Darvekara sarpa and its contemaporary

this ppt is about darveekara sarpa which can be compared with cobra snake

1. WELCOME

2. D arvikara sarpa and its contemporary

3. INTRODUCTION PREVALENCE OF SNAKE BITE CLASSIFICATION OF SARPA IN AYURVEDA DARVEEKARA SARPA-IN DETAIL TREATMENTS FOR DARVEEKARA SARPA DAMSHA. YOGAAS MODERN ASPECTS DISCUSSION CONCLUSION. contents

4. The problem of poisons and their treatment has been coming since prehistoric times. Information pertaining to the poison is available in Vedic literature. The word AGADA has referred several times in vedas. Later AGADATANTRA was developed as one of the eight branches of Ayurveda that deals with diagnosis and treatment of poisons. introduction

5. Mrityu is categorized into two in classics KALA Mrityu : Natural AKALA Mrityu : Unnatural The second category is also said to be AGANTUJA and may occur because of Water - that is infected / polluted / contaminated Agni - like fire accidents Weapons Stree / Visha Kanya - who is contaminated with STDs VISHA – POISONING (Dalhana on Sushruta Sutra 34/6)

6. Among all these factors responsible for unnatural death VISHA is an important one. VISHA may be any substance that interferes normal physiology resulting in VISHADA Under different categories of Visha SARPA VISHA is an important factor that causes unnatural death.

7. Prevalence of snake bites As per the estimates of WHO; India has highest number of deaths due to snake bites in the world

8. Majority of the deaths are due to Delay / Lack in treatment, Unable to reach hospitals in time

9. I t has been reported that, there are ONLY 52 VENOMOUS SNAKES out of 216 species in India . Yet, every year 50,000 Indians, mostly poor villagers, die in 250,000 incidents of snakebites (~ 20 %) . High incidences are noticed in the states of Tamil Nadu, West Bengal, Maharashtra, Uttar Pradesh, and Kerala.

10. CLASSIFICATION OF SARPA IN AYURVEDA SARPA DIVYA BHAUMA 80 Vasuki Etc. DARVIKARA MANDALI Rajimanta Vaikaranja 12 26 22 10 Nirvisha 10

11. CLASSICS HAVE COMPREHENSIVELY MENTIONED ABOUT Characteristic features to identify snakes, symptoms of their poisoning, management of poisoning etc .

12. BIG FOUR Saw-scaled viper ( Echis carinatus ) Russell’s viper ( Daboia russelii ) Common krait (bungarus caeruleus) Indian cobra (Naja naja) Neurotoxic 20-30% 1 2 4 3 Majority of bites 70-80% hemotoxin / vasculotoxic

13. तत्र दर्वीकरा- कृष्णसर्पो, महाकृष्ण, कृष्णोदर, स्वेत्कपोतो, महाकपोतो, बलाहको, महासर्प, शङ्खकपोलो, लोहिताक्षो, गवेधुकः, परिसर्पः,खण्डफ़न्, ककुद्, पद्यो, महापद्यो, दर्भपुष्पो, दधिमुखः, पुण्डरीको, भ्रकुटिमुखो, विष्किर, पुष्पाभिकिर्णो, गिरिसर्प, हृजुसर्प, श्वेतोदरो, महाशिरा, अलगर्द, आशीविष इति ! सु.सु.४/३४ TYPES OF DARVIKARA SARPA

14. 1. Krishna sarpa 10. Gavedhuk 19. Bhrakutimukh 2. Mahakrishn 11. Parisarpa 20. Vishkir 3. Krishnodar 12. Khandfan 21. Pushpabhikirn 4. Shwetkapot 13. Kakud 22. Girisarpa 5. Mahakapot 14. Padhya 23. R ijusarpa 6. Balahak 15. Mahapadya 24. Swetodar 7. Mahasarpa 16. D arbhpushp 25. Mahashira 8. Shankhkapal 17.Dadhimukh 26.Algard,Ashivish 9. L ohitaksh 18.Tundrik TYPES OF DARVIKARA SARPA

15. रथाङ्गलाङ्गलच्छत्रस्वस्तिकाङ्कुशधारिणः | ज्ञेयादर्वीकराःसर्पाः फणिनःशीघ्रगामिनः || सु.क.४/२२ PHYSICAL APPEARANCE OF DARVIKARA SARPA

16. In general, these snakes Are ... H ooded Fast-moving Having marks of wheel Plough ( हल,मण्डल) Umbrella Swastika (Auspicious cross) Goad ( अन्कुश ) on the body.

17. These snakes are … More poisonous during day time ...दर्विकरास्तु तरुणा Darvikara are fatal in young stage of life. कोपयन्त्यनिलःजन्तोः फणिनः सर्व एवतु All hooded (Darvekara) snakes aggravate Vata. AGGRAVATING FACTORS

18. दर्वीकरविषेण त्वङ्नयननखदशनवदनमूत्रपुरीषदंशकृष्णत्वं रौक्ष्यं शिरसो गौरवं सन्धिवेदना कटीपृष्ठग्रीवादौर्बल्यं जृम्भणं वेपथुःस्वरावसादो घुर्घुरको जडता शुष्कोद्गारः कासश्वासौ हिक्का वायोरूर्ध्वगमनं शूलोद्वेष्टनं तृष्णा लालास्रावः फे ना गमनं स्रोतोऽवरोधस्ताश्च वातवेदना भवन्ति ; सु.क.४/३७ Poisons of Darvikara causes Blackness in skin Eyes , Nails , Teeth , Face , Urine and place of bite, roughness, heaviness of head, pain in joints, dullness, dry eructation, cough, dyspnoea, hiccough, upward movement of Vayu, cramp due to pain, thirst, salivation, emitting froth, obstruction in channels and different types of vatika pain. GENERAL SYMPTOMS OF DARVIKARA SARPA VISHA

19. दर्वीकराणांप्रथमेवेगे विषंशोणितंदूषयति,तत् प्रदुष्टंकृष्णतामुपैति,तेनकार्ष्ण्यं पिपीलिकापरिसर्पणमिवचाङ्गे भवति ; द्वितीये मांसं दूषयति , तेनात्यर्थं कृष्णता शोफो ग्रन्थयश्चाङ्गे भवन्ति ; तृतीयेमेदो दूषयति , तेनदंशक्लेदः शिरोगौरवं स्वेदश्चक्षुर्ग्रहणं च ; चतुर्थे कोष्ठमनुप्रविश्यकफप्रधानान्दोषान्दूषयति , तेन तन्द्राप्रसेकसन्धिविश्लेषाभवन्ति ; पञ्चमेऽस्थीन्यनुप्रविशति प्राणमग्निं च दूषयति,तेन पर्वभेदहिक्का दाहश्च भवति;षष्ठे मज्जानमनुप्रविशतिग्रहणीं चात्यर्थंदूषयति,तेनगात्राणां गौरवमतीसारोहृत्पीडा मूर्च्छा च भवति ; सप्तमे शुक्रमनुप्रविशति चात्यर्थं कोपयतिकफं च सूक्ष्मस्रोतोभ्यः प्रच्यावयति , तेन श्लेष्मवर्तिप्रादुर्भावः कटीपृष्ठभङ्गः सर्वचेष्टाविघातो लालास्वेदयोरतिप्रवृत्तिरुच्छ्वासनिरोधश्च भवति || सु.सु.४/३९ SPECIFIC SYMPTOMS OF DARVIKARA SARPA DAMSA

20. Vega Dushti Symptoms Prathama Rakhta Infects blood and manifests Paridaha (Burning sensation), कृष्णतामुपैति ( black discoloration) Dwitheeya Mamsa कृष्णाता शोफ़ो भवन्ति (black discoloration of body parts) , Tritheeya Meda Earlier symptoms & शिरोगौरवं दंसक्लेदः stiffness of eyes Chathurtha Kostha Pravesha कफ़प्रधान दोषदूषयति Drowsiness Salivation Looseness of joint

21. Vega Dushti Symptoms Panchama Bones/ asthi Vitiate prana and Agni Generalized pain, burning sensation, hiccough Shasta Majja Grahani Dushti (Impairs functions of GIT ), Atisara (Diarrhea), Hritpida (Cardiac Arrest), Murcha (Unconscious), Sapthama Shukra Pain in flanks and lumbar Arrests all functions Respiratory arrest

22. TREATMENT CAN BE VIEWED THROUGH ‘ CHATURVIMSHATI UPAKRAMAS ’ मन्त्रारिष्टोत्कर्तन निष्पीडनचूषणाग्नि परिषेकाः ! अवगाह रक्तमोक्ष्ण वमनविरेकोपधानानि !! ह्रुदयावरणाञ्जन नस्यधूमलेहौषधप्रशमनानि ! प्रतिसारणं प्रतिविषं संज्ञासंस्थापनं लेपः !! मृतसञ्जीवनमेव च विंशतिरेते चतुर्भिरधिकाः ! स्युरुपक्रमा यथा ये यत्र योज्याः श्रृणु तथा तान् !! च . चि . 23/25-27

23.   TREATMENT MEASURE PROBABLE COMPARISON 1 Mantram Chanting Mantras 2 Arishta bandhanam Application of Tourniquet 3 Utkartanam Incision over the bite excluding vital points 4 Nishpeedanam Compression 5 Achushanam Sucking through the site 6 Agni Thermal cauterisation 7 Parishekam Sprinkling water 8 Avagaham Water bath 9 Rakta mokshana Blood letting 10 Vamana Emesis 11 Virekam Purgation 12 Upadhanam Medication on incised scalp 13 Hrudayavaranam Protection of heart 14 Anjanam Medicated collyrium

24.   TREATMENT MEASURE PROBABLE COMPARISON 15 Nasya Medicated nasal insufflations 16 Dhumam Medicated smoking 17 Leham Medicated linctuses 18 Aushadham Anti-poisonous drugs 19 Pradhamanam Medicated snuffing 20 Pratisaranam Local applications 21 Prativisham Specific antidotes 22 Sajna Samstapanam Resuscitation 23 Lepam Application of Medicated pastes 24 Mruta Sanjeevanam Revivation

25. Charaka emphasized NOT TO FOLLOW all these 24 UPAKRAMAS in all cases of poisonings. A wise physician has to examine and decide justifiable procedures for specific condition.

26. USEFULNESS OF THESE UPAKRAMAS Different Upakramas may be helpful in different ways. Are to be applied / used appropriately. THESE MAY BE HELPFUL .. Example from 24 Upakramas .. in restricting the entry of the poison into the systemic circulation Arista Bandhana , Utkartana , Chushana etc .. to eliminate the poison form body Rakta Mokshana , Vamana , Virechana etc .. to counteract the poisons (Anti-dot activity) Leha , Aushadha , Prativisha etc .. as supportive / symptomatic measures Samjnasthapana , Mrita sanjivana etc .. as topical applications Anjana , Pratisarana etc

27. सिन्दुवारक मूलानि रसेन स्वेन् पेषयते ! मधुयुक्त तोयमगद पानं दर्वीकृतां विषे सिन्दुवारक मूलानि स्वेता च गिरिकर्णिका !! पानं दर्विकरे दष्टे नस्यं मधु सापकलम ! अ.स.उ.४२/२६-३० 1- Root of सिन्दुवारक macerated in its own juice added with madhu for पान 2- R oot of सिन्दुवारक and swetha गिरिकर्णिका made into paste with water and consumed. 3- for नस्य the juice of कुष्ठ with मधु can use. 4-In the case of black cobra bite,blood letting is done and paste of charti and nakuli applied 5-Drink prepared out of ghee, honey, manjishta , and griha-dhum DARVEKARA SARPA DAMSA VISHESHA CHIKITSA

28. VEGANUSARA VISHA CHIKITSA Vega Dushti Chikitsa Prathama Raka Dushti Raktamokshana by sira vedhana Dwitiya Mamsa Dushti Madhu , Ghrita and Yavagu Pana Tritiya Medo Dushti Teekshna Virechana , Yavagu Pana Chaturtha Kostha Pravesha Vamana , Yavagu Pana Panchama Asthi pravesha Sheetalopachara, Virechana , and Yavagu Pana Shashtha Majja Dushti Sheetalopachara, Virechana , and Yavagu Pana Saptama Shukra Dushti Tikshna anjana , nasya , kakpada shaped incision on the scalp and application of blood mixed flesh over the incision

29. लेपन योग External application of HINGU , MARICHA , VACHA ground in the juice of KIMSUKA BARK on the bite mark subsides darvikara visha. Lepa with tankana and grihadhooma ground in urine. Lepana with paste of lasuna, maricha, ardraka and pippali ground in the juice of arkapatra. FEW YOGAS

30. I nternal administration of trikatu equal amount of pippali , maricha & sringavera with kanji or water nullifies all visha. Intake of paste of Ashwagandha with pure water. Mixed paste of guduchi and kola(piper cubeba). Oral administration of shirisha flower and seed of arka and equal amount of vyosha is ground in arka kshira. पान योग

31. Saindhava ground in the juice of tambula patra and dhatura patra is used as nasya in unconscious poisoned person. Nasya with swarasa of tulasi & dronapushpi with maricha. Nasya with hingu maricha & saindhav in human urine or tulasi swarasa . नस्य प्रयोग

32. महागदा Trivrt visalya , madhuka , haridra , daruharidra , rakta manjistha , aragvadha and the group of salts and trikatu -these should be powdered finely, mixed with honey and preserved in a horn. This anti-poisonous formulation destroys poison used as intake. This is known as MAHAGADA as it has great power.

33. It is prepared by grinding the fine powder of vidanga,patha , triphala ajamoda , hingu , tagara , trikatu,chitraka and pancha lavana with honey into a fine paste and kept covering with the lid of same material अजितागदा

34. COMMON COBRA The name "cobra" is short for cobra-de- capelo , which is uses for " snake with hood", or "hood-snake" Zoological name- Naja naja Latin name-naja tripudians King cobra- राज नाग, राज सर्प/ Naja bangarus ,Ohiophagus hannah Common name- नाग ( Hindi ), Moorkan ( Malayalam ) Nagara Havu ( Kannada ) Family - Elapidae Venom- neurotoxic Common cobras are usually brown or black in color Hood is present. Dorsal aspect of hood may have monocellate or binocellate mark Ventral surface of hood have two dark spot MODERN ASPECT

35. THE COBRA RANGE

36. CHARACTER OF COBRA & KING COBRA Are Cobras aggressive? Most cobras are shy, and will usually run and hide when people are around. The exception is King Cobra, who is aggressive and will rear up and stand his ground when confronted . What unique power do they have ? This is one of those supernatural cobra facts that Cobras are the only snake in the world that can spit their venom, and they are accurate up to about half their own length How powerful is their Venom ? Cobras venom is not the strongest there is , but cobras can inject so much venom in a single bite that they can kill an elephant . Are they poisonous ? Cobras are not POISONOUS , they are VENOMOUS . This means that even though they have deadly venom in their sacs Are they great parents? King Cobras are the only snake in the world that build a nest for their young, just like a bird, but on the ground !

37. Can they hear ? Cobras can hear, although they sense sound through contact with the ground much better than humans. How old do they get ? Cobras typically live up to 20 years or more, when they’re in the wild . Do they eat their own? King Cobras, known also as the Ohiophagus hannah, eat other snakes! The Latin word for “snake-eater” is ophiophagus . How Long are they? King Cobras are the longest venomous snake in the world! The average male grows 18 feet long, and some have been known to grow more than 20 feet long . All toxic snakes are venomous and not poisonous, well all of them except one The Asian TIGER SNAKE is both poisonous and venomous

38. The cobra is greatly respected and feared and has its own place in Hindu mythology as a powerful deity The Hindu god SHIVA is often depicted with a cobra coiled around his neck VISHNU is usually portrayed as reclining on the coiled body of ADISHESHA Cobras are also worshipped during the Hindu festival of NAG PANCHAMI HINDUISM

39. SPITTING COBRA

40. Snakes by nature are timid and they bite humans, birds or other animals for the following reasons… For food By fear Being touched by the feet Accumulation of more venom Anger By hatred FACTORS INFLUENCING SNAKE BITES

41. The Indian cobra's venom mainly contains a powerful post-synaptic neurotoxin and cardiotoxin The venom acts on the synaptic gaps of the nerves , thereby paralyzing muscles , and in severe bites leading to respiratory failure or cardiac arrest . The venom components include enzymes such as hyaluronidase that cause lysis and increase the spread of the venom . The venom of cobra is mainly made up of proteins and polypeptides of neurotoxins and cardio-toxins VENOM

42. FATAL DOSE AND PERIOD AND AMOUNT OF VENOM INJECTED PER BITE Snake Fatal dose Amount of venom injected per bite Fatal period Cobra 12mg of dried venom 200-300mg 20min to 6 hour Krait 6mg of dried venom 20-22mg Russel viper 15 mg of dried venom 150-200mg 1-2 days Saw scaled viper 8mg of dried venom 25 mg

43. Systemic features Pre-paralytic stage - characterized by vomiting, headache, giddiness, weakness, lethargy Paralytic stage – ptosis, opthalmoplegia, drowsiness, dysartheria, convulsion, bulbar paralysis, respiratory failure, coma, cardiac arrest, Local features Symptoms start within 6-8 min Sleepy , intoxicated Nausea and vomiting Fang marks Burning pain, excessive salivation Swelling and discoloration sometimes associated with some blisters. COBRA BITE LOCAL AND SYSTEMIC FEATURES

44. COBRA BITE

45. TREATMENT

46. Don’t Cauterization should never be attempted in viper bites Avoid alcohol for both internal and external use Hot, chilli, sour , salt, oil, fruits , tubers, meat, fish, intercourse should be avoided Do Site of bite is irrigated with water or ones own urine. Assure the patient Tourniquet is applied 2-3 inch above the bite mark Poison is sucked out to minimize the poison level in the body Never allow the patient to sleep Cauterization only in the initial 1-2 min. poison gets neutralized at 100c GENERAL MEASURES IN SNAKE BITE TREATMENT

47. While there is no general agreement or standard therapeutic measures and modalities for snake poison, the following principles are widely accepted methods for therapy… Allaying the anxiety and fear Prevention of spread of venom Hospitalisation Use of anti-venom and other anti toxic therapies General measures

48. Blood Complete blood count Blood group and cross-matching 20 min whole blood clotting test(20 WBCT) Blood gas analysis Liver Liver function test Kidney Kidney function test ECG Chest x-ray LABORATORY INVESTIGATION

49. Most of the deaths are due to shock rather than poison. It is always advised to re-assure the patient by following points … All the snakes are not poisonous Poisons snakes are not fully charged Even it is charged with poison, it cannot always inject lethal dose ALLAYING THE ANXIETY AND FEAR

50. Keep the patient warm calm and restful Non sedating, non salicylate analgesic (paracetamol) is the best Broad, sterile, firm bandage on the area of the bite and on the limb In the case of bite on the trunk, head or neck, firm pressure over the bitten area If bite is on extremity, firm ligature is applied few inches above the site of the bite. The ligature is loosened for 90 sec once in every 10 min Limb immobilizing to prevent spread of venom Cross incision of 1cm long and 1/2cm deep over each mark is made and the blood and lymph are drained Draining is continued until anti venom is administered PREVENTION OF SPREAD OF VENOM

51. Any interference with the bite wound may introduce absorption of venom and increase local bleeding Washing increases the flow of venom into the system by stimulating the lymphatic system AVOID MANIPULATION..

52. Anti snake venom should not be administered as a routine measure. It should be carefully and selectively given as it leads serious allergic reactions Indications for antivenom administration are… In coaguable blood Spontaneous systemic bleeding Hypotension Neurotoxic or myotoxic features Expanding local swelling Tender regional lymph node ANTI –VENOM TREATMENT

53. Before administration the anti snake venom should be tested sub cutaneous as it produces serious anaphylactic reaction in sensitive persons DOSE Cobra -5-20 ampoules The anti venom powder is dissolved in distilled water or normal saline and administered in appropriate dose as infusion in 500 ml of normal saline at a rate of 15-20 drops per minute. Flow should be completed in 1-2 hour so that further dose can be repeated, if required(every 6 hour) It is useful if given within 4 hour of bite METHOD OF ADMINISTRATION

54. There is no absolute contraindication to ASV ASV should not be used indiscriminately because it carries a risk of severe adverse reaction Patients must be closely observed for at least 1 hour after starting IV antivenom so early anaphylactic shock can be detected CONTRAINDICATIONS

55. Poisoning is usually accidental Rarely homicidal or suicidal Cattle are sometimes poisoned by snake venom MEDICO-LEGAL ASPECTS

56. Evidence of fang marks, local swelling, discoloration, blister formation, bleeding Bleeding diathesis Froth at mouth and nostrils Pulmonary oedema Congested organs Cellulitis around the bite mark Venous clots POST MORTEM APPEARANCE

57. DISCUSSION Immobilising and transporting snakebite victims to the hospital and prompt administration of anti-snake venom remain the best way to reduce morbidity and mortality. It is also important to practice correct first aid measures, as otherwise they may cause more harm than good.

58. CONCLUSION Treatment modalities have their own significance in neutralizing the poison in different ways. Chaturvimshati Upakramas can be used judiciously even in case of DARVEKARA Visha. Application of Tourniquet also has certain limitations in case of DARVEKARA Visha (cobra poisoning) considering the danger of increasing the local effects of the necrotic venom .

59. E vidences are available regarding the clinical efficacy or anti-venom activity of the formulations mentioned for the treatment of DARVEKARA Visha . Though there is certain ambiguity in the approach as compared to modern medical science; the treatment modalities emphasized in Ayurveda have a great significance and are valuable particularly in remote areas, where medical facilities are meager.

60. REFERENCES Charaka Samhita chikitsasthana Sushruta Samhita kalpasthana Ashtanga hrudaya U ttaratantra Ashtanga Samgraha Uttaratantra Review of forensic medicine & toxicology Illustrated Agada Tantra Vishavaidya Jyotsnika Internet

61. Thank you