|Year : 2016 | Volume
| Issue : 4 | Page : 245-248
Snake bite treatment in Prayoga samuccayam
Ittoop Jacob Ancheril, T Sharanesh, K Naveen, V Deepthi
Department of Post Graduate Studies and Research in Agada Tantra, Parassinikkadavu Ayurveda Medical College, Kannur, Kerala, India
|Date of Web Publication||10-Aug-2016|
Ittoop Jacob Ancheril
Department of Post Graduate Studies and Research in Agada Tantra, Parassinikkadavu Ayurveda Medical College, Kannur, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ancheril IJ, Sharanesh T, Naveen K, Deepthi V. Snake bite treatment in Prayoga samuccayam. Ancient Sci Life 2016;35:245-8
Editor: Kochunny Thampuran
Year of Publication: 1999
ISBN: SB 22 1299-.2000
Binding: Paper Back
Published by: Sulabha Books, Thrissur
| Introduction|| |
Kerala has a rich tradition in Ayurveda, especially in Pancakarma treatment. Apart from this, there are certain other branches of Ayurveda which were popular and well developed. One of them is viṣa cikitsā (Toxicology) and others are Netra cikitsā (Ophthalmology), Bāla cikitsā (Paediatrics) and Marma vijnāna (Orthopedics). Enough literature is available on these subjects in Malayalam language. Kriyākaumudi,  Jyotsnikā and Viṣa Nārāyaṇīyam are popular works in the domain of toxicology. Here, we attempt to highlight the importance of Prayoga samuccayam , a famous book on toxicology.
| About the Book and Author|| |
Prayoga samuccayam is one of the most popular and widely practised book in toxicology in Malayalam. Prayoga samuccayam was written in the Malayalam era 1110, which is 1934 – 35 CE. It was published by Sriramavilasam press and book depot, Quilon and was printed at Srikrishna press. A revised edition was published in 1970. The author of the work is Kochunni Thampuran who was a member of the erstwhile Royal Cochin dynasty. He was born at Trichur and brought up at Trippunithura, Kochi. His teacher was Kochunni Valya Thampuran who was a famous toxicologist. Kokkara Namboodiri who was the teacher of Kochunni Valya Thampuran was an eminent toxicologist who was a master of dūta lakṣaṇa (features of informer). He is said to be capable of preparing the appropriate medicines for the victim even before the patient reached him based on astrological calculations alone.
| Contents of the Book|| |
The book is divided into 11 chapters (paricchedas). The first chapter starts with salutations to the favourite Gods - Pūrṇatrayīśa (Viṣṇu), Vaḍakkumnātha (Śiva), Dhanvantari , Bhadrakālī , the Maharaja of Kochi; his teacher, Kochunni Valya Thampuran and Garuḍa. The work classifies viṣa into two groups, viz. sthāvara and jañgama (animate and inanimate). This is followed by a brief description of the origin of snakes. A mythological story is narrated in this context. It is said that in the beginning, there were only 8 snakes, ananta, guḻika, vāsuki, śaṅkhapālaka, takṣaka, mahāpadma, padma and karkoṭaka and that all other snakes originated from these.
| Description of the Snake Life-Cycle as Per Prayoga Samuccayam|| |
Snakes conceive in the three months beginning with the karkiḍaka month (August – September) of the Malayalam calendar. After 4 months of gestation, they lay eggs, 21 in all, seven each in three different places. According to the colour of eggs, red will hatch into females, yellow into males and mixed colour will be napuṃsaka (hermaphrodite). According to the month in which they hatch, their characters differ. In that, the snakes born in caitra month (March- April) will have evil habits, those in dhanu (Dec- Jan) month will be strong and energetic, the ones in makara (Jan- Feb) month will be more poisonous than others. Snakes open their eyes on the 7th day after hatching and take further five days more to gain consciousness and to teeth. In another 30 days, they become poisonous. The off springs are five aṅgulas (1 aṅgula = 1.905 cm) of length, body will be red coloured with black head. Mother snake will let only three off springs live and consumes all others.
| Classification of Snakes|| |
Snakes are divided into four categories. The Mūrkha family (hooded) with 26 varieties, Maṇḍali (viperine) family with 16 varieties, Rājila (Krait) with 13 varieties and Ventira (cross breeds) with 21 types. Snakes are again divided into 4 kulas (families). The specific distinguishing features, diet, place of dwelling, time of travel, direction of vision of each family are explained in detail. For example, main food of kṣatrīya kula (“warrior” family) snakes will be rat, water and snow. They travel during noon time, reside in big buildings, walls, holy trees etc., The author also opines that they stay usually in the Valmīka (anthill) and will come out attracted to the smell of first rain. The doṣa predominance of each variety, their potency with respect to age, season and time of travel are same as described in Ayurvedic classics.,
| Snake Bite, Its Causes and Prognosis|| |
The author has given a detailed description of types of bite mark and the corresponding causes and prognosis which is explained in [Table 1].
If vital parts in body such as forehead, cheeks, nose, ears, temples, palmar surface of hands, nipples, cardiac area, axillary area, umbilicus, groins and thighs are bitten, the chance of survival becomes doubtful. Four types of poisonous teeth and their prognosis are mentioned, which are:
- Karālī – Bite resembles cow's horn with the smell of agaru
- Makarī – Bite resembles a bow with oily smell
- Kalarātri – Bite resembles foot of a bird with sandal wood smell
- Yamadūtikā – Edema will be seen with the smell of milk.
Spread of poison is compared to spread of tamarind in milk. Viṣa (poison) stays at bite site for 100 mātras (unit of time), then combines with vāta and subsequently circulate throughout the body. The sequence of its travel will be first to the forehead, then to eyes, all over the face and eventually into the sapta dhātus (constituent elements). Signs and symptoms which indicate forthcoming death are tremors, redness of lateral ends of eyes and edematous appearance of mouth. If signs of life cannot be seen even after expulsion of urine and faeces, death can be assured. Root of Nīlī (Indigofera tinctoria) ground in juice of Nīlī itself, rolled into the size of the fruit of Vibhītaki (Terminalia bellirica) and dried is given with milk. If vomiting occurs immediately, prognosis is good. If not, its asādhya (incurable).
Symptoms of impending death are also mentioned in the first chapter. Significant indicators are: (i) No swelling even when the thighs are beaten with a stick, (ii) eyes are open and dilated, (iii) mouth is open and dilation in rectum is observed, (iv) if semen oozes out automatically on massaging mūtra nāḍi (urethra). Eight different confirmatory tests for impending death are described. One of them is as follows: Juice of haridrā (Curcuma longa) and oil should be equally given orally. If it remains in stomach, he will live but if the mixture goes through the GI tract and is seen in the anal region, death can be assured.
The second chapter deals with darvīkara (hooded) snake poisoning. Immediate treatments, names, specific symptoms and treatment of 26 types of darvīkara are explained in detail. Fume therapy using certain drugs can help regain consciousness. The first dung of a calf is ground in the urine of a goat and a suppository is made which is used for dhūmapāna (fume inhalation). This chapter also includes many nasya (nasal administration), añjana (collyrium), lepa (external ointment/liniment), pāna (drink) with simple drugs mentioned.
The third chapter covers maṇḍali (viperine) snake treatment. Vegānusāra cikitsā (stage wise treatment), specific symptoms and treatment of 16 types of maṇḍali snakes are explained here. E.g.: In rakta maṇḍali bite, bleeding from nose and mouth, foul smell, deep enmity, hatred, fainting etc. will be seen. When these are the symptoms, curd, trikaṭu (three pungents), saindhava (rock salt), butter, honey and kuṣṭha (Saussurea lappa) should be mixed and used internally. Management of complications in maṇḍali viṣa also has been explained. In bleeding from hair follicles, fried powder of root of śigru (Moringa oleifera) mixed with cow's ghee should be massaged all over the body. Medicines that need to be given in case of thirst, burning sensation, pain, swelling, yellowish urine, bleeding from mouth, haematemesis, weakness of joints, retention of urine, vomiting and in severe rise of temperature are also explained. In yellowish urine, bark of karañja (Pongamia pinnata) should be given in hot water. In the ulcer at the maṇḍali bite site, daśapuṣpa  (bhadra, viparita lajjalu, indravalli, musali, durva, bhringaraja, ahukarni, vishnukranti, lakshmana and sahadevi) svarasa (juice) or pārantyadi tailam can be used.
Chapter four explains Rājila viṣa (krait family) treatment. Vegānusāra cikitsā (stage wise treatment), symptoms and treatment of 13 types of Rājila snakes are mentioned. In arresting of whole body movements, triphalā (three myrobalans) ground in milk is recommended to be given orally. In excessive phlegm production, juice of arka (Calotropis gigantea) leaf mixed with hingu (asafoetida) is recommended to be given internally. Nasya and añjana to revive a person from unconsciousness have been described.
The fifth chapter explains common measures that can be adopted in all snake bite cases when exact identification of snake cannot be done. Single drug preparations that relieve fainting and all types of poisons are mentioned. Highly potent medicines are mentioned under the tile of kāla vañcana prayogas (extreme measures). Medications to regain the pulse of a bite victim, drugs which make the poison to get vomited out have also been detailed here. The common medicines used in Kerala for snake bite treatment such as Jīvarakṣā guḻika, Vilvādi guḻika, Taruṇabhāskaraṃ guḻika, Mṛtyuñjaya rasa have also been explained.
Poisoning due to Mūṣika (rat), its 16 types, symptoms and treatment are dealt with in the chapter six. Five stage wise symptoms and treatment are explained. Application of certain single drugs over vertex along with many internal medications which helps in quick elimination of rat poison have been mentioned. Nasya (nasal administration) using egg of fire ants, external medicines for severe swelling and many internal medications have also been mentioned.
Vṛścika viṣa (scorpion envenomation) is the subject matter of chapter seven. The text recommends initial dhārā (pouring of a continuous and soothing stream of medicines) followed by pāna yogas (drink recipes). If sting is severe, snake bite management steps should be undertaken. Immediate application of juice of karañja (Pongamia pinnata) into eyes, mouth and bite site is said to relieve all types of scorpion poison according to the author.
Chapter eight deals with lūthā (spider) poisoning treatment. Signs, symptoms and general treatment of 20 types of lūthā has been mentioned here. Day to day changes of the lesion for 7 days and the corresponding treatment have been explained. Medicines for tumorous skin growths, simple and effective dhārā recipes are also explained.
Chapter nine explains about the symptoms and treatment of most of the poisons of cat, mongoose, monkey, horse, millipede, fox, lizard, garden lizard, frog, chameleon, poisonous leech, poisonous fish, wasp and even human poisoning due to nails and teeth. In case of garden lizard poisoning, coin like round lesions appear all over body. In this condition, oral intake of nīlī (Indigofera tinctoria) root decoction will be effective. Alarka viṣa (rabies) is also mentioned in this context. Signs and symptoms, the differentiating features of a rabid dog bite, prognosis, diet restrictions and the treatment protocol with formulations are explained here. Symptoms of poisoned pet animals, treatment of bhinna viṣa (fragmented poison) and dietary restrictions for poison victims of all kinds are also detailed. The specific quantity of each formulations that should be administered for a poison victim is quoted along with various surgical procedures.
The tenth chapter deals with dūta lakṣaṇas (features of the informer). Features of an informer which bring about good prognosis and the vice-versa are detailed. Twelve nakṣatras (asterisms) which are inauspicious in poisoning cases are explained on the basis of lunar calculations. The text gives a description of detection of the type of snake to be deduced form the position of the informer in the physician's room. If the dūta (informer) utters the snake's name first, then the death of the patient is almost inevitable. Prognosis was also assessed by counting the words uttered by the informer. The place where the snake bite happened and the sex of snake can also be deduced from informer. The part of body bitten and intensity also can be deduced from the informer's and physician's positions.
Chapter eleven deals with kaiviṣa (homicidal poison) treatment. Tests to detect the site of poison, signs and symptoms of sthāvara viṣa (poisoning due to inanimate things) and its treatment are explained. Simple medications such as continuous pouring of cold water and buttermilk treated with vilva (Aegele marmelos) leaf for internal use are recommended. Along with the above, antidotes for 33 poisonous drugs, atibhakṣaṇa (over-eating) treatment, incompatible foods and its treatment, food poisoning features and treatment are also explained in a practically feasible manner.
| Discussion and Conclusion|| |
Viṣa cikitsā (toxicology) is given highest importance among the branches of medicine owing to its need for emergency management. The physician who treats a snake bite victim needs to be careful and confident. Slightest mistake can risk the life of the patient. The practice of managing snake bite cases with Ayurvedic drugs is on the decrease these days due to misinformation and lack of research. There are many traditional vaidyas who are successfully treating snake bite cases using these medicines and practices even this day. There are a number of books written in regional languages on Ayurveda. It will be of great use to humanity if they are given greater exposure. It will also help throwing light on the ancient regional practices prevalent in different parts of the country. Prayoga samuccayam is one such book popular in Kerala. It contains many simple and practically feasible formulations which can be easily prepared and used for managing poisoned conditions. It is a compiled work which contains the cream of many toxicology books and saṃhitās (compendiums) which can give confidence to young practitioners of Ayurvedic system in handling emergencies with simple combinations. There is a need of further research on the formulations given in the text in both literature and clinical levels.
Prayoga samuccayam is an important book to be read by all Ayurvedic scholars and needs to be given wide publicity.
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