Madatyaya - alcoholism

alcoholism in ayurveda

1. MADATYAYA PRESENTED BY- DR. GOPENDRA CHANDRA KAMAL PG-2 ND YEAR GUIDED BY- DR. ASHWINI KUMAR S. BHARATI PROFESSOR DEPARTMENT OF AGADA TANTRA, SDM COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN 1

2. CONTENTS- INTRODUCTION ACUTE ALCOHOLISM/ STAGES OF MADA CHRONIC ALCOHOLISM/ MADATAYAYA WITHDRAWL SYMPTOMS DRUNKENNESS DRUNK DRIVING TREATMENT CASE STUDY ARTICLE DISCUSSION CONCLUSION 2

3. INTRODUCTION MADYA- T he Dravya which vitiates the buddhi and causes Mada, such dravyas are tamo guna pradhana and hence called as madya or madakari which is available in the form of Asava, Arishta, Sura, Varuni, Sithu .- (Sha. Sa. P.kh-6) ALCOHOL- The term alcohol originally refers to ethanol , the predominant alcohol in alcoholic beverages. It is classed as a CNS Depressant. 3

4. GUNAS OF MADA VS OJAS- Laghu -------------------------- Guru Ushna -------------------------- Sheeta Amla -------------------------- Madhura Teekshna -----------------------Mridu Aashuga-------------------------- Prasanna Rooksha-------------------------Snigdha Vyavayi --------------------------Sthira Vikasi -------------------------- shlakshna Visada -------------------------- Picchila Sukshma-------------------------bahala Ch . Chi- 24/30-31 4

5. ALCOHOL CONTENT IN BEVERAGES Spirits (whisky, brandy, rum, gin, vodka)- 35-50% Wine- 10-15% Champagne- 10-13% Beers 4-8% 5

6. ALCOHOLISM IN INDIA About 30% of indian consumes alcohol regularly. An individual consumption of alcohol per year in India is -4.3 litres. 1 death every 96 minutes occur in India due to alcohol. Supreme court has banned the sale of alcohol within 500 meters of national highway. 6

7. STAGES OF MADA/ ACUTE ALCOHOLISM STAGES LAKSHANAS (Su.Ut. 47/11-12) ) BEHAVIOURAL CO-RELATES OJAS AWASTHA (Ch. Chi. 24/37) BAC FIRST पूर्वे वीर्यरतिप्रीतिहर्षभाष्यादिवर्धनम् | STATE OF EXCITEMENT ओजस्यविहते पूर्वो हृदि च प्रतिबोधिते| 50-150 mg% SECOND प्रलापो मध्यमे मोहो युक्तायुक्तक्रियास्तथा | STATE OF IN-COORDINATION मध्यमो विहतेऽल्पे 150-250 mg% THIRD विसञ्ज्ञः पश्चिमे शेते नष्टकर्मक्रियागुणः | STATE OF COMA विहते तूत्तमो मदः| >250 mg% 7

8. STAGE OF EXCITEMENT- person is euphoric, action, speech and emotions are less restrained, increased confidence , low self-control, poor concentration, impaired judgement and memory . STAGE OF INCOORDINATION- person my become cheerful/ irritable / ill-tempered. I ncoordination of fine and skilled movements, alteration in speech, nausea, vomiting, flushed face, rapid pulse, hypothermia, breath smells of alcohol, pupil dilated. STAGE OF COMA- thick, slurred speech, becomes giddy, stagger and fall, rapid pulse, hypothermia, pupils contracted, McEwan’s sign positive. 8

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11. RECOVERY is the rule unless large quantity of alcohol is consumed within a short time. About 35% drinkers may experience a blackout. With recovery, coma gradually lightens up into deep sleep followed by alcohol hangover (depression of mood, nausea, headache). I f victim does not return from coma within 5 hour, prognosis is bad and may result in death from shock, respiratory centre depression or aspiration . 11

12. FATAL DOSE - 150- 250 ML consumed within 1 hour. Death is typical if the BAC is between 300- 400 mg/dl FATAL PERIOD- 12- 24 HOUR 12

13. TREATMENT FOR ACUTE ALCOHOLISM Patient must be kept warm to treat hypothermia. Patient made to lie on side to prevent aspiration. Gastric lavage with alkaline solution within 2 hours of ingestion. One litre of normal saline or 10% glucose with 15 unit insulin to check hypoglycaemia. Thiamine 100 mg to prevent neuropathy. Respiratory support. D ialysis may be required. 13

14. CHRONIC ALCOHOLISM/ MADATYAYA मदेनात्ययो मदात्ययः - A.SA.NI.6 Excess intake of madya may cause excess excitement which is madatyaya. One should consider the anna, pana, vaya, vyadhi, bala, kala, three dosas(vata, pitta , kapha) and three types of manas - satwa , rajas and tamas before taking madya. ( Ch.Chi. 24/68 ) 14

15. Ch. Chi.24/101-106 15

16. TYPES OF MADATYAYA- ACC TO CHARAKA - Ch. Chi.-24/89-97 DOSHAS NIDANAS LAKSHANAS VATA Indulges in stree, shoka, bhaya shrama, disturbed sleep and ruksha madya . Hikka, shwasa, kampa, parsva shula, prajagara, pralapa PITTA tikshna and ushna food tiksna and amla madya Trushna, daha, jwara, sweda, murcha, atisara, bhrama. KAPHA Intake of madhura, sneha, guda, day sleep and not properly fermented alcohol . Chardhi, arochaka, hrillasa, tandra , gaurava and sheeta. SANNIPATA Mixed nidana of tridoshas, effect will be as of visha, but not as powerful as visha . Mixed signs and symptoms, may cause death or leads to disease. 16

17. Ch. Chi. 24/201-202 17

18. ACC TO SUSHRUTA- Su. Ut. 47/17-21 TYPES LAKSHANAS PANAATYAYA VATA- Sthambha, angamarda, hrudaya graha, toda, kampa, shiroruja PITTA- Sweda, pralapa, mukhashosha, daha, murcha KAPHA- Vamathu , sheeta , kapha praseka SANNIPATA- Presence of all symptoms PARA MADA Ushma , guruta, Loss of taste sensation, Aruchi, Malamutra sanga, Trishna , Shiroruja and sandhibheda . PANAAJIRNA Adhmana, vomiting, sour taste sensation in mouth, daha- during digestion, pitta prakopa lakshana . PANAVIBHRAMA Hrudgatra toda, chardi, jwara, murcha, shiroruja, daha, Dvesha- towards sura and food. 18

19. SYSTEMIC EFFECT OF CHRONIC ALCOHOLISM- PHYSICAL- lack of personal hygiene, gastroenteritits, wasting, loss of appetite, neuropathy, sterility, impotency, cirrhosis, fatty changes in heart and liver, tremors, insomnia, intermittent infections. MENTAL - loss of memory and impaired power of judgement. MORAL- it manifests as crime, domestic violence, suicides. 19

20. 1 . DELIRIUM TREMENS- Clouding of consciousness with disorientation in time and space. Coarse muscular tremors of face, tongue and hands. Insomnia, loss of memory, agitation, ataxia. Tendency to commit suicide, homicide. Fever, sweating, hypertension and pupillary dilatation. 20

21. 2 . ALCOHOLIC HALLUCINOSIS 3. WERNICKE’S ENCEPHALOPATHY 4 . KORSAKOFF’S PSYCHOSIS 5. ALCOHOL PERIPHERAL NEUROPATHY 6. ALCOHOLIC PARANOIA 7. ALCOHOL SEIZURE 21

22. TREATMENT FOR CHRONIC ALCOHOLISM AND WITHDRAWL SYMPTOMS Withdrawal of alcoholic drinks. Ant abuse- Disulfiram Dose- 250-500 mg/day for 1-2 weeks followed by maintenance dose of 250 mg/day at bed time. Metronidazole Nutrients and vitamins. Thiamine 50-100 mg daily for a week. Diazepam 40-80 mg/ day in divided dose 22

23. DRUNKENNESS DRUNKENNESS – it is a condition which results from excessive intake of alcohol. Loss of self-control Inability to perform the duty Dangerous to himself and others. 23

24. Diagnosing a case of drunkenness-NYSTAGMUS TEST 24

25. Walk and turn test N ystagmus test One leg stand test Romberg test Finger nose test 25

26. BREATHALYZER TEST 26

27. DRUNK DRIVING Permissible BAC in India- 30 mg/dl According to Motor vehicles act 1988, punishment for up to BAC 60 mg/dl- First offence- 6 months imprisonment or fine Rs. 2000 or both Second offence within 3 years- imprisonment for 2 years and Rs 3000 fine. For BAC 60-150 mg/dl- imprisonment for 1 year and/or RS 4000 fine. If repeated within 3 years- imprisonment for 3 years and Rs. 8000 fine For BAC more than 150 mg/dl- imprisonment for 2 years and /or fine Rs.5000 If repeated , imprisonment for 4 years, fine of Rs. 10, 000 and cancellation of license. Age of possession of and consumption of beverages- 18-25 years. 27

28. GENERAL LINE OF TREATMENT सर्वं मदात्ययं विद्यात् त्रिदोषमधिकं तु यम् दोषं मदात्यये पश्येत् तस्यादौ प्रतिकारयेत् कफस्थानानुपूर्व्या च क्रिया कार्या मदात्यये पित्त मारुत पर्यन्तः प्रायेण हि मदात्ययः (च.चि.२४/१०७-१०८) All types of madatyaya are tridosaja. Treatment should be based on the dominant dosa. However, most of the time treatment is started for kapha dosa as pitta and vayu are manifested towards the end in most of the cases of madatyaya . 28

29. Justification for Giving Alcohol in Alcoholism The excessive intake of usna, tiksna madya causes vidagdha avastha of anna rasa. This turns to kshara rasa/ alkaline in stomach. To neutralize this, one needs amla rasa/ acid. And alcohol is best among those having amla rasa by virtue of the 14 properties ( 10 guna and madhura, kasaya, katu, tikta anurasa ). Ch. Chi 24/112-113 Also the dosas which have been aggravated by intake of madya, obstructs the vayu in srotas causing headache, bone pain and joint pain. This may be relieved on clearing the srotas. This requires amla rasa. Madya is suitable for this purpose. Ch. Chi 24/118 29

30. Ethanol is considered as antidote for methanol. It is given in case of alcohol poisoning ( methnol poisoning ) as it acts as competitive antagonist with methanol. Ethanol has higher affinity for alcohol dehydrogenase enzyme than methanol and hence prevent the formation of formaldehyde and formic acid. 30

31. PRACTICAL APPROACH SCREENING – ASSESMENT- TREATMENT SCREENING- CAGE QUESTIONAIRE Have you ever felt you needed to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning ( Eye-opener ) to steady your nerves or to get rid of a hangover? 31

32. ASSESSMENT INTOXICATION WITHDRAWL DEPENDENCE 32

33. TREATMENT FOR INTOXICATION If fit for Vamana - SADYO VAMANA with Yastimadhu Phanta and Saindhava Jala. If unfit for Shodhana – symptomatic treatment. Shamana Aushadhi – siro-pichu, panchakola phanta Kharjuraadi mantha Sreekhandasava, Draksharista . 33

34. TREATMENT FOR WITHDRAWL SANTARPANAJANYA CHIKITSA- Deepana , Pachana, Abhayanga, Takradhara U ses of anticraving agents. Use of medhya and sedative ayurvedic drugs. Shodhana therapy Satvavajaya chikitsa 34

35. TREATMENT FOR DEPENDENCE USE SEDATIVE DRUGS USES OF ANTI CRAVING SODHANA THERAPY- Deepana , Pachana , Takradhara, Abhayanga, Panchakarma Psychotherapy Motivational Counselling Group Counselling Bhayadarshana about the disease 35

36. SINGLE DRUGS USED BRAHMI ASWAGANDHA BHRINGARAJA KUSMANDA JATAMANSI SANKHPUSHPI MANDUKPARNI GUDUCHI 36

37. FORMULATIONS USED 37

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39. CASE STUDY Pt.name: XYZ Age-35 yrs. Sex: male. OP-001724 Presenting complaints : Pt. was brought by his friends with c/o generalized body ache, pain in the sides of chest, tremors, severe thirst, sweating with burning sensation, irrelevant talk. History of present illness:- k/c/o of alcoholic since 1 year. patient had consumed around 300-400ml of alcohol with out taking food since last 4 days. 39

40. Systemic examination : CNS: Conscious., partially oriented Vitals: BP: 118/70mmhg, PR: 88/min. A- reduced B- irregular M- mild burning sensation S- disturbed Diagnosis : PANATYAYA (Vatapitta pradhana) Treatment given : Ashwasana Shirodhara with Brahmi taila Kharjuradi mantha 100ml bd 2days. Mrudvikadi kashaya 20ml tid Ksheera pathya Result : Body ache, pain in the sides of chest, tremors- reduced Thirst, sweating ,burning sensation, irrelevant talk- relived 40

41. 40 diagnosed patients of madatyaya, aged between 16 – 70 years attending OPD of N.I.A Jaipur, were randomly selected and assigned into two groups. Vamana with Madana Phala yoga & Draksha kashaya followed by Astanga Lavana with dose 6 gram b.i.d & in control group vamana followed by placebo capsule b.i.d for duration of 1 month was given. Follow up was done for 2 months. Assessment done on the basis of self scoring symptoms based on subjective and objective parameters of Madatyaya. The study clearly showed that there is marked improvement in both group with added effect in group 1. Patients of Madatyaya is better treated with Vamana followed by Astangalavana as Shamana Oushadhi 41

42. Clinical researches done on Ashwagandhadyarishta shows its very good effect on Anxiety neurosis and its symptom like nervousness, palpitation, tremors, headache, anorexia, fatigue, irritability, lack of concentration, etc. As we know that all above symptoms are also seen in alcohol withdrawal. By this study we can conclude that Ashwagandhadyarishta is a good drug for treating Vataja Madatyaya patients and it also strengthens the chikitsa sutra or line of treatment given by Ayurvedic classics. 42

43. DISCUSSION In charaka samhita, we find madatyaya being discussed elaborately after visha chikitsa and before dvivraniya chikitsa. As properties of madya are same as those of visha and after taking madya , intoxicated person has high chance to get trauma and get wounds. A charya S ushruta has used the word panatyaya instead of madatyaya. And he has described it after description of murcha and before trisna. Mostly because madya is one of the reason for both murchha and trisna. I n most of the text ( V agbhatta, yogratnakara, madhava nidana, kashyap samhita) description of madatyaya comes along with description of bhrama, murcha, trisna , daha, krimi roga and visha. 43

44. Gunas of madya are similar to those of visha , however less potent. Acharya C haraka and Acharya V agbhatta has considered “amla” as one of the property of madya. Panatyaya is acute alcoholism. Paramada is immediate effect after the paka of mada leading to slesmaadhikya. Paanajirna occurs if madya is not digested. Panavibhranma is chronic alcoholism . 44

45. CONCLUSION Madatyaya is a disease affecting annavaha, rasavaha and manovaha srotas predominantly. When used appropriately, madya acts as fortune drink giving pleasure to all the sense organs. However, excessive and improper intake of madya affects the ojas by virtue of opposite gunas and hence cause disease like madatyaya which has physical, mental and social effects. 45

46. REFERENCE Gautam Biswas. Review of forensic medicine and Toxicology. 3rd edition, New Delhi:jaypee Brothers Medical Publishers (p)Ltd.;2015 K.S . Reddy. The Essentials of Forensic Medicine and Toxicology.26th edition, hyderabad;2007 Charak samhita Sushruta samhita Astanga hridaya Rajmane NM, Wali DS, Kadam AA. International Journal of Applied Ayurveda Research ISSN: 2347-6362 MADATYAYA (ALCOHOL INTOXICATION) A REVIEW . www.googlescholar.com 46

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