वविषपररीकक्षा / वविषवनिदक्षानि

(Diagnosis of poisoning)

Dr. ATHULYA C.M

ASSISTANT PROFESSOR
DEPT. OF AGADTANTRA
CHAITANYA AYURVED MAHAVIDYALAYA
 पक्षापांचभभौवतिक पररीकक्षा

शब्द पररीकक्षा - हुतभभुकक् ततेनक् चक्षानतेनक् भभृशशं चटचटक्षायतते

रूप पररीकक्षा - मययूर कण्ठ प्रततममो जक्षायतते
गन्ध पररीकक्षा - दभु:सह:तभनक्षातचर्चिसरीकक्ष्णधयूमश्च
नतचरक्षाश्चमोपशक्षाम्यतत
रस पररीक - वम्रियनन्ते जरीविजरीविक

स्परर्श पररीक - पक्षावणिपक्षापपां पक्षावणिदक्षाहपां निखरक्षातिपां

कररोवति च
 लकणि अनिनुसक्षार

जपांगम वविष लकणि

तनदक्षाशं तनक्षाशं क्लमशं दक्षाहशं सपक्षाकशं लमोमहरर्चिक्ष्णमक् ।

शमोफशं चचैवक्षाततसक्षारशं च जनयतेजङक् म व षम |।

. .
च तच 23/ 15
 ससक्षाविर वविष लकणि
ससक्षावरशं तभु ज्वरशं तहकक्षाशं दन्तहरर्षं गलग्रहमक् ।
फतेनवम्यरुतचशक्षास मयूरक्षार्चिश्च जनयतेतद्विरमक् ॥

. .
च तच 23/16
 EXPERIMENT ON ANIMALS
वविष भकणि
चकरोर -अवकविवैरक्षागपां (Looses its redness of eyes) - दृषषक्षा अन

जरीविजरीविक( Type of bird ) – वम्रियनन्ते ( Death)

करोवकल: ( Cuckoo) - स्वर विवैककृतिमम् (Voice becomes abnormal)

कभौञ्ज (Heron- dokari) - मद (Excited)

हहषन्तेन्मययूर (Peacock ) - Unstable and agitated

रनुकसक्षाररकन्ते ( Parrot , Myna) - उवद्विगग्नः करोरति ( Scream in fear )

हपांस ( Swan ) - कन्तेडवति ( Creates voice excessively )

भहङ्गरक्षाज ( Type of bird) – कयूजवति ( Rises its inarticulate voice )

पकृषतिरो ( a species of spotted dear ) - वविसहजत्यशनुपां ( Sheds tear )

मकर्शट ( monkey ) - वविष्ठ : मनुञ्जवति ( Defaecates)

DIAGNOSIS OF POISONING

(1) In the Living

(2) In the dead

 In the Living
● There is no single symptom, and no definite group of
symptoms, which are absolutely characteristic of
poisoning.

● A detailed clinical history is of great importance.

● Toxicological, medical, psychiatric and social history

for the diagnosis of poisoning.
● This history can be acquired from friends and
relatives also.
● A detailed history of the quality and quantity
of the poison administered
● The character of the symptoms with
reference to their onset, and
● The time that passed between the taking of
the poison and the development of
symptoms,
● The duration of illness,
● The treatment given. and
● The time of death, should be obtained from
the relatives of the deceased.
● Suicide note, presence of any suspicious
article like; tablets, bottles, vials, ampoule
etc. are helpful for the assessment of
poisoning in the unconscious poisoned
patients or dead persons.

● If the poisoning occurs in the children,

poisoned material may be present at around
their mouth or on their clothing.
 Symptoms
The following groups of symptoms are
suggestive of poisoning.
(1) The sudden onset of abdominal pain,
nausea, vomiting, diarrhoea and collapse.

(2) The sudden onset of coma with constriction

of pupils.

(3) The sudden onset of convulsions.

(4) Delirium with dilated pupils.
(5) Paralysis, especially of lower motor neuron type.

(6) Jaundice and hepatocellular failure.

(7) Oliguria with proteinuria and haematuria.

(8) Persistent cyanosis.

(9) Rapid onset of the neurological or gastrointestinal

illness in persons known to be occupationally exposed to
chemicals.
 Symptoms of Chronic Poisoning
(1) The symptoms are exaggerated after the
administration of suspected food, fluid or medicine.
(2) Malaise, cachexia, depression and gradual
deterioration of general condition of the patient is
seen.
(3) Repeated attacks of diarrhoea, vomiting, etc., are
seen.
(4)When the patient is removed from his usual
surroundings, the symptoms disappear.
(5) Traces of poison may be found in the urine, stool or
vomit.
 Collect
(1) Stomach wash (entire quantity).

(2) 10 ml. blood.

(3) Urine, as much as possible.

 Diagnosis of Poisoning in the Dead
● Postmortem findings

● Chemical analysis

● Oral and Circumstantial evidence

● Experiment in animals
●Collect information from the inquest report
and from the relatives of the deceased.
 (I) Postmortem Appearances

External :

(1) The surface of the body and the clothes

may show stains or marks of vomit, faeces
or the poison itself.
The colour changes in the corroded skin and mucous
membrane are:
(a) Sulphuric and hydrochloric acid - Grey, becoming black
from blood;
(b) Nitric acid - Brown
(c) Hydrofluoric acid - Reddish-brown
(d) Carbolic acid - Greyish-white;
(e) Oxalic acid - Grey, blackened by blood;
(f) Cresols - Brown, leathery;
(g) Caustic alkalis - Greyish-white;
(h) Mercuric chloride - Bluish-white;
(i) Zinc chloride - Whitish;
(j) Chromic acid and potassium chromate - Orange, leathery.
 (2) Colour of postmortem staining
The skin may be
● Dark-brown or yellow - Phosphorus and acute
copper poisoning
● Cherry-red - Carbon monoxide
● Chocolate-coloured - Nitrites, aniline,
nitrobenzene, acetanilide,
bromates, chlorates, etc.
due to the formation of
methaemoglobin.
 (3) Smell about the mouth and nose :

(a) Garlic-like : Phosphorus, arsine gas,

arsenic (breath and perspiration),
thallium, tellurium, selenium,
dimethylsulphoxide, parathion,
malathion.

(b) Sweet or fruity : Ethanol

Chloroform
Nitrites.
(c) Acrid : Paraldehyde, chloral hydrate.

(d) Rotten eggs : Hydrogen sulphide,

mercaptans, disulfiram.

(e) Fishy or musty: Zinc phosphide.

(f) Other substances are: Cyanides, phenol,

opium, ether, camphor, etc.
( 4) The natural orifices - e.g., mouth, nostrils,
rectum and vagina may show the presence of
poisonous material or the signs of its having
been used.

(5) Injection marks should be looked for with

care.
 (6) Skin should be examined for lesions

● e.g. Hyperkeratosis and pigmentation may be

found in chronic arsenical poisoning.

● Jaundice may occur in poisoning from

phosphorus and in susceptible persons by
potassium chlorate.
(7) Condition of pupils and hands if relaxed
or clenched

(8) Any evidence of marks of violence :

Such as bruises, or wounds of any nature,
may suggest some form of death other
than poison.
 Internal
(1) Smell : On opening the body, note any peculiar
smell.

(2) Mouth and Throat : Examine the tongue, mouth

and throat for any evidence of inflammation, erosion or
staining.

(3) Oesophagus :Corrosive alkalis produce marked

softening and desquamation of the mucous
membrane.
 (4) Upper Respiratory Tract :
● Examine the larynx, trachea and bronchi for
evidence of volatile irritants or inhaled
poisonous matter.

● Oedema of glottis, and

congestion and desquamation of mucous
membrane of the trachea and bronchi
may be seen in corrosive acid or
alkali poisoning when it enters the respiratory
tract.
 (5) Stomach
Toxic substances may be held in high
concentrations in the rugae and crypts of
the mucosa, or even in the blood in the
actual stomach wall.
● Hyperaemia
● Softening
● Ulcer
● Perforation
● Contents
 (a) Hyperaemia :

● Hyperaemia of the mucous membrane caused by an

irritant poison is usually patchy and of a deep
crimson colour.

● Redness of the mucosa is also found during

digestion, in asphyxial deaths due to general
venous congestion, and when it is exposed to
atmosphere.

● Hyperaemia caused by disease is uniformly spread

over the whole surface and not in patches.
● Mercury - Slate coloured stain
● Arsenic - White particles adherent
● Strong sulphuric, acetic or hydrochloric acids,
and concentrated oxalic acid - Blacken or char
the wall
● Nitric acid - Yellow colour
● Cresols - Brown colour
● Copper - Blue or green colour.
 (b) Softening
● Softening of mucous membrane of stomach, is
usually caused by corrosive poisons, chiefly
alkaline corrosives.
● lt is also seen in mouth, throat and oesophagus.

● In disease, it is limited to stomach and is

usually found at its cardiac end.
 (c) Ulcers
● Ulceration due to corrosive or irritant poisons
appears as an erosion with thin, friable
margins.

● An ulcer from disease is usually seen on the

lesser curvature and the margins are well-
defined, thickened and indurated.
 (d) Perforation
● Perforation is occasionally observed, when the
strong mineral acids have been taken,
especially sulphuric acid;
● Ammonia can cause perforation of stomach.
The stomach, in such cases is blackened and
extensively destroyed, the aperture is irregular,
the edges sloughing, and the adjacent
tissues easily torn.
● Chronic ulcer – commonly oval or rounded,
margins are punched out , the stomach
shows signs of adhesion to the neighbouring
organs.
 The Contents of the Stomach

● The wall is examined for fragments of

poison adhered to it, such as powdered
poisons, fragments of capsules, starch
from tablets, fragments of leaves or
fruit,foreign bodies, such as nails, pins,
glass, etc.
 (6) The Duodenum and Intestines
● Sodium hydroxide can rarely cause perforation
of duodenum.
● Ulceration beyond the pylorus is usually due
to natural disease.
● The only characteristic change which occurs in
the intestine is seen in mercury poisoning.
● A normal gastrointestinal tract rules out
poisoning by corrosive acids and alkalis,
phenols, mercury and arsenic.
 (7) Liver
● Liver necrosis - Phosphorus, chloroform,
carbon tetrachloride

● Fatty liver - Arsenic, carbon tetrachloride,

yellow phosphorus and rarely
ferrous sulphate

● Jaundice - Phosphorus,potassium
chlorate due to acute
haemolytic anaemia.
 (8) Kidneys
● Parenchymatous degenerative changes are
commonly found in irritant metal poisoning,
and in cantharidin poisoning.

● Extensive necrosis of proximal convoluted

tubules - deaths from poisoning by mercuric
chloride, phenol, lysol and carbon
tetrachloride.
 (9) Heart

Subendocardial haemorrhages in the left

ventricle occur in most cases of acute arsenic
poisoning.
 (10) The bladder, and in females the vagina
and uterus -
● For poison is occasionally introduced into the
body by these routes.

● In criminal abortion, it may be necessary to

send the vagina and uterus for analysis.
 (II) Chemical Analysis
● Blood is the specimen of choice for detection of
poisons, as it gives the best indication of the
quantity of drug exerting an effect on the person
at the time of death.

● The urine concentrates the drug or poison in

many cases
 THE ANALYTIC PROCEDURE
Toxicological analysis of biological tissues involves:
(1) Separation of the drug from the biological tissue.

(2) Purification of the drug.

(3) Analytical detection and quantitation.

● Thin-layer chromotography (TLC),
● Gas chromatography (GC),
● Gas chromatography-mass sepectrometry (GC-MS), and
● rarely UV spectrophotometry.
 For toxicologic analysis, poisons can be
divided into five groups.

● GROUP I. GASES:
Gases - Separated from blood or lungs by
simple aeration procedures

● GROUP II. STEAM VOLATILE POISONS:

Both organic and inorganic substances -
separated from biological materials by steam
distillation from an acidic or basic medium,
● GROUP III. METALLIC POISONS:
(1) In Dry Ashing Procedure
(2) The Wet Ashing Procedure

● GROUP IV. NONVOLATILE ORGANIC

POISONS:
This group includes all compounds that are
alcohol and water soluble.
(1)Organic acids and An acidic
organic neutral compounds, aqueous medium
such as barbiturates, acetanilid, by chloroform
phenacetin, etc. or ether

(2) Organic bases, such as A basic

cocaine, quinine, strychnine, aqueous medium
imipramine, nicotine, demerol, etc. by chloroform or
ether
 (3) Morphine, dionin, Aqueous solution,
dilaudid, etc which is faintly alkaline
with ammonia or sodium
bicarbonate, by
chloroform with 10% ethanol.

● For the above substances 200 to 500 g. of tissue is finely

ground, and treated with alcohol, filtered and alcohol
evaporated, and process repeated and a final residue is
obtained and tests, such as TLC, GC, GC-MS
carried out to find out specific poison
GROUP V. MISCELLANEOUS:
This includes all substances which are not
classified in any of the above four groups, such
as non-metallic inorganic substance and
water and alcohol insoluble organic
compound.
 (Ill) Experiments on Animals
● This is not an ideal test, for signs and symptoms may
be due to other causes.
● Absence of signs and symptoms may be due to
insusceptibility of the animal to the particular poison,
e.g., Cat and dog are affected by poisons almost in the
same way as man.
● Rabbits are insusceptible to belladonna,
hyocyamus and stramonium
● Pigeons are not affected by opium.
● They may be fed with the suspected food, or with the
poison after it is separated from the viscera and the
symptoms noted.
 (IV) Moral and Circumstantial Evidence

● Such evidence may consist of motive,

● The evidence of witness about the recent
purchase of the poison,
● His behaviour before and after the commission
of the offence, and
● The recovery of the poison from the possession
of the accused
SIGNS AND SYMPTOMS
OF
VISHA AFFLICTED ORGANS
AND
PERSONAL EFFECTS
 वविषयनुक्त अनभक्षाष्प लकणि

उपतकप्तस्य अनस्य वक्षाषतेक्ष्णणॊरर्षं प्रसपर्चितक्षा ।

हहतरीडक्षा भक्षान्तनतेत्रतशं तशरमोदभु:खशं च जक्षायतते ॥

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सभु क 1/ 35
 वविषयनुक्त अनस्परर्श

पक्षावणिपक्षापपां पक्षावणिदक्षाहपां निखरक्षातिपां कररोवति च |

सनु . क. 1/37
 सवविष अन लकणि

स चतेतक् प्रमक्षादक्षानमोहक्षाद्विक्षा तदनमभुपसतेवतते ।

अषरीलक्षावत्ततमो तजहक्षा भवत्यरसवतेतदनरी ।।
तभुद्यतते दह्यतते चक्षातप शतेषक्षा चक्षास्यक्षातक् प्रतसच्यतते ।

. .
सभु क 1/ 38-39
 आमक्षारयगति वविष लकणि

मयूरक्षार्चि छतदर्चिमतरीसक्षारमक्षाधक्षानशं दक्षाहवतेपसभु ।

इननयक्षाक्ष्णक्षाशं च वचैकहत्यशं कभुयक्षार्चिदक्षामक्षाशयशं गतमक् ॥

. .
सभु क 1/ 40
 पकक्षारयगति वविष लकणि

दक्षाहशं मयूरक्षार्चिमतरीसक्षारशं तहषक्षातमननयवचैकहतमक् ।

आटमोपशं पक्षाणभुतक्षाशं कक्षारर्षं कभुयक्षार्चितक् पकक्षाशयशं गतमक् ॥

. .
सभु क 1/ 42
 सवविष द्रवि द्रव्य लकणि

द्रविद्रव्यन्तेषनु सविर्वेषनु करीरमदरोदकक्षावदषनु ।

भविनन वविवविधक्षा रक्षाज: फन्तेनिबनुदम्बनुदजन्म च ॥

छक्षायक्षाशक्षात्र नि दहश्यनन्ते दहश्यनन्ते यवद विक्षा पनुनि : ।

भविनन यमलक्षानश्छिद्रक्षास्तननरो विक्षा वविकहतिक्षास्तसक्षा ॥

सनु . क. 1/ 44-45
 सवविष रक्षाकसयूपक्षावद लकणि

शक्षाकसयूपक्षानमक्षाशंसक्षातन नक्लनक्षातन तवरसक्षातन च ।

सद्य: पयभुर्चितरतक्षानरीव तवगन्धक्षातन भवनन्त च ॥

गन्धवक्ष्णर्चिरसचैहर्हीनक्षा: सवर्वे भकक्षा: फलक्षातन च ।

पकक्षानक्षाशभु तवशरीयर्चिन्तते पक्षाकमक्षामक्षातन यक्षानन्त च ॥

. .
सभु क 1/46-47
सवविष दनकक्षाष्ठ वजहक्षावनिलर्वेखनिपां , कविल लकणि

तवशरीयर्चितते कयूचर्चिकसभु दन्तकक्षाष्ठगतते तवरते ।

तजहक्षादन्तन्तौष्ठमक्षाशंसक्षानक्षाशं शयसभुश्चमोपजक्षायतते ॥

. .
सभु क 1/ 48
 सवविष अभ्यङ्ग , उतक्षादनि , पररषन्तेक , कषक्षाय,
अनिनुलन्तेपनि, रयक्षा, विस, कविच लकणि

तपनरलमो बहुलमो अभ्यङमो तववक्ष्णणॊ र्चि वक्षा तवरक्षानन्वित । :

:
समोटजन रुजक्षा सक्षावस्त्वकक्षाक सस्वॆदनशं ज्वर :॥
दरक्ष्णशं चक्षातप मक्षाशंसक्षानक्षामभ्यङते तवरसशंयभुतते ।

सभु . क. 1/ 51-52
अविलन्तेखनि , वरररो अभ्यङ्गम् , वररसक्षाणिक्षा,पां सक्षानि,
उषरीष

कतेशशक्षात: तशरमोदभु:खशं खतेभ्यसच रुतधरक्षागम: ।

ग्रनन्थिजनमोत्तमक्षाङतेरभु तवरजभुषस्वॆ अवलतेखनते ॥

. .
सभु क 1/ 56
 वविषयनुक्त मनुखक्षालन्तेप

मभुखक्षालतेपते मभुखशं रक्षावशं यभुक्तमभ्यङक् लकक्ष्णचै: ।

पतद्मिनरीकण्टकप्रखचै: कण्टकचैश्चमोपचरीयतते ॥ सभु. क. 1/60
 सवविष विक्षाहनि लकणि

अ सक्षासशं कभुञ्जरक्षादरीनक्षाशं लक्षालक्षासक्षावणॊ अतकरकतक्षा ।

अ

नसकक् पक्षायभुमतेढढ्रमभुषतेरभु यक्षातभुश्च समोटसशंभव : ॥

सभु . क. 1/62
 सवविष निस, धयूम लकणि

शमोतक्ष्णतक्षागमनशं खस्वॆभ्य: तशरमोरुक कफसशंसव :।

नस्यधयूमगतते तलङक् तमननयक्षाक्ष्णक्षाशं च वचैकभृतमक् ॥

. .
सभु क 1/ 63-64
 सवविष पनुष्प लकणि

गन्धहक्षातनतवर्चिवक्ष्णर्चितशं पभुषक्षाक्ष्णक्षाशं मक्षानतक्षा भवतेतक् ।

तजघ्रतश्च तशरमोदभु:खशं वक्षाररपयूक्ष्णस्वॆ र्चि च लमोचनते ॥

. .
सभु क 1/ 65
 सवविष कणिर्शतिवैल लकणि

कक्ष्णर्चितचैलगतते शमोत्रवचैगभुणशं शमोफवतेदनते ।

कक्ष्णर्चिसक्षावश्च तत्रक्षाशभु कतर्चिवशं प्रततपयूरक्ष्णमक् ॥

. .
सभु क 1/ 67
 सवविष अञ्जनि लकणि

अशभुपदतेहमो दक्षाहश्च वतेदनक्षा दृतषतवभम : ।

अञ्जनते तवरसशंसहषस्वॆ भवतेदक्षान्ध्यमसक्षातप च ॥
सभु. क. 1/ 69
 सवविष पक्षादनुकक्षा , पक्षादपरीठ लकणि

शमोफ : सक्षावससक्षा सक्षाप: पक्षादयमो: समोटजन च।

भवनन्त तवरजभुषक्षाभ्यक्षाशं पक्षादभुकक्षाभ्यक्षामसशंशयमक् ॥
सभु. क. 1/ 72,73
 सवविष भयूषणिक्षावद लकणि

भयूरक्ष्णक्षातन हतक्षाचर्हीतरर्चि न तवभक्षानन्त यसक्षा पभुरक्षा ।

सक्षातन ससक्षानक्षातन हनभुश्च दक्षाहपक्षाकक्षावदक्षारक्ष्णचै : ॥
सभु. क. 1/ 74
 वविषदक्षातिक्षा लकणि
इतङतजमो मनभुषक्षाक्ष्णक्षाशं वक्षाकतेषक्षामभुखवचैकहतचै : ।
तवद्यक्षातद्विरस्य दक्षातक्षारमतेतभतलर्चिङचैश्च बभुनद्धिमक्षानक् ॥
न ददक्षात्यभुत्तरशं पभृषणॊ तववकनक् ममोहमतेतत च ।
अपक्षासर्षं बहु सङरीक्ष्णर्षं भक्षारतते चक्षातप मयूढवतक् ।।
समोटयत्यङक्गभुलरीभयूर्चितममकसक्षातद्वितलखतेद्धिसतेतक् ।
वतेपसभुजक्षार्चियतते तस्य त्रसश्चक्षानमो अनमरीकतते ।
कममो तववक्ष्णर्चिवक्त्रश्च नखचै: तकतञ्जनरनत्यत्त्यतप ॥
आलभतेतक्षासकहदरीन : करतेक्ष्ण च तशरमोरुहक्षानक् ।
तनतयर्चियक्षासभुरपद्विक्षारचैवर्हीकतते च पभुन : पभुन : ।।
वतर्चितते तवपररीतशं तभु तवरदक्षातक्षा तवचतेतन : ।सभु. क. 1/18-22
●
न ददक्षात्यभुत्तरशं पभृषणॊ - Does not speak nor does he answer when a
question is put to him
●
तववकनक् ममोहमतेतत - fear to speak even he is willing to or breaks in
the middle
●
अपक्षासर्षं बहु सङरीक्ष्णर्षं भक्षारतते चक्षातप मयूढवतक् - Talks incoherently and
indistinctly like a fool
●
समोटयत्यङक्गभुलरी - Press or cracks the joints of his fingers
●
भयूर्चितममकसक्षातद्वितलखतेद्धिसतेतक् - or to scratch the earth and laughs suddenly
●
वतेपसभु - Shiver
●
त्रसश्चक्षानमो अनमरीकतते - Looks here and there or looks each other
●
कममो तववक्ष्णर्चिवक्त्र- krisha gatra and vivarna mukha
●
नखचै: तकतञ्जनरन - Will cut something with his finger nails
करतेक्ष्ण च तशरमोरुहक्षानक् - He will scratch his head in an agonised and
confused state
तनतयर्चियक्षासभुरपद्विक्षारचैवर्हीकतते च पभुन : पभुन :- Will look this and that way
Trying to slip away by a back or side door
वतर्चितते तवपररीतशं - Does opposite things
तवचतेतन - Without consciousness
 VISHA UPADRAVA

जज्वरककासज्वममिशकासमहिधमिध्मो तषत षका अमतमिमररर नमिम |

मज्वशध्मोभदभ ध्मोऽमतककामठिनन्यनकाहिध्मो बमसतमिमधज्वररुकम |

शन्यथथ: पममतददंशतज्वदं रक्तसकाज्वध्मो मज्वषकामनल: |

थ द्रज्वका: ||
इमत षध्मोडश मनमदरषका मज्वषकातकारनकामिप
थ का मज्वषरध्मोमगष : ||
थ मभ क्षितका नकाशदं न्ययररष
गररनतन्यप

- अ. सदं. उ. ४७/1-३
1. Jwara
2. Kasa
3. Vamana
4. Shwasa
5. Hidma
6. Trushna
7. Ati moorcha
8. Atisara
9. Very hard faeces
10. Anaha
11. Basti ruk
12. Moordwa ruk
13. Shwayadhu
14. Pootidamshatwa
15. Raktasrava
16. Visha anila
 ववषमक
म कक लकण
प्रशक्षान्तदमोरशं प्रकभृततससधक्षातभुमक्षाहक्षारकक्षामशं सममयूत्रवरीटक्कमक् |
प्रसनवक्ष्णर्वेनरीयतचत्तचतेषशं वचैदयमोऽवगरतेदतवरशं मनभुषमक् ||

. . . ४७/८३
अ सपां उ
THANK YOU