Ayur emergency-ksr02032013

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

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 . . . . . .

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 – Stroke– Heart attack, etc.



All these are Crisis in the Medical Practice – needs the Crisis Management

A CME of Kayachikitsa@ Mahatma Gandhi Ayurved College Hospital & Research Center, Salod (H),

Wardha, Maharastra

On – 02-03-2013


Crisis Management in Ayurveda Medicine

Now let us deal with the


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



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Ayur emergency-ksr02032013