Book Review

1. Introduction

Agadatantra is the toxicology branch of Ashtanga Ayurveda. It deals with animate & inanimate poisons. Agadatantra focuses mostly on the toxicological element of Ayurveda and codes of conduct pertinent to the medical field, such as Ayurveda professional medical ethics and the responsibility of Ayurveda physicians. Agadatantra has been in practice in the state of Kerala since ancient times. The geographical background of Kerala has always presented a seedbed for snakes to survive. Thus the incidence of snake bites increased, which marked the beginning of a Visha Vaidya Parampara (tradition of toxicologists) of Kerala. References regarding Agadatantra are there in almost all classical Ayurveda textbooks. But there are some textbooks which are in local languages. By using the therapeutic philosophies outlined in those books, numerous toxicology clinics were founded in Kerala at the time. Such literatures are now becoming scarcer.

According to great epics of India like Mahaabharata and Ramayana, Prajapathi Kashyapa is considered as first toxicologist. Atharva veda had described poisons and detoxification methods in different hymens. Agnipurana and Garuda purana are also studied with references on poisons and their treatment. The use of arrow poisons are mentioned in Chandyogaupanishad. The literary works that followed the footprints of the Puranaas and Upanishad had done tremendous contribution to the field of Agadatantra. In the greatest treatises of Ayurveda, Charaka and Susruta Samhitha, the poisons were studied. Several treatises exclusively dealing with agadatantra came in to being. Of these seven texts are considered as authentic and they formed the backbone of Agadatantra. They are Narayaneeyanm, Uddeesham, Utpalam, Haramekhala, Ashtanga Hrudraya, Lakshanamruta and Kalavanchana. Shankha Samhitha, Latyayana Samhita and Brihaspathi Samhitha is other notable works in Agadatantra.

The development of toxicology in this state thus became a necessity rather than a convention. The treatment system developed as two school of thought in Kerala. One is Vaishnava tradition and the other Shaiva tradition. The Shaiva tradition of snake bite management originated from the pioneering work of excellent scholars Nachunda naathar and Cherulla pattarathe much known work of Shaiva tradition is the Paatalam a bilingual text in Malayalam and Tamil. Udeesha tantra is followed in the southern part of Kerala and Prayoga samuchaya is followed in the northern part of Kerala [1]. They contain several herbomineral preparations contains metals are used in Kerala in the treatment of snake bite. Kerala has a rich heritage in the treatment of Agadatantra. For the ultimate growth of Agadatantra, the knowledge recorded in those regional scriptures must be thoroughly investigated.

This article is based on the text Prayoga Samuchayam written by Kochunni Thampuranan published by Sulabha printers, Kochi in the 20th century AD. Most popular and widely practiced book in toxicology and was written in the Malayalam era 1110 1934 -35 CE. This book was written in Malayalam [2].

2. Authors recognition

Kochunni thampuran was the foremost Visha Vaidya in Kerala. He was a member of Kochi royal. He was a great independent, brave, generous person. He resided at Peingavu, close to Trissur. He was the founder of Veera Kerala Varma Vaidya shala, that institution offered free treatment and care for poisoned victims. Kochunni Valya Thampuran, a renowned toxicologist, was his guru. Kokkara Namboodiri, eminent toxicologist was the teacher of Kochunni Valya Thampuran who was a master of doota lakshana (features of informer). Like guru he also was an expert in jyotisha, dhootalakshana and shabdalakshana [3]. 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. He was expired on Malayala era.1113 Kumbam 1. Prayoga Samuchchayam 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.

2.1. Subject matter at a glance

This book consist of 11 chapters described as Parichedas. It includes different types of animal bites and management. Dhatugata symptoms of snake poisoning, Madali damsha complications and management, Vega lakshanas of Mushika, Vrischika, are some specific areas highlighted in this textbook. Parvathi prayoga, Sudha vela prayoga, Kalavanchna are some interesting concepts mentioned in this book for the management of snake poisoning. Jeevaraksha gulika, Taruna bhaskaram, Nabhi nirvishadi, Sigrupunarnavadi are some of the potent formulations that is mentioned in Prayoga samuchayam.

2.2. Table 1. Chapter contents at a glance

Table 1.

Chapters and Contents of Prayoga Samuchaya.

Sl no.	Name of the chapter	Highlights
1	Prathama paricheda	Origin of sarpa, Visha danta, Sapta dhatugata lakshana
2	Dwitheeya paricheda	Darveekara visha vega, vishesha chikitsa, samanya chikitsa
3	Triteeya paricheda	Mandali visha chikitsa
4	Chaturtha paricheda	Rajila visha chikitsa
5	Panchama paricheda	Sarpa samanya chikitsa, Kalavanjana, Sudhavela prayoga
6	Shashta paricheda	Mooshika vega & chiktisa
7	Saptama paricheda	Vrischika visha & Chikitsa
8	Ashtama paricheda	Loota visha& Chikitsa
9	Navama paricheda	Nakula, Marjara,Mandooka, Markada, Ashwa, Alarka,Shardoola, Manushya, Galagolika,Kanbha, Jalooka,thottarotti, Matsya, Nalkali visha & its respective management
10	Dashama paricheda	Dhoota lakshana
11	Ekadasha paricheda	Kaivisha chikitsa, Sthavara visha chikitsa, Asudha bhakshana chikitsa, Virudha bakshana, Agni pareeksha, Mruga pareek sha

2.3. Chapter discussion

2.3.1. Chapter 1

The first chapter begins with salutation to lord Tripunitura appan, goddess Parvathi, LordVadakkumnatha,Dhanwantari, Kali, Garuda, his teacher Kochunni Valya Thampuran, Kochi raja. The chapter begins with classification of visha. It is of two types sthavara visha (plant poisons) and jangama visha (animal poisons). A thorough description of life cycle of Sarpa (snake) is given in the first chapter. Classification of different types of snakes, reasons for snake bite, asadaya sthanas, the visha kshaya karana, visha danta, savisha lakshana, sapta dhatu vega lakshanas, asadya lakshana, lakshanas of dead person are also mentioned in this chapter.

Detailed description regarding the origin of sarpa, types of sarpa and concept of nagakkavu has given in this chapter. Moorkha, mandala,rajila, vyantara are the 4 types of snakes. Karalee, Makaree, Kaalaratri, Yamadoothika are the 4 types of Vishadantha (fangs) are preseneted, along with Sapta dhatugata lakashanas of snake poisoning and visha samprarpti.

Certain procedures are mentioned in order to assess the prognosis of poisoning. Amarimula (Indigofera tinctoria) triturated with Amari swarasa and made in to tablet of Vibheetaki size and given with milk. If patient vomits then it is of good prognosis, if there is no vomiting, it will lead to death. Methods of identification of a dead person is also described.

Asadya lakshanas of snake bite is mentioned here. Methods to detect the asadya lakshanas have also been described. Shashasruthi swarasa (Emelia sonchifolia) dropped in to one eye of poisoned person, if it also appears in the next eye, the person is considered to be dead.

2.3.2. 2nd chapter

Sadyodashta chikitsa (first aid management of Sarpa visha) is described in this chapter. Darveekara vega lakshanas and chikitsa. Detailed description of 26 Moorkha (cobra) snakes along with signs and treatment have been mentioned. General treatment principles of Moorkha is also described. When visha is present in first 3 dhathus (charma, rakta and mamsa) oothu chikitsa is effective, if it is in medas and asthi, divya oushada lepana and seva, if it is in majja and sukram nasya and anjana is good. Special treatment modality Oothu chikitsa is mentioned in this chapter.

2.3.3. 3rd chapter

Third chapter covers Saptadhatugata lakshanas of Mandali (Viper) along with treatment. Detailed description of 16 types of Mandali with treatment and signs are given. General treatment principle of Mandali is mentioned. In order to treat Upadravas of Mandali so many other formulations are said. For bleeding conditions like hematemesis, epistaxis, bleeding and swelling various simple formulations have been mentioned.

2.3.4. 4th chapter

Fourth chapter explains Rajila (Krait) sarpa chiktsa, lakshana are mentioned.

2.3.5. 5th chapter

General treatment principles of snake has been mentioned. Various Kalavanchana prayogas have been mentioned in this chapter, Kalavanjana prayogas are the administration of highly potent drugs for the snake poisoning. Parvathi prayoga, Nalsara prayoga Adrushya prayoga, Narma prayoga Karaskara prayoga are some peculiar procedures that are used to eliminate poison from the body. Vishahari Lehyam, Jeevaraksha Gulika, Hinguadi Gulika, Vilwadi Gulika, Visha Vilwadi, Taruna Bhaskaram, Nabhinirvishadi, Gaudanjana, Dasa Beejanjana are few significant formulae that early traditional vaidyas were used. Shudha vela prayoga (Cleome viscosa) is another concept that is used for the removal of poison.

2.3.6. 6th chapter

16 types of Mooshika (Rat poisoning). Four methods of transmission of Visha have been mentioned. Dhatugata lakshanas & chikitsa of visha, treatment of 16 types of Mooshika visha, samanya chikitsa of mooshika, and asadyalakshana.

2.3.7. 7th chapter

Description of four types of Vrischika (Scorpion). It is said that Vrischika are as venomous as sarpa, Dosha predominance is vatapaithiaka whereas in other classics it is vatadhika. Samanya chikitsa is also mentioned briefly.

2.3.8. 8th chapter

16 types of Lootha visha (spider poisoning),7 day symptoms with treatment, Samanya chikisa are presented in this chapter. Neelithulasyadi ghrita is an important formulation, many practitioners are using this combination till date.

2.3.9. 9th chapter

Mongoose poisoning, cat poisoning, frog poisoning, monkey poisoning, horse poisoning, dog poisoning-90 days treatment, horse, millipede, fox, lizard, garden lizard, frog, chameleon, wasp, leech, fish poisoning,4 legged animal poisoning, poisoning due to nail and teeth of human along with brief description of management of respective animals were mentioned. Binna visha is explained in this chapter.

Pathya & Apathya of visha, Pramana (dose) of oushadas (medicines) in poisonous cases, Snana (bath) and Swedana (sudation) prayogas, surgical methods, have also been also mentioned in this chapter.

2.3.10. 10th chapter

This chapter explores Doota lakshana in detail.

2.3.11. 11th chapter

Kaivisha chiktsa, Sthavara visha chikitsa, samanya chikitsa, sthavar vishesha visha chiktsa are dealt in this chapter. Antidotes of Upavisha, Asudha bhakhana chiktsa, Athibhakshana chikitsa, Virudha bhaskhana chikitsa, Savishanna panadi lakshana, Sthavara jangama visha samanya chiktsa are some other interesting topics in this chapter.

2.4. Critical evaluation of the text – unique methodologies adopted in Prayoga samuchaya

2.4.1. Oothuchikitsa

Three persons are made to chew powder of Viswa (Zingiber officinale), Maricha (Piper nigrum), Dusparsa (Tragiain volucrate), Vishavega (Aristolochia indica) in equal quantities and then blow simultaneously over both ears and vertex for 150 times. The medicinal air stimulate the nerves and helps in regaining consciousness. In severe pain this procedure can be administered locally.

2. Bhinna visha

Bhinna Visha is a condition in which the Visha scatters in the body for various reasons and manifested as systemic disorders on rare occasions.

2.4.3. Karu prayoga

Karu is a device (in the shape of Datura flower of length 6 Angula for male and 8 Angula for female), to administer the medicine in to the orifice like anus, urethra, vagina, ear and shiras. This is done in unconscious conditions and when the patient is unable to take oral medicine. At first karu is introduced in to the canal then put the special medicine in the karu. This process is not practiced now.

2.4.4. Kalavanchana prayoga

The concept is to overcome the fatal stage and save the life of the poisoned person. This is done by special oushadas administered in the form of Lepa, Dhara along with oral medicines. Parvathi prayoga, Nalsara prayoga, Adrushya prayoga, Narma prayoga, Karaskara prayoga are the examples of Kalavanchana prayogas.

2.4.5. Vellott prayogam

Vellott prayogam is described in Mahamandali visha. Ikshvaku is administered to patients who come with headache, anorexia, elevated Vata dosha, and Visha situated at Amashaya. It is boiled with goat's milk in a bronze pot.

2.4.6. Sudhavela prayoga

Vela (Cleome viscosa) is a herbal medicine. In vela prayoga the plant is made to grow in a square shaped pit. The juice of Karaskara is poured in the mud. 2 The grown plant, Vela (with roots) is triturated with surasa swarasa and gulika is made in to the size of gunja. It cures all the poisoning. Few formulations of Vela is also mentioned.

2.4.7. Mooshika vega & chikitsa

5 Mooshika visha vega lakshanas and their respective management is mentioned only in Prayoga samuchaya.

2.4.8. Atibhakshana chikitsa

If the edible food are taken in excessive quantity it creates some problems. The management of these edible foods are explained in athibhakshana chikitsa. e.g. If milk is taken in excess quantity it causes indigestion, it can be cured by Shunti jala (hot water with a pinch of dry ginger, i. e. Zingiber officinale Roscoe).

2.4.9. Doota

Doota lakshanas (messengers sign) are elaborately described in 10th chapter. Doota lakshanas based on Rashi (astrological sign), direction of swasagati of vaidya in relation with doota, vaidya cheshtas during time of arrival of messenger is delineated. In ancient times the messenger or an informant comes to the vaidya (physician) bringing the news about a snake bite. Based on the characteristics shown by the messenger the vaidya (physician) draws prognosis of the snake bite. The book describes both auspicious and inauspicious characteristics of the messenger.

2.5. Comparative analysis with Susuta samhita & Visha Vaidya jyolsnika

In classical Ayurveda treatises Susruta Samhita gives elaborated description regarding toxicology. Separate Sthana, 8 chapters in Kalpasthana wholly belongs to Agadatantra. In Susruta samhita various aspects of Agadantra is mentioned very precisely. Concepts like dooshivisha, garavisha, environmental poisonoing, Sthavara visha & Jangama visha and the management of each poisoning is mentioned. Compared to Samhitas traditional Visha vaidya text books like Visha Vaidya jyolsnika & Prayoga samuchaya are practically oriented. They focused mainly on the management of poisoning. Many single drug usages and various treatment modalities apart from Panchakarma procedures are mentioned in Prayoga samuchayam like Kalavanchana prayoga, oothuchikitsa, thooku dhara etc. Compared to Visha Vaidya jyolsnika, Prayoga samuchaya gives detailed description of symptoms and management for each poisoning. Keraleeya visha chikitsa modalities like Oothuchikitsa, Thooku Dhara, formulations like Sigrupuarnavadi, Paranthyadi Tailam, Shudhvela Prayoga, Tharuna Bhaskaram, Nabhinirvishadi, Pavitra Vatakam are mentioned in both the textbooks. In visha Vaidya jyolsnika doota lakshana is mentioned first, whereas Prayoga samuchaya it is explained in last chapter. Mantra chikitsa is explained in Vishavaidya jloysnika only. In Prayoga samuchayam this part is missing. Karandaka, various treatment modalities to assess the prognosis of Sarpa visha, concept of serpant temple, different Kalavanchana prayogas like Nalsara prayoga are mentioned only in Prayoga samuchchayam. Some formulations like Visha hari lehyam is specifically mentioned in Prayoga samuchchayam.

2.6. Practical aspect

According to a study conducted on traditional practices in the field of Visha chikitsa, 78% Vishavaidas are presently following Prayogasamuchchaya in practice [4]. Vishahari lehyam, Jeevaraksha gulika, Hinguadi gulika, Vilwadi gulika, Visha vilwadi, Taruna bhaskaram, Nabhinirvishadi, Gaudanjana, Dasha beejanjana these are the herbo mineral & herbal preparations medicines, which were used by ancient Visha vadiyas. Neelithulasyadi ghrita, Sigru punarnanavadi lepa, paranthyadi taila, vilawdi agada are some other formulations. These medicines are currently available in market. Doorvadi keratailam is indicated in mandali prakarana is available in market. It is effective for skin manifestations like dadru, kandu etc. Paranthyadi keratailam is advised for treatment of non healing ulcers.

Most of the important formulations that are mentioned in this textbook are mineral preparations. The advantage of rasachikitsa are minimal dose, absence of bad taste and immediate action towards restoration of health. Apart from these formulations, many single drug uses & simple combinations of drugs are also mentioned in this book which we can practice. Apart from toxicological cases we can use these formulations in for treatment of other diseases.

3. Future goal

• •Translation and critical study of this book is needed to explore, analyse and interpret the subject matter.
• •Extensive research can be conducted for the clinical evaluation of drugs given in this text book.
• •Observational study can be conducted in case of Nakshatra, Rashi, Doota lakshanas in this text book for revalidation

4. Need for translation

Translation of this book in any other languages is unavailable, which is a lacuna of this book.

5. Conclusion

The book offers understanding of Visha chikitsa. This book explained numerous visha hara formulations. Both herbal and herbo-mineral formulations, single drug usage have been mentioned. Organised presentation of materials can be found in this text. Majority of the drugs are readily accessible. It gives a detailed description of Sarpa and management of each type of sarpa. Kaivisha chikitsa is very well explained in this book. The author gives much importance to doothalakshana. This book has not been translated yet. There is sufficient knowledge in regional languages which should be translated to a common language so that the knowledge can be open to all. To this day, the physicians practicing Visha chikitsa in Kerala adhere to the treatment protocols outlined in the text.

Sources of funding

None.

Author statement

Deepthi M K: Conceptualization, Writing Original Draft, Visualization, Writing review and editing, Deepak A S:Visualization, Writing Review and Editing, Supervision Rajni Sharma: Visualization, Review and editing.

Conflict of interest

None.