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\begin{document}


\def\RunningAuthor{Prasanth R Krishnan et al.}
\firstPage{1162}
\articleType{Original Article}
\receivedDate{12 Jan 2021}
\acceptedDate{18 Feb 2021}
\revisedDate{16 Feb 2021}
\journalVolume{2021, 12}
\journalIssue{2}
\journalDoi{ijrps.v12i2.4649}
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\title{A critical review on vrischika visha W.S.R. to keraliya visha chikitsa}
\author{Shanti~R~Nair\textsuperscript{1},  
            Suwarna~Meshram\textsuperscript{2}, 
            Prasanth~R~Krishnan\textsuperscript{*}\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Research Scholar, Department of Agada Tantra, Parul Institute of Ayurved, Parul University, Vadodara, Gujrat, India}~\\{\textsuperscript{2}Faculty of Ayurved, Parul University, Vadodara, Gujrat, India}}

\begin{abstract}
Scorpion stings are major public health problem 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, In India we have identified around 86 species. Poison due to insect bite is common and can be accompanied with a variety of symptoms ranging from simple itching to life threatening situations. Many may go through minor problems like swelling, tingling or numbness due to the sting. Scorpion sting usually results in severe symptoms, as its venom is more potent. Young children and older adults may require immediate treatment. Vrischikadamsha is such a specific envenomation that requires medical attention. There are ample references treatment modalities and medicines in Keraleeyavisha chikitsa granthas and ayurvedic classics which are described for managing vrischikavisha. Many of the keraliyavishagrantha are written in Malayalam hence there is a need to explore and bring out the remedies. So in this article a humble effort is made to bring out the different vrischika and treatment modalities described in keraleeyagrandhas along with the specific symptoms. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Literary Review Vrischika Visha,\newline Keraliya Visha Grantha,\newline Scorpion
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Prasanth~R~Krishnan~\\ Phone:\ 9746113833~\\  Email:\ prasanth.r.krishnan@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
Agadatantra is a single subject in which maximum number of books is written in keraliyavisha chikitsa grantha and samhitas. Keraliyavishavaidyas has an ancient and renowned background. In this system, both vedic and non-Vedic schools of thoughts were present. The renowned keraliyagranthas which have description on vrischikavisha are VishaVaidyaJyotsnika: Classification, symptoms and treatment of vrischikadamsha, vegalakshanas are described in the 12\ensuremath{^{th }}adhikara named `vrischikavisavijnaniyapratishedam'. Written by SreelekhaK.G, PrayogaSamuchaya in saptamapariccheda we get reference of origin, classification, signs and symptoms and treatments of vrischikadamsha. Written by KochunniTamburaan. Narayaniyam which is also well known as Tantra Sara Sangraha gives Different Yogas used in vrischikadamsha are explained 10\ensuremath{^{th }}patala written by Narayanan. KriyaKoumudi by Sri V M KuttiKrishnaMenon detailed description about vrischika, vegalakshnas, vrana and upadrava due to vrischikadamsha. 

\textbf{Origin of Vrischika}

According to acharyavagbatta those born from the cadaver of snakes are Mahavisha, Born from cadaver of animals killed by poisoned arrow are Madhyav- 


\begin{table*}[!htbp]
\caption{\boldmath {Morphological Features of Vrischika} }
\label{tw-0cc6fcd50916}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.19830000000000002\linewidth-2\tabcolsep}p{\dimexpr.3217999999999999\linewidth-2\tabcolsep}p{\dimexpr.25689999999999998\linewidth-2\tabcolsep}p{\dimexpr.223\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Vrischka & \cAlignHack SU & \cAlignHack AH & \cAlignHack AS\\
\tblmidrule 
Teekshnavisha Vrischika  &
  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 \unskip~\citep{1030815:21639331}. &
  Appear like fire, have one joint, belly is red, black or white \unskip~\citep{1030815:21639338}. &
  Reddish brown, spotted variegated colour, resembles blood or fire, have only one joint, belly is reddish black or white in colour \unskip~\citep{1030815:21639342}.\\
Madhya vishavrischika &
  Red, yellow or brown colour in body, smoky in belly, three joints in tail &
  Smoke coloured abdomen, 3 joints, brown, slight red, reddish brown body spotted, variegated and resembling blood. &
  Smoke coloured abdomen, 3 joints brown or reddish brown in colour\\
Mandha visa vrischika &
  Colours such as black, blue, brown, white and colour like cows urine, coarse (dull), blue{\textendash}black, yellow or smoky, having hair on their belly resembling algae, red or white, having more number of joints in the tail than others. &
  Yellow, white-blue, many colours of black, dry, hairy has many joints, abdomen red and pale &
  Yellow, white, blue, dry, rough, brown or dark brown in colour, hairs on the body, many joints belly being reddish or white.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Lakshanas of vrischikavisha} }
\label{tw-76dbc44dffd4}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.063999999999999995\linewidth-2\tabcolsep}p{\dimexpr.6055\linewidth-2\tabcolsep}p{\dimexpr.06999999999999997\linewidth-2\tabcolsep}p{\dimexpr.0924\linewidth-2\tabcolsep}p{\dimexpr.0836\linewidth-2\tabcolsep}p{\dimexpr.0845\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}No. & Signs and symptoms & A.S & PS & KK & CS\\
\tblmidrule 
1. &
  Penetrating nature &
  + &
   &
   &
  \\
2. &
  Burning sensation  &
  + &
  + &
  + &
  +\\
3. &
  Ascends quickly and descends, settles at the site of bite &
  + &
   &
   &
  +\\
4. &
  Pain  &
  + &
  + &
  + &
  +\\
5. &
  Bluish Discoloration &
  + &
   &
   &
  \\
6. &
  Pricking pain &
  + &
   &
   &
  +\\
7. &
  Burning sensation  &
  + &
   &
   &
  \\
8. &
  Sarpatulyavishavega &
   &
  + &
   &
  \\
9. &
  Swelling &
   &
  + &
   &
  \\
10. &
  Foul smell of blood &
   &
  + &
  + &
  \\
11. &
  Heaviness of head and eye &
   &
  + &
   &
  \\
12. &
  Fainting  &
  + &
  + &
  + &
  \\
13. &
  Giddiness  &
   &
  + &
  + &
  \\
14. &
  Severe sweating &
  + &
  + &
  + &
  \\
15 &
  Palpitation &
   &
  + &
  + &
  \\
16. &
  Karnika &
   &
  + &
  + &
  \\
17. &
  Fever &
  + &
  + &
  + &
  \\
18. &
  Anorexia &
   &
  + &
  + &
  \\
19. &
  Shivering  &
   &
  + &
  + &
  \\
20. &
  Vomiting &
   &
  + &
  + &
  \\
21. &
  Mental instability &
  + &
  + &
  + &
  \\
22. &
  Horripilation &
   &
  + &
  + &
  \\
23. &
  Redness &
   &
  + &
  + &
  \\
24. &
  Grief and discomfort &
  + &
   &
  + &
  \\
25. &
  Severe thirst &
   &
   &
  + &
  \\
26. &
  Swelling of tongue &
  + &
   &
   &
  \\
27. &
  Rigidity of body &
  + &
   &
   &
  \\
28. &
  Black color blood comes out from all the orifices &
  + &
   &
   &
  \\
29. &
  Loss of sensory perception &
  + &
   &
   &
  +\\
30. &
  Dryness of the mouth &
  + &
   &
   &
  \\
31. &
  Wasting of the muscle &
  + &
   &
   &
  +\\
32. &
  Probably even death &
  + &
   &
   &
  +\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{A.S-Astanga samgraha \unskip~\citep{1030815:21639342}; P.S-Prayogasamucchayam \unskip~\citep{1030815:21639347}; KK-Kriya Koumudi \unskip~\citep{1030815:21639330}; C.S-Caraka Samhita \unskip~\citep{1030815:21639348}}
\end{tablenotes}
\end{threeparttable}

\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Symptoms Produced by Different Types of Vrischika} }
\label{tw-b635dde7aa72}
\def\arraystretch{1.1}
\ignorespaces 
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\tbltoprule \rowcolor{kwdboxcolor}Visha bheda & Symptoms Acc to SS and VVJ\\
\tblmidrule 
Maha visha &
  Manifestation of symptoms of all stages at once, development of vesicles, dizziness, burning sensation, fever, black blood flows out from orifices and with these dreadful symptoms the person dies quickly.\\
Madhya visha &
  Produces aggravation of doshas similar to the three kinds of snakes, Give rise to swelling of the tongue, obstruction to swallowing of food, severe fainting. \\
Manda visha &
  Pain, shivering, stiffness of the body, flow of black colored blood from site of sting. When bitten in the extremities pain travels upwards, giving rise to burning sensation, sweating, oedema at the area and fever.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Damsha Lakshana According to Dosha Predominance} }
\label{tw-c7bc1ec4b27c}
\def\arraystretch{1.1}
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\tbltoprule \rowcolor{kwdboxcolor}VatajaVrischikaDamsha & PittajaVrischikaDamsha & Kaphajavrischikadamsha\\
\tblmidrule 
Pain in the region of heart, stoppage of movement of vata in upward direction, engorgement dilatation or formation of network of vein, pain in joints and bones, rolling on the ground, twisting pain in the calves and blue discoloration of the body &
  Loss of consciousness, warm expiration, burning sensation in the heart, bitter taste in the mouth, tearing of muscles, swelling which is reddish yellow in color. &
  Vomiting, loss of taste/appetite, nausea, excess of salivation, running nose, feeling of cold and sweet taste in mouth \unskip~\citep{1030815:21639349}.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Dathugata Vrschika Damsha Lakshana} }
\label{tw-c0d4230d92b7}
\centering 
\begin{threeparttable}

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\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1318\linewidth-2\tabcolsep}p{\dimexpr.28530000000000005\linewidth-2\tabcolsep}p{\dimexpr.3329\linewidth-2\tabcolsep}p{\dimexpr.25\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Dathu &  PS & KK & VishaVaidhya Sara Sangraha\\
\tblmidrule 
Twak &
  Soochibhirivatudyati &
  Pricking pain, vomiting, convulsions, delirium &
  Muhusthodam\\
Rakta &
  Paramadaham &
  Twakgatalakshana, Fatigue, Daham, jwara, atisara &
  Angadaham\\
Mamsa &
  Sopham \mbox{}\protect\newline Hikka &
  Hikka, Granthi &
  Hikka, Granthi\\
Meda &
  Greevashushkata &
  Gala sosam &
  Kandasosham\\
Asthi &
  jwaram &
  Jwaram &
  TeevraJwara\\
Majja &
  Manahasantapam &
  Manaprayasam &
  Manasthapa\\
Sukra &
  Raktanetra \unskip~\citep{1030815:21639343}; Maranam &
  Raktanetra, hridayaroga, marana \unskip~\citep{1030815:21639332}. &
  RaktaNetra \unskip~\citep{1030815:21639336}.\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{P.S-Prayogasamucchayam; KK-Kriya Koumudi }
\end{tablenotes}
\end{threeparttable}

\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Dosha Predominance of Vrischika Visha According To Different Acharyas} }
\label{tw-dadbdc88d4f8}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3672\linewidth-2\tabcolsep}p{\dimexpr.6328\linewidth-2\tabcolsep}}
\tbltoprule 
Grantha &
  Dosha predominance\\
Charaka samhita &
  Vatolbana\\
Ashtanga sangraha &
  Vatolbana\\
Ashtanga hridaya &
  Vatolbana\\
Sushruta samhita &
  Did not mention specific dosh predominance for vrischikabt mentions vatakapha predominance for keetavisha\\
Prayoga samucchaya &
  Mostly vatapittapradana, very few are Kapha predominance,\\
Kriya koumudi &
  Mostly vatapittapradana, Rarely of kapha predominance.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
isha, and Born from the putrefied dung of cow and other animals are Mandavisha \unskip~\citep{1030815:21639346}. 

According to sushrutaacharya those born from decomposed dead body of snakes and such other poisonous animals are termed as TeekshnaVisha. Those born from decomposed materials wood and brick are termed as Madhya Visha. Those born from decomposed cow dung are termed as MandaVisha \unskip~\citep{1030815:21639341}. According to Prayogasammuchaya the four types of vrischika- vata, pitta, kapha and sannipathika {\textendash} are born from the decayed faeces, urine, semen, egg, and dead bodies of snakes \unskip~\citep{1030815:21639328}. According to kriyakoumudivrischikas are born from the cadaver of snakes, decomposed materials or from dead body of animals killed by poisoned arrow, Born from decomposed cow dung \unskip~\citep{1030815:21639319}.

\textbf{Classification of Vrischika}

Based on potency (AS \unskip~\citep{1030815:21639324}, AH \unskip~\citep{1030815:21639320}, Prayoga Samuchayam (P.S) \unskip~\citep{1030815:21639325})-3 TYPES


  
  \begin{enumerate}
  \item \relax Mahavisha {\textendash} Powerful Poison
  \item \relax Madhya Visha {\textendash} Moderate poison 
  \item \relax MandaVisha {\textendash} Mild poison 
  \end{enumerate}
  According to Su. Ka \unskip~\citep{1030815:21639339} and VishaVaidyaJyotsnika(V.V.J)


  
  \begin{enumerate}
  \item \relax MahaVisha -15 types
  \item \relax Madhya visha- 3 types 
  \item \relax Mandavisha- 12 types \unskip~\citep{1030815:21639334}.
  \end{enumerate}
  Thus total vrischika are 30 types. In Table~\ref{tw-0cc6fcd50916}  Morphological Features of Vrischikas are shown.

According to Kriya.Kaumudi(K.K)- 2 Types


  
  \begin{enumerate}
  \item \relax Ugravisha
  \item \relax Alpaveeryavisha \unskip~\citep{1030815:21639333}
  \end{enumerate}
  Based on effect of poison (Ch.chi)


  
  \begin{enumerate}
  \item \relax DooshivisajaVrischika
  \item \relax Pranaharam/Asadhyam \unskip~\citep{1030815:21639323}
  \end{enumerate}
  But a detailed description regarding this type of vrishika is not available in charaka Samhita

Based on dosha predominance

According to P.S: 4 Types 


  
  \begin{enumerate}
  \item \relax Vatapradhana
  \item \relax Pittapradhana
  \item \relax Kaphapradana
  \item \relax Sannipatika \unskip~\citep{1030815:21639326}
  \end{enumerate}
  According to K.K


  
  \begin{enumerate}
  \item \relax Vatapradana (vayavyam)-18
  \item \relax Pittapradana (agneyam)- 24
  \item \relax Kaphapradana(soumyam)-13 
  \item \relax Sannipatikam(sankeernam)-12 \unskip~\citep{1030815:21639333}.
  \end{enumerate}
  \textbf{Adhisthana of Vischika} \textbf{\space }

According to P.S VrischikaVisha is situated in the tail \unskip~\citep{1030815:21639344}.

Bhavamishra also gives similar explanation in Bhavaprakasa. He says that the pain in vrischikadamsha will be like a fire or burning sensation, radiating upward which afterwards will get settled at the site of the sting \unskip~\citep{1030815:21639322}. Asadhyavrischikadamshalakshanas are mentioned it can be considered as sannipatikavrischikavishalakshana, which includes severe pain at hridaya, nasika, Jihwa: patient feels as these organs have stopped functioning .skin at the site of the sting starts is necrosed and sheds. Prayogasamuchaya explains the symptoms similar to vaghbatta with some differences. The symptoms of vata pradhana pain in region of heart, regurgitation, stretching pain in the nerves, rigidity of body, pain in joints and bones, dizziness and pain at the site of bite. The symptoms of pittapradanavrischikadamsha are loss of consciousness, dyspnea, fainting, fuming sensation with burning pain mainly in chest region, breakdown and fall of musculature, inflammation with redness. In Table~\ref{tw-76dbc44dffd4}  Lakshanas of vrischikavisha have been explained and in Table~\ref{tw-b635dde7aa72} -Symptoms Produced By Different Types Of Vrischika have been enumerated.

The kaphapradhana vrischikadamsha lakshanas are vomiting Alpavishaveerya, anorexia, salivation, watery discharge from nose, chest congestion, dominance of sweet taste I~moth and chills \unskip~\citep{1030815:21639340}. KriyaKoumudi also gives explanations for the dosha predominant symptoms of vrischika. The symptoms of vata predominant vrischika include sirastoda, astitida, hridvyada, urdwavayu, darkness and pain in the veins. The symptoms of paittikavrischikadamshalakshana include swasavriddhi, raktapitta, moha, burning sensation and heartburn. The symptoms of kaphajavrischikadamsha are hrillasa, chardi, saitya,mukhamadhurya and excessive salivation \unskip~\citep{1030815:21639335}. Two types of vrischika {\textendash}and ugravishaveerya. Alpavishaveeryavrischika produces severe pain, numbness, swelling and burning sensation. Ugravisha has vegas similar to that of snake and effects nerves. The power of visha depends upon the size of vrischika \unskip~\citep{1030815:21640815}. PrayogaSamuchaya and KriyaKaumudi explained signs and symptoms of vrischikadamsha in step by step as it enters deeper and deeper in subsequent dhatus. It is referred as vega of vrischikadamsha. In Table~\ref{tw-c7bc1ec4b27c} -Damsha Lakshana According To Dosha Predominance have been told. And in Table~\ref{tw-c0d4230d92b7} -Dathugata Vrschika Damsha Lakshana have been enumerated. The Table~\ref{tw-dadbdc88d4f8} -Shows The Dosha Predominance Of Vrischika Visha According To Different Acharyas.
    
\section{Conclusion}
From all these references it can be concluded that vrichikas are numerous in nature so the vishalakshanas associated with each of them are unique in nature and the treatment protocols that should be adopted to each vrichikavishadamshas must be specific according to the nature of vrichika, also it can be noted that majority of acharyas have described vrischikavisha as vatolbana in nature and some as vatapittolpana in nature. Prayogasamuchaya explains the symptoms similar to vaghbatta with some differences. The symptoms of vata pradhana pain in region of heart, regurgitation, stretching pain in the nerves, rigidity of body, pain in joints and bones, dizziness and pain at the site of bite. The symptoms of pittapradanavrischikadamsha are loss of consciousness, dyspnea, fainting, fuming sensation with burning pain mainly in chest region, breakdown and fall of musculature, inflammation with redness. The symptoms of kaphajavrischikadamsha are hrillasa, chardi, saitya, mukhamadhurya and excessive salivation. Two types of vrischikaugravishaveerya. Alpavishaveeryavrischika produces severe pain, numbness, swelling and burning sensation. ugravisha has vegas similar to that of snake and effects nerves. The power of visha depends upon the size of vrischika. 
\section*{Acknowledgements}I have a great pleasure to acknowledge all the supports and cooperation that I~have received from my teachers, parents and friends during the conduction of this research.

\textbf{Funding Support}

No Funding Supports were availed from any agencies for the conduction of this research.

\textbf{Conflict of Interest}

No conflict of interest was reported during this Research work.
    

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