Etiology based management of Loota Visha - A Case Report

Mahesh P. Savalagimath; Komal M. Jadhav; Neha M. Saunshimath

Etiology based management of Loota Visha - A Case Report

P. Savalagimath M.^1*, M. Jadhav K.², M. Saunshimath N.³

DOI:

^1* Mahesh P. Savalagimath, Reader, Department of Agada Tantra, Kaher’s Shri BMK Ayurveda Mahavidhyalaya, Belagavi, Karnataka, India.

² Komal M. Jadhav, Second Year PG Scholar, Department of Agada Tantra, Kaher’s Shri BMK Ayurveda Mahavidhyalaya, Belagavi, Karnataka, India.

³ Neha M. Saunshimath, Second Year PG Scholar, Department of Agada Tantra, Kaher’s Shri BMK Ayurveda Mahavidhyalaya, Belagavi, Karnataka, India.

Spiders are the Anthropoids and there are more than 40000 species. In India 600 different spiders are found. Spider bites are common in some parts of the world. In India it is uncommon and fatalities are rare. They are invariably poisonous but majority of species do not pose risk of death. Spider venom is of two types neurotoxic and cytotoxic. Black widow or hour glass spider (cytotoxic) and violin spider or brown recluse (cytotoxic) produces severe toxicity, and act on the myoneural junction or peripheral nerve endings causing ascending motor paralysis or damage to peripheral nerve endings. Death may occur because of infection rather than venom. In Ayurveda Visha mainly classified as Sthavar and Jangam. Sthavar includes plant origin whereas Jangam includes animal origin like snake, spider, scorpion and insects etc. The detailed explanation of Loota Visha origin, symptoms, mode of poisoning and treatment is available in our classical texts. A female patient approached our OPD with complaints of Vesicular lesions on the forehead extending to the right side of temporal region and right eye with oozing since 3 days and she was treated with principles of Agadatantra which includes Vishagna, Kusthagna, Rakshogna etc. The symptoms were reduced completely within short period of time.

Keywords: Loota, Vishagna, Spider, Poison

Corresponding Author	How to Cite this Article	To Browse
Mahesh P. Savalagimath, Reader, Department of Agada Tantra, Kaher’s Shri BMK Ayurveda Mahavidhyalaya, Belagavi, Karnataka, India. Email:	Mahesh P. Savalagimath, Komal M. Jadhav, Neha M. Saunshimath, Etiology based management of Loota Visha - A Case Report. J Ayu Int Med Sci. 2022;7(11):201-205. Available From https://jaims.in/jaims/article/view/2184

Introduction

Some of the spider bites occur while people are asleep or dressing. Most bites are harmless and cause local irritation, but some bites can cause significant morbidity and rarely, mortality. Initially, bites are painless and unnoticed but burning sensation develops after few hours with swelling.

Spider bite may cause local tissue injury and ulcers at the bite site, later which may spread over the bitten limb, leading to immediate intense pain and swelling along with muscle spasms and tremors, which later involves muscles of the back, shoulder, thighs, legs, arms and face. Nausea, vomiting, abdominal cramps, difficulty in breathing, hypertension, tachycardia, restlessness, irritability, sweating, and swollen eyelids are the systemic presentations. Complications are muscle cramps, intravascular hemolysis, acute renal failure, and neurotoxicity.^[1]

Origin of Loota according to Acharya Sushruta is by sweat on the forehead of Vasishta Maharshi that fell on the grass.^[2] Acharyas also mentioned the various number of Loota i.e., Acharya Sushruta 16, Astanga Hruday 16, 28, 1000 or innumerable. Based on the effect of poison Acharya Sushruta has also mentioned the fatal period of 7, 10 and 15 days for severe, moderate and mild poisoning respectively.^[3]They emit their venom through bite, feces, urine, semen, saliva, nail, menstrual blood and breath.^[4] when cloths etc. get contaminated with any secretions of spiders and they too serve as means of contact poisoning.^[5] Symptoms of poisoning were explained depending on predominance of Dosha, site of poisoning, day wise manifestations etc.

General symptoms of poisoning include swelling like an urticaria which may be pale, blackish, reddish, yellowish or grayish, soft, elevated and black or blue in the center. Eruption of fine vesicles around the site giving Sieve like appearance. There will be swelling which will be spreading in nature along with different types of pain and fever. The bite wound quickly progresses towards tissue death, leading to exudation, putrefaction and shedding of deeper tissues.^[6] Dosha Avastha of Loota is Pittakaphadhika^[7] Agneyaloota Vishaja Laxanas include burning sensation, thirst, fever, delusion, high temperature, vesicles, reddish and yellow color exudation and swelling like grape fruit Kaphajaloota

Vishaja Laxanas are hard pale swelling like Parooshak fruit, increased sleep, rigors, fever, cough and severe itching.^[9] Vagbhata included Loota under the Keeta so it also possesses the features of Keeta Visha.^[10] Various treatments were explained like Shodhana - vomiting, purgation, nasal drops, etc. and local - Chedana, application of heat, collyrium, massage, application of paste, medicated liquid for drinking and pouring over the site, medicated fumes, bloodletting, etc.

Case Report

A 75year old female patient from Anandawadi, Belagavi came with complaints of Vesicular lesions on the forehead extending to the right side of temporal region and right eye with oozing since 3 days. This condition was associated with headache and fever along with difficulty in opening of the right eye. She is known case of Diabetes and under modern medications for the same. There is no history of hypertension. There was no any significant family history related to above said problems. On elucidating the history, she revealed that in the evening hours something fell on her right side of the face and she wiped it off. Later in the night she developed slight irritation at site from where she wiped off something (right side of forehead) and gradually it started to spread to the right side of temporal region and right eye. By the 2^nd day evening she also developed the vesicular lesions along with oozing.
Personal History

Bowel: Clear

Appetite: Reduced

Micturation: Clear

Sleep: Disturbed

Diet: Vegetarian

Habits: No

O/E of wound on 1^stvisit

Site: right side of forehead extending to the right side of temporal region and right eye.
Symmetry: Asymmetrical
Color: reddish black
Margin: elevated
Discharge: clear watery
Scaling: Absent

Crusting: Present
Tenderness: Mild
Opening of eye: difficulty in opening the right eye

Based on history and clinical presentation this case is diagnosed as Loota Visha.

Details of treatment
Follow-ups: 1^st Visit

Clinical Presentation: Asymmetrical reddish black skin lesions with crusting and elevated margins onright side of forehead extending to the right side of temporal region and right eye associated with clear watery discharge, mild tenderness and difficulty in opening of right eye.

Treatment
1. Patolakaturohinyadi Kashaya: 10ml thrice a day one hour before food with half cup warm water.

2. Bilwadi Gulika: 1 tablet four times daily after food with warm water.

3. Triphala Kashaya: freshly prepared Kashaya for washing the lesions.

Follow-ups: 1^st Follow up

Clinical Presentation: Asymmetrical brown skin lesions with crusting and elevated margins on right side of forehead extending to the right side of temporal region and right eye. watery discharge and tenderness reduced, but difficulty in opening of right eye still persists.

Treatment
1. Patolakaturohinyadi Kashaya:10ml thrice a day on empty stomach with half cup warm water.

2. Bilwadi Gulika:1 tablet four times daily after food with warm water.

3. Triphala Kashaya: freshly prepared kashaya for washing the lesions.

Follow-ups: 2^nd Follow up

Clinical Presentation: Hyperpigmentation present. Remaining all complaints were reduced. Patient is able to open the right eye.

Treatment
1. Asanadi Kashaya:10ml thrice a day after food with warm water

2. Nimbadi Guggulu:1 tablet twice a day after food with warm after

3. Triphala Kashaya: freshly prepared kashaya for washing the lesions

4. Nalpamaradi Taila: external application on skin lesions.

Figure no 1 and 2: Pictures at 1^st Visit

Figure no 3 and 4: Pictures at 1^stfollow-up

Figure no 5 and 6: Pictures are 2^nd follow-up

Discussion

In Ayurveda Acharyas have explained Trisootra as Hetu, Linga and Aushada, which are helping in the diagnosis and treatment of the condition. This case proves the importance of etiology and adapting treatment protocols accordingly. This is the case of Loota Visha which led to skin manifestations so here treatment was started based on etiology i.e., Vishagna and Kusthagna line of treatments are adopted. Along with other suitable Shamana Yogas depending on Dosha predominance i.e., Pitta-Kapha.

Patolakaturohinyadi Kashaya does Shodhana, Rechana of Pitta and indirectly removes Kleda or Dusta Kapha. And more effective in Pitta-Kaphaja conditions also indicated in Visha and Jwara, it has Tikta Rasa, which can bring Amaavastha of Pitta to Niramaavastha and normalize the Prakruta Pitta Karma and enhance wound healing. All the ingredients are having Katu Rasa, Ushna Veerya, and Katu Vipaka and that will act as Vishaghna, Rakshoghna, Krimighna etc.^[11] Bilwadi Gutika was added as it will act as Vishaghna, Krimighna, Rakshoghna. All ingredients are Tikshna, Ushna and mild Ruksha Guna. It is Vatakaphahara, does Shoshana of Srava. It can act as an immunomodulator. The ingredients possess anti-inflammatory, immunomodulatory, diuretic, anti-toxic properties and rich in tannins and phenolic compounds which can bring down secretions. Triphala Kashaya is used for Sthanika Prakshalana because the condition was more of Pittakapha Pradana and increases the healing of Vrana by avoiding further infection.^[12]

Application of Nalpamaradi Taila helped in reducing the Daha (burning sensation) and Shotha (inflammation) as it is having Ksheerivriksha Dravyas (Kashaya Rasa dominant) helped in pacifying the Pitta and Kapha. It also contains tannins as their main chemical constituents which inhibit bacterial growth and acts as physical barrier when applied locally.^[13]

Conclusion

This case is an example to establish that Spiders cause contact poisoning also and usually present as vesicular lesions. As per Ayurveda Loota Visha is caused more often by contact with body secretions. Usually, they present with Pitta dominant Dosha

association. In this case the patient presented with Pitta-Kapha dominance and treated with Shamana formulations that correct Pitta-Kapha and as it was caused by Visha, Vishagna drugs were also used and highly encouraging results were found. Hence while attending any condition, we need to assess aetiology along with clinical presentations.

Consent: Written consent from the patient was taken to publish the case report.

Reference

1. Reddy, K.S.N. (2017) The Essentials of Forensic Medicine and Toxicology. Organic irritant poisons, 34th Edition, Jaypee, New delhi, 526.

2. Shastri Kaviraj. Sushruta Samhita of Acharya Sushruta (Reprint 2017), Kalpasthana; Chapter 8, Verse 92,93. New Delhi; Chaukhamba Sanskrit Sansthan: 2017; p.95.

3. Shastri Kaviraj. Sushruta Samhita of Acharya Sushruta (Reprint 2017), Kalpasthana; Chapter 8, Verse 83,84. New Delhi; Chaukhamba Sanskrit Sansthan: 2017; p.94.

4. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, Verse 58. New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.918.

5. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, Verse 57. New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.918.

6. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, Verse 55,56,57. New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.918.

7. Murthy shrikantha.: Astanga Sangrah Samhita of Vaghabhat Edited by Dr sharma shivaprasad (Reprint 2016) Uttaratantra; Chapter 44, Verse 19. New Delhi: Chaukhamba Sanskrut Sansthana:2016; p.g.883

8. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, Verse 48. New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.917.

9. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, Verse 49. New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.917.

10. Shastri H.; Ashtang Hridaya Samhita of Vagbhat Annotated by Dr. Kunte A. M. and Navre K. (Reprint 2019), Uttaratantra; Chapter 37, New Delhi: Chaukhamba Sanskrut Sansthana: 2019; p.914-923.

11. SuryajeetPawar, Ruta, Kadam, SharvariJawale, An open randomized study study of Patolakaturohinyadi kashaya in alcoholic liver disease, International Journal of Ayurveda and Pharma Research, 3(7),(2015).

12. Kanna S, Hiremath SK, Unger BS. Nephroprotective activity of Bilvādi agada in gentamicin induced ne- phrotoxicity in male Wistar rats. Anc Sci Life. 2015 Jan-Mar;34(3):126-9. doi: 10.4103/0257-7941.157146. PMID: 26120225; PMCID: PMC4458901.

13. Srikanth, Narayanam & Rana, Rakesh & Jameela, So- phia & Khanduri, Shruti & Amin, Hetal & Anumol, K& Rao, Bcs. (2019). Clinical Evaluation of Efficacy and Safety of Classical Ayurveda Formulations, Panchatikta Ghrita and Nalpamaradi Taila, in the Management of Psoriasis: A Study Protocol. Journal of Re- search in Ayurvedic Sciences. 3. 68-73. 10.5005/jras- 10064-0079.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-11-01	2022-11-02	2022-11-09	2022-11-16	2022-11-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Case Report

Loota Visha

Journal of Ayurveda and Integrated Medical Sciences