COMPILATION WORK ON ALARKA VISHA

(CLASSICAL AND CONTEMPARORY VIEW)

 CONTENTS:
1. CAUSE OF ALARKA VISHA
2. SIGNS AND SYMPTOMS IN THE ANIMAL AFFECTED
3. ALARKA VISHA LAKSHANA
4. SAMANYA LAKSHANA OF ALARKA VISHA
5. SAVISHA DAMSHA LAKSHANA OF ALARKA VISHA
6. NIRVISHA DAMSHA LAKSHANA OF ALARKA VISHA
7. ASADYA LAKSHANA OF ALARKA VISHA
8. JALASANTRASA (HYDROPHOBIA)
9. CHIKITHSA SIDDHANTHA
10. INTRODUCTION TO RABIES
11. RABIES
12. HYDROPHOBIA
13. IMMUNISATION
 अलर्क विष

• श्वा शृंगाल तरवृक्ष व्याघ्रादीनां यदाऽनिलः । श्लेष्म प्रदुष्टो मुष्णाति संज्ञां

संज्ञावहाश्रिताः।। (सु. क. ७/४३)
 निदान
(Cause of अलर्क विष)
• When vata gets aggravated in the body of dog, fox, jackal,
hyena, bear, tiger etc,
1 • combines with the aggravated kapha

• Accumulates in the channels of their

2 sense organs

• Causes loss of sensation or

3 hampers the consciousness
Signs and Symptoms in the Animal Affected
प्रसस्त लाङ्गूल hanging its tail

हनु drooping down of lower jaw

स्कन्ध drooping of its shoulders

अतिलालवान् copious flow of saliva from the mouth

अत्यर्थ बधिर animal is intensely deaf

अत्यर्थ अंध animal is intensely blind

अन्योन्यमभिधावति animal moves here and there

 अलर्क विष लक्षण
(Features of Rabies Poison )

1. सामान्य लक्षण
2. सविष दंश लक्षण & निर्विष दंश लक्षण
3. असाध्य लक्षण
 सामान्य लक्षण
देशस्तेन विदष्टस्य सुप्तः कृ ष्ण क्षरत्यसृक् ।
हच्छिरोरुक् ज्वर स्तम्भ तृष्णा मृच्छोंद्धव अनु च।। (अ.सं.३. ४६/१२)
Bitten by a rabid dog the person develops :
 loss of sensation at the bite site
 black coloured blood comes out from the site of bite
 he develops pain in the heart and head
 fever
 Rigidity
 thirst
 fainting
 सविष दंश लक्षण & निर्विष दंश लक्षण
1. कण्डू -Itching
2. निस्तोद-Pain
3. वैवर्ण्य- Discoloration
4. क्ले द-exudation
5. ज्वर[-fever
6. विदाह-burning sensation in the abdomen
7. राग-site of bite becomes red
8. रुक-pain
9. पाक-suppuration
10. शोफ-swelling
11. देशावदरण-contractures
12. मण्डल-development of round patches
13. स्फोट-tearing and falling of muscles development of round patches
14. कर्णिका-development of swelling like lotus seed
The bites without above symptoms are said to be निर्विष दंश लक्षण.
 असाध्य लक्षण
दष्टो येन तु तच्चेष्टा रुतं कु र्वन् विनश्यति । पश्यंस्तमेव च अकस्मादादर्श
सलिलादिषु ।।
The person bitten by a rabid animal imitates the
animal in actions and voice, sees them in
mirrors, water etc without any reason and finally
dies.
 जलसंत्रास (Hydrophobia)
• The condition called jalasantrasa is explained which
is also an asadhya lakshana of alarka visha.
• त्रस्यति अकस्मात् यो अभीक्ष्णं दृष्ट्वा स्पृष्ट्वा आपि वा जलम्। जलत्रासं तु विद्यासं रिष्ट
तदपि कीर्तितम्।। (सु.फ. ७/४८)
When the person bitten by a rabid dog becomes afraid even by
seeing or touching water without any cause, the condition
is called as Jalasantrasa which is to be considered as fatal.
• जलदर्शन संस्पर्श शब्देभ्यो यश्च सन्वसेत्। अदृष्टमपि तं जाज्जल सन्त्रास रोगिणम्।।
(अ.सं.उ. ४६/१७)
He who gets frightened by the sight, touch and sound
of water, should be considered as a patient of
jalasantrasa which is a fatal sign.
 अलर्क विष चिकित्सा
• विस्रावण/ रक्तमोक्षण :The blood should be
removed from bite site.
• दहनःThe site of bite should be burnt with
hot ghee.
• प्रदेहः Agada is applied as warm poultice on
the bite site.
• पुराण सर्पि पानःLater, patient is to be made to
drink old ghee.
५. लेपः Roots of nala macerated with water is
beneficial for pana and lepa.
६.शोधन / विरेचनःPatient should be
administered a purgative drug along with
milky sap of arka.“
७.नस्य अञ्जन- लेप- पान: Lasuna, ushana, vaidehi
and vara macerated with ox bile is used for
nasya, anjana, lepa and pana.
 शरपुङ्ख प्रयोग
(Sharpunkha Prayoga)
This is a special treatment explained for alarka
visha.
1. Root of sharapunkha -1 कर्ष
2. Root of धत्तूर -1/2 कर्ष
3. तण्डु ल (Rice) -as required
All above are Macerated with required quantity
of tandulodaka and paste is prepared.
 Procedure:
• This ball of paste is enveloped with leaves of dhatura and
aapoopa or pan cake is prepared out of it. This aapoopa is
to be consumed at the time of meals (mid-day) by the
person suffering from poison of rabid dog for complete
nullification of the poison.
• The use of these cakes may cause some other
complications at the time of its digestion which should be
subdued by retiring the patient to a dry and cool chamber
away from water. After the symptoms subsides, the patient
should be given bath the next day, he must be made to take
warm meals of shashtika shali along with milk.
• This treatment should be done for 3 or 5 days with half the
quantity of mentioned drugs.
 Snana Vidhi
One hundred and eight pots are filled with water, precious
gems and potent herbs. A place near a river, meeting of four
roads or a sacrificial ground, of the size of a cow's hide is
selected, cleaned, washed with cow dung water and covered
with kusha grass. The pots are placed on this place,
decorated with garlands and their mouth covered.
Fire is lit near by, the pots are sanctified with holy hymns
108 times. The person bitten by rabid dog is then given a
ceremonial bath with water in the pots, chanting hymns.
Shodhana
After snana vidhi, the person should be administered with
strong purificatory therapies because in a person who is not
purified well, the alarka visha gets aggravated again, though
the wound has healed.
RABIES
INTRODUCTION
• Rabies is caused by Lyssa Virus.
• It is spread when an infected animal
scratches or bites another animal or
human.
• Saliva from an infected animal can also
transmit rabies if the saliva comes into
contact with the eyes, mouth, or nose,
treatment is almost never effective and
mortality is over 99%
 Rabies Progresses in Five Distinct
Stages:
1. Incubation
2. Prodrome
3. Acute Neurologic period
4. Coma
5. Death
 Incubation Period:
• This is the time before symptoms appear.
• The incubation period is typically 1-3 months in
humans.
• Incubation periods as short as four days and longer
than six years have been documented, depending
on the location and severity of the contaminated
wound and the amount of virus introduced.
• The closer the bite is to the brain, the sooner the
effects are likely to appear.
 Prodrome:
Early, flu-like symptoms including:
• A fever of 100.4°F/38°C or above.
• Headache
• Anxiety
• Feeling generally unwell
• Sore throat and a cough
• Nausea and vomiting
• Discomfort may occur at the site of the bite
These can last from 2 to 10 days, and they worsen over
time.
 Acute Neurologic Period:
Neurologic symptoms develop, including:
• Confusion and aggression
• Partial paralysis, involuntary muscle twitching, and rigid neck muscles
• Convulsions
• Hyperventilation and difficulty in breathing
• Hypersalivation or producing a lot of saliva, and possibly frothing at the
mouth
• Fear of water, or hydrophobia, due to difficulty in swallowing
Hallucinations, nightmares, and insomnia
• Priapism, or permanent erection, in males
• Photophobia, or a fear of light
• Toward the end of this phase, breathing becomes rapid and inconsistent.
 Coma and Death
• If the person enters a coma,death will occur
within a matter of hours,unless they are
attached to a ventilator.
 HYDROPHOBIA
• It is the historic name for rabies
• It refers to a set of symptoms in the later stages of an
infection in which the person has difficulty in swallowing,
shows panic when presented with liquids to drink, and
cannot quench their thirst.
• Any mammal infected with the virus may demonstrate
hydrophobia.
• Saliva production is greatly increased, and attempts to
drink, or even the intention or suggestion of drinking, may
cause excruciatingly painful spasms of the muscles in the
throat and larynx
• This can be attributed to the fact that the virus multiplies
and assimilates in the salivary glands of the infected
animal with the effect of further transmission through
biting.
• The ability to transmit the virus would decrease
significantly if the infected individual could swallow saliva
and water.
Prevention Immunization in people
1. Pre Exposure Prophylaxis
2. Post Exposure Prophylaxis
 Pre Exposure Prophylaxis
• Human rabies vaccines exist for pre-exposure
immunization.
• Pre-exposure vaccination may be offered to high risk
groups like laboratory staff handling the virus and
infected material, clinicians and persons attending to
human rabies cases, veterinarians, animal handlers and
catchers, wildlife wardens, quarantine officers and
travelers from rabies free areas to rabies endemic areas.
• The Indian Academy of Pediatrics (IAP) has
recommended pre-exposure prophylaxis of children.
Approach to Post Exposure Prophylaxis

1. Management of animal bite wound

2. Passive immunization with Rabies
Immunoglobulin (RIG)
3. Active immunization with Anti-Rabies Vaccines
(ARV)
 Management of Animal Bite Wound

1. Wound Washing – 15 mins

2. Iodine containing topical preparations.
3. Suturing ❌
4. If unavoidable adequate RIG given .
5. Minimal and loose sutures.
 Passive Immunization
Types of RIGS:
A. Equine Rabies Immunoglobulin (ERIG):
ERIGG is of heterologous origin produced by hyperimmun-isation of horses.
The dose of ERIG is 40 IU per kg body weight of patient
B. Human Rabies Immunoglobulin (HRIG):
HRIG are of homologous origin and are relatively free from the side effects
encountered in a serum of heterologous origin.
The dose of the HRIG is 20 IU per kg body weight.
 Administration
• The RIG should be brought to room temperature (25°C to 30°C) before administration to the patient.
• As much of the calculated dose of RIG as is anatomically feasible should be infiltrated into and around
the wound.
• Multiple needle injections into the wound should be avoided.
• The total recommended dose of RIG must not be exceeded as it may suppress the antibody production
stimulated by the anti-rabies vaccine.
• Rabies immunoglobulin for passive immunization is administered only once. preferably within 24 hours
after the exposure (on day 0 along with the first dose of anti rabies vaccine).
• If RIG was not administered when ARV was begun, it can be administered up to the seventh day after
the administration of the first dose of ARV
• Beyond the seventh day (after 3 doses of vaccine have been administered). RIG is not indicated since
an antibody response to ARV would have occurred and administration of RIG at this stage can supress
the immune response of the patient to the ARV received.
• Rabies Immunoglobulin should never be administered in the same syringe or at the same anatomical
site as vaccine.
• The dose is 0.5 ml of 0.1 percent solution (1 in 1000, 1mg/ml) for adults and 0.01ml/kg body weight for
children, injected subcutaneously or IM.
• RIG must never be given intravenously.
• A full course of ARV should follow thorough wound cleansing and passive immunization.
 Active Immunization

• The first live attenuated injectable rabies

vaccine, developed by Louis Pasteur and
Emile Roux, was first tested in a human bite
victim in 1885 .
 Post Exposure Prophylaxis

• Intra-muscular (IM) Regimen:

• A. Cell Culture Vaccines:
1. Human Diploid Cell Vaccine (HDCV)-1 ml
2. Purified Chick Embryo Cell Vaccine (PCECV)-1ml
3. Purified Vero Cell Rabies Vaccine (PVRV), 0.5ml
and 1ml
• B. Purified Duck Embryo Vaccine (PDEV), Iml
Intradermal Regimen
Guided By-
Dr Adarsh Sir Presented By-
Dr Shivanand Sir H M Supriya