structures are quite common in Amaravathi sthupas. Burma, Malaysia, Java also have shreds of evidence.

According to Mahavamsha purana, the kingdom of Majerika, with Buddhist tradition was famous for snake worship.

It is Vagbhata with his work Ashtanga Hridaya who has been recognized as the author with the transcended vision. Charaka and Susrutha are almost forgotten in the south of Vindhyas.

The first invocation in Vagbhata’s Ashtanga Hridaya is either to Buddha or a Buddhist deity.

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Considering its internal evidence, it can be assumed that Vagbhata was a follower of

Buddha. Many tales substantiate it. One account state that Vagbhata was a Brahmin who became a follower of the Buddha due to the persuasions of a Buddhist monk. It was the

Buddhist monks who brought out science from the cult of mantras and the Brahmin priesthood. Secretive knowledge was liberated and exposed to society by them. Later, the growth of Ayurveda was completely turned down by the civil wars and other internal crises;

People were contented in blindly following whatever portion of knowledge they got and gradually formed as the heirs of a frozen tradition.87

The role of Ezhavas is also important. They are the largest community in Kerala. They reached Kerala along with Buddhist monks from Srilanka before the arrival of Brahmins, according to historical beliefs. ‘Ezha’ is the old Tamil name of Srilanka. They were also following Buddhist traditions. They were experts in treatment, war, and trade. They might have received medical expertise from the Buddhist monks. Most of them lead an agrarian life but some of them were master’s in medicine, Jyotisha, martial arts, etc. Knowledge in medicine and Sanskrit made good physicians from them.88 Itty Achyuthan, was the expert brain behind Hortus Malabaricus of Van Rheede which formed the database of the rich flora in the western ghats. Being the agrarian and working community, they were more familiar with the medicinal plants of Kerala than the upper-class communities of the society. Many other scholars in Ayurveda and Sanskrit like Thayyil Kumaran Krishnan and Uracheri gurukkal were from Ezhava community. Many expert vaidyas of Kerala were from Ezhava community. Many formulations have been used by Ezhava vaidyas which are not mentioned in Aryan traditions.

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Recent researches have established the influence of thought process designated as Arya in sangham literature during the early centuries of the Christian era. Before that, no concrete evidence of civilized society is obtained in Kerala. Considering all these facts, it is possible to conjuncture that non-Sanskritic ways of treatment and related ideas existed even when the society was dominated by Sanskritic culture.89 They must have raised from the subaltern sections of the people or came to the land from other places through trade contacts.

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HISTORY OF VISHACHIKITSA IN KERALA

Kerala has proven unique proficiency in toxicology and specific remedies have been proved effective for each varied poison. A unique skill has been identified by the physicians to identify the minute differences among the poisonous manifestations. The significance of potent remedies hints to the intense research done in this field by Kerala toxicologists.

Kerala’s Vishavaidya tradition has an ancient and wealthy background. The names

‘Sahyadri’ (sa-ahi-adri- Mountain of snakes) and ‘Ahi bhoomi’90 of Kerala gives evidence of the abundance of snake in this geographical region. The climatic conditions of Kerala were favorable for many plants and animal species especially snakes. Hence poisonous bites were a factor of major fear for the society which lived in agrarian civilization. This eventually led to the development of remedies to combat the problem. These methods have refined and processed through centuries and have evolved into a highly efficient indigenous treatment methodology.

During the days of hunting, animal husbandry, and even in the days of early agriculture, man controlled his surroundings by mantric methods. This was common to civilizations all over the world. Many things which occurred by natural phenomenon were mantric to the primitive man. By the development of agriculture and by the invention of advanced equipment capable to recast even nature, the interaction with nature became more intensive and consequently, he acquired more knowledge about it. Natural forces remained beyond his power so long as he concentrated on gathering his food by using crude stone implements instead of production and he conceived nature in terms of his individual feelings or group experiences. He believed that nature also has a life, feelings, and passions like him and that it

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can also be subjugated by invocations or protestations as he deals with human beings. This was the background of mantric rituals. While adopting mantric methods against nature, he had to observe nature and imitate it. This led to attaining more knowledge of nature. In the primitive period, though the mode of treatment was mainly mantra- based, it can be observed that gradually the predominance in medicine and methods of treatment took precedence over mantras.91

Vishavaidya system of Kerala encompasses three different streams.

 One non-vedic Dravidian tradition

 A Vedic Aryan tradition, and

 A tribal tradition

The tribal tradition was extraordinarily rich and effective, but they remained within the forest limits itself. The tribes believed that if they share the knowledge with anyone, the effect of medicines will be lost, and still they are using traditional Vishachikitsa itself for poisonous bites.

According to prominent historians, it would be reasonable to think that before the propagation of Sanskrit classics in Kerala by the Aryans, there existed an unstructured yet highly effective and indigenous Dravidian system of treatment and that the Ayurvedic system and Sanskrit literary works that came later reformed this system and gave it a new form and content. Even the Aryans respected and followed the non-vedic Dravidian tradition which was established here before the arrival of Vedic tradition. Later, both the Dravidian and Aryan cultures went together with the mantra- tantra along with medicines. Gradually

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Aryans dominated the tantra-mantra form of Vishachikitsa. It may be presumed that, from the background of both these streams, a combined tradition which is purely indigenous to

Kerala evolved and became immensely popular.92

According to V.M. Kuttikrishnamenon, ‘Cheruvalli pattar’ and ‘Nanjunda Nathar’ were considered as the masters of the Kerala tradition of Visha chikitsa.93 ‘Pullayar patalam’ is considered as the primitive textbook of Vishachikitsa in this geographical area with mantras and medicines. It is composed in a mixed language of Tamil and Malayalam and it depicted

Tamil viruthas as mantra prayogas. This work is itself is an evidence of the Dravidian tradition existed here.

Different versions of old Tamil literature are observed by language experts– Centamil,

Karintamil, and Koduntamil. Among them, Centamil is a pure Dravidian version whereas

Karintamil and Koduntamil are Sanskrit mixed versions evolved from Aryan- Dravidian interactions.94 The research works on Malayalam literature by Hermen Gundert maintains that the Malayalam language got evolved from Karintamil. While some other language experts opine that the three Dravidian languages- Tamil, Malayalam, and Kannada originated from a common root of Dravidian language and developed individually. This common language is considered to have been used in ‘Pullayar patala’ as observed by Maina

Umaiban.

A lot of literary works are available in Kerala on Visha chikitsa. According to P.

Govindapillai, evolution of Malayalam language was through four different stages-

Karintamil Malayalam, Old Malayalam, Medival Malayalam, and modern Malayalam94.

Literary works on Vishachikitsa are available in all these stages according to Maina

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Umaiban. The predominance of Vishadamsha is evident in Malayalam literature also.

Situations of Vishabadha or sarpa damsha and chikitsa are depicted in numerous works of

Malayalam. The following works are some of them.

Table no.11: Malayalam literary works with references to Vishachikitsa

Khasakinte ithihasam- O.V. Vijayan

Thattakam- Kovilan

Atmakuruthiyude venal- K.S Vinod

Vishahari- Bakkalam Damodaran

Vishachikitsa was a subject for popular media also. ‘Sreekrishna parunthu’ is such a movie depicting the life of a Vishavaidya and his magical practices.

The incidence rate of the snake and other poisonous bite was too high in Kerala compared to other places of the country. So, it was the need of the society to develop a highly effective treatment methodology for Visha. The vast flora and fauna of western ghats also favored this endeavor. According to Kuttikrisna menon, all the literary works available on Vishachikitsa in classical Sanskrit textbooks of Ayurveda will not be enough to manage serious snake bites.93

Karattu Namputhiri is the author of the popular text ‘Vishavaidya Jyotsnika’ which is considered as one of the basic textbooks of Keraleeya Vishachikitsa tradition. Before that,

Sundarabhata authored Lakshanamrutham with mantra khanda but it did not gain much popularity. The language of mantras in Jyotsnika and Lakshanamrutham was Sanskrit. Many

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manuscripts were available in a common title, ‘Vishachikitsa’ in Kerala. Later Cochin

Royal Family acquired knowledge of Vishachikitsa95 from Kokkara Namputhiri, who modified Jyotsnika’s Vishachikitsa into the present form. The members of the royal family preached Visha chikitsa giving importance to medicines than mantras. All these traditions gradually grew up through families, disciples, and books.

Karattu Namputhiri

He is the author of ‘Jyotsnika’ which is one of the most popular works on Vishachikitsa in

Kerala. But details about his life and whereabouts are not exactly available. The present generation of Karattu Namputhiri’s family lives near Kozhikode. But they have no idea regarding his time and disciples. He pioneered the popularization of the Arya- Dravida combined tradition of Keraleeya Vishachikitsa through his work. Kuttikrishnamenon opines that many Vishavaidyas followed Karattu Namputhiri’s tradition by following his book,

‘Jyotsnika’ as the authentic one. Experts like Kokkara Namputhiri, Thamattur Namputhiri,

Cherukulappurathu Krishnan Namputhiri belong to this tradition. His disciples include

Brahmins and even non-brahmins as observed. Vallur Sankaran Namputhiri is the student of

Cherukulappurathu Krishnan Namputhiri. Vimala thampuratti of Thrissur Ullannor mana is the daughter of Vallur Sankaran Namputhiri. Vimala Thampuratti, and her son,

Brahmadathan Namputhiri are still practicing Visha chikitsa in the traditional way. Jyotsnika gives importance to both mantras and medicines but the mantra prayogas did not flourish well. The formulations mentioned in Jyotsnika are highly effective and are still in vogue.

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Kokkara Namputhiri

His original name and exact period of life are unknown. It can be assumed that it is somewhere in the latter half of the 1800s. He resided at Puthencruz near Thrippunitura. He was once the Royal physician of the Cochin royal family. The Cochin royal family mastered

Vishachikitsa from this master toxicologist of Kokkara family. The King Ramavarma

Kunjikidavu, popularly known as Madirashiyil theepetta Thampuran (1858-1932) was his prominent disciple in Vishachikitsa. Many eminent toxicologists were his students and they practiced across the state and popularized the system.

Many stories related to him are popular even now. According to Dr. Murali K, the first

Kokkara vaidya’s name was Subrahmanyan Nampoothiri. According to Puthezhathu Rama

Menon, in the introduction to Prayogasamuchayam, ‘Kokkara Namputhiri was a famous poison healer of the entire state’. According to many traditional vaidyas, it was Kokkara

Namputhiri who modified Keraleeya Vishachikitsa into an advanced form by incorporating even folklore traditions. According to Avanapparambu Maheshwaran Namputhiri, Kokkara

Namputhiri modified many treatment methods, gave more importance to treatment using medicines than mantras, and added many formulations and transferred the great tradition to many disciples. He reduced Alarka Visha treatment of ninety days to just three days.

He traveled across Kerala and learned treatment methods and formulations from folklore vaidyas, tribal healers and yogis. He had students across Kerala and the prominent one among them is Tharanallor Namputhiri96. Avanapparambu Maheshwaran Namputhiri, who is a master of Vishachikitsa of the present era is also a part of this tradition. Some manuscripts of treatment methods are still preserved in Kokkara mana which includes Lakshanamrutham.

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Thuppan Parameshwaran Namputhiri was the last person to practice Vishachikitsa in

Kokkara family.97 He died in 1957. Brahmasree Thiruva Namputhiri, a student of Kokkara, was also a master of Vishachikitsa. He wrote the book ‘Chikitsa Sthanam’ on Vishachikitsa in Malayalam for the common man who is not familiar with the Sanskrit language.

Contributions of the Cochin Royal family

The Cochin royal family occupies a unique position in the Kerala tradition of Vishachikitsa.

It was at the time of King Kerala Varma that, Vishavaidyasalas were opened at all taluks of

Cochin state. Trippunithura, which was the capital city of the cochin state is a place of utmost importance in Vishachikitsa tradition of Kerala.98 Kokkara Namputhiri, one of the maestros of Vishachikitsa in Kerala lived at Tripunithura. From the information available from the old generation of Trippunithura, the King purchased the land for building Hill palace (official abode of Cochin state) from Kokkara family. The king ‘Ramavarma

Kunjikidavu’ was his student.

Kerala Varma Midukkan Thampuran (1863-1943)

Kerala is proud to have the one and only King in India who was a physician too. He practiced Vishachikitsa even during his period of reign in the state of Cochin (Fig.26). He was known as Midukkan Thampuran or Vishavaidyan Thampuran. He was regarded in high esteem by the people of Cochin due to his expertise in various fields. His real name was

Keralavarma Kochunni Thampuran. He was crowned the King of Cochin at the age of 78 in

194199 and died within two years.

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He was born as the second son of KavuThampuran and Ashtamurthi Kuttan Nambuthiri of

Panamana illam. He became the king after his elder brother Ramavarma Kunjikidavu

Thampuran (1914- 1931) and Ramavarma Kunjunni Thampuran (1932-1941)100. He got the name ‘Midukkan Thampuran’ in honor of his vast knowledge. Midukkan Thampuran learned Vishachikitsa from Tharananalloor Namputhiri, who was a famous toxicologist and student of Kokkara Namputhiri.

Midukkan Thampuran was accompanied by three other students during his training. Before starting the teaching, guru made all of them to take an oath that ‘Nothing will be accepted in return as remuneration for doing Vishachikitsa’. But guru felt that an extra oath should be taken by the royal family member as normally he will not accept a fee for the treatment.

Midukkan Thampuran was made to take the extra oath that ‘I will be ready to do

Vishachikitsa whenever any victim comes irrespective of the time, caste, creed, or any other discrimination’. He kept that promise even when he ruled the kingdom and up to the end of his life. He took food only twice a day. Once when he was about to have his food, he was approached by a victim and suddenly he attended the case. After that, he did not even take food that day as he stood with the victim monitoring the victim every minute. Generally, he was an introvert and reticent person, but he was kind and compassionate to patients and to those who came to discuss Vishachikitsa.

Cochin government started a Vishachikitsa hospital (Fig.30) at Kizhakke kotta,

Trippunithura under the initiative of Midukkan Thampuran.101 All facilities including a well for jaladhara, emergency medicinal plants, and 20 beds for IP admission of Visha cases were

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arranged at the center. The hospital and surrounding land were later handed over to

Government Ayurveda College, Trippunithura for Vishachikitsa.

He passed on his knowledge in Vishachikitsa to others also, especially royal family members, who were later famed as experts in the field. To spread awareness on

Vishachikitsa to society, he started a one-year course (Fig. 28) on Vishachikitsa for the public under his direct supervision at the present Government District Ayurveda hospital,

Thrissur which was the study center. The name of the hospital at that period was

RamaVarma Central Ayurveda Hospital. A twenty-four-hour working department exclusively for Vishachikitsa was functioning there.

He encouraged the Cochin government language reforms committee to publish books and textbooks on Vishachikitsa in common man language. Most basic textbooks of Kerala

Vishachikitsa like Haramekhala, Uddisha were unavailable. Midukkan Thampuran took the initiative and met the expenses to translate and publish ‘Lakshanamrutham’ in Malayalam by

Kavithilakan Oduvil Sankarankutty Menon. The translator has mentioned his gratitude to

Midukkan Thampuran for this act, in the first slokas of Lakshanamrutham itself. It was

Midukkan Thampuran who found today’s largest Ayurvedic pharmaceutical company of the country in the public sector, ‘Oushadhi’ at Thrissur in 1941. A handbook ‘Visha vaidya praveshika’ was published by Midukkan Thampuran for scout students and the public for emergency and first aid management of snakes and other poisonous bites. Government notifications were issued in the State of Cochin regarding measures to be taken as first aid in poisonous bites.

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In Kokkara Namputhiri’s tradition in which Midukkan Thampuran learned, the management of Visha was by medicines itself and not by mantras. He had observed dootha lakshana and

Omens very carefully as the field of Vishachikitsa requires immediate management as soon as the patient arrives. It is said that he could even predict the number of patients about to come in a day and their prognosis just by observing the omens and Jyotisha. At some nights after treating some cases he may say, ‘Don’t close the front gate, one more case will come tonight’ and was always right as reported by Dr. K. Murali.

Kochunni Thampuran (1897-1937)

He learned Vishachikitsa from King Ramavarma (Madirashiyil theepetta Thampuran) who was well versed in Ayurveda and Vishachikitsa (Fig.27). Kochunni Thampuran’s major contribution to Vishachikitsa is ‘Prayoga samuchayam’, one of the most popular books on

Vishachikitsa in Malayalam which was published by him after translating Sanskrit slokas in various manuscripts across Kerala into common man’s language. He lived at Peringavu near

Thrissur.102 He started ‘Veera Keralavarma Vaidyasala’ to provide free treatment and care for victims of Visha. His place of residence was open to all irrespective of time, caste or colour for Vishachikitsa. He was an expert in Jyotisha, dootha lakshana, and sabda lakshana also.

According to Avanapparambu Maheshwaran Namputhiri, when a patient was brought who was declared dead by other vaidyas, Kochunni Thampuran recognized by doothalakshana that he is alive and saved that patient by using karu prayoga. He could even predict and order to his attender, ‘A patient will be brought here today by 10 pm, some milk, and specific medicines should be ready for that patient’. After a certain period of practice, he could not

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even meet all the expenses needed for treating Visha cases. He applied for a government grant in aid but did not receive any.

Keralavarma Thampuran

He was the nephew and student of Midukkan Thampuran. He practiced Vishachikitsa at the state capital Trippunithura itself as honorary physician at Vishachikitsa hospital, Kizhakke kotta.103

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TRIBAL VISHACHIKITSA TRADITION OF KERALA

The tribal population of Kerala also possesses a rich tradition of Vishavaidya which goes in harmony with nature.

Types of tribes

According to the 2011 Census of India, the Scheduled Tribe population in Kerala is 4,84,839

(1.5 % of the total population). Wayanad district has the highest number of tribals (1,51,443) in Kerala, followed by Idukki (55,815), Palakkad (48,972), Kasaragod (48,857) and Kannur districts (41,371). Paniyan, Irula, Cholanayikkan, Kani, Kurichyar, Kattunaikan, Mannan,

Muthuvan, and Adiyan are some of the major communities among Kerala tribals.

They transfer the knowledge through family traditions and improves their skill by regular observation and experimentation.

They are using most of the herbal medicines which are used in Ayurveda but different names. Some of the Vishachikitsa methods used by different tribes of Kerala are:

Table no. 12: Tribal Vishachikitsa practices in Kerala

For Alarka damsha  Agnikarma, chincha and sarshapa lepa, Achyranthes aspera kalka for pana- three months.  Leopard’s dried flesh, skin, teeth, and bones are made into bhasma and used for lepa.  Jambu twak swarasa for pana104 For Centipede bite Fat of hornbill for lepa For honeybee sting  Plantain leaf paste

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 Haridra and salt for lepa For rhizome poisoning Ash mixed in water is drunk and garcinia is drunk after mixing in water. For vrischika Visha  Agnikarma  Haridra and jasmine flower for lepa In snake bite  Oothu chikitsa will be done  Keerikizhangu for internal administration105  Haridra and nilamparanda for lepa  Haridra in kanjika for lepa.  Vanasoorana and tree mushroom is made into a paste and applied externally.  Vanasoorana alone is also used for pana and lepa.  Durva and Haridra for lepa  Kaipanarachi leaves for pana and lepa  Ishwari samoola for lepa  The dried tongue of the mongoose for lepa and pana  Analivega kalka for pana, haridra, and kupilu for lepa  Wild tobacco root and lemon are used for lepa  Vishakallu is used

They keep the root of analivegam always to save themselves from snakebite.

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SNAKES AND CULTURE

The ways of tackling foes are two, worshiping or defeating. Snakes are dangerous animals as their bites may be fatal. So, the primitive man worshiped serpents and thought that by worshiping they will be pleased and will not harm humans. Thus, snake worship and charms became a custom and part of the healing art especially in cases of poisoning. The mythological bird, ‘Garuda’ that eat snakes is also worshiped after Aryan invasion, for getting rid of snake bites and snake venom.

Mythology

In mythology, the snake symbolizes mind, libido, cruelty, anger, time, and the ‘Naga’ cult.106

Ashtanga sangraha starts with a prayer to Buddha who subdued the ‘mind serpent’. This conceptual serpent is described to have a very long body of desire, head of different kinds of unrealistic notions, hatred as hood, lust, and anger as venom, irrational arguments as fangs, greed as red eyes, and confusion as the mouth. The serpents dwell within the cavity of the body and when controlled are conducive for the goodness and wellbeing of the society.

In Buddhism and Jainism

In the ‘Mahaavamsha’, it is mentioned that Sangamitra, daughter of emperor Ashoka, took the form of an eagle to vanquish the magic power of nagas who wanted to take away the branch of Peepal tree that she was carrying to Ceylon. In Buddhism, there is frequent mention of snake worship. Idols of Lord Buddha under the hood of a seven–headed serpent is seen in many places. In Jainism ‘Theerthankaras’ are depicted sitting in meditation canopied with seven-headed hoods of a cobra on their heads.

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Mythological origin of Sarpa

Sarpas are classified into celestial and terrestrial.107 The eight celestial snakes (mahasarpas) are Anantha, Gulikan, Vasuki, Shankapalan, Thakshakan, Mahapadman, Padman, and

Karkodakan. In the next generation, there were 500 sarpas all of which possessed immortality like their ancestors. In the succeeding generations, innumerable sarpas were born, but most of them were killed and eaten by vainatheyan. This resulted in a situation of great fear among sarpa kula and the representatives of each kula approached their originators for the protection and creating an atmosphere for survival. Thus, Ananta sarpa approached

Vishnu at Ksheerasagara.108 Vasuki sarpa went to Sankara for support and Thakshaka found a resort in Indra. Rest all, out of fear scattered and hid in different regions and continued to live there. Thus, they are now inhabiting deep seas, mountainsides, graveyards, places of worship, and on earth. All the terrestrial snake varieties seen on earth are progenies of these sarpas.

According to Susrutha Samhita, sarpas are a total eighty in number.109 They are classified as:

 Darvikara

 Mandali

 Rajila

 Nirvisha

 Vaikaranja/Vyantira

According to Prayoga samuchayam110, Moorkha (Darvikara) is of 26 types, Mandali-16 and

Rajila are of 13 types.

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Table no.13: Classification of Snakes

Sl.no. Moorkha varieties Mandali varieties Rajila varieties

1. Krishnan Sweta Pundarikan

2. Shwetan Kushta Ahisreshtan

3. Shankhapalan Kutila Chithrakan

4. Sarvakrishnan Mahan Kardamahi

5. Valahakan Bhuya Trinashosha

6. Kakoduran Bhrama Sarpahi

7. Mahakarnan Theekshna Lodhrapushpan

8. Mahapadman Krishna Alakan

9. Kulasthakan Pishacha Shwethapincharan

10. Girikarnan Hema Lohitha

11. Vatakarnan Visarpa Chakrapahi

12. Cheerakarnan Peethanethraghya Krithisadan

13. Bhritimukhan Naga Krishnaraji

14. Kapothan Kumbha

15. Lohitan Sonitha

16. Vepathu Sopha

17. Mahadardukan

18. Kundhinasan

19. Mahasarpam

20. Kukkutan

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21. Trinashoshakan

22. Thithiri

23. Parisarpam

24. Vichitrakusumakhyan

25. Akhandaphani

26. Darbhapushpan

Serpents and Kerala

It is a popular myth in Kerala that Parasurama, an incarnation of Lord Vishnu, raised the land of Kerala from the ocean. Snakes are believed to be situated in ‘Paathala’ or subterranean sea. So, Kerala originally was the abode of snakes and that is why every residential compound in Kerala has a snake park kept aside for snake worship called ‘Sarpa kavu’ or ‘Pampinkavu’(Fig.55).

Myth of Sarpakavu

It was believed that sarpa has a lifespan of 1000 years and when they attain half of their age, they will prepare to serve Lord Shiva. Then they will start residing at places with treasure considering it as Shiva’s foot for 500 years. On completion of 500 years, the treasure will be converted into a precious stone (Manikyakallu) and the body of sarpa into gold. Then they will fly to Kailasa with the stone and will be burnt into ashes very soon by the hot rays of the sun. The places where the ashes fall on earth’s surface are worshiped as ‘sarpakavu’ especially in Kerala.

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Many reasons are attributed to serpent worship111. Some are psychological, some materialistic. Commonly they are:

 For self-protection

 As a token of gratitude

 To preserve the ecosystem

 For the prosperity of the worshipper

 For progeny

 Connected to tantric psychology of serpent worship

Self-protection

Primitive people came across many fears like floods, calamities, fire, thunder, and

poisonous creatures. Among these, snake bite was very much dreaded as they were fatal

to them. The ways to tackle them are, either succumbing by worship or attacking them to

defeat. Snakes were dangerous for human beings as they can cause death very soon. So,

the primitive people worshiped the serpents and thought that by worshiping they will be

pleased and may not harm them.

As gratitude

For the agrarian folk, the psychological motive behind snake worship maybe that of

expression of gratitude for saving their food grains from rodents and other pests. In such

cases, it is a rightly felt duty to express gratitude to the savior of their agricultural

products.

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To preserve the Ecosystem

Snakes have importance in the maintenance of ecological balance as they are very much inter-related with the environment. Hence the preservation of snakes is a method of conserving the ecosystem. In Kerala, there are special abodes for snakes, even in residential areas, where snakes are worshiped with great respect. They are popular as

‘sarpakaavu’ or ‘paampinkavu’. Such centers are naturally grown forests with various types of trees, bushes, creepers, climbers. Conserving such centers eventually results in the conservation of the ecosystem. Fear of snakes and religious restrictions will be barriers for enthusiasts of deforestation from destroying such mini forests. In such centers of snake worship idols of snakes are kept on raised platforms, mostly under trees.

There will be regular rituals in connection with these places and special offerings are submitted to snakes. The snakes are supposed to come and accept the offerings.

Related with prosperity

In the story of churning the ocean of milk, the serpent Vasuki was utilized as a rope for churning. Gods recovered 14 inestimable jewels. The author of ‘snakes in India’ observes that this may be related to the following story. The Aryans requested the Naga kings to bring a ship called Meru. Naga king Vasuki was made the captain of the ship.

He sailed far and brought wealth to India.

As gems and other precious stones are usually found in the bottom of the earth, Nagas came to be regarded as guardians of treasures, and thus they were worshiped for prosperity. Prayogasamuchaya mentions as:

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“Gopyamayi dhanamulloru dikku nokki vasichidum

smarichu shankaran thante charanambhojamayathum”

At many places of India, outside Kerala, snakes are worshiped not out of fear, but for

prosperity.

For progeny

In the myth related to the Mannarasala temple, Parasurama requested Naga Raja to

remove the salinity of soil by poison so that, the land became fertile. It was not only for

land but also for the body, that snake worship provides fertility as the devotees believe.

In some scriptures, snakes represent male fertility, and its worship results in progeny.

Now also people have a custom of ‘Urulikamizhthu’ for worshiping snakes for getting

good progeny.

Tantric concept

Tantric worships are of four types:

 Intellectual worship

 Sensory worship

 Universal worship

 Yogic worship

Intellectual worship is worshiping the universal consciousness of God through meditation.

Sensory is to worship five celestial gods in the representation of the five sense organs.

Universal worship is devotion to the deities in temples which are linked to panchabhuthas.

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Yogic worship represents Kundalinee yoga. The supreme power, kundalinee is stationed as a coiled female cobra at the lower end of the vertebral column. It gradually ascends the spinal cord to reach the ‘sahasraara padma’ passing through shad chakras. Snake worship in tantric philosophy is the symbolic representation of the worship of Kundalinee or female serpent power leading to the union of Siva and Sakthi which leads to liberation. It represents the spiritual body.

A sarpakavu can be considered as a replica of the body with climbers representing the nerves and vessels, the tree as a skeletal system, and the idol representing the spirit. It is a microcosm of the universe and it is like the body itself. So, the tantric philosophy of serpent worship is very much related to the human body, universe, and nature itself. Lord Shiva is depicted wearing a garland of cobra around his neck and Lord Krishna subduing Kaaliya sarpa. These are representations of serpent power and self-control of mind as snake symbolizes mind. Thus, the psychology of snake worship has roots in various perspectives of life and the universe.

Temples related to Visha

According to Indian philosophy, if somebody harms the snakes, they will be cursed by the sarpa and many ill-effects will follow. Many offerings, ritualistic art forms, and prayers were conducted to get rid of that sarpakopa. Some astrological advice will also guide people to serpent worship temples. Daiva vyapashraya chikitsa is a method of treatment in Ayurveda.

Many religious places are there in Kerala concerning Visha chikitsa. Many sarpa temples are in various parts of Kerala where people used to give offerings to get rid of sarpakopa.

Sarpakopa is believed to cause infertility and skin diseases

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1.Mannarasala Temple

It is located near Harippad in southern Kerala (Fig.58). The prasadas given here are Visha samana in action.112

 Haridra- Good for allergic skin diseases and raktha dosha

 Gritha- Good for fertility, increases intellect and memory

 Taila- Good for skin

 Banana – Improves fertility

 Milk and banana- Acts as virudha in action. Virudhas in small doses will act as an

antidote to Visha which enters the body

The Aayilyams of the Malayalam months of Kanni, Thulaam, and Kumbham is celebrated with festivities. "Sivaraathri" is the most pompous and grand festival of this temple, with

"Niramaala", "Sarpabali" and "Ezhunnallathu". "Sarpam Paattu" is an especially important and satisfying ritual as far as the "Sarpa Devathaas" are concerned. During the subsequent year, the Velans perform "Pallippaana", and the year after that the "Gandharvan Paattuu" is performed, in which the "Kurups" prepare the ritualistic murals (Kalam Ezhuthu) on the floor, while the Valiya Amma performs Pooja. In the fourth year, "Pula Sarpam Paattu" is performed. The annual Noorumpaal Pooja in the Nilavara is on the day after Sivaraathri.

Five days later, Amma opens the Nilavara after the daily Pooja at the temple and distributes the Noorumpaal Prasaadam to the family members who consume it with devotion.

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2.Pambumekkadu mana

It is located at Mala in central Kerala113. It is famous for sarpa worship and Vishachikitsa

(Fig.59). According to tradition, sarpa worship started there by the blessings of divya sarpa

‘Vasuki’. As is the custom in all snake shrines in Kerala, the snakes here too are feted and officially "fed" on ritual days. It is believed that the snakes’ favorite diet includes rice flour, turmeric, milk and (Kadali) bananas, and so they are duly fed on the first day of Vrischikam.

On that day, all worshippers are allowed in irrespective of their faith or caste affiliation.

A similar open-day policy is also observed on Aayilyam in the month of Kanni, between the days of Thiruvonam and Bharani in the month of Meenam and on the 10th day of Medam.

However, nobody is allowed into the actual sanctum in the eastern quarter. In the mandala season, there are also special celebrations. Apart from the snake Gods, right in the central courtyard of the family is installed a Goddess, in the "guise" of the traditional Guardian

Matron of the Mekkaad family.

The Mekkaad family hails from Irinjalakuda and so in close temporal proximity (before or after) to the annual festival at the Koodal Maanikkam temple in Irinjalakuda, the Mekkaad family shadow it by propitiating their own domestic Goddess through a ritual named

"Mudiyettu’, usually on the Monday and Friday in the month of Medam. The privilege of holding this is assigned to the Kurup of Varanaattu. The main offerings are "payasam" with milk or ghee. The devotees are offered bananas and turmeric powder from the Pooja and oil from the perennial light. The much reputed but demanding ritual of "naagabali” has also been extinct for several generations now.

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3.Peralassery temple

It is a Subrahmanya temple located in northern Kerala near to Kannur (Fig.60). Sarpabali and eggs are the main offerings here.

4.Vettikode temple

It is located near Bharanikkavu in southern Kerala. ‘Anantha sarpa’ is worshiped here.

5.Ameda temple

It is located near to Trippunithura, Ernakulam (Fig.61). Saptha Nagas are worshiped here.

6.Palliyara Devi temple

A temple located at Kodumon, Pathanamthitta is well known for the healing of spider- insect bites. It is also known as ‘Chilanthi ambalam. The temple is dedicated to spider deity.

7.Thiruvizha Mahadeva Temple

A temple located at Cherthala, Alappuzha which is famous for the treatment of ‘Kaivisha’ or Garavisha.

A family at Udiyannur uses an antidote for rat poisoning handed down from generation to generation. The "Valiya Amma" of Mannarasala also treats rat poisoning by administering a paste made from a particular drug. The Paruthipra family near Ottapalam uses their age-old traditional practice of detoxication by making the victim vomit the poison. Pambumekkatt and Mannarasala do not practice Vishachikitsa. After the snake bite-victims are brought there, they spray Theertham and drop Bhasmam on the victims. It is believed that the victims

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are saved through the blessings of the serpent gods. Amedamangalam, Pathirikkunnath,

Athippatta, etc. are famous for eliminating the wrath of serpents and ritually relocate sacred serpent groves.

Art forms related to Serpent worship

Both Aryan and Dravidian cultures worshiped snakes even though in different ways and methods. They performed art forms like Sarpam thullal, Sarpa kalam (Fig. 56), Pulluvan paatu (Fig. 57), and Naga theyyam to please the snake gods, popularly known as sarpas.

Sarpakalam

It is a traditional practice of worshiping sarpa by drawing designs on the ground with indigenous colours. The sarpakalam will be drawn by Pulluva. Apart from its religious aspects, Kalamezhuthu is an entrancing art, a rare combination of sculpture, performance, music- both vocal and instrumental. Ottakkalam, irattakkalam, Ashtanagakkalam,

Kootakettu Sivalinga padmam, Padika kalam are few of the kalams popular in Kerala. A shed specially decorated for the purpose is made. Kalams are diagrams drawn on ground using five primary colour powders. The ritual is followed by singing, percussion and performance. In northern Kerala, sarpa kalams are drawn in houses in relation to sarpam thullal. The primitive tribes of Kerala had serpents as their diety. The Pulluva caste became practitioners of the ceremonies connected with serpent worship. They remain part and parcel of these rituals by creating the atmosphere for the ceremony; worshiping the snake deities; receiving their blessings and transferring them to the other members of the village community and their land. It is a representation of ancient modes of worship among the

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primitive people. It is intimately associated with the concept of Saivism. The coloured powders are made from natural products. White colour from rice powder, black from the burnt husk of paddy, yellow from turmeric, green from dried leaves and red by the mixture of turmeric powder and lime. These five colours represent the five natural elements; yellow represents earth, black for the sky, white for water, green for air, and red for energy. It is intimately related to the tantric concept114.

According to V. Vishnu Nampoothiri, certain other communities also draw Nagakkalam.

Theyyampadi Nambiar of Kolathu Nadu used to perform nagapaatu and draw Nagakkalam.

Nagaraja and Nageshwari concepts are depicted in two sarpas drawn in an entangled manner.

Kallattu kurup draws Nagakkalam in Valluvanadu region. Kanyakas will perform steps according to the song of kurup and by the end of the performance, the kalam will be erased.

In Thrissur district, Varanattu kurup draws Nagakkalam especially at places like

Pambumekkattu and Amedamangalam. In Kottayam district, Chennakattu kurup of

Amayannur draws the kalam. In northern Kerala, some members of the Thiyya community are also engaged with Nagakalam. Nagatheyyam and Naga thottam are other art forms related to serpent worship in northern parts of Kerala.

Pulluvan Paatu

Pulluvan pattu is a form of serpent worship performed in Kerala at houses in addition to serpent temples. The Pulluvar of Kerala is closely connected to sarpa. They consider the snake gods as their presiding deities and perform sacrifices and sing songs. A Pulluvan is a male member (female Pulluvatti) of a caste- called Pulluvar. The term pullu means a bird of omen. The term pulluvan means a person who predicts from the sound of birds. There are

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many sub-divisions of the Pulluva community. The majority among them are called Nagampatikal (people who sing snake-songs). Some pulluvars are not Nagampatikal.

They are known as Pretampatukal (people who sing ghost songs). The women of the houses where the ritual takes place performs the serpent dance (Sarpam Thullal). Most of the art forms of the Pulluvar are ritualistic. Most of their songs are related to worship, ritual, custom, and exorcism. Pulluva art is expressed in the background of snake-worship.

The songs conducted by the Pulluvar in serpent temples and snake groves are called

Sarppapaattu, Naagam Paattu, Sarpam Thullal, Sarppolsavam, Paambum Thullal or

Paambum Kalam. The main aspects of this are Kalamezhuthu (drawing of Kalam, a ritual art), singing, and dancing.

“Drishtibadhakalokke ozhiyenam anpatharu karappanozhiyenam

Pullu peedayum pakshi peedayum sarpakopangal ellam ozhiyenam”

The songs are about various diseases believed to be caused by sarpakopa115.

Nagakaali theyyam

Nagakaali theyyam is a fierce fertility goddess worshiped by childless parents. It is more popular in the northern parts of Kerala. During the theyyam, devotees offer pulluvan paatu to please the deity. The costume includes a huge headgear made of wood. The performance is accompanied by traditional instruments like chenda, kuzhal and ilathaalam.

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VISHACHIKITSA AND ASTROLOGY

Kerala Vishavaidya books explain much about relevance of astrology in treatment. Based on lunar assessment and stars experts could assess the diagnosis and prognosis of bites.

According to C.V.Govindan116, fate is considered as one of the reasons for snakebite.

Unfavorable positioning of Rahu, its period in life sub-period predisposes one to snakebites.

Each star has a period of one hour 36 minutes occupied by Vishaghatika and a similar period by Amritaghatika also. Venomous bites during the toxic period are difficult to cure. Those during Amritaghatika respond well to treatment. The duration of toxic and amrita periods on each star is tabulated in the Panchanga calendar. Unlike other diseases, in the olden days’ patients of snakebite rarely make a direct appointment with the physician. A messenger usually reports to the physician as it may be difficult for the patient to travel or was dangerous to transport the patient. Omens are of great importance in arriving at the prognosis in the proxy. Position, speech, act, etc of the messenger in ancient books are based on

‘Nimitta’ of astrology.

According to Dr. P. Unnikrishnan, the moon represents life force117. Many things in nature are controlled by the lunar calendar. A declining moon reduces the life force. Solar and lunar eclipses render the bite incurable. Five days after the solar eclipse and three days after the lunar eclipse are considered bad periods. It is held that the following lunar days are inauspicious.

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Table no.14: Inauspicious lunar days118

Chathurthi

Ashtami

Chathurdashi

Panchadashi

Navami

Panchami

Poisoning during the dark lunar fortnight (krishna paksha), is believed to be more dangerous.

Days of the week: Tuesdays and Sundays are dangerous

The following stars are designated inauspicious and dangerous in poisonous bites:

Table no.15: Inauspicious stars in Poisonous bite

Ashlesha Poorvashada

Poorvaphalguna Ashwini

Uthara Phalguna Bharani

Chithra Krittikaa

Svaati Rohini

Vishakha Arudra

Jyeshta Sravana

Moola Purvabhadrapada

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Inauspicious Kala 119

Triyoga: If the bite has occurred on a day which has a combination of any of these ten nakshatras- triketta, chothi, chithira, bharani, ayilya, karthika, pooram, pooradam, pooruruttadi, chataya with any of these dates like dwadashi, shashti, chathurthi, navami or any of these days like Tuesday, Sunday or Saturday then death is almost inevitable.

Uparaga: solar/lunar eclipse. It is believed that if snakebite occurs on eclipse day and even if the patient survives, the poison remains inside as Dooshivisha and will produce symptoms later on.

Birth star: Bites on the birth star are incurable, so is the third, fifth, and seventh star from the birth star.

Sankrama: The period when the sun moves from one rasi to another is known as rasi sankranthi. This period is considered as inauspicious.

Twilights: One hour 12 minutes before sunrise and 48 minutes after sunset are termed morning twilight and evening twilight. Bites during these periods are considered difficult to cure.

Ashtamarsha: The eighth rasi of a nakshatra from the Chandra rasi at the time of the birth of a person is called ashtamarsha of that person. Snakebite on ashtamarsha nakshatra is deemed very much inauspicious.

Parivesha: The day when a dim coloured band appears around the sun and moon is regarded as inauspicious in the treatment of poison.

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The kujan; mandhan, ahi, gulikan, the trikona of these (i.e) if the fifth/ninth position of the rashi of the bitten day is occupied by these grahas are considered inauspicious. If at the time of the bite, the above-mentioned grahas fall on the 7th position of the rashi of that bitten day, it is called drishti and is considered awfully bad.

Fatal combinations119:

Table no. 16: Fatal combinations of stars in poisonous bites

Sunday and Makha

Monday and Visakha

Tuesday and Arudra (Thiruvathira)

Wednesday and Moola

Thursday and S’atabhishak (Chathayam)

Friday and Rohini

Saturday and Uttarashada (Uthradam)

Dagdhayoga

Table no. 17: Dagdhayoga in Jyotisha

Sunday- Dwadasi

Monday- Ekadasi

Tuesday-Panchami

Wednesday-Dwiteeya

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Thursday-Shasti

Friday-Ashtami

Saturday-Navami

These combinations are called dagdhayogam in Vishachikitsa. If a bite occurs on dagdhayoga, it is considered extremely inauspicious.

Doothalakshana in Vishachikitsa

Doothalakshana is one of the most important aspects of Keraleeya Vishachikitsa. Vaidya will derive conclusions based on various aspects of dootha.

“Doothanal venam sakalamarivathum

Doothanakunnavan vannathum ninnathum

Vakkum swabhavavum nilkunna rashiyum

Orka prakrithi vikrithi bhedangalum”120

Every inference should be derived from the dootha at first. His body language, words, mannerism, direction, character, premises, etc should be observed very carefully.

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Table no. 18: Auspicious Messengers 121

Good looking man/woman belonging to a good family

Impeccably dressed in white

Narrates the matter clearly in uninterrupted words

If a messenger comes to Vishavaidya with these features, then it is considered a good sign, and chances of survival are more.

Table no. 19: Inauspicious messengers

One who lost his way

Unhappy

Possess weapons

Dressed in black/red

Carrying stick in hand

Narrates matter in stammering words

Stands crossing hands and legs

Crys frequently

Carry dried things

Wearing wet clothes

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Hangs cloth on the shoulder

Uncombed and untied hair

Hurts his nails, bosoms, eyes, groins

Handicapped

Small boy

Barber

If the messenger has one of the above features, it is considered inauspicious.

Table no. 20: Inauspicious desha122

Forest/garden

Abandoned place

Graveyard

Near water source

Hole of a tree

Junction

Sacred place

Anthill

Meeting places

Under shigru, udumbara, ashwatha, vata, aksha, Jambu, Bamboo Islands

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Mountains

End of road, village

Animal shelter

Grassland

Unused well

If a bite occurs at these places, the prognosis is difficult.

Table no. 21: Inauspicious Vaidyakarma

Pitrukarma

About to start a journey

In argument

Shaving

Bathing

Having meal

Sleeping

Untidy

Dull

If vaidya is engaged in any of these activities, the prognosis will be bad.

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Diagnosis of bite based on the direction of Messenger

If dootha narrates the matter to vaidya standing in any of the four main directions-Nort,

South, East, and West, then the Visha is extremely poisonous like that of the cobra. If the dootha stands in a corner and then narrates, then the snake may be krait and if the dootha stands in the middle of these two directions, then the snake maybe rajila. If dootha’s direction is still an uncertain one, then it may be a bite of rat, scorpion, etc. If dootha stands in vayukon, then the poison may be that of four-legged animals; if dootha stands fixing his right leg, the snake is male.

Shara pareeksha123

If dootha narrates the matter during inspiration of the vaidya, then the patient survives, and if during expiration, the patient dies. At the time of narration, if the site of the bite is on the right half of the victim’s body and vaidya has a dominant airflow on the left nostril, the case is kashtasadhya. If swasa is taken from the left side and dootha also comes from the left side, it is better to send back the dootha refusing to treat.

If the dootha utters the patient’s name first and confirms the snake, these two cases are difficult to manage. If the dootha moves to south direction while narrating the matter, then also it is considered that the patient may die. If the dootha and wind come from the right side of vaidya, then Visha is considered less dangerous and can be treated easily. If the dootha utters the snake’s name first and also confirms it, then the death of the patient is almost inevitable. If the dootha comes with arrows or any other weapon, then also the patient’s prognosis is considered bad.

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Amritakala124

In the male, Amritakala climbs upwards from the right side of the body and then runs downwards through the left side respectively. Amritakala climbs from purvapaksha prathipada to Krishnapaksha respectively. In females, the position of Amritakala is on the left side of the body. The 15 points of the body through which the sudhakala extends are mentioned here. They are toes, legs, knee, genitals, umbilicus, heart, breast, throat, nose, eyes, ears, the midpoint of eyebrows, forehead, and scalp. Visha remains in the 7th position of Amritakala always. All the ill-effects due to Visha will be destroyed by the vimardana of

Amritakala. If a bite occurs over the part of the body affected by Vishakala, death will occur suddenly. Even if a highly venomous bite has happened on Amritakala, the victim can be saved.

Position of Sun with the star

When sun occupies the field of a star, the star 5th and 9th stars in the ascending and descending order is bad and bites occurring during the period of such stars will be cured only after treatment for a long time. Bites on the 4th and 6th stars in ascending and descending order can be easily cured.

Auspicious time

Adityan, mangal, sani, rahu and ketu are considered as papagrahas. Budhan, guru, sukra,

Chandra, etc are known as shubhagrahas. If at the time of the bite, these subha grahas are in a good position (i.e, if these grahas are positioned in the udayarasi or if they occupy the

5th/9th position) the position of Chandra in trikonodayam are both considered as auspicious.

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Vishaghatika

In each nakshatra, 4 nadikas are Vishaghatikas and the bite occurred in Vishaghatika is considered duschikitsyam.

The narration of the messenger

The total number of letters in the first word uttered by the dootha is divided by three, if one remains, then Visha is presumed as sukhasadya; if two remains, then Visha is cured with difficulty and if three remains death is sure.

Table no. 22: Diagnosis from Narration of messenger125

If the number of letters in the first word is divided by eight, and if:

If one remains Darvikara Visha

If two remains Mandali Visha

If three remains Rajila Visha

If four remains Vyanthira Visha

If five remains Mooshika Visha

If six remains Keeta Visha

If seven remains False information

If eight remains NirVisha

If the first letter of the first uttered word is a deergha akshara, then the snake would have bitten twice.

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Table no. 23: Sites of the bite which are difficult to treat126

Head

Forehead, temples

Cheeks

Nose

Ears

Eyes

Throat

Palmar surface of hands

Nipples

Chest

The upper part of the trunk, hands

Axilla

Abdomen

Umbilical area

Groin

Thigh

Heel

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Good and Bad omens

At the time of the beginning of a journey or on the way, if vaidya comes across the following situations, it is considered either good or bad omens.

Table no. 24: Good and bad omens in Vishachikitsa127

Bad omens Good omens

Hearing words- go, gone, died, killed Hearing blessed words

Someone sneezing A loud sound of an elephant

A cat crossing the road Thunder

Sees emptying of a full pot Song, instrumental music

Snake Voice of chakora, peacock, cuckoo, crow

Someone digging a pit Chanting of mantras.

Ashes Virgin lady

Oil King

Sesame Elephant, cow

Broken pot Water source

Buffalo skull Fruits

Dried wooden pieces Prostitute

Cotton Two Brahmins

Monkey Milk

Salt Silver, gold

Carpenter Sankha

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Uncombed person Curd, honey, ghee

Flesh, bones Flag

Cowdung Drum

Dirty clothes Umbrella

Axe Rice

Items for balikarma White flower

Single brahmana Fire flame

Male child

Specific medicines were given for victims initially in snakebites on specific days

Table no. 25: Specific medicines for bites on specific days128

Sunday Maricha choorna in ghee

Monday Tippali choorna in madhu

Tuesday Saindhava choorna in takra

Wednesday Pata choorna in milk

Thursday Shweta gunja moola choorna in milk

Friday Shunti and tippali choorna in madhu

Saturday Patala moola in milk

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Table no. 26: Specific medicines for Nasya in snakebites on specific days

Sunday Kakamachi, saindhava, and ardraka swarasa

Monday Tamboola patra swarasa and butter

Tuesday Karpasa patra and vacha in hot water

Wednesday Chincha patra swarasa and lashuna swarasa

Thursday Shigru moola, shunti, ajamoda in lashuna swarasa

Friday Tamboola swarasa, lashuna swarasa and tulsi

swarasa

Saturday Hibiscus root and leaf grinded in kanjika

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VISHACHIKITSA- PRACTICES AND CLINICAL ASPECTS

Vishavaidyas of Kerala were highly efficient. It is believed that some of them even saved lives while taking the body for cremation through special procedures called Karu prayogas.

Vishachikitsa in Kerala was practiced as a service to the society in the olden days. Every big family will have one member who will be designated to do free Vishachikitsa to society. He will not be assigned any other responsibilities of the house. Usually, he will lead a life of celibacy also. Many beliefs were related to Vishachikitsa. One among them is that the vaidya and his family will be ruined by the curse of a snake when he practices it. So, when any mishap occurs in the family, it was believed to be due to the practice of Vishachikitsa. Many mantras were also used in chikitsa. They were also believed to cause ill effects on the family.

Greatness in rescuing a poisoned person

“Danayagadi karmangal palathum cheykilum thatha

Vishartha lakshanathodu samyamallennu kelppithu

Tasmadarabhatham chethi manushyanam visheshatha

Avighnamasthu vighyathakeerthischa bhuvaneshVishaha” 129

Saving the life of a poisoned person is more virtuous than performing hundreds of yagas or offerings. It was thought that this great and pious profession of saving a life should be undertaken even without accepting any rewards.

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Qualities of a Guru

Guru should have proper vidya, bhakthi, japadhyana, snana, tapa, kripa, satyam, mantra samarthyam, and budhi, etc. This was the concept of a good guru.

Qualities essential for a student of Vishachikitsa

The student also was expected to have calmness, celibacy, knowledge, cleanliness, enthusiasm, truthfulness, intelligence, belief in god, dedication, obedience, empathy, rational thought, less sleep, and forgiveness.

Qualities of Vishavaidya130

An ideal Vishavaidya is one who respects his teacher, god, and brahman. He should possess cleanliness of body and mind and should be compassionate and sincere to his profession.

Patients to be avoided by a Vishavaidya

The following types of patients were to be avoided.

Table no. 27: Patients to be avoided131

Practice violence

Violate dharma and rules

Misbehaves

Hates himself

Thankless

Coward

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Epicari

Short-tempered

Mentally unstable

Near to death

Disobedient

King’s enemy

Patients who ought to be treated

The following categories are not to be avoided.

Table no. 28: Patients who ought to be treated132

Teacher

Brahmin

King

Relatives

Traveler

Scholar

Pet animals

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Two methods were employed in Vishachikitsa in the olden days.

 Visha vidya

 Visha vaidya

Visha vidya is the method of detoxification using mantras and related procedures.

“Visham nashikkum mantram kond- adangum durithangalum bhoothagrahadi peeda cha mattullapalganangalum sidhoushadangalekondum sidhikkum kshvela shantiye”133

“Manthirathin palamarivan Vishathe paaru” 134

It was believed that the use of mantras will cause ill effects to the vaidya. Vishavaidya is the method of detoxification using medicines only. Most families and vaidyas of Kerala clubbed these systems together in their treatment. According to Susruta, mantra can pacify Visha quickly than using medicines135. 60 years ago, in Kerala, the life of the famous artist,

Thiruvegappura Ramapothuval was saved by famous toxicologist Thrikkovil Kunjikrishna

Varier by mantra parayoga alone while his body was taken for cremation following a snakebite. All mantras were of 51 letters. Many types of mantra prayogas were in practice.

One among them is of summoning back the biter snake by mantra to devenomate the victim.

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But it was forbidden by many gurus as it was believed to cause serious ill-effects to the family of the toxicologist. A lifestyle with strict restrictions in ahara- vihara was compulsory for the practice of Vishavaidya. Mantras should be mastered by chanting them up to one lakh times136 as advised by guru for them to have proper effect according to Prayogasamuchaya.

Mantra prayogas should be used with utmost caution as it can cause ill-effects. Many families stopped the practice of mantra prayoga due to this fear. Mantras were used injudiciously by some practitioners also out of hatred and ego, such prayogas resulted in ill- effects as opined by Avanapparambu Maheshwaran Namputhiri. If the prayoga of bringing back the bitten snake is practiced once, the entire siddhi attained by Vaidya for mantra prayoga will be lost it was believed. Lakshanamritham, Vishanarayaneeyam, Vishavaidya mantramritam, and Jyotsnika describes the various mantra prayogas. But later treatment using mantraprayogas got declined and oushadha chikitsa gained more acceptance.

Neelakanta trayakshari is considered as the mahamantra. After bath one should sit in a convenient asana facing either east or north direction. First dhyanasloka should be chanted and later moolamantra should be chanted for lakh times. Nobody was permitted to chant mantra without the permission of guru.

Mantras were mentioned as ‘karuthu’ prayogas in Dravidian style whereas it was used as mantras itself in Aryan style. Most of the ‘karuthu prayogas’ used for Vishachikitsa in

Kerala were of old Malayalam or Tamil- Malayalam mixed composition137. Garuda,

Dhanwantari, Vishnu were not mentioned in mantras of Dravidian origin, whereas names of

Shiva and Parvathi, names of animals and other objects were commonly used. Garuda,

Dhanwantari, and Vishnu were used commonly in Sanskrit mantras of the Aryan tradition.

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Table no. 29: Names of mantras and karuthu 138

Garuda panchakshari mantra Bhasma karuthu

Neelakanda trayakshari mantra Jala karuthu

Sreerama mantra Thukil karuthu

Kaali mantra Nuchin karuthu

Keeri karuthu Kanji karuthu

Panni karuthu Pindi karuthu

Sree Garuda Dhyanam Yoni karuthu

Chempothin karuthu Pilla karuthu

Urumbin karuthu Munthiri karuthu

Kozhi karuthu Chedi karuthu

Vettila karuthu Neer karuthu.

Agni karuthu Anna karuthu

These mantras are used according to situations. Certain specific mantras are chanted for a certain variety of snakes and other poisonous bites like mooshika, lootha, vrischika, etc.

Some vaidyas will apply bhasma or water on the victim along with mantras. Mantras were used for many purposes:

Table no. 30: Different purposes of Mantra prayoga138

To pacify Visha To pacify Visha in Vaidya

To spread Visha To bring ants

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To increase Visha To bring snake

To arrest Visha at a site To calm snake

To avoid snake bite To catch snake

Dr P. Raman139 observes the effect of mantras in treatment as the power of the subjective mind to capture the sense of foreign language. The saints and sages utilized such a phenomenon to solve problems and to heal the ailments. Vedas explain the power of mantras, tantric saadhanas, and various rituals in restoring health, social harmony, ecological balance, and universal harmony. He points to examples of saints who had a period of severe saadhana in their life, after which they became divine. Lord Buddha, Prophet Mohammed,

Jesus Christ, Rishis, and yogis are examples. Repetition of saadhana is aimed at the submission of the objective mind to the subjective mind. When progresses, various unusual capacities are observed at the objective mind level. When the surrender is complete, the objective mind fully resonates with the subjective mind.

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CLINICAL ASPECTS

Types of Visha mentioned in Keraleeya Vishachikitsa books

Table no. 31: Types of Visha dealt in Keraleeya Vishachikitsa140

Snake Horse

Rat Dog

Scorpion Garden lizard

Spider House lizard

Mongoose Chameleon

Cat Wasp

Frog Millipede

Monkey Centipede

Poisonous plants Poisonous

minerals

Poisoning in Food poisoning

animals

Leena jeevan

If within an hour of poisonous bite, the patient becomes unconscious and if death confirmation tests are negative, then the person is said to be a leenajeevan, i.e, still, there is little life left within him.

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Asadya lakshana

Table no. 32: Asadya lakshana in Vishachikitsa141

Frequent and profuse sweating, fatigue, tremors, loosening of the joint, dryness of mouth

Deep inspiration, shivering, pain, and heaviness of cardiac region, delirium, dimness of vision

Vomiting of thick mucus and bile, bluish discolouration of nails and teeth, cyanosed lips and tongue, excessive salivation

Sound of nasal tone, redness of medial canthus, red or bluish swollen ulceration around the bite mark

All these are considered as incurable signs in a poisoned person.

Table no. 33: Nashtajeeva or Mrita lakshana142

Involuntary passage of urine and feces

No bleeding even after incising the forehead

Dark colouration and swollen body

Wet appearance

The appearance of no struck marks if hit by a stick

Anus, eyes, and mouth if remain open

No movement of eyeballs

All these signs are confirmatory of death in a poisoned person.

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Table no. 34: Reasons for Snake bite143

Out of fear

Due to mada

Irresistible thirst and hunger

During the gestation period out of fear of danger to offsprings

Due to contact with foreign body

Misunderstanding as a foodstuff

Aggravated Visha to such an extent that it can’t resist itself from biting

Due to enmity

Factors affecting the potency of Visha

Snakebites out of mada and enmity are fatal. If due to anger and hunger, the potency will be aggravated. If snakes bite during the following conditions, the potency will be less.

Table no. 35: Factors reducing the potency of venom in snakes144

Snakes fell in the water

Weakened by sexual activity

Away from their native habitat

Defeated by mongoose

After a heavy meal

Residing beneath Vishahara trees

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Symptoms of poisonous bites are mentioned followed by general first aid measures to be done in snakebites. Specific characteristics of each variety of three venomous snakes are also explained along with their specific medications.

Poisonous fangs of the snake

Table no. 36: Names of fangs in snake145

Karali Bite mark in the shape of cow’s feet

Makari Bow shaped mark

Kalarathri Bird’s leg shaped mark

Yamadoothi Swollen bite mark

These are the four poisonous fangs mentioned in Jyotsnika with an increasing fatality, the last one being most poisonous. The first two, karali and makari are the fangs on the left side and the last two on the right side.

Table no. 37: Classification of snakebite types146

The saliva of snake present, no bite marks Tundahata

One or two fang marks, no bleeding Vyaleeda

One or two fang marks with bleeding Vyaluptha

Three fang marks with oozing of blood, muscle punctured Dashtaka

Four fang marks, muscle penetrated, puncture of blood vessel Dashtanipeeditha

The first two are non-poisonous and the last three venomous.

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Table no. 38: Characteristics of Sarpavisha147

Cobra Katu rasa, rooksha, vata kopana, increases during the rainy season

Viper Amla rasa, ushna, pitta kopana, increases during the cold season

Krait Madhura rasa, sheeta, kapha kopana, increases in the summer

season

Oothu chikitsa148

In this practice, Vishva, Dusparsha, and Maricha are taken in equal amount, chewed up and blown into ears and scalp simultaneously for 150 times to destroy the action of Visha in the first three dhatus.

Table no. 39: Matra of oushadha in Vishachikitsa149

Swarasa or kwatha 90 ml

Lehya 12 gms

Kalka Vibhitaki pramana

Lepa Size of rice grain

Anjana Size of barley

Nasya 6 drops each

Dhara 90 minutes

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Vishahari Lehya:

A lehya which is especially useful in diagnosing venomous and non-venomous snake bites is prepared as follows:

250 gms of seeds of Luffa amara ground in the juice of about 500 betel leaves should be tied in a cloth and hung on a hook. The juice flowing down is collected and an equal quantity of old neem oil is to be added. One-fifth quantity each of purified mercury and purified sulphur is added to it, mixed in a mortar and the water is removed by evaporation and kept in a glass jar. 50 to 100 mg of the lehya spread on a betel leaf is given to the victim150.

Vishahari lehya

Table no. 40: Taste felt in Vishahari lehya prayoga

Taste felt Inference

Strongly bitter Non-poisonous

Slightly bitter Slightly poisonous

Astringent Moderately poisonous

Bland Severely poisonous

Sour Viper poison

Acrid Cobra poison

Sweet Krait poison

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After proper diagnosis, measures are done to regain the consciousness with tikshna Nasya or anjana or blowing therapy if needed. Prognosis of the bite is also assessed by agni pareeksha.

External applications like lepa, dhara, and thalam and internal administration of kwatha yogas are given in darvikara Visha. Several symptoms seen in darvikara Visha and the corresponding treatment measures are elaborated151][152]. The treatment period extends to seven days.

In Mandali Visha, specific internal (pana, nasya, anjana) and external applications (lepa, dhara, kizhi, thala) are given for each of the associated complications153 like:

 Edema

 Hiccups

 Blisters

 Haematemesis

 Fever

 Bleeding (through hair follicles, urine, nose, mouth, rectum, ears)

 Fainting

 Urine-bowel retention

 Burning sensation

 Headache

 Decreased visual acuity

 Discolouration of urine

 Psychiatric disorders

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 Restlessness

 Excessive thirst

 Anorexia

 Tears

Various preparations like kwatha, choorna, gulika, kalka, swarasa, gritha, taila, lehya are used. Formulations and therapies to manage post-bite ulcers are also mentioned in detail.

The treatment period in Viper bite is up to 21 days.

In Rajila Visha, prayogas for lepa, oral intake and nasya- anjana prayogas are explained154.

Procedure for bath after treatment is also explained. Symptomatic treatments are explained for:

 Kapha vridhi

 Jwara

 Burning sensation

 Shivering

 Fatigue

 Edema

 Vomiting

 Fainting

 Joint pain

 Excessive thirst

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Management of other venomous snakebites like Seasnake bite and non-venomous bites like that of Ratsnake, Water snake, and Vine snake are also enumerated in Kriyakaumudi.

Kalavanchana prayogas are dealt with in some books are measures to be done in extremely critical conditions of Sarpavisha. Prayogas to be done if Vishavaidya himself get envenomated by snakebite are also described.

Vishakallu

The usage of stone therapy in Vishachikitsa is mentioned in Kriyakaumudi155. According to

Fr. Antonius, it works as a synthetic magnet which attracts toxins in blood when placed at the bite site. After usage, stones are kept in cow’s milk for half an hour and is washed and dried to make them ready for reuse.

Loothavisha

There are several small and large varieties of spiders. General symptoms of poisoning, development of lesion, and appearance of symptoms are given in classics. Severe spider poisoning is fatal. The classification and treatment are based on the vitiation of humors and the potency of venom. Dress and articles of daily use contaminated by spiders also cause toxic manifestations. Symptoms of Lootha Visha and treatment are mentioned in detail.

Common features mentioned in Jyotsnika include:

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Table no. 41: General symptoms in LootaVisha156

Vesicles, swelling and bullae at the site of lesion

Intense pain

Severe headache

Discolouration

Intense fever

General treatment of spider poisoning is explained with lepa, nasya, anjana and with drugs for oral intake. Kwatha, taila, gritha preparations are also prescribed for it.

Vrischikavisha

Based on the strength of venom, scorpions are classified into slightly venomous, medium venomous, and highly venomous in the classics. The venom spreads upwards from the site of sting very fast, returns, and remains at the sting. Vata is mainly vitiated. General signs and symptoms of Vrishchika Visha are dealt with in Jyotsnika157 are:

Table no.42: General symptoms in Vrischika Visha

Intense tremor Vomiting

Delirium Pain

Sweating Intense fever

Splitting of hair Tingling sensation

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Common treatment measures to be adopted are mentioned which include nasya, dhara, lepa, dhoopa, and oral intake of drugs.

Mooshikavisha

Rat semen is said to be the substrate of poison and the main vitiation is of Kapha. Burning, bloodletting, irrigation, external application of medicines, administration of emetics and purgatives, nasal medication, collyrium are employed in its treatment. If not eliminated, it will flare up in cloudy days according to classics. In Mooshikavisha, the following sixteen types158 of Mooshika are mentioned in Jyotsnika.

Table no.43: Types of Mooshika

Kulachandra Bhutaka

Karaghna Teekshna

Vishagathi Sudarsa

Bhayanaka Simhasya

Ugra Sudantha

Krura Sumukha

Kumuda Ekachari

Meghanada Sugarbha

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Symptoms of Mooshikavisha in general

Table no.44: General symptoms of Mooshika Visha

Inflammatory swelling at the bite site Coldness

Acute pain Malaise

Fever with headache Circular patches on different parts of the

body

Abdominal pain Gradual aggravation of pain

Anorexia The desire for exposure to the sun

Diseases of eye Running nose

Tremor Retention of bowel and urine

Mucous Horripilation

Immediate medicines to be given for rat poison within one and half days of exposure and general medicines to be given after this period is detailed. Formulations are also given to cure anorexia, vomiting, fever, swelling and to induce purgation and emesis. Kwatha, choorna, gritha preparations are prescribed for lepa, pana, etc. Five stages of an attack of mooshika Visha are also explained.

Table no. 45: Five stages of Mooshika Visha159

1st vega Pain and itching

2nd vega Burning sensation and lump all over the body

3rd vega Headache, yellowish discolouration of urine

4th vega Pain in joints

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5th vega Thirst, vomiting, pain all over the body, and later chances of death.

Keetavisha

Keetas are classified and treated based on their ability to vitiate humors. The predominant vitiation is of vata and kapha. Sudation is permitted. Specific poisoning symptoms and treatment in the case of various insects and creatures are also explained160. It includes:

 Wasp, Hornet, Bee, Ant, Millipede, Centipede, Crab, Cockroach, Mosquito, Dogbug,

etc.

They can be classified into manda and teekshna based on severity. Most of the insect poisons are neurotoxic. Some are vasculo-toxic and some cause allergies.

Table no. 46: Effects of Insect poisoning

Physical trauma

Injection of venom

Allergic and sensitivity reactions

Secondary infections

Invasion of the host tissue

Contact reactions to the secretions

Reaction to retained mouthparts

Transmission of diseases

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Table no. 47: Clinical features of insect poisoning161

Itching and pain Urticarial wheal

Firm papule Pigmented macula

Bullae Ulceration

Cellulitis Anaphylactic shock

Secondary infections Irritations

Eczema Impetigo, folliculitis

Table no. 48: Symptoms of severe insect poisoning

Systemic symptoms

Fever Fainting

Bodyache Yawning

Horripilation Tremors

Vomiting Dyspnoea

Diarrhea Hiccup

Thirst Coldness

Burning sensation

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Table no. 49: Local symptoms in mild poisoning

Local symptoms Symptoms of mild poisoning

Carbuncles Salivation

Edema Anorexia

Cyst Vomiting

Urticarial rash Heaviness of head

Various skin lesions Coldness

Local carbuncles

Urticaria

Itching

AlarkaVisha

The vitiated kapha of a fox, dog, and other quadrupeds block the sensory nerves causing characteristic symptoms of madness. Bitten by these animals, one becomes mad as the poison progresses. The bite should be cauterized with hot ghee or metal. Datura prayoga in the form of a cake is mentioned in classics. The signs and symptoms of a rabid dog bite are explained along with its detailed treatment procedure which includes kwatha, lepa, dhara, vamana, virechana etc162.

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Other Jangamavisha

Other animate poisons explained in Keraleeya Vishavaidya books are those from:

 Elephant, Cow, Tiger, Bear, Horse, Donkey, Boar, Camel, Fish, Leech, Lizard,

Garden Lizard, Monitor Lizard, Chameleon, Porcupine, Palm civet, Frog, Human,

Monkey, Jackal, Cat, Crocodile, and Mongoose [163][164].

The treatment procedure includes lepa, nasya, anjana, dhoopa and dhara prayogas and formulations for oral intake.

Dooshivisha [165][166][167]

Attenuated or latent poisons function as latent toxins in the human body. One who suffers from latent poison will have loose motion, his complexion will be altered, his mouth will emit a foul smell, his olfactory and gustatory senses will be impaired and will suffer from unquenchable thirst. Slurring and broken speech, vomiting, sorrow, and sudden bouts of unconsciousness are also seen. All humors will be vitiated. Hairs will fall off; the body will be emaciated, and he appears like a bird clipped off from feather and wings. The ill-effects increase when the season is cold and windy. On cloudy days, the sun will aggravate the symptoms. Advancing further causes flatulence, impair functions of reproductive tissue, stammering, and insanity. Widespread skin lesions are also seen.

The patient is subjected to sudation, after which induction of emesis and catharsis will have to be done. The latent humors in dhatus should be brought to koshta by sudation and can be eliminated through mouth or anus.

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Garavisha [168][169]

Concocted poison is artificial poison. Different parts of the body of insects, blood, menstrual blood, urine, feces, etc of animal and human origin, medicines having diametrically opposing action on the same physiological system, ashes of metallic and mineral origin containing toxic material and poisons of low potency are mixed in the composition of gara.

Females infatuated by the male used to give concocted poisons to seduce him to be her husband. History tells that it was also used to poison the king as per the direction of spies of the enemy. Concocted poisons mixed with food was given to the king with the help of workers in the royal kitchen. Lust, vanity, etc may also be the motive behind this.

Loss of weight, anemia, anorexia, cough, breathing disorders, fever, narcolepsy, depression, ascites, 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. Psychic disorders are also seen in the second stage. He dreams of fox, cat, mongoose, ferocious animals, monkey, dry ponds or wells, dry climbers, etc. The patient suffers such or more severe afflictions of the body and mind. Unless treated immediately he awaits impending doom. Induction of emesis by suitable emetics, consumption of compatible food and drinks, and medication with gold are the treatment methods.

Kaivisha, YogaVisha, Vishadatha lakshana, Vishabadhi lakshana are also explained in

Keraleeya Vishachikitsa books along with the methods to diagnose and eliminate Kaivisha.

Poisoning related to food is well explained in contexts of Ashudhabhakshana chikitsa,

Virudha bhakshana chikitsa, and Athibhakshana chikitsa170.

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Vishopadrava171

There are sixteen vishopadravas mentioned in various textbooks. These are described along with their treatment.

Table no. 50: Vishopadrava

Jwara Kasa

Vami Swasa

Hidma Trishna

Moorchana Vitbheda

Vitbandha Anhaha

Vastiruk Moordharuk

Svayathu Pootidamshatwa

Rakta srava Vishanila

Bhinna Visha172

If the treatment given for Visha was inappropriate, it will spread all over the body, gets split, and gets retained in joints. Then, tremors and fatigue in joints will be felt. Burning sensation and fainting also may occur. This condition is known as bhinna Visha. Physalis minima with milk are effective in this condition.

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Sthavara Visha and Prathyoushadha Prayoga173

General signs and symptoms of inanimate poisons are explained in the textbooks. It includes herbal and mineral toxicity.

Symptoms of Sthavaravisha poisoning include:

Table no. 51: General symptoms of Sthavaravisha poisoning

Swelling Warmth Intense fever Sorrow Weakness Fainting Vomiting Emaciation Retention of bowel and urine

Table no. 52: General line of management in Sthavaravisha poisoning

Oral intake and external application of Tanduleeyaka with Kanjika

Oral intake, snana, and external application of Neeli moola with Saindhava. Kalaka, kwatha, taila, gritha preparations are used for various purposes

Saindhava, vyosha, daruharidra to be used as kalka for preparing taila and gritha

Shathadhoutha gritha for external application

Specific treatment methods to be used in poisoning from Bhallathaka, Nagadanthi, etc are included in it.

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Table no. 53: Prathyoushadha Prayoga (Antidotes)174

Poisonous dravya Antidote

Kannampatti Bark of puzhaparuthi

Alcohol Lemon juice

Bhanga Bimbi

Aveen Datura- moola and patra

Langali Neeli moola

NirVisha (Delphinium denudatum) Maricha

Pashana Sarshapa, Neeli moola, Mrinala

Chirivilwa, Chitraka Eranda, Navaneetha and Satavari

Kupilu Gunja tender leaves for internal and external

administration

Vatsanabha NirVisha, Neeli moola

Parada Kushmanda

Taila virya Lavana jala

Panasa Vrishchikali, Shunti

Curd, buttermilk poisoning Old unripe mango brine and cotyledon

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Poisonous plants in Kerala

Table no. 54: Poisonous plants in Kerala175

Sl. No. Name of plant Toxic part

1. Atmagupta- Mucuna pruriens Hairs on fruit

2. Tuvaraka- Hydnocarpus laurifolia Fruit, oil

3. Eranda- Ricinus communis Leaf, seed, seed oil

4. Kramuka- Areca catechu Fruit

5. Snuhi – Euphorbia ligularia Resin, stem, leaf

6. Bhallathaka- Semecarpus anacardium Resin, fruit

7. Arka- Calotropis gigantea Resin, leaf, root, flower

8. Gunja- Abrus precatorius Seed, leaf, root

9. Dusparsha- Tragia involucrate Leaf, stem

10. Bhanga- Cannabis sativa Resin, flower, leaf

11. Guggulu- Commiphora mukul Resin

12. Vatsanabha- Aconitum napellus Root, stem, leaf

13. Langali- Gloriosa superba Rhizome

14. Chitraka- Plumbago indica Root

15. Madana- Catunaregum spinosa Fruit

16. Jaypala- Croton tiglium Fruit, leaf, root, stem

17. Sarpagandha- Rauvolfia serpentine Root, leaf, stem

18. Dravanthi- Jatropha curas Fruit, resin

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19. Ahiphenam- Papaver somniferum The resin of the capsule

20. Kupeelu- Strychnos nuxvomica Seed, root, leaf, stem

21. Karaveera- Nerium oleander Root, leaf, flower, fruit

22. Dhathura- Datura metel Whole plant

Table no. 55: Panchakarmas in Vishachikitsa

Nasya

Anjana

Snana

Paana

Lepa

These five treatment modalities are known as Panchakarmas of Vishachikitsa176. They should be done according to the condition of the victim and potency of venom.

Management of poisoning in animals

Symptoms and treatment of poisoning in animals are also explained in the texts177.

Table no. 56: Signs and symptoms of poisoning in animals

Shaking of head

Splitting of hair

Swelling at the site of the bite

Weakness

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Blindness

Fever

Inability to walk

Excessive salivation and secretion from nostrils

Lockjaw

Hair fall

Table no. 57: Treatment of poisoning in animals

Dahana over site of bite

Saindhava and gritha lepa

Vacha, trikatu with kanjika for oral intake and external application

Shireesha, neeli, tanduleeyaka, Nisha and daruharidra in kanjika for oral intake

Nasya prayoga

Treatment to be done if the Elephant got poisoned, is explained in Kriyakaumudi.

SarvaVisha chikitsa

If the biter snake cannot be identified from signs and symptoms, then certain medicines are prescribed which are capable of pacifying sarvaVisha vikara.

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Table no. 58: SarvaVisha chikitsa178

Veliparuthi (Pergularia daemia)- moola, patra and pushpa to be taken along with milk immediately after contact with poison

Neeli moola with milk for oral intake and with kanjika for external application

Tanduleeyaka and neeli moola equally for pana and lepa

Karanja, neeli, and bimbi together for oral intake

Nishadwayam, tanduleeyaka and ashwagandha along with milk and water for oral intake

Tankana with cold water for oral intake, lepa, and nasya

Ishwari and shunti for internal and external application over the forehead and nasal region

Many yogas for Nasya-Anjana-dhoopa prayogas are also mentioned.

Pathya-Apathya in Visha

Table no. 59: Conducive foods in Visharogi179

Tandula

Shashtika

Koradusha

Foods with Kashaya, Madhura rasa, laghu guna, Vatakara, kapha pitha samaka, sita virya

Pippali and shunti churna mixed with food is taken with ghee and aadhaki

Only rice food is good, then drink kanjika mixed with vyosha and saindhava

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Hot yavagu mixed with shunti, tanduliyaka and punarnava.

Yavagu made from mixing root of nili, gokshura, and ashwagandha.

Yavagu made from tagara.

Panchagavya

Table no.60: Conducive vegetables

Tanduliyaka Ardraka

Leaves and flowers of Indivara Nimbu

Matsyakshi Amra

Mandukaparni Palandu

Arishdamanjara Hingu

Leaves and flowers of Jeevanthi Saindhava

Lakshmana Maricha

Haridra Shunti

Table no. 61: Conducive fruits and meat in Visharogi

Conducive fruits Conducive meat

Kusmanda Mongoose

Indravaruni Peacock

Karavellaka Cuckoo

Patola Fish

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Brihati Deer

Vyaghri

Kadali

Table no.62: Non-conducive Diet and Activities in Visharogi

Non-conducive diet Non-conducive activities

Sesamum Excessive physical labor

Betel leaf Sexual intercourse

Mustard Contact with fumes

Coconut Exposure to sun rays, snow, wind, and dust

Buttermilk Excessive anger

Alkaline foods Excessive walk

Meat with curd Sadness

Wine Day sleep

Sugarcane Excessive talking

Jackfruit Talking cruel words

Black gram Actions which harm the mind and body

Horse gram

Excessive intake of leafy vegetables

Hot food

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Postgraduate research works done in Kerala on formulations and concepts in Keraleeya Vishachikitsa

Table no.63: Postgraduate research works related to Formulations in Keraleeya

Vishachikitsa

Toxicity Study of Jeevaraksha Gulika

Author: Satish rao B N; Guide: Dr M K Sasidharan

Year: 2006; Department of Agada Tantra, GAC Trivandrum

Objective –To evaluate the toxicity of jeevaraksha gulika in albino mice, in-vivo experiment

Results – Oral administration of the drug was found safe and no mortality was observed.

A Therapeutic Study of Vishavilwadi Gulika In Dooshivishajanya Vicharchika

Author: Krishna Singh; Guide: Dr M K Sadanandan

Year: 2006; Department of Agada Tantra, GAC Trivandrum

Objective –To study the efficacy of Vishavilwadi gulika in the management of

Dushivishajanya vicharchika in human models- RCT

Results – The result of the study was compared, and the study group found significant

A Clinical Study on The Efficacy of Nimbanilavakadi Kwatha In Virudhaharajanya

Vicharchika. Author: Bimal C A; Guide: Dr M K Sadanandan

Year: 2006, Department of Agada Tantra, GAC Trivandrum

Objective- To study the Vishahara property of Nimbanilavakadi kwatha in virudhaharajanya vicharchika, an open clinical trial

Result- significant effect than control kwatha in reducing the symptoms of vicharchika

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An Open Clinical Trial on The Efficacy of Eritailam In the Management Of

Jangamavisha Shopha

Author Gopikrishna S; Guide: Dr S R Manju

Year: 2007; Department of Agada Tantra, GAC Trivandrum

Objective- To find the efficacy of Eritailam in the management of Jangamavishajasopha an open clinical trial

Results-Eritailam was more found more effective in the management of

Jangamavishajasopha

A Clinical Study to Evaluate the Efficacy Of Jeevaraksha Gulika In The Emergency

Management Of Sarpavisha

Author: Shiju P S; Guide: Dr S R Manju

Year: 2008; Department of Agada Tantra, GAC Trivandrum

Objective- To assess the efficacy of jeevaraksha gulika in Ayurvedic management of snakebite, a clinical study

Results- Jeevaraksha gulika was significant in reducing the signs and symptoms of snakebite envenomation.

A Randomized Controlled Trial On The Efficacy Of Neelidaladi Kera In Dooshivisha

With Signs And Symptoms Of Kitibha Kushta

Author: Bijay Kumar Gupta; Guide: Dr S R Manju

Year: 2010; Department of Agada Tantra, GAC Trivandrum

Objective- To find the efficacy of neelidaladikera for kitibha caused by Dooshivisha, RCT,

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clinical study

Results- Study group showed more significant results

Toxicity Study Of Mritasanjeevani Gulika

Author: Brijendra Sing Tomar; Guide: Dr S R Manju

Year: 2008; Department of Agada Tantra, GAC Trivandrum

Objective- Evaluation of the toxic effect of Mritasanjeevani gulika, in-vivo experiment

Results- The drug has toxicity in a double dose

Effect Of Mritasanjeevani Gulika In The Emergency Management Of Cobra

Envenomation In Mammalian Model

Author: Hanzu Sherif; Guide: Dr C G Sreevidya

Year: 2013; Department of Agada Tantra, GAC Trivandrum

Objective- To analyze the activity of mritasanjeevani gulika in the emergency management of cobra envenomation, in albino mice.

Results- Proper dosage of the drug through oral and nasal route in mice is effective than the oral route alone in managing cobra envenomation.

Antivenom Activity of Mritasanjeevani Gulika Against Daboia Russelli Venom

ByInvivo And Invitro Methods -Author: Sherin K; Guide: Dr S R Manju

Year: 2015; Department of Agada Tantra, GAC Trivandrum

Objective- To analyze the anti-venom activity of mritasanjeevani gulika in the emergency condition of Russel viper envenomation in albino mice models

Results- Proper dosage of medicine at the proper time can be management in Russell viper envenomation. The drug significantly inhibited the proteolytic activity of venom.

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Acute and Subacute Toxicity Of Pavithra Vataka In Albino Rats

Author: Divya S Unni ; Guide: Dr. S.R.Manju

Year: 2017; Department of Agada Tantra, GAC Trivandrum

Objective- To evaluate the toxicological profiles of Pavithra vataka and to study the acute and subacute toxicity and safe dose, animal study

Results- Pavithra vataka is safe to use in its therapeutic dose without toxic side effects

Clinical Evaluation Of Bhinna Visha And Its Intervention With Physalis Minima

KsheeraGritha Against Physalis Minima KsheeraKwatha

Author: Reji M Varghese; Guide: Prof Dr. P. Unnikrishnan M.D (Ay)

Year: 2005; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To analyze the bhinnaVisha in the background of Dooshivisha, to study the clinical impact of bhinnaVisha in snakebite, to evaluate the efficacy of physalis minima ksheeragritha in bhinnaVisha against physalis minima ksheerakwatha, clinical trial

Results-after 30 days of study, in ksheerakwatha group, the symptoms joint pain and headache were reduced to 86% and 89% respectively. Thirst and temperature were reduced by 100%. In ksheeragritha group, all the four symptoms were reduced by 100%. Both groups showed a significant reduction in blood parameters after 30 days of study. Marked reduction was seen in ksheeragritha group.

An Open Clinical Trial On The Role Of Administration Of Shigrupunarnavadi Churna

In The Treatment Of SashophaKeetavisha

Author: Ushakumari P. K; Guide: Prof. Dr. P Unnikrishnan

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Year: 2005; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To study about Vishajasopha and effect of shigrupunarnavadichoorna in 3 groups, RCT, clinical study

Results- In the group which received shigrupunarnavadichoorna both internally as an infusion and as lepa showed more improvement in curing Vishajashopa.

A Comparative Study On Lodhrasevyadi Yoga And Neelithulasyadi Yoga In

LutaVisha

Author: Jesy P Mathew; Guide: Dr. C.M. Sreekrishnan

Year: 2006; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To study the effect of lodhrasevyadi yoga and neelithulasyadi yoga in

Loothavisha, comparative clinical study

Results- Group which received lodhrasevyadi yoga internally in the form of phanta and externally over applied area got more results than the group which received neelithulasyadi yoga similarly.

A Comparative Study On Efficacy Of Kottamtagaradi Yoga With Shigrupunarnavadi

Yoga In Trimeresurus Gramineus Bite

Author: Sirosha M; Guide: Dr. C. M. Sreekrishnan M.D (Ay)

Year: 2006; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To study the comparative effect of shigrupunarnavadichoorna and kottamthagaradi yoga in TrimeresurusGramineus bite when administered internally in the form of hot infusion and externally in the form of a paste, clinical study

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Results- Both the drugs are found highly significant in reducing the cardinal symptoms selected for the study

A Critical Study About Fatality Of Snake Bite With Reference To DamshaSthana,

Desa, Vara, Tidhi, Nakshatra And Paksha

Author: Manjusha Menon; Guide: Dr. C. M. Sreekrishnan,

Year: 2008; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To study the mortality in snakebite poisoning with reference to damshastana, desa, vara, tithi, nakshatra, and paksha, in 1000 case records, retrospective cohort study

Results- There is no association between mortality in snakebite with reference to the selected parameters.

A randomized control trial on lasunadivati versus saribaneeli phanta in pittakapha, pittavataja and pittajalutaVisha

Author: Aiswarya.K; Guide: Dr K.V. ASHA MD (Ay) PhD

Year: 2016; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To analyze Vishahara property of lasunadivati and to compare doshahara property of lasunadivati with saribaneeliphanta, clinical study

Results- overall effect showed a highly significant reduction of signs and symptoms in both groups. No statistically significant difference was noted between both groups.

A Randomized Control Trial On Arkapatra Sweda Against SaksharaAranala Dhara In

Vrischika Damsha

Author: Bijoy V; Guide: Dr. K. V Asha

Year: 2009; Department & College: Agada Tantra, VPSV, Kottakkal

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Objective- To study the usefulness of arkapatrasweda and saksharaaranaladhara in specific conditions of Vrischikavisha, RCT, clinical trial

Results- Both treatments were found equally effective

A Randomised Control Trial On Vishavilwadi Agada Versus Dashanga Agada With

SaksharaAranala Dhara In The Management Of Vrischika Damsha

Author: Jeevankumar S; Guide: Dr. P. B. Benil

Year: 2011; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To make a phytochemical fingerprint and a TLC profile of Vishavilwadi agada, to compare the effect of Vishavilwadi agada against dasanga agada along with saksharaaranaladhara in management of Vrischikavisha, clinical study

Results- Both the drugs showed significant results in reducing symptoms of pain, erythema, edema, burning sensation, tingling sensation of the tongue. Vishavilwadi agada showed slightly more effectiveness than dashanga agada in Vrischikavisha.

Evaluation Of Hepatoprotective Effect Of Vilwadi Agada On Paracetamol Induced

Hepatotoxicity In female Wistar Rats-Author: Maya N. M; Guide: Dr. C. M. Sreekrishnan

Year: 2011; Department & College: Agada Tantra, VPSV, Kottakkal

Objective- To evaluate the antioxidant activity of vilwadigulika, to evaluate the hepatoprotective effect of vilwadi agada on paracetamol-induced hepatotoxicity in rat, to compare the hepatoprotective effect of vilwadi agada against the standard drug, silymarin, experimental study. Results- Vilwadi agada showed antioxidant activity in the in-vitro assay model. In the in-vivo assay, both the concentrations of vilwadi showed significant hepatoprotection as that of standard drug.

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A Comparative Clinical Trial To Evaluate The Efficacy Of Neelimoola Kalka As An

Add On Therapy With Vilwadi Gutika In The Emergency Management Of Pit Viper

Envenomation

Author: Divya.K.M; Guide: Dr. Leena Raman MD (Ay.)

Year: 2016; Department of Agada Tantra, MVR Ayurveda Medical College,

Parassinikadavu

Objective- To study Vishahara property of neelimoolakalka in pit viper envenomation when administered along with vilwadigulika, a comparative clinical trial at IPD level

Results- Neelimoolakalka when administered along with vilwadigulika produced faster relief in symptoms.

A Comparative Clinical Study To Evaluate The Efficacy Of Shireeshabeejadi Choorna

Lepa Against Kottamramachadi Lepa In The Management Of Lootha Visha

Author:C.K. Rukma; Guide: Dr. Leena Raman MD (Ay.)

Year:2016; Department of Agada Tantra, MVR Ayurveda Medical College, Parassinikadavu

Objective- To assess the luthaVishahara property of shireeshabeejadichoornalepa. To compare the effect of shireeshabeejadilepa against kottamramachadilepa with the intake of lodhrasevyadi Kashaya in luthaVisha, clinical study

Results- The study group was found more effective than the control group.

A Comparative Clinical Trial To Evaluate The Efficacy Of Kushmandabeejadi Lepa

Against Shigrupunarnavadi Lepa In The Management Of Keetavisha With Special

Reference To Wasp Sting

Author:Vijitha Vijayan; Guide: Dr.Arathi Rajesh MD (Ay.)

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Year: 2017, Department of Agada Tantra, MVR Ayurveda Medical College,

Parassinikadavu

Objective- To compare the efficacy of kushmandabeejadilepa against shigrupunarnavadilepa along with dashangagulika in wasp sting, clinical study

Results- both treatments were significant in the management of wasp sting and kushmandabeejadichoornalepa is equally effective in managing wasp sting when compared with shigrupunarnavadichoorna

An Uncontrolled Clinical Trial to Evaluate The Efficacy Of Kottamtagaradi Yoga In

The Management Of Mandali Damsha With Special Reference To Pit Viper

Author: Athulya.C.M; Guide: Dr. Leena Raman MD (Ay.)

Year: 2017, Department of Agada Tantra, MVR Ayurveda Medical College,

Parassinikadavu

Objective- To analyze the action of kottamtagaradi yoga used internally in the form of

Kashaya and externally as lepa in pit viper envenomation, clinical study

Results-The drug kottamthagaradishow marked improvement in all the symptoms of pit viper envenomation and the effect of the treatment was statistically significant

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