|
 
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| CASE REPORT |
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| Year : 2023 | Volume
: 6
| Issue : 1 | Page : 14-18 |
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Management of Keeta damsha (~insect bite) based on Dhooshivisha chikitsa: A case report
Anjali Nandakumar
Department of Agada Tantra, Nandha Ayurveda Medical College and Hospital, Erode, Tamil Nadu, India
| Date of Submission | 15-Aug-2021 |
| Date of Acceptance | 08-Feb-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Dr. Anjali Nandakumar
Department of Agada Tantra, Nandha Ayurveda Medical College and Hospital, Pichandampalayam, Erode - 638 052, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jacr.jacr_68_21
The number of allergic reactions caused by arthropods varies from trivial bites and stings to severe systemic reactions and even death. The bite of certain insects if left untreated or if treated partially will lead to the manifestation of complications in later stages. The etiological factors including changes in lifestyle, food habits, and climatic changes further point on to the possibility of involvement of Dhooshivisha (~weak poison) which in turn leads to a relapsing tendency. The long-term management of Dhooshivisha demands grass-root level intervention. If there is an involvement of Dhooshivisha, the treatment should be adopted focusing on its management. Here is a case of a 62-year-old female with a history of Keeta damsha (~insect bite) which was left untreated giving complications in a span of every six months duration. In this case, an attempt was made to find out the involvement of Dhooshivisha, and treatment was given considering the principles of Dhooshivisha chikitsa. Two sittings of Siravyadha (~venepuncture) along with internal medicines including Patolakaturohinyadi kashayam and Dhooshivishahari agada were given for a span of 21 days. The treatment provided interesting results; however, further studies can be conducted in this area for a better line of intervention.
Keywords: Dhooshivisha keeta damsa, Dhooshivishahari agada, Patolakaturohinyadi kashayam, Siravyadha
How to cite this article:
Nandakumar A. Management of Keeta damsha (~insect bite) based on Dhooshivisha chikitsa: A case report. J Ayurveda Case Rep 2023;6:14-8 |
How to cite this URL:
Nandakumar A. Management of Keeta damsha (~insect bite) based on Dhooshivisha chikitsa: A case report. J Ayurveda Case Rep [serial online] 2023 [cited 2023 May 30];6:14-8. Available from: http://www.ayucare.org/text.asp?2023/6/1/14/372252 |
| Introduction | |  |
Keeta visha (~insects venom poisoning) is classified under Jangamavisha (~animal poison).[1] Keeta visha is the commonest type of poison, next to Sarpa visha (~snake venom poisoning) which one comes across in daily clinical practice. Although insect bite reactions are mostly transient, papules and nodules occasionally persist for long periods, sometimes as a result of unrestrained scratching. Poisonous Keeta damsha (~insect bite), if not completely expelled from the body can lead to the formation of Dhooshivisha (~weak poison).[2] In the present case, the clinical presentation is exactly the same as mentioned by Charaka while explaining the Dhooshi vishaja keeta damsa lakshana.[3] The utility of Siravyadha (~venepuncture) has been advocated in such cases as Dhooshivisha.[4] Siravyadha helps to eradicate diseases from the root level just like how rice and other crops in the fields get destructed completely by removing the bunds in the field.[5] This case demanded an intervention that uproots the disease from the grass root level as there is a relapsing tendency of the symptoms during the advent of the rainy season and cold season in particular, so the treatment collates both internal medicines along with Siravyadha procedure, which aims at the elimination of Dhooshivisha, which developed post untreated insect bite.
| Patient Information | | |
A 62-year-old female patient came with a clinical presentation of itching associated with marked brownish discoloration over the left leg for the past two years. On examination, a few small papules with 1–2 cm in length and brownish-black discoloration were noted [Figure 1]. The patient also gave a history of insect bites followed by which the symptoms started to take shape. The present history states that she was apparently asymptomatic for two years, later, she was bitten by a vector insect commonly found on the coconut tree, which crept onto the patient's left leg and she rubbed the insect with her dress against the skin while trying to kill the same. In the following days, she developed severe itching and tiny raised eruptions with brownish discoloration over the left leg. The patient had used some home remedies for the same and the condition was left untreated. The history reveals that the symptoms had a relapsing tendency of the same during the advent of early winters and in the rainy season and she gives a history of relapse of the same symptoms thrice within a span of two years, especially with the advent of the rainy season and early winters. As she found it difficult to cope with the symptoms, she approached the clinic for treatment. She did home remedies by herself and was not treated for her present illness previously.
The patient does not have any allergic history before the present illness. No previous history of diabetes mellitus, hypertension, or thyroid dysfunction was found. No complaints of other systemic illnesses. The patient is a moderately built woman with a good appetite. Bowel habits were normal. Day sleeping as a habit was present. She is a non-vegetarian.
| Clinical Findings | | |
Itching associated with marked brownish discoloration over the left leg for the last two years has complained. On examination, few small papules were noted.
| Timeline | | |
In the present case, the treatment was continued for 21 days. The timeline of the treatment is shown in [Table 1].
| Diagnostic Assessment | | |
The diagnosis was purely based on the clinical history given by the patient which reveals an insect bite. Considering the history and symptomatology, the case was diagnosed as Dhooshivisha keeta damsa (~insect bite).
| Therapeutic Intervention | | |
The patient was advised to consume Dhooshivishahari agada[6] (500 mg) two times daily along with Patolakaturohinyadhi kashayam[7] (20 ml) mixed with lukewarm water (60 ml) twice daily before food by 6:30 am and 5:30 pm for 21 days and Siravyadha was done in two sittings with a time gap of 15 days [Table 1].
| Follow-up and Outcome | | |
The patient presented with itching, associated with marked brownish discoloration over the left leg. Siravyadha was done on the next day. The patient was advised to take internal medicines for 21 days. On the seventh day of management, itching was reduced and papules disappeared and the patient was feeling lightness in the left leg [Figure 2]. On the 20th day, the second sitting of Siravyadha was performed. Marked relief in all the symptoms including itching, discoloration, and papules was noticed after this [Figure 3]. Further, the patient was followed up for one year. During this time, no relapses were reported.
| Discussion | | |
Certain insects naturally will be having low-potency venom in them, in such conditions the true quality of venom cannot be completely exhibited at the time of bite. Acharya Charaka clearly states the Lakshanas (~symptoms) of Dhooshi visha keeta damsha, which includes Kandu (~itching), Shyava varnata (~blackish discoloration), Pidaka (~papules) etc.[4] These were evident in the present case. Naturally, all Visha (~poison) whether Sthavara (~poisons of plant origin), Jangama (~animal poison), or Krithrima (~synthetic poison) possess ten Gunas (~attributes) such as Tikshna (~sharp), Sookshma (~penetrating), and Vyavayi (~quickly spread even without digestion) and the presence of all these Gunas together can cause acute or subacute poisoning.[8] That is why the bite of the same insect during various period tend to show different prognosis as it purely depends on the amount of venom injected, the time of the bite, and the physical status. The patient was left untreated. Desha (~regional factors), Kala (~seasonal factors) particularly in Sheeta (~cold climate) and Durdina (~cloudy day), Anna (~food habits) like consuming Kulatha (~horse gram), which are spicier and having hot potency, when used repeatedly along with habits such as day sleeping cause the vitiation of Dhatus (~major structural components of the body) which manifested as Dhooshivisha.[9] Acharya Dalhana says that if any poison that does not contain all ten natural Gunas of Visha or has Heena visha guna (~lesser intensity of attributes of poison), i.e., incapable of producing acute symptoms of poisoning and can be designated as Dhooshivisha.[2] Chakrapanidatta define Dhooshivisha as “Kalanthara prakopi visham dhooshivisham,” i.e., the toxic symptoms which manifest after a long time because of the Visha which is Kapha aavritha (~covered or clogged by Kapha).[10]
In this case, the patient gives a history that she is suffering from recurrences of the same symptoms during the cold and rainy seasons. This part of the patient history increases the evidential background for diagnosis which is particularly Dhooshivisha which made to add Siravyadha in the treatment plan.
It is mentioned that blood is the vehicle that aids in carrying the poison as the wind is for fire, so Siravyadha can prevent the flow of vitiated blood to the rest of the Dhatus.[11] Acharya Charaka has clearly stated that in case of Dhooshivisha and in Rakthasrita dosha (~the Dosha which is lodged in the blood), Siravyadha is indicated. It is mentioned that based on the location of Visha in Pittaste (~in the location of Pitta), it is Pittasthana sthita visha (~poison resides in the seat of Pitta dosha) while mentioning Dhooshi visha it is mentioned as Sira (~any tubular vessel of the body) is the Sthana (~seat) of Dhooshivisha.[12]
The treatment was focused on Dhooshivisha, hence Snehana (~oleation) was not given to the patient. Initially, the patient was fed with Kanji (~sour rice gruel) with more water in it (Dravaprayaanna) in an adequate quantity of around 120 ml to initiate a better flow of blood into Sira. After intake of rice gruel, waited for about 48 min and Siravyadhana was done.[13] Swedana (~sudation therapy) was done locally as it is indicated in Dhooshivisha.[14]
Siravyadha was done in the nearest Siras of the affected area. A bandage roll was tied below the knee neither too tight nor too loose to make the Sira prominent so as to do the procedure. A mild blow was given over to the Sira and a sterile needle of No 18 gauge was mildly introduced into the Sira. When the needle was in situ kidney trays were kept beneath it for collecting the blood. During the procedure, an approximate amount of 200 ml of blood was drawn in each sitting. The needle was withdrawn when the blood flow stopped by itself.[15] The same procedure was repeated on the 18th day.[16] After the bloodletting procedure, the area was cleaned with a cotton swab and sterile cotton pad was kept and a bandage cloth was tied around it. The patient was asked to take rest for around half an hour and was advised to follow Pathya (~wholesome diet). On the day of Siravyadha, the patient skipped the internal medicines as she found it to be difficult.
The internal medicines Patolakaturohinyadi kashayam[7] and Dhooshivishahari agada[6] were selected as they are effective in managing all types of Visha. Acharya charaka has mentioned Kandu as a symptom caused by vitiated Kapha (~ dosha responsible for regulating body fluids and keeping the body constituents cohesive) and vitiated Pitta (~Dosha responsible for regulating body temperature and metabolic activities) while explaining Nanatmaja vyadhis (~various diseases) caused by Doshas at the same time itching is a symptom caused due to Vata dosha. Hence, here Tridosha (~three regulatory functional factors of the body) vitiation is responsible for itching. Relief in itching may be due to the removal of vitiated morbid Doshas from the affected area.
With the help of Siravyadha, the color of her skin become lighter and she was feeling lightness in her leg. Pidaka (~papule) is mentioned as a Pitta predominant symptom mentioned by Acharya kashyapa and Charaka. It is stated that, if Pitta is involved there will be involvement of Rakta dosha (~blood tissue). Due to the removal of Rakta which is Ashraya sthana of Pitta, Pidaka was reduced in a better way by Siravyadha. In this study, Dhooshivisha is an important Nidana (~etiology). Acharya Charaka mentioned Siravyadha in Dhooshivisha, as Sira is the Sthana of Dhooshi visha.[12] If so, when the treatment was given specifically to the root cause, i.e., Dhooshivisha, there was marked relief from symptoms.
In general, various probable mechanisms are going to change in the body by bloodletting, it helps to improve local blood supply, metabolism, and local drainage system which reduces the intravascular pressure, and in turn, reduces pigmentation and itching. It helps in releasing hormones and sympathetic nerve function is triggered which directly stimulates bone marrow and immune-related T-Lymphocytes helping in re-launching the healing mechanisms.[17] Symptoms such as Kandu, Shyava varnata, Pidaka are mainly dominant with Kapha and Pitta Dosha, so the drug of choice Patolakaturohinyadhi kashayam which is known for reducing Kapha and Pitta dosha also might have added on to the reduction of symptoms. Moreover the Vishahara (~antitoxic) property of the formulation act as a catalyst for a speedy recovery.[7]
Dhooshivishahari agada was selected as the drug of choice as it is indicated in cases where there is a history of toxicity and is proven to have potential anti-microbial and anti-fungal activities.[18] The choice of medications was based on individualistic assessment but with a strong background of classical references. The present case study was successful and demands further research in this area of Agada tantra (~toxicology). This case study was truly an eye-opener that compels a detailed history taking to diagnose and treat the disease from the grass root level.
| Conclusion | | |
The case report infers that Ayurveda treatment modalities can be satisfactorily applied in conditions such as Dhooshivisha keeta damsha (~insect bite). Such customized approaches are proven in this case to successfully prevent further complications.
Declaration of patient's consent
Authors certify that they have obtained the patient consent form, where the patient has given her consent for reporting the case along with the images and other clinical information in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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