E-ISSN:2456-3110

Review Article

Chaturvinshati Upkrama

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Chaturvinshati Upkrama and its role in management of poisoning

Abaji Dudhe P.1*, Surajalal Ukey J.2
DOI: http://dx.doi.org/10.21760/jaims.8.5.23

1* Pranali Abaji Dudhe, Assistant Professor, Department of Agadtantra, Bhausaheb Mulak Ayurved College and Research Hospital Butibori, Nagpur, Maharashtra, India.

2 Jaiprakash Surajalal Ukey, Associate Professor, Department of Agadtantra, M.S. Ayurvedic Medical College Hospital and Research Institute Kudwa, Gondia, Maharashtra, India.

Agadtantra is the branch of Astanga Ayurved having system of knowledge for conquering poisons. Acharya Charaka has explained twenty-four modalities of treatment which are to be employed while treating poison. Chaturvinshati Upkramas are unique in the management of poisons. It can be seen that most of them are based on same principle of modern medicine. Chaturvinshati Upkramas is common for all types of Visha i.e., Sthaavara, Jangama, Gara, Dooshi Visha etc. In most of the cases Upakramas should be selected by the physician on the basis of the type of Visha Prakruti (constitution), Saatmya (compatibility), Ritu (season), Desha (place), Vega (impulse) and Balaabala (strength and weakness of both the patient and poison).

Keywords: Chaturvinshati Upkram, Visha, Chikitsa, Poison

Corresponding Author How to Cite this Article To Browse
Pranali Abaji Dudhe, Assistant Professor, Department of Agadtantra, Bhausaheb Mulak Ayurved College and Research Hospital Butibori, Nagpur, Maharashtra, India.
Email: 		Pranali Abaji Dudhe, Jaiprakash Surajalal Ukey, Chaturvinshati Upkrama and its role in management of poisoning. J Ayu Int Med Sci. 2023;8(5):145-149.
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https://jaims.in/jaims/article/view/2473

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-25 2023-03-28 2023-04-04 2023-04-11 2023-04-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Pranali Abaji Dudhe, Jaiprakash Surajalal Ukeyand 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].

Journal of Ayurveda and Integrated Medical Sciences 2023;8(5)145
Dudhe P et al:Chaturvinshati Upkrama and its role in management of poisoning

Introduction

Agadtantra is branch of Astang Ayurveda science, not from today since long time Visha Vaidyas are successfully treating cases of animate (Jangam) and inanimate (Sthawar) poisoning. Vishatantra or Agadtantra is science of use of medicines to treat poisoning. Charaka Acharya has explained general treatment of poisoning as twenty four modes of treatment applicable to animate and inanimate poison for envenomation. These 24 modes of general treatment of poisoning are similar with principles of modern treatment. Some changes have done but principles are similar. 1. Removal of unabsorbed poison by Vamana, Virechana. 2. Use of antidotes (Prativisha). 3. elimation of absorbed poison by Raktmokshana, 4. Symptomatic treatment – Anjana, Nasya Awgahana, Sadnyasthapana, etc. 5. General care of patient. In modern toxicology there are five above principles of treatment of poisoning. After seeing carefully these 5 principles are nothing than our Chaturvinshati Upakrama.

Materials and Methods

There are two major types of treatment of poisoning

1. General

2. Specific

In this article we are going to discuss about general treatment of poisoning.

Mantra: This is said to be most effective and sure treatment in almost all envenomation procedures, especially in toxic bites. Mantras may be monosyllable, bisyllable or multisyllable. They are combination of words but the stress on syllables, ascent, tone and style of pronunciation differs. Effectiveness depends upon Siddhhi of Mantra of practitioner. Effect of these Mantras are beyond comprehension. There are so many Vishavaidyas who practice Mantras in rural area of India. Mastery achieving is a very difficult task in today’s era hence our Acharya recommended other modalities.[1]

Mode of action of Mantra is unknown but according to some experts it works like as counselling which may prevent deaths from non toxic bite and Shankavisha.


Aristha Bandhana: The spread of poison is to be arrested by Aristha Bandhana. Aristha may be made of silk thread, bamboo, cloth, etc. Charak Acharya used Venika word for Arishta Bandhana (it made up from hair). Physically applying ligature, blocks spread of the poison. It should be done 4 Angula (4 inches) above the bite site.[2] It is applied quickly after toxic bite and release slowly after 2 minutes gap for 2sec. To prevent gangrene of that part. Modern toxicology does not permit ligature at bite point for prevention of gangrene. But in emergency conditions we can apply it to prevent life. In case of Asian cobra and pitted viper we must take precaution for gangrene.

Utkartan and Nishpidana: Excision of bitten part is termed as Uttkartana. This can be done when bitten part is the tip of finger or toe. Nispidana is done by using fingers or roller like object, the venom is brought to the site of bite. Incision is done for permitting bleed can remove venom from bite site. This treatment has to be done before spread of venom over body. Utkartana and Nishpidana only can done when that part is not Marma Sthana.[3] Incision at bite point and permitting bleed is another method of removing of unabsorbed poison.

Chooshana: This procedure is done to absorb unabsorbed poison. In ancient time it is said to suck poison with mouth by keeping dried cow dung, sand or soil in mouth however this procedure is outdated.[4] While using this principle we can suck poison with the help of suction bulb, dry sponge, capillary etc. This was a very effective method in ancient times, if someone practice for this method now a days he/she must be trained otherwise it may harm to live of Vaidya. Suction should be done within 5 minutes after bite.

Agni: When bite is on a part of the body that cannot be subjected to Arishta Bandhana such as the trunk or face suction, excision and burning indicated. The bite spot should be burned with red hot gold, iron or ember. Master principle behind it is “fire is capable to burn everything then why not poison”.[5]

Parishek: Parishek means washing of affected area with plain or medicated water, cold, warm, lukewarm water can be used depending upon condition of the patient. Santalum album and Vetiveria zizanoides can be used as medicines for Parishek.[6]



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Avagaaha: Avagaaha is done in the presence of severe pain or pain caused by retention of urine. A metal vessel large enough to the level of neck is filled with warm water and patient is directed to sit in it in such way that is body remains immersed in water. When the water loses warmth additional warm water is supplemented after removing an equal quantity of cold.

Raktamokshan: Bloodletting is the last and most potent treatment when the poison has spread to entire body. When poison has spread, bloodletting is to be done because when toxic blood is removed the toxic manifestations fail to sustain and vanishes altogether.[7] It is contra indicated in children, old age and in pregnant women's.[8]

Vamana: In cold season in presence of cold saliva, predominant Kapha and when patient is of Shleshma constitution. Induction of Vaman or emesis to be done by emetics.[9] It is also done in latent poisoning (Dushi Visha) and concocted poisoning (Gara). It is done in animate and inanimate both types of poisoning. In case of Jangam Visha, Vamana is to be done as follow Cobra - 2nd, 4th, 5th and 6th Vegas viper - 3rd Vega, krait - 2nd, 4th, 5th Vegas

Gastric Lavage /Stomach Pumping/Gastric Irrigation

This treatment is useful any time within three hours after ingestion of poison. It is done with stomach wash tube (ewads or boas) tube or ordinary soft non collapsible rubber tube of 1cm diameter and 1.5m. Length. It is contra indicated in corrosive poisoning and hydrocarbons. Epicac, zinc sulphate, apomorphine is used to emesis and water, kmno4 (1:5000), 5% Nahco3, 4% tannic acid and 1% sodium or potassium iodide is used for stomach wash.

Virechana: When the patient suffers from burning sensation and pain the gut (Koshtha), flatulence and block or difficulty in passing urine purgatives are indicated.[10] It is done in first stage of Dushivisha and second stage of Sthawar Visha.[11] In rabies, purgation is to be done with medicines that are with milky latex of Arka.[12]

Upadhan/ Vishasankramana/ Kakpada

It is a treatment in which vertex is incised in cross shape or crows leg shape and fresh flesh is kept at site. This is done in seventh phase of poisoning after Nasya and collyrium.[13]

Hradayawarana: In general ghee and poison have diametrically opposing properties. Poison derange Tridosha including their reservoirs and then occupy the heart and spreads all over body. Administration of ghee immediate after poisoning slow downs spread of poison and this is the principle. Emesis is done with emetics and later Hradayawarana is done with following drugs.[14] Honey, Ghee, milk, Gairik, juice of cow dung, Ikshu, blood of goat, Soil mixed with water, ash mixed with water.

Anjana: This is done to awake patient of snake bite victim from loss of consciousness. It is very useful in cobra bite when patients eyes are oedematous and when he is sleepy.[15] Anjana is used in third phase of cobra bite, Agadas are used as Anjana in 7th phase of cobra bite and 6th phase of krait bite.

Nasya: It is usually given when patient is unconscious, pungent drugs are used. Strong Nasya is indicated in 7th phase of cobra bite, Pradhaman Nasya is indicated in 6th phase of krait bite.

Dhoom: Fumes or smoke of medicines are given. Basic principle of Dhoom is same as like Anjana and Nasya.[17]

Leha: Lehan of various Agada ex. Dashang Agada, Dooshivishari Agada etc.[18]

Prashamana: Prashaman is done in case of bleeding after bloodletting.

Pratisaran: Sprinkling of medicated powder. It absorbs excess moisture reduces itching, irritation, cools the skin and also dries the oozing.[19]

Prativisha: Vridha Vagbhata described in A.S.U. 48 about use of Prativisha. This treatment is useful when spread of poison is uncontrolled, after 5th phase but before 7th phase. This is last most hopeful treatment hence should be used carefully.[20]
Sadnyasthapana: Charaka stated that this measure is done in sixth phase of Visha. Following drugs mixed with cow bile shall be consumed.[21] Rajani (Curcuma longa), Manjistha (Rubia cordiafolia), Maricha (Piper nigrum), Pippali (Piper longum). In commentary of Ayurveda Dipeeka it is stated that above drugs can used for Sandnyasthapana.

Mritsanjeevanam: These drugs are used in conditions when patient is apparently dead but life energy is still hidden in body. Surasadi Yoga, Kakandkadi Yoga, Vartakadi Yoga these are some Yogas for Mritsanjeevan can be used.[22]


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Dudhe P et al:Chaturvinshati Upkrama and its role in management of poisoning

Discussion and Conclusion

Chaturvimshati Upkramas explained by Acharya Charaka are unique in the management of poisons. It have all the measures needed in the management of poisons. Chaturvimshati Upkramas is common for all types of Visha i.e., Sthaavara, Jangama, Gara, Dooshi Visha etc. In most of the cases Upkramas should be selected by the physician on the basis of the type of Visha, Prakruti, Saatmya, Rtu, Sthaana, Vega and Balaabala. In Chaturvimshati Upkramas, the pacifying measures are Anjana, Lepa, Dhupana, Leha, Upadhana, Prashamana, Prathisarana. The counteracting medications are Mantra, Aushadhe, Prativisha. The elimination therapy are Raktamokshana, Vamana, Virechana, Nasya. Supportive symptomatic treatment are Hrdhayavarana, Sanjasthapana, Mrthasanjivani. The measure that restrict entry of poison into systemic circulation are Arishta, Uthkarthana, Nishpidana, Chushana, Agni, Parisheka, Avagaha.

References

1. Shastri kaviraj Ambikadutta sushruta samhita (Kalpasthan). Varanasi: Chaukhambha Sanskrit sansthan 2012, ch.5, verse 13

2. Ashtanga Samgraha with sarvanga sundhara commentary of Arundatta and Ayurveda Rasayana commentary of Hemandri. Reprint Varanasi (India) : Chaukhambha orientalia: 2005; utharasthaan P903

3. Ashtang Hruday, Bramhanand Tripathi, sutrasthana, ch 36, verse 44, Chaukhambha Sanskrit pratishthan.

4. Acharya YT Charaka Samhita with Ayurveda Deepika Commentary of Chakrapanidatta, Reprint ed: Varanasi: Chaukhambha Orientalia, 2015; chikitsasthaan p573

5. Ashtang Hruday, Bramhanand Tripathi, sutrasthana, ch 36, verse 45,46, Chaukhambha Sanskrit pratishthan.

6. Acharya JT, Sushruta Samhita of Sushruta Nibandha Samgraha Commentary of Sri Dalhan Acharya and Nyaya Chandrikapanjika of Sri Gayadasa Acharya. Reprint ed: Varanasi, Chaukhambha Sanskrit Sansthan; 2014; kalpasthana p575

7. Ashtang Hruday, Bramhanand Tripathi, sutrasthana, ch 36, verse 47, Chaukhambha Sanskrit pratishthan.

8. Shastri Kaviraj Ambikadutta sushruta samhita (Kalpasthan). Varanasi: Chaukhambha Sanskrit sansthan 2012, ch.5, verse 30

9. Shastri Kaviraj Ambikadutta sushruta samhita (Kalpasthan). Varanasi: Chaukhambha Sanskrit sansthan 2012, ch.5, verse 39

10. Shastri Kaviraj Ambikadutta sushruta samhita (Kalpasthan). Varanasi: Chaukhambha Sanskrit sansthan 2012, ch.5, verse 40

11. Ashtang Hruday, Bramhanand Tripathi, sutrasthana, ch 35, verse 38, Chaukhambha Sanskrit pratishthan.

12. Ashtang Hruday, Bramhanand Tripathi, sutrasthana, ch 38, verse 36, Chaukhambha Sanskrit pratishthan.

13. Acharya YT Charaka Samhita with Ayurveda Deepika Commentary of Chakrapanidatta, Reprint ed: Varanasi: Chaukhambha Orientalia, 2015; chikitsasthaan p574

14. Charak samhita chikitsa sthana, chapter23, verse 46,47, vidyotini Hindi Commentary by K.N.Shastri and G.N.Chaturvedi 1989, 16th edi, Chaukhambha Bharti Academy

15. Acharya JT, Sushruta Samhita of Sushruta Nibandha Samgraha Commentary of Sri Dalhan Acharya and Nyaya Chandrikapanjika of Sri Gayadasa Acharya. Reprint ed: Varanasi, Chaukhambha Sanskrit Sansthan; 2014; kalpasthana p576

16. Acharya YT Charaka Samhita with Ayurveda Deepika Commentary of Chakrapanidatta, Reprint ed: Varanasi: Chaukhambha Orientalia, 2015; chikitsasthaan p575

17. Pawde uday, general principles of management of poisoning in Ayurveda and modern medicine-A conceptual study, IAMJ, ISSN: 23205091, http//iam.in/posts/image/upload/3004-3014.pdf

18. Ashtanga samgraha with sarvanga sundhara commentary of Arundatta and Ayurveda Rasayana commentary of Hemadri. Reprint varanasi (India) : Chaukhambha orientalia: 2005;uttarsthana p853.

19. Sonali chalakh Review article of 24 upakrama of charaka in modern era, journal of Indian system of medicine 2014 JISM1403H oaji.net/articles/2016/3020-145


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20. Ashtanga samgraha with sarvanga sundhara commentary of Arundatta and Ayurveda Rasayana commentary of Hemadri. Reprint varanasi (India) : chaukhamba orientalia: 2005;uttarsthana p904.

21. Acharya YT Charaka Samhita with Ayurveda Deepika Commentary of Chakrapanidatta, Reprint ed: Varanasi: Chaukhambha Orientalia, 2015; chikitsasthaan ch 23, verse 49

22. Acharya YT Charaka Samhita with Ayurveda Deepika Commentary of Chakrapanidatta, Reprint ed: Varanasi: Chaukhambha Orientalia, 2015; chikitsasthaan P584


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