Ayur emergency-ksr02032013

Emergency in Ayurveda

• At mid night when the doctor is
at deep sleep . . .
• Telephone rings . . .
• When attended, the husky
nurse voice tells “Doctor there
is an Emergency for bed
number 69 . . . . . .

Dr. K. Shiva Rama Prasad, at http://www.technoayurveda.com/


What is an Emergency?
• Emergency is a sudden unforeseen crisis
(usually involving danger / pain / bleeding
or life threatening) that requires immediate
action
• Emergency Medicine is the branch of
medicine concerned with the prompt
diagnosis and treatment of injuries or
trauma or sudden illness



• It might be –
– Anxiety
– Stiff-neck
– Back pain
– Pain abdomen
– Asthma
– Hemorrhage
– Accident
All these are Crisis in the Medical Practice – Stroke
– needs the Crisis Management
– Heart attack, etc.


Crisis Management in Ayurveda Medicine

Now let us deal with the

Crisis Management in
Ayurveda Medicine
A CME of Kayachikitsa
@ Mahatma Gandhi Ayurved College Hospital & Research Center, Salod (H),
Wardha, Maharastra
On – 02-03-2013



Does Ayurveda have any emergencies?
• Yes! Any medical Practice do have the
emergency conditions
• Ayurveda enlist the disease crisis states
as “Upadrava” and “Arista Lakshana”
• The Upadrava may lead the patient in to
unforeseen troublesome conditions
• Where in the Arishta Lakshana are the
symptoms denoting the bad prognosis



What emergencies Ayurveda is capable of dealing?

• As a medical science even Ayurveda do
explain the emergencies of all categories
• Any emergency tackling depends upon the
availability of –
– Medicine
– Skilled physician
– Equipment



Does any practitioner or teaching hospital
have Ayurveda emergencies data?

• Very unfortunately – NO
• It is because – no body wants to have the
blame of lack of medicine, skill and
equipment and refers to the nearest
centers of emergency care
• Another interested thing is – Institutional
Ayurveda Hospitals have the Emergency
Cell – that never works



Do Ayurveda have any drug
database to treat emergencies?
• Once again the answer is – NO
• There is no effort made towards
the isolation of the emergency
drug database or testing under
the competent research guidance
• But still the enthusiastic Ayurveda
lovers do their contributions of
experiences to safeguard the
crisis management in Ayurveda



Feed back
• Many medicines at present the contemporary
medical faculty is used are developed from
plants initially and the chemical structure is
isolated to prepare artificially by chemistry dept –
example: morphine, acetyl salicylic acid,
xylocaine, and many more
• The physics and chemistry contributions are well
utilized by contemporary medical branch and the
Ayurveda on the orthodoxy stand where it is.



How treatable disease become crisis?
• Charaka has long ago stated that the lack of
equipment and attendants, patients incapability,
lack in physicians skills, non availability of
management and delayed treatment schedules
makes the curable disease as incurable and
crisis establishes.

Charaka Nidana 2/22-23



Feed back
• The skills of physician are developed
• Equipment can be procured
• Attendants are employed
• How to make the Ayurvedist to identify the
proper medicines of crisis management
and Research when Govt. policies are
discouraging?



Govt. Policy
• Many Ayurveda used medicines and ingredients are
banned by the Govt. or non available due to inadequate
usage
• Mruta sanjeevani Sura is not available with full
ingredients in the market
• Natural cortisone – Pushkaramoola is banned (Many
more on the name of extinct or rare drugs)
• Ahiphena got the ban, even the gold rates are at high
• Even the mercurial drugs are getting banned soon
(instead of ban the Govt. should regulate the pharmacies
for proper Ayurveda Method of purification)



Charaka principle
• Ayurveda put forth many principles for crisis
management. Few of them are –
– When any crisis occurs – Guru/Laghava
discrimination is done at first (Gulma)
– Major is attended first then the lighter problems
– The disease management is done along with or in
due course
– The Vata is the major dosha always in the emergency
• The above context makes us to focus on two
areas while understanding the “Emergency”



1) Isolation of Emergencies in Ayurveda
• Ayurveda emergencies are classified as –
– Disease bad prognostic symptoms causing
inconveniencies (status asthmatics)
– Sudden bleeding conditions developed
(trauma)
– Physiological disturbances (frost bite / sun
stroke)
– Drug reactions (allergy / anaphylaxis)
– Procedural malpractices (Panchakarma, etc)



2) Drug distribution in emergency
• Mainly the CM refer to the Drug potency and
distribution
• The drug action in emergency depends upon –
– Fast acting alkaloids (isolation)
– Absorption (methods of preparation)
– Target reaching process (administration)
– Drug interaction
• Unfortunately – when all these are done, it
becomes modern instead of Ayurveda - - -
• As the mind set is Ayurveda means “Crude
Drug Distribution”



Plan of Action
• The plan of action is a two tire program
– A methodical Research of the enlisted
Ayurveda drugs in emergency are tested under
test conditions
– Admissible drug usage and procedural
protocols recordings at time to time (data base)
• Any Medicine is a chemical and susceptible
for either action or reaction



SOP in Ayur-Emergency-1
• Attend the patient at call
• Emphasis the Dosha –
– Vata = Pain (Pain Management)
– Pitta = burning sensation (Local Application /
sedation)
– Kapha = Heaviness (sedation)
• We stuck here – as we do not have the
effective Pain Management or Sedative
drugs



SOP in Ayur-Emergency-2
• If the presenting symptom has any
established management – administer
– Eg: Status Asthmatics
• Dhashamoola Taila Matravasti
• Dattura Patradi dhoopa
• Kanakasava + Pushkaramoolasava



Plans for Emergency?
• Emergencies are always Emergencies and are
unplanned but to be tackled methodically
• We may develop some protocols with deviational
and exceptional
• These protocols are divided in major course and
sub course
• Aim of these protocols is to maintain the Dosha
– Dushya – Mala – Srotas – Agni functions in
normal
• Resuscitated Vital functions – TPR / Deglutition /
outputs (Urine / stools)



Tips for Emergency Management
• Ayurveda follows –
– Nano-Ayurveda practice
• Pottali Practice (Hemagarbha pottali)
• Garala Practice (oral snake poison)
– Preparation techniques
• Dilution of medicine
• Bulk medicine practice
– Administrative techniques
• Nasal
• Rectal
• Trans-dermal



Nano Ayurveda
• It is not a coined term but use in Ayurveda
for centuries
• Many Rasa medicines are prepared with
nano standards
• Ayurveda injections took place a 3
decades back have been stopped
• In those injections (Aravind Pharma) –
vatagajankush ras injection is capable of
pain control



Dilution of medicine
• It is very practical to use the medicinal dilution
and form emergencies – few instances are –
– Oral administered medicine takes about 30 minutes to
reach the target
– If the same is added with a vehicle of Milk/ Honey
(carbohydrate) and diluted reaches with in 10 minutes
– The same medicine pondered and added with alcohol
(Asava/ Arista ) reaches target in 5 minutes
– Alcohol / water diluted medicines are fast absorbed in
the GIT mucosa and reach the target in 2 to 3 minutes



Bulk medicine practice
• When the crude herbs are practiced to
tackle emergencies –
– Herbal juice / decoctions are prescribed along
with the Saindhava to facilitate the buffer
action and fast absorption either from –
• Oral route (kwatha / kashaya)
• Rectal route (vasti)
• Trans dermal route (avagaha / parisheka)



Nasal Administration
• Many neural diseases or psychological
conditions are dealt with rapid nasal
administrations –
– Nasa dhooma (Asthma)
– Shodhana Nasya (Pratishyaya)
– Dhmapana Nasya (unconscious state)
– Pratimarsha Nasya (Hypertension)



Rectal administration
• Any condition of unconscious state reffer to
rectal administration of the medicine as this
route by pass the portal circulation (BHutagni
paka) and reach the target soon
– Diluted alkaloid contents are faster to absorb and
reach the target in time
– Buffers like – Honey, Saindhava and Shatapushpa
helps the drug to act faster and sooner
– Vatahara Sahacharadi / Dhanvantara taila as Vasti in
status asthmatics is very useful
– If the same is



Trans Dermal administration
• Many feels that this route is not in much
use – but Ayurveda practiced long ago
with effective emergency practice of trans-
dermal route
– Sharapunkha arka or Arista externally spread
over the surface makes the anaestetic effect
of the part and prepares for the surgery



Need of the Hour
• Many scattered recordings are to brought
forward as separate Chapter “Atyayika
Chikitsa”
• A proper methodical validation of the
evaluated formulas
• Introduction of new time medicines of
traditional combinations – such as intra
muscular / intravenous Injections, skin
patches, etc.



Cardiovascular system
• Common emergencies are palpitation, pain or
arrhythmias
– Brihat Kasturi Bhairava Ras 100mg
• Is used with Beetle leaves juice for sublingual absorption
– Akika Pisti 100mg
• Is used along with honey for sublingual absorption
– Dashamoolarista / Arjunarista 30ml
• Is used in dilutions for faster absorption
• These Asava / Arista Soaked cloth application over the
surface facilitates the rapid action
– Trilokya Chintamani Ras, Makardhwaja Ras,
Vatakulantaka Ras, Dhanvantari Guti, etc. are used
along with the other medicines required



Respiratory emergencies
• Common emergencies are – dyspnoea,
obstruction, etc.
• Any surgical complaints are treated accordingly
• Hing Karpuravati, Shwasa Kasa Chintamani,
Shwasanand Ras, etc. in 100mg dose internally
used along with Honey or Kanakasav,
Pushkaramoolasav, etc.
• Externally – Karpoorataila Abhyanga followed by
the Swedana will make the relief
• In addition Vasti (Matravasti) with Shwasahara,
Vatahara oils



Uremia
• The person who are having cow dung powder
like on forehead (Gomaya Churna) will die in
one month
– Even though the Motra virechana treatment is
prescribed in many occasions we found that it is
incomplete to tackle the situation
– We undertake the patients who are undergoing
dialysis and monitored with Vasti chikitsa –
• The result is encouraging – the BUN, Uria, SGPT, SGOT, S.
Creatinine and its clearance are regularizing to Normal
• after 3 months – patient was not responding



Neurological emergencies
• Hypertension, Diabetes (metabolic disorders)
influence along with neurological disorders to
precipitate the stroke
– Rasaraja Ras, Brihatvat Chintamani, Yogendra Ras
125mg in every 3 hours sublingual will help the
regularization of situation
– Punarnavasa, Mritasanjeevani Sura, etc are helpful to
fast recovery
– Sanjna Prabodhana Nasya (Mundi, Apamarga, etc)
along with Vasti is helpful



Conclusion
• Even though we have examples of emergency
management in Ayurveda the practice is poor
either because of non availability of medicines or
the exposure to emergencies in curriculum
• We need to develop –
– Rapid Pain Management medicaments and protocols
– analgesics, antispasmodics
– Faster Sedatives (half of the management is sleep)
• There by the situation of emergency in in the control of
physician attending


Ayur emergency-ksr02032013

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