Conceptual study of Thookudhara on Mandali Vishaja Sopha

V H Hima; Shidhin K Krishnan; Anagha Madhusoodhanan; P P Anjali

doi:http://dx.doi.org/10.21760/jaims.8.4.15

The most important envenomation’s by snakes are from Elapidae and Viperidae families. Envenomation by the Viperidae induces necrosis of the skin and deep structures. Edema at the site of injury occurs very early and can be extremely intense. Mandali Sarpa Visha is Pitta predominant Visha and Lakshanas are Daha (burning sensation), Ruk (pain), and Sopha (swelling). Thookudhara drugs are Pitta Rakta Shamaka and it is indicated for Mandali Vishaja Sopha. Keraleeya Vishachikitsa Grantha’s, Visha Vaidya Jyotsnika and Prayoga Samuchayam mentioned the Yoga in Mandali Visha Chikitsa.

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V H Hima, Post Graduate Scholar, Department of Agada Tantra, MVR Ayurveda Medical College, Kannur, Kerala, India.
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V H Hima, Shidhin K Krishnan, Anagha Madhusoodhanan, P P Anjali, Conceptual study of Thookudhara on Mandali Vishaja Sopha. J Ayu Int Med Sci. 2023;8(4):92-95.
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2023-02-23

2023-02-25

2023-03-04

2023-03-11

2023-03-18

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Introduction

Keraleeya Visha Chikitsa Grantha’s, Prayoga Samuchayam^[1] written by Kochunni Thamburan and Vishavaidya Jyotsnika^[2] written by Karattu Namboothiri. Prayoga Samuchaya explained about Thookudhara in Thritheeya Parichedam. Thookudhara is a treatment indicated in Vishaja Sopha. Ingredient of Thookkudhara is Sheeta Veerya and Pitta Shamaka. Vishaja Sopham caused by Mandali Visha is Pitha Dosha predominant and Lakshanas are Daha (burning sensation), Ruk (pain) and Sopham (swelling).^[3]

An estimated 5.4 million people are bitten by snakes each year with up to 2.7 million envenoming’s. Around 81000 to 138000 people die each year because of snake bites and around three times as many amputation and other permanent disabilities are caused by snake bites annually.^[4]

The Viperidae snakes are divided in to 2 main classes namely Pit vipers and pit less vipers. Viper snake bite induces intense inflammation, oedema and necrosis.^[5]

Mandali Damsha Visha produces Daha (burning sensation), Ruk (pain), Sopha (swelling) which are similar to that of hemotoxic poison in viper snake bite cases.

Review of Literature

Name of Yoga

Thookudhara

The reference of Yoga can be found out in Prayoga Samuchayam, Thritheeya Parichedam, Mandali Samanya Visha Chikitsa and Visha Vaidya Jyotsnika, Mandali Visha Chikitsa.

Ingredients:

1. Karaskara pullunni (Loranthus ingiflorus)

2. Chandana (Santalum album)

3. Satavarai (Asparagus racemosa)

4. Kumari swarasa (Aloe vera)

5. Kushmanda latha (Benincasa hispida)

6. Eranda pathram (Ricinus communis)

Eranda patra

Chandana

Table 1: Rasa Panchaka^[6]

Drug	Rasa	Guna	Veerya	Vipaka	Karma	Indication
Karaskara pullunni	Tikta	LaghuRuksha	Sheeta	Katu	Grahi, Mutrala	Srama, Kashta Artava
Chandana	Tikta, Madhura	Laghu, Rooksha	Sheeta	Katu	Kapha Pitha Shamana	Daha, Raktapitha, Jwara
Satavari	Madhura, Tikta	Guru, Snigda	Sheeta	Madhura	Vata Pitha Shamana	Seethapitha, Arsas, Atisara
Kumari	Tikta	Guru, Pichila	Sheeta	Katu	Vathapitha Shamana	Rechana, Raja Pravarthaka
Kushmanda Latha	Madhura	Laghu	Sheeta	Madhura	Balya	Mutraghata, Mutrakrscha, Prameha
Eranda Pathram	Madhura, Katu	Snigda, Teekshna	Ushna	Madhura	Vajikarana, Vrsya	Mutrakrchra, Gulma

Method of Preparation

All the drugs are grounded, squeezed and filtered through a cloth. The Swarasa is poured in to a Dhara pot and left hanging with the help of a rope. It is placed half inch above affected area of the patient and continuously poured. This Prayoga is very effective for reducing Vishaja Sopha.

Indication

Daha, Sopha, Visha, Pitha Vikaras arising due to Manadali Visha

Action of Thookudhara on Vishaja Sopha

In Vishaja Sopha there is Pitha Raktha vitiation. The Lakshanas of Vishaja Sopha are Mrdu (soft), Chala (movable), Avalambi (drooping down), Sheegra (quick to manifest), Daha Rujakara (causing burning sensation and pain).^[7] Drugs in Thookudhara are having Seetha Virya, Madhura Vipaka and Pitha Raktha Samaka property. Nidana of Vishaja Sopham determine the Dosha. Predominant Dosha of Mandali Vishaja Sopham is Pitta Dosham and cause Vishaja Sopham. Thookudhara drugs are Pitta Samaka and Seetha Veerya.

Action of swelling in viper bite

Snake venoms are complex mixtures of proteins that exert a wide range of toxic action. Venoms from the snakes of the family Viperidae causes local effects and systemic manifestations. Due to increased capillary hydrostatic pressure, there will be decreased plasma oncotic pressure therefore the increased capillary permeability causes the obstruction of the lymphatic system and causes the swelling.^[8] Swelling may become apparent within 15 minutes and become massive in 2-3days.^[9]

Discussion

Visha Vaidya Jyotsnika explained about treatment of Mandali Vishaja Sopha. On analysis of the symptoms, it reveals that Mandali produces Sopha and Daha over the bitten area. Mandali being a Pitha predominant snake, Mandali Damsha Lakshanas leads to Pitha Raktha Dushti. Formulations adopted for Mandali Visha are Sheetha Veerya, Pitha Samana, Raktha Prasadana and Visha Hara in nature. Thookudhara explained in Visha Vaidya Jyotsnika, Prayoga Samuchayam contains Sheetha Veerya drugs like Karaskara Pullunni, Chandana, Sathavari, Kumari, Kusmanda Latha, Eranda. It is found to be very effective for reducing burning sensation, swelling, and feeling of extreme heat.

Conclusion

Mandali Sarpa Visha is Pitta predominant Visha. All the constituents of this Yoga are easily available and having anti-poisonous properties. Further studies have to be conducted to prove its clinical efficacy.

Reference

1. Kochunni Thampuran, Prayoga samucchayam, Puthezhath Ramamenon, first sulabha edition Thrissur, november 1999, pg 84.

2. Karattu Namboothiri, Visha Vaidya Jyotsnika, Kerala 6th Chapter, Mandali Visha Chikitsa.

3. Acharya Vagbhata. Ashtanga Hridaya, Arunadatta Sarvanga Sundara, Hemadri Ayurveda Rasayana. edited by Pt. Bhishagacharya Harshastri Paradkar Vaidya, reprint edition 2010, vol uthara sthana. Chapter36 Chaukambha Surbharti Prakashan, Varanasi.

4. https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming.

5. Divya KM, A Comparative clinical trial to evaluate the efficacy of Neelimoola kalka as an add on therapy with Vilwadi gutika in the emergency management of Pit viper envenomation, MVR Ayurveda Medical College college, Parassinikadavu, 2015-2018

6. Indian medicinal plants edited by P.K Warrier, V.P.K Nambiar, C Ramankutty, Vaidyaratnam P.S Varier’ Arya Vaidya Sala Kottakal published by Orient Longman Private Ltd.

7. Acharya Vagbhata. Ashtanga Hridaya, Arunadatta Sarvanga Sundara, Hemadri Ayurveda Rasayana. edited by Pt. Bhishagacharya Harshastri Paradkar Vaidya reprint edition 2010, nidana sthana. Ch 13, Chaukambha Surbharti Prakashan, Varanasi. Pg- 129,130.

8. Andrea D Thompson, Michael J Shea, Oedema, modified september 2022, MSD Manual Professional Version.

9. https://www.ncbi.nlm.nih.gov- Clinical features and management of snake bite

Review Article

Mandali Vishaja Sopha

Journal of Ayurveda and Integrated Medical Sciences