Management of poisons _101004_091241.pptx

Types of poison, it's types,treatment

1. Management of poison (विष चिकित्सा) ,चतुर्विशति विषोपक्रम

2. Department of agad tantra Dr. Babita verma ( Associate professor ) Dr. kuber giri Dr. pooja singh Dr. Deboleena PRESENTED BY – AKSHAT DUBEY ALEENA YUSUF BATCH ( 2021 – 22)

3. In modern toxicology it has six steps -:

4. Resuscitation

5. REVIVAL The first step is to revive or resuscitate patient by checking the working of vital organs. Maintenance of cardiac activity and blood circulation. If signs of respiratory failure are evident then artificial respiration should be restored. In case of unconscious patient and when his cough reflexes are ceased a cuffed endotracheal tube should be inserted.

6. VENTILLATION T he crowd around the patient should be cleared and appropriate ventilation of room should be done by opening the windows and doors. The clothes of the patient should be loosened Arterial blood gas should be analysed

7. TREATMENT OF HYPOTENSION Systolic blood pressure should nor fall below 90mmHg . Check blood pressure and pulse rate and rhythm. To enhance renal blood flow, if required dopamine, norepinephrine should be used Beginning of the intravenous infusion.

8. REMOVAL OF THE UNABSORBED POISON The rate of absorption depends on the route of administration. Certain time frame is required for the body to get absorbed in the body, so this process should be done before there absorption. route of poison - 1. tropical poison 2. inhaled poison 3. injected poison 4. ingested poison

9. CONTACT POISON – Washing the area with soap Use of specific antidote INHALED POISON – Shifting the patient to fresh air Artificial respiration and oxygenation . INJECTED POISON – Application of tourniquet near the site of injection. Application of ice pack. Incision and suction . INGESTED POISON – Induction of vomiting or purgation. Gastric lavage

10. Use of antidote Antidotes are the substances that counter attack or neutralizes the effects of poison. Types of antidotes – 1. mechanical or physical antidote 2. chemical antidotes 3. physiological antidotes 4. universal antidotes

11. MECHANICAL OR PHYSICAL ANTIDOTE – Bulky food articles Demulcents Activated charcoal CHEMICAL ANTIDOTES – Weak alkali magnesium oxides for acids. Weak acetic acid or vinegar for alkalis. Lime for oxalic acid. Potassium permanganate for various poisons.

12. PHYSIOLOGICAL OR PHARMACOLOGICAL ANTIDOTE – Naloxone in the poisoning of opoids . Use of BAL ( british anti lewisite ) in arsenic and mercury poisoning. Desferrioxamine in the poisoning of iron Pencillamine in the poisoning of copper. Sodium nitrate in the poisoning of poisoning of cyanide. UNIVERSAL ANTIDOTE – Charcoal ( 2 parts ) + magnesium oxide ( 1 part) + tannic acid ( 1 part )

13. Elimination of absorbed poison If more than six hours has passes from the time of poison then elimination is done. FORCED DIURESIS ( poisoning of barbiturates) PERITONIAL DIALYSIS ( salicylate poisoning among children ) HEMODIALYSIS ( for elimination of barbiturates, boric acid, methyl alcohol from blood )

14. Symptomatic treatment For pain relief – morphine For respiratory failure – artificial respiration and oxygen therpy For fall in blood pressure – cardio stimulants For pyrexia – antipyretic drugs Constipation – purgative For dehydration – fluids For convulsion – barbiturates To enhance peripheral circulation adrenaline and nor adrenaline should be given by drip method

15. maintenANCE OF GENERAL HEALTH Body temperature, functioning of various organ, strength and consciousness should be reassessed at regular intervals. Optimum nursing care, psychological support and medical management. After recovery from poisoning the patient should be counselled for optimistic attitude towards life. After recovery in suicidal poisoning cases the patient should be put to psychiatric counselling under the guidance of expert psychiatrist and the patient should only be discharged only after the approval of psychiatric in charge.

16. Vishopakrama CHATURVIMSHATI UPAKRAMA

17. CHARAKOKTA UPAKRAMA मन्त्रारिष्टोत्कर्तननिष्पीडनचूषणाग्निपरिषेकाः | अवगाहरक्तमोक्षणवमनविरेकोपधानानि ||३५ || हृदयावरणाञ्जननस्यधूमलेहौषधप्रशमनानि [२७] | प्रतिसारणं प्रतिविषं सञ्जासंस्थानपनं लेपः ||३६ || मृतसञ्जीवनमेव च विंशतिरेते चतुर्भिरधिकाः | स्युरुपक्रमा यथा ये यत्र योज्याः शृणु तथा तान् ||३७||

18. 1 . Mantra. 14 . Anjana 2. Arista Bandhan 15 . Nasya 3. Utkartana 16. D hoom 4. Nispidana 17. leha 5. Chusana 18. aushadh a 6. Agnikarma 19. prashman 7. Pariseka 20 pratisarana 8. Avagaaha 21. sangyasthapana 9. Raktamoxana 22. lepa 10. Vamana 23. mritsanjeevna 11. Virechana 12. Upadhaana 13. hridyavrana

19. Mantra MANTRAS – are words/short sentence recited in a well rhythmic & prescribed manner, are full of divine power &energy . The right and systematic chanting of mantras have a collective effect on the mind which ultimately commands our body . With the help of that healing power or positive energy in person is stimulated. Due to this, poison is eliminated from the system quicker than medicine.

20. Arishta bandhana सर्वैरवादितः सर्वैः शाखादष्टस्य देहिनः | दंशस्योपरि बध्नीयादरिष्टाश्चत्रङ्गले ||३|| प्लोतचर्मान्तवल्कानां मृदुनाऽन्यतमेन वै । न गच्छति विषं देहमरिष्टाभिर्निवारितम् ||४|| Su Ka 5 In all kind of snake bite to the lower and upper limbs a ligature/ torniquet has to be tied 4 angula above the site of bite . Materials : Plota (Cloth), Carmanta (leather), valkala ( Vruksha twak ) Soft materials If ligature is tied the visha cannot progress above the ligature.

21. Arishta means unfavorable or which gives the indication of death. When the intensity of poison increases it signifies the Arishta . As poison mix with blood it gets spread all over the body invading the other organs . Thus , to prevent fatal consequences the physician has to stop its spreading by applying BANDHANA (Ligature/ tourniquet) as it resists the Arishta Nature of Ligature should be According to site it has to be tied It should not be too tight or too loose . And should be tied within 100 matra kaala from bite .

22. Types of Arista bandhana

23. Utkartana Incision at the bite site is known as Utkartan . Incision when it is done within 5-10 min after bite is an effective but that incision must be parallel to fang marks, about 1 cm long & no deeper than 3mm in the long axis of the limb मात्राशतं विषं स्थित्वा दंशे दष्टस्य देहिनः । देहं प्रक्रमते धातून् रुधिरादीन् प्रदूषयत् ।। एतस्मिन्नन्तरे कर्म दंशस्योत्कर्तनादिकम् । कुर्याच्छीघ्रं यथा देहे विषवल्ली न रोहति ।। ... अ.सं.उ . ४२/२ Visha stays for 100 matra kaala at the site of bite After that it spreads to all dhatus and vitiates them . Within 100 matra kaala one has to perform utkartanadi chikitsa modalities .

24. Nishpidana Nishpidana means to squeeze out the locally entered venom along with blood depending on the accessibility of body part. But this should be done more precisely on Marma & Joints. Its purpose is to stop the spreading of venom from the bite into the circulation

25. Chushana Sucking of blood through mouth is known as Chushan Through these the visha which is spread nearby the site of bite, gets removed along with the blood & further the visha does not get spread in the body . It should always be done by the person who do not have any ulcers or wound in their mouth. Before suction a person should always apply ghee in their mouth .

26. AGNIKARMA It means to burn the site of poison. In modern it is known as cauterization. When the bite is on the part of the body that can be subjected to arishtabandhan in that case agnikarma is applied. It is mainly done by gold or iron shlaka . This destroys some tissues in an attempts to mitigate damage, removed an undesired growth or minimize infection when antibiotics are not available.

27. PARISHEKA It is the method of sprinkling medicated decoction over the site of bite. Decoction prepared by Chandana ( Santalum album) and Usheera ( Vetivera zizanoides ) is used for parisheka . Visha vega is prevented by using cold decoction. It helps in keeping the patient awake. In Viper bite, the commonly practiced dhara is Panch avalkala kwatha dhara . In Cobra bite Grtha saindhava dhara is used

28. AVAGAHAN Avagahan means immersion or dipping the affected part in the medicated decoction or oil . As per modern terminology it is known as immersion bath. They help in proper circulation and eliminates toxic matter from the body .

29. RAKTMOKSHANA Raktamokshana i.e. Bloodletting eliminates the poison from the blood as the blood is the major media which blow up the poison . Raktamokshan should be speedily restored in the case where the poisoned area has become discolored , rigid, swollen & painful . It should be performed by scraping, application of horns, leech.

30. VAMANA ( Emesis ) It the method of induced vomiting. in Kaphaja bites, associated with excessive salivation, in sheetkala it shoul d be done with tikshna vamana yoga. In modern it can be related with stomach wash .

31. VIRECHANA It is the method of inducing purgation. It is indicated in burning sensation, pain and obstruction of urine, in pitta prakrithi . Purgation is induced by giving Neelini choorna ( Indigofera tinctoria ) with milk, Trivrit choorna ( Operculina turpethum ) along with Triphala kwatha .

32. UPADHANA Upadhana is a special procedure in which medicine is applied over the incised scalp. This treatment is to be done if the patient is having asadhya lakshana . After making incision like crow’s feet on the forehead of the patient raktamokshan is done and then bilwa kalk is applied over incised area.

33. 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. In previous times honey and ghrit were administered or swarnagairik with water was given. Others – gomayras , ikshu ,

34. 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) . If there is any obstruction in netra then Anjana should be done using Devadaaru ( Cedrus deodara ), Shunthi ( Zingiber officianale ), Maricha , (Piper nigram ) Pippali (Piper longum ), Haridra (Curcuma longa), Karaveera , ( Nerium indicum ) Karanja ( Pongamia pinnatta ) Nimba flowers ( Azadirachta indica ) and Tulasi ( Ocimum santum ) are made into pishti using goat’s urine. Commonly practiced yoga are Bilvadi gulika with Tulasi pathra swarasa in all types of poison.

35. NASYA Nasal medications are given in the form of liquids or fine powders It is the instillation of medicine in the nose. If poison enters the head, nasya is said to be the main line of treatment. According to Charaka if there is obstruction in nose, eyes, ear, tongue, throat , nasya should be done . Different combinations are used for Nasya karma like Bharngi mula ( Clerodendrum serratum ), Tulsi ( Ocimum santum ) .

36. DHOOMA DHOOPANA ( Fumigation) It is the procedure, wherein medicated smoke is used for the purpose of fumigation and this helps to nullify the adverse effect of the poison . Ex. Nrikeshadhi dhoopana for Keeta visha (insect poisoning) Anti-toxic material that is emitted from the smoke enters the body and clears the channels of circulation and nullify the toxic effects of poison.

37. LEHA It is the preparation of medicine in linctus form . Lehyas are used, to prevent the drying of throat, palate by visha . Sharkara ( Jaggery ) and Madhu (Honey) should be given with Swarna bhasma and is used as sarva visha prashamana leha ”.

38. A USHADHA Internal medicine for the treatment of visha are explained. Some examples for aushadha yogas - are mrthasanjivani agada , gandhahasthi agada , dhumagada , kshara agada , pancha sirisha agada , etc . Commonly practiced aushada yogas : In cobra bite15 ml of Maha kalyanaka grtha , 10 ml honey, Vilvadi gutika can be given.3-5 minute, later Jeevaraksha gutika along with milk is given. In viper bite decoction of Patoladhi gana and Vilvadi gutika are given as primary medication. In case of haematuria, Taruna bhaskara gutika and tender coconut is useful. In insect bite, Dasanga agada is usually prescribed.

39. PRADHAMANA Blowing up of medicated powders into the nose or on the site of the bite is called as Prdhamana . When the medicated powder is blown into the nose it gets spread through the respiratory passage into the body by which the spreading of poison is reduced & this is one of the preventative measures to reduce spread of poison . The powders of medicine like Katuki , trikatu , Katphala should be blown up into the persons nostrils to reduce the spreading of the poison .

40. PRATISARANA PRATHISARANA or (Rubbing ) It is a method of applying or rubbing the infected area with medicated powders . It is indicated in Raktamokshana when blood fails to come out. Drugs used are Trikatu ( Zingiber officinale , Piper longum , Piper nigrum ) Gruhadooma (soot), Haridra (Curcuma longa), etc Prathisarana increases the flow of blood or body fluids . The medicated powder absorbs excess moisture, reduces itching, irritation, cools the skin.

41. PRATIVISHA (COUNTERPOISON) Substances used to treat poison is named as Prativisha . It is indicated if the visha vega in between 5 th and 7 th vega . 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 .

42. SANgyaSTHAPANA It is the method of regaining consciousness. In 6 th visha vega sangyasthapana chikitsa is to be done . It is attained by pana of gopitta along with haridra (Curcuma longa), manjishta , ( Rubia cordifolia ), maricha (Piper nigrum ), pippali churna . (Piper longum )

43. LEPA It is the method of applying medicated paste at the site of bite . If a pitta prakrithi person suffers from thirst, unconsciousness, then sheethala lepa should done . After Raktamokshana for the removal of residual poison lepa should be applied at the site of bite . Commonly practiced lepa is Sigru punarnavadi lepa in allergy caused by viper bite. Bilvadigulika and Dasanga lepa is used in insect poisoning”.

44. MRITASANJEEVANAM Just as amrita gives life even to the dead person, in the same way mrthasanjeevani can be used in all cases of visha . Charaka explains a formulation named as Mrthasanjeevani agada which is in the form of gutika . This cures all types of visha . This agada is used for resuscitation, when the patient is apparently dead, but life energy remains hidden in the body ”. In today’s time it is totally extinct.