E-ISSN:2456-3110

Review Article

Vrischika Visha

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 2 February
Publisherwww.maharshicharaka.in

A review on Vrischika Visha and its Chikitsa in classics

Tewary M.1*, Shrinidhi R.2, Hebbar C.3, Shubha P.4
DOI:

1* Moumita Tewary, Post Graduate Scholar, Department of Agada tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

2 R Shrinidhi, Associate Professor, Department of Agada tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

3 Chaithra Hebbar, HOD & Professor, Department of Agada tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

4 PU Shubha, Assistant Professor, Department of Agada tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.

Scorpion stings are an intimidating problem in India, especially in rural parts of India. Envenomation from scorpions if estimating on yearly basis it is about 12 lakh people per year and is responsible for nearly about 3250 deaths. There are about 1400 species of scorpions identified worldwide out of this only 53 are reported to be dangerous to humans. The common clinical feature of the scorpion sting is sharp localized burning pain which gradually spreads to the whole limb followed by the variable nature of paresthesia and swelling. Even death is immediately seen in untreated cases of scorpion sting. Vrischika Visha is categorized under Keeta Visha in Ayurveda. Its warning signs are Urdhwa Gati of Daha, Toda, Sphutana, Sotha, Shyavata etc. Vrischika Damsha is such a specific envenomation that requires medical attention. Several treatment approaches are explained in our classics which are described for managing Vrischika Visha.

Keywords: Vrischika Visha, Scorpion, Brihatrayee, Prayoga Samucchaya, Kriya Kaumudi

Corresponding Author How to Cite this Article To Browse
Moumita Tewary, Post Graduate Scholar, Department of Agada tantra, Sri Dharmasthala Manjunatheshwar College of Ayurveda, Udupi, Karnataka, India.
Email: 		Moumita Tewary, R Shrinidhi, Chaithra Hebbar, PU Shubha, A review on Vrischika Visha and its Chikitsa in classics. J Ayu Int Med Sci. 2023;8(2):151-159.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-12-27 2022-12-29 2023-01-05 2023-01-12 2023-01-19
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© 2023by Moumita Tewary, R Shrinidhi, Chaithra Hebbar, PU Shubhaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Tewary M et al: A review on Vrischika Visha and its Chikitsa in classics

Introduction

Agada Tantra, one among eight branches of Ayurveda encompasses topics of both toxicology and toxinology. Excruciating pain, burning sensation, swelling and erythema seen in scorpions bite resemble the symptoms of Vrischika Damsha[1] (Scorpion sting) in Ayurveda. Excruciating pain at the site of sting is an important factor for the immediate search for medical care. Even though many external medicinal preparations have been mentioned in Ayurvedic Classics and Granthas to address the acute symptoms. The term Vrischika is derived from a root word means Chedane to cut. Based on Vishadamsa Lakshanas[2] classified into three i.e., Manda, Madhya and Tikshna.

Materials and Methods

The detail study on Vrischika Visha and its Prabhava on human body is carried out with the help of references which are available in Samhitas - Sushruta Samhita[3] Astanga Samgraha[4], Astanga Hridaya[5], Prayoga Samucchaya[6], Kriya Kaumudi [7] and other Ayurvedic Classics.

Historical Review[8]

Charaka Samhita[9]

Acharya Charaka has explained the Chikitsa (Treatment) of Vrischika under 23rd chapter of Chikitsa Sthana.

Sushruta Samhita

Acharya Sushruta has explained in detail about Vrischika under 8th chapter, Keeta Kalpa Adhyaya of Kalpa Sthana.

Harita Samhita

In Harita Samhita, 55th chapter of 3rd Sthana, Mantra Chiktsa has been mentioned for the management of Vrischika Damsha.

Astanga Samgraha

Acharya Vriddha Vagbhata has elaborate the details of Vrischika in Keeta Visha Partisedha Adhyaya (43rd chapter) and Visha Opayogiya Adhyaya (48th chapter) of Uttartantra.

Astanga Hridaya

Acharya Vagbhata has also mentioned the context of Vrischika in 36th and 37th chapter of Uttartantra.

Prayoga Samucchaya

Prayoga Samucchaya has explained in detail about Vrischika, under Saptama Pariccheda, Vrischika Visha Chikitsa Adhyaya.

Kriya Kaumudi

Kriya Kaumudi has mentioned the context of Vrischika in Keeta visha Prakarana.

Origin of Vrischika[10]: According to Acharya Sushruta based on origin of Vrischikas are said to be 3 types i.e., Manda, Madhya and Mahavisha. The one which are originated from Go Shakrit Kotha (putrefied cowdung) called Manda Visha, those from Kastha Isthika (decayed wood or bricks) are called Madhya Visha and those are originated from the Sarpakotha (cadaver of snakes) are Mahavisha. Other Acharya opine the same.

Classification of Vrischika[11]

Table 1: Based on Visha Prabhava

Samhitas Types Vrischika
Charaka Samhita (Chiktsasthana) [12] 2 types 1. Dooshivishaja Vrischika
2. Prana Haram / Asadhyam
Sushruta Samhita (Kalpasthana)[13] 3 types 1. Mahavisha - 15 types
2. Madhya Visha - 3 types
3. Manda Visha - 12 types
Astanga Samgraha (Uttartantra) 3 types 1. Mahavisha - Powerful Poison
2. Madhya Visha - Moderate Poison
3. Manda Visha - Mild poison
Astanga Hridaya (Uttartantra) 3 types 1. Mahavisha - Powerful Poison
2. Madhya Visha - Moderate Poison
3. Manda Visha - Mild poison
Prayoga Samucchaya 3 types 1. Mahavisha - Powerful Poison
2. Madhya Visha - Moderate Poison
3. Manda Visha - Mild poison
Kriya Kaumudi 2 types §     Ugra Visha §     Alpa Veerya Visha

Table 2: Based on Dosha predominance

Samhitas Types Vrischika
Prayoga Samucchaya[14] 4 types 1. Vata Pradhana
2. Pitta Pradhana
3. Kapha Pradhana
4. Sannipatika
Kriya Kaumudi 3 types 1. Vayavya - 18
2. Agneya - 24
3. Soumya - 13
4. Sankrina - 12
Gaya Das [15]   3 types 1. Manda - 10
2. Madhyama - 3
3. Pranahara - 13

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Table 3: Morphological Features of Vrischika[16]

Acharyas Maha Visha Vrischika Madhya Visha Vrischika Manda Visha Vrischika
Sushruta White or variegated colours, brown or reddish in body, belly being red white, reddish blue, yellowish red, bluish yellow, pink, bluish white, red or grey, having 2 joints in tail, having different shapes and colours are terrifying. Red yellow or brown colour in body, smoky in belly, three joints in tail Colours such as black, blue, brown, white and colour like cow’s urine, coarse, blue -black, yellow or smoky, having hair on their belly resembling algae, red or white having more number of joints in the tail than others.
Astanga Samgraha Reddish brown, spotted variegated colour, resembles blood or fire, have only one joint, belly is reddish black or white in colour. Smoke coloured abdomen, 3 joints, brown or reddish brown in colour. Yellow white, blue, dry, rough, brown or dark brown in colour, hairs on the body, many joints belly being reddish or white.
Astanga Hridaya Appear like fire, have one joint; belly is red black or white.  Smoke coloured abdomen, 3 joints, brown, slight red, reddish brown body spotted, variegated and resembling blood. Yellow white-blue many colours of black, dry, hairy has many joints, abdomen red and pale.
Prayoga Samucchaya Pingala Varna (resembles fire), Na Na Varna (various colour) ‘Reddish, having 1 or 2 joints in tail, combinaton of red, white &black colour abdomen. Brass colour, reddish, copper colour abdomen, tail have 3 joints. Yellowish (Haridra Varna), white, blackish and dark colour, Na Na Varna (various colour), Predominance of Ruksha, having more hairs, many joints in tail (Asangyam), white colour abdomen.
Kriya Kaumudi Copper colour, black, white or reddish colour stomach, possess various colour (Aneka Varna), resembles fire (Agnitulya Prakasha), having 2 joints in tail. Reddish or bluish body, stomach greyish, having 3 joints in tail. Dark, yellow, light white colour, stomach whitish colour, rough body (Ruksha Deha), having 7 joints in tail.


General symptoms of Vrischika Visha[17]

Most of the scorpions are neurotoxic in nature and causes locally severe pain (Vedana), burning sensation (Daha), Swelling (Sotha) and redness at the site of bite. The patient suffers from above symptoms and pain moves in upward direction from the bite site.

According to Acharya Vriddha Vagbhata, the bite site of poisonous scorpion is similar to fire, suddenly pain moves in upward direction and later on it fixed at the site of bite. The bitten site becomes blackish in colour and unbearable pain and burning sensation is present at the site.

Acharya Charaka has been explained the symptoms of Dooshi Visha and Pranahara. The bite of Dooshi Visha Vrishchika is similar to fire and there will be burning sensation and Bhedavat Pida (piercing pain) at the site of bite and pain moves in upward direction. When bitten by Pranahara Vrischika, there will be loss of sensation of eyes, nose, tongue and flesh cut and fall from the site of bite and excessive pain also present at the site of bite. Pranahara Visha is also known as Asadhya.[18]

Types of Vrischika Visha & Lakshana

Table 4: Based on Varna (Colour) & Lakshanas[19]

SN Vrischika Bheda Varna Samanya Lakshanas
1. Manda Visha Vrischika §   Krishna §   Shyava §   Karbura §   Pandu §   Gomutra §   Karkasha §   Mechaka §   Peeta §   Dhooma Varna §   Romayukta §   Shadvala §   Rakta Varna §   Vedana §   Kampa §   Gatra Stambha §   Krishna Rakta §   Daha §   Sotha §   Jwara §   Sweda
2. Madhya Visha Vrischika §   Rakta §   Peeta §   Jihva Sotha §   Bhojanasya Abarodha §   Murcha
3. Maha Visha Vrischika §   Shweta §   Chitra §   Shyamala §   Lohita §   Rakta Shweta §   Rakta Neela §   Peeta Rakta §   Neela Peeta §   Neela Shukla §   Rakta Vabru §   Sarpa Visha Vega §   Sphota §   Daha §   Jwara §   Manovibhram

According to Kriya Kaumudi[20]

Table 5: Damsha Lakshanas of Vrischika Visha according to Dosha predominance

SN Type Damsha Lakshana
1. Vayavya Severe pain, Pricking pain
2. Agneya Burning sensation, redness, slight oedema, Kharjura Varna.
3. Soumya Continuous thick blood discharge, Alpa Vedana, Udumbara Varna
4. Sankirna All type of symptoms are seen

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According to Prayoga Samucchaya & Kriya Kaumudi[21]

Table 6: Dhatugata Damsha Lakshana of Vrischika Visha

SN Dhatu Prayoga Samucchaya Kriya Kaumudi
1. Twak Severe pain Pricking pain, vomiting, delirium, convulsion
2. Rakta Severe burning sensation All above + fatigue, burning sensation, Atisara, Jwara
3. Mamsa Hidhma, Oedema Granthi all over body
4. Meda Greeva bhanga Hidhma, Galasosha
5. Asthi Jwara Jwara
6. Majja Manasantapa, Dukha Vyasana Manasantapa
7. Shukra Rakta netra, Death Rakta Netra, Death

Table 7: Dosha predominance of Vrischika Visha according to different Acharyas

SN Samhita Dosha predominance
1. Charaka Samhita Vataolbana
2. Sushruta Samhita Did not mention specific Dosha predominance for Vrischika, mentions Vatakapha predominance of Keeta Visha
3. Astanga Hridaya Vataolbana
4. Astanga Samgraha Vataolbana
5. Prayoga Samucchaya Mostly Vata Pitta predominance, very few are Kapha predominance
6. Kriya Kaumudi Mostly Vata Pitta predominance

Sadhya and Asadhya Lakshana of Vrischika Visha[22,23]

Table 8: Sadhya and Asadhya Lakshana according to different Acharyas 

Acharyas Sadhya Lakshana Asadhya Lakshana
Astanga Samgraha Stambha Sopha Sa (Loss of movement of penis) -
Drishta Romatam (Horripilation)
Sitambu Seka Anganam Eba (Feeling as though cold water is sprinkled all over the body)
Charaka Samhita - Drig, Ghrana, Nasa Na Upahata Nara (Patient loses his power of vision, smell &taste
Muscle tissue gets sloughned and falls out (Mamsai Patati).
Excessive pain (Atyartha Vedana)
Succumbs to death


Samanya Chiktsa of Vrischika Visha[24,25]
According to Acharya Charaka the general management of Vrischika Visha is Swedana, Abhyanga with Ghrita and Saindhava, Parisheka (Irrigation), food along with Ghrita.

According to Yoga Ratnakar, Mantra Chiktsa has been explained for Vrischika Visha. This procedure might have been used for assurance of the patient. Anyhow it is no more relevant in the present era.

According to Acharya Sushruta the treatment of Maha and Madhyama type of Vrischika should be done similar to the Sarpa Vega (Snake bite). Site should be cleaned properly and the Swedana should be done. Pratisarana should be done by Haridra, Saindhava Lavana, Trikatu and Churna of Sirisa Phala and Pushpa.

Acharya Vagbhata has explained the general management of Vrischika Visha with Seka, Upanaha, Lepa and various Yogas.

Mantra Chikitsa (Chanting)[26]

1. ‘Om Kshah Fat Swaha’ by spraying water along with this Mantra scorpion poison is destroyed.

2. ‘Adityarathvegen Vishnu Banabalen Cha, Garunapakshanipaaten Bhumyam Gachha Mahavisha’ scorpion poison destroyed by chanting this Mantra along with spraying water to the patient.

Seka[27]: The site of scorpion sting should be immediately bathed with Chakra Taila or Taila prepared by Vidargandha or Ghee mixed with Saindhava Lavana or Milk added with Saindhava Lavana or fermented luke warm rice water.

Upanaha[28]: The paste of Ajaji fried in ghee and added with Saindhava Lavana should be applied as warm poultice (Upanaha).

Lepa [29]

1. Jirakadi Lepa[30]: Application of warm paste of Jiraka mixed with Ghee, honey and Saindhava removes Vrischika Visha and pain.

2. Ajakshiradi Lepa[31]: Lepa prepared with the equal parts of Sirisha Phala and Pippali by processing in Ajakshir should be applied over the affected spot.

3. Karpaspatradi Yoga[32]: Karpasa should be rubbed into a paste with addition of Ghee and applied over scorpion bite.


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4. Ullipashan Lepa[33]: Ullipashan (Arsenic) and Nimbu Swaras are pounded to fine paste and applied over bite site.

5. Kshirivrikshadi Lepa: Application of paste of bark of Kshirivriksha after the patient has undergone Shodhana therapy destroys the poison of

6. Mukta Lepa: Application of paste of Mukta is best to cure swelling, pricking pain, burning sensation and fever.

7. Hingu-Haritala Lepa: Pill prepared with Hingu, Haritala, along with Matulunga Swaras can be used for application on the bite and Anjana is best to remove the poison of

8. Palasha-Arka Kshira Lepa: Seeds of Palasha are ground into a paste with milky sap of Arka (Arka Kshira) and applied over the bite site.

9. Jayapala Lepa: Seeds of Jayapala are grounded to fine paste by adding water and are coated over the wound

10. Karanjadi Lepa: Karanja, Arjuna, Shelu, Katabhya, Kutaja, Sirisha Pushpa macerated with Mastu is paste to be applied on the site of bite.

Specific Yogas[34] (Formulation)

1. Dashanga Agada: Vacha, Hingu, Vidanga, Saindhava, Gajapippali, Patha, Prativisha, Vyosa all are taken in equal quantity should be made into Kalka by adding water and given internally.

2. Manasiladi Gutika: Suddha Manasila, Karanja Bija, Gambhari Bija, Kustha are taken in equal quantity and mixed and made into pills. This pill is administered internally and applied as Lepa over the bite spot.

3. Paravatadi Agada: Paravata Sakrit, Pathya, Tagara and Vishwabhesaja mixed with juice of Bijapura is a best choice antidote for Vrischika Visha.

4. Nagaradi Agada: Nagara, Griha Kapota Purisha, Haritala, Saindhava mixed with Bijapuraka rasa, this Agada immediately destroys the poison of the

5. Sirishadi Agada: Seeds of Sirisha soaked and macerated for 3 times in the Arka Kshira and then mixed with powder of Pippali, this Agada destroys the poison of Keeta, Sarpa, Loota & Vrischika.

6. Bilwadi Gutika: Roots of Bilwa, flowers

of Surasa, fruits of Karanja, Nata, Surahavam, Phalatrika, Vyosa, Nisa Dwaya (Haridra & Daruharidra) all macerated in goat’s urine and made into a nice paste. Used as Anjana, Pana, Nasya, this medicine cures the poison of Vrischika, Loota, Sarpa, Mooshika.

According to Kriya Kaumudi[35]

Kriya Kaumudi has explained various formulations in the context of Vrischika Visha management.

1. Lashuna, Maricha, Hingu, Sunthi, Tulsi leaves are taken and Bhavana with Arka Kshira and Gutika is prepared for external application.

2. Manasila, Sirisa Bija, Kumkum, Kustha are taken and Gutika is prepared for internal administration.

3. Dhara Yoga[36]: Cavarkaram and Saindhava made into powder form and added with Tandulodaka, Dhara should done with luke warm state.

4. Vaca, Hingu, Saindhava, Gajapippali, Patha, Vyosa, Vidanga, Ativisha is indicated for

According to Prayogasamucchaya[37]

1. Dhara Yoga: Dhara should do with Ghrita and Saindhava in luke warm condition.

2. Ajamoda should be fried with Ghrita and made into paste and added with Paste should be applied on the site of bite and tied. After that Swedana Karma should done, immediately after Swedana Karma is followed by Raktamokshana. After this Haridra, Saindhava, Sunthi, Maricha, Pippali, Sirisha Bija and Pushpa- all should be taken in equal quantity and made into powder form. Sprinkled over the site of bite.

3. Trivrit and Tandulodaka both should be mixed with Ghrita in the form of

4. After Vamanadi Karma, bark of Nalpamara is made into paste to be applied on the bite site.

Diet in Vrischika Visha (scorpion sting)

1. Ghrita added with more of honey or milk with more of sugar or solution of jaggery each one added with powder of Chaturjata (Cinnamomum verum, Elettaria cardamomum, Cinnamomum tamala, Mesua ferrea) and very cold should be consumed.[38]

2. Food which is warm, unctuous, sour, sweet and mitigating Anila (Vata) should be consumed.


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Upadravas (complication) of Vrischika Visha[39]

Prayoga Samucchaya and Kriya Kaumudi have explained about the Upadrava of Vrischika Visha, which may appear due to the bite of Mahavisha Vrischika. These complications are:

a. Asahyavedana (Severe pain)

b. Sotha (Swelling)

c. Swasa (Breathlessness)

d. Trishna (Thirst)

e. Moha & Pralapa (Delirium)

Upadrava Chikitsa

1. Lepa - Churna of Vibhitaki, Haridra, Pippali, Manjistha, Maricha and Visha should be grinded in the Swarasa of Brihati and it should be applied in the Lepa

2. Anjana - Karanja, Tintidika, Saindhava and Karaskarapatra Swarasa should be taken in the form of Anjana.

3. Pana - Ghrita and Dadhi should be taken in the form of Pana.

Discussion

Scorpions are venomous in nature especially which are belongs to class Buthidae. Of the nearly 100 Indian species, the commonest are Mesobuthus (red scorpion) and Palamneus swammerdami (black scorpion), the former is more venomous.[40] Acharyas have explained in detail about its classification, appearance, signs and symptoms, numbers, mode of action of venom, complications and treatment. Various types of Vrischika Visha are described by our Acharyas. They are dangerous to human beings. So, the management is very important. There are ample references of treatment modalities and medicines in Samhitas and Ayurvedic classics. Acharya has described Mantra Chikitsa (Chanting), Lepa (external application), Vatika/Gutika (oral medications), Dhoopana (fumigations), Ushna Swedana (fomentation), Parisheka (Spraying water) Vamana Karma (Emesis), Siravyadha (Venesection) and many Agada (Anti-poisonous drug). Hingu[41], Takra, Haridra, Karanja, Saindhava Lavana, Triphala, Manjistha, Sukshma Ela,

Chandan, Sirisha, Tandulodaka these drugs have been described as Vishaghna having Tikta, Katu Rasa, Ushna Veerya, Katu Vipaka, Krimighna Karma, Kapha Vatahara and also anti-inflammatory, anti-fungal, anti-bacterial properties. Therefore, these medicines can be used in scorpion sting. Ghrita and Gomutra (cow’s urine) are used in treatment of scorpion bites. Analgesic and antioxidant properties of cow’s urine are scientifically proven. These Herbs are easily available, common and cheaper. The method of preparations and mode of action is also simple and convenient. There are also some food preparations which are suitable for scorpion poisoning.

Analgesics, anti-inflammatory and antihistaminic properties of some ingredients used to treat scorpion sting. Therefore, (Hingu, Vatsanabh[42], Ativisha Arka) these ingredients help to reduce pain, redness and oedema caused by scorpion stinging.

Jwara (Pyrexia) may occur in scorpion sting, there are many ingredients like Sariva, Manjistha, Draksha, Patha, Yashtimadhu, Kutaja and Tulsi shows Jwaraghna Prabhava (antipyretics). Therefore, these medicines are effective in controlling pyrexia.

Sotha (Inflammation) at the site of scorpion sting may appear. Haridra, Karanja, Vatsanabh, Yashtimadhu shows Sothaghna Prabhava (anti-inflammatory properties) so it is used in scorpion sting.

External application of Apamarga, Haridra, Mustak, Hingu, Vacha may become helpful to overcome muscular spasms occurring at the site of scorpion sting. Respiratory failure or pulmonary oedema are the cause of death in patients with upper respiratory infections or related problems. Apamarga, Haridra, Maricha, Tulsi and Arka possess Kasaghna Prabhava (anti-asthmatic effect). These herbs help to prevent respiratory failure in scorpion sting.

There are many herbs which shows various kinds of pharmacological effects like antipyretics, analgesics, anti-inflammatory, anti-asthmatics, anti-oxidants, antispasmodics, anti-convulsant, cardioprotective which are being used in scorpion sting management. Further there is still need to study these herbs for their chemical contents and toxicity, which may help to increase efficacy and authenticity of the claims.


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Conclusion

From all these references it can be concluded that Vrischikas are different kind so the Visha Lakshanas associated with each of them are unique in nature and the management that should be adopted to each Vrischika Damsha must be specific according to the nature of Vrischika. Several herbal medicines are being used traditionally in management of scorpion stinging. There are many herbs given in this paper that are commonly available that can be used as emergency management of scorpion sting. Still a need for precaution pertains due to devastating conditions and fatality in children depending upon factors various of scorpion stinging.

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