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Changes
→Vidhi Vimarsha
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===
==== ''Sura'' and its varieties in present era ====
Sura, is the liquor prepared with shalidhanya which is nutritionally superior type of rice grain. Sura, if consumed as per the standard directives of limited consumption, leads to pleasure; otherwise it leads to the undesirable conditions like hangover, intoxication and the state of unconsciousness.
Depending upon the methods of preparation followed alcoholic drinks are of different types like sura, madhu and maitreya. The term sautramani has two meanings in different contexts, the former emphasizes the use of alcohol for the purpose of oblation, while the later as sacrificial Soma2.
The advice to use utensils made up of gold and silver for serving liquor is due to their property of being highly non-reactive. In present era metals have been replaced by glass, which is also an inert substance to serve liquor. The principle is to serve liquor in utensils made up of inert substances.
==== Qualities of good liquor ====
The liquor consumption must be in optimal amount suitable to individual’s body constitution and should not cause vitiation of dosha.
Good liquor is prepared from multiple ingredients of varied qualities which have diverse actions to help regulate the three doshas and prevent their vitiation, which may occur in case of use of single ingredient. Sushruta mentioned that the increase or decrease of the dosha is mainly influenced by the ingredients (dravya) of liquor. Therefore, manufacturing liquor with multi-component of varied quality substances will help to maintain state of homoestasis.
Features of intoxication:Hangovers are a frequent, though unpleasant, experience among people who drink to intoxication. Multiple possible factors to cause hangover state by liquor have been investigated, and evidence suggests that hangover symptoms depend upon its effects on urine production, the state of gastrointestinal tract, blood sugar concentrations, sleep patterns, and biological rhythms. In addition, researchers postulate that effects related to alcohol withdrawal depend upon, alcohol metabolism, biologically active non alcohol compounds in beverages; the use of other drugs; certain personality traits; and a family history of alcoholism may contribute to the hangover conditionas shown in table 2 below.
Table 1: Symptoms of hangover:
Class of Symptoms Type
Constitutional Fatigue, weakness, and thirst
Pain Headache and muscle aches
Gastrointestinal Nausea, vomiting, and stomach pain
Sleep and biological rhythms Decreased sleep, decreased REM, and increased slow-wave sleep
Sensory Vertigo and sensitivity to light and sound
Cognitive Decreased attention and concentration
Mood Depression, anxiety, and irritability
Sympathetic hyperactivity Tremor, sweating, and increased pulse and systolic BP
Table 2: Possible Contributing Factors to Hangover3
Direct effects of alcohol
• Dehydration
• Electrolyte imbalance
• Gastrointestinal disturbances
• Low blood sugar
• Sleep and biological rhythm disturbances
Alcohol withdrawal
Alcohol metabolism (i.e., acetaldehyde toxicity)
Non-alcohol effects
• Compounds other than alcohol in beverages, especially methanol
• Use of other drugs, especially nicotine
• Personality type
• Family history for alcoholism
Table 3: Dubowski’s stages of Alcoholic influence
BAC gms/100ml Stages of Alcoholic Influence Clinical Signs /Symptoms
0.01 to 0.05 Subclinical Influence / effects usually not appearent or obvious
Behaviour nearly normal by ordinary observation
Impairment detectable by special tests
0.03 to 0.12 Euphoria Mild Euphoria, Socialbility, Talkativeness
Increased self confidence, Decreased inhibitions
Diminished attention, Judgement and control
Some sensory motor impairment
Slowed information processing
Loss of efficiency in critical performance tests
0.09 to 0.25 Excitement Emotional instability, Loss of critical judgement
Impairment of perception, memory and comprehension
Decreased sensory response, Increased rection time
Reduced visual acuty and peripheral vision& slow glare recovery
Sensory motor incoordination, Impaired Balance
Slurred speech, Vomitting, Drowsiness
0.18 to 0.30 Confusion Disorientation, Confusion, Vertigo, Dysphoria
Exagarated emotional states, (fear, rage, grief etc.)
Disturbances of vision (Diplopia) & 0f color, form, motion & dimensions
Increased pain threeshold
Increased muscular incoordination, staggering gait and ataxia
Apathy, Lethargy
0.25 to 0.40 Stupor General inertia, approaching loss of motor functions
Markedly decreased response to stimuli
Marked muscular incoordination, inability to stand or walk
Vomiting, incontinence of urine and feces
Impaired conciousness, sleep or stupor
0.35 to 0.50 Coma Complete unconciousness, Coma, Anesthesia
Depressed or abolished reflexes
Subnormal temperature
Impairement of circulation and respiration
Possible death
0.45 + Death Death from respiratory arrest
Role of olfaction in intoxication:
Alcoholic beverages provoke massive orthonasal and retronasal stimulations (Bragulat et al., 2008) which constitute strong appetitive cues (Bienkowski et al., 2004) and might be involved in causing alcohol-dependence as they rapidly lead to conditioned alcohol-seeking behaviors (Pautassi et al., 2009). Olfactory stimulations elicit strong drinking desires (Schneider et al., 2001), this olfactory craving being even stronger than those provoked by visual–auditory cues, particularly during withdrawal (Kareken et al., 2004; Little et al., 2005) and thus being potentially involved in relapse.
The olfactory system relates to cognitive and emotional brain regions, and exploring olfaction might improve the understanding of emotional-cognitive deficits in alcohol- dependence (up to now explore with visio–auditory stimulations). Olfaction is indeed directly connected with limbic (Soudry et al., 2011) and fronto-temporal regions (Rolls, 2004).
The orbitofrontal cortex is a crucial area in this perspective, being simultaneously involved in emotional, executive, and olfactory processing (Rolls, 2008). Strong correlations between olfactory and cognitive abilities have been shown (Purdon, 1998; Schu- bert et al., 2008; Sohrabi et al., 2012), underlining their common cerebral basis. Olfaction thus constitutes an interesting way to renew the exploration of emotional-executive deficits in alcohol-dependence.
In view of the above research; the consumption of liquor in pleasent atmosphere, with perfumes, esscense and garlands has a reason to avoid false stimulation of olfactory nerve and to maintain the consciousness during and after liquor intake.
The intention of using perfumes etc is based upon the understanding of its effect on olfaction and there by on the cerebral functions; which otherwise termed as gandha-jnyana, meaning knowledge of olfaction. The most preferred aromas will help maintaining the psycho-neuro axis well in control and it prevents the intoxicating effects on human body.
Factors affecting addictive behaviour: Addictive behavior associated with alcoholism is characterized by compulsive preoccupation with obtaining alcohol, loss of control over consumption, and development of tolerance and dependence, as well as impaired social and occupational functioning. Like other addictive disorders, alcoholism is characterized by chronic vulnerability to relapse after cessation of drinking.
More recently, increasing attention has been directed toward the understanding of neurobiological and environmental factors in susceptibility to relapse5.
The BAC’s showed in the following tables are the maximum attainable concentrations for a specific amount of alcohol consumed.
Table 4: Factors determining maximum BAC:
The calculations are based on Widmark’s Formula:
A = Amount of alcohol measured in grams
P = Mass of the individual in kilograms
C = Blood Alcohol Concentration in gram/100ml
R = Distribution Factor (f=0.7 =0.6)
10 = Conversion Factor from g/1000 ml to g/100ml
A = P x C x R x 10
In a fat person the r-factor will be less than in a muscular one. Theoretically a fat person with the same mass as a muscular one will become more intoxicated on the same amount of alcohol consumed over the same period. (alcohol is not fat soluble but water soluble)
The given blood alcohol concentration is a reflection of the minimum alcohol that was absorbed in the gut.
It does not reflect the:
a) Alcohol remaining in the
b) Alcohol already metabolized
c) Alcohol excreted in the urine and still in the bladder
d) Alcohol perspired
e) Alcohol exhaled
Alcoholism jointly leads to olfactory and memory source impairment and these two categories of deficits are associated. These results strongly support the proposition that olfactory and confabulation measures both index orbitofrontal functioning, and suggests that olfaction could become a reliable cognitive marker in psychiatric disorders6.
Table 5: ICD classification
ICD 11 – Alcohol
Y91 categories in ICD-10:
Evidence of alcohol involvement determined by level of intoxication
Y91.0
Mild alcohol intoxication
Smell of alcohol on breath, slight behavioural disturbance in functions and responses, or slight difficulty in coordination
Y91.1
Moderate alcohol intoxication
Smell of alcohol on breath, moderate behavioural disturbance in functions and responses, or
Moderate difficulty in coordination
Y91.2
Severe alcohol intoxication
Severe disturbances in functions and responses, severe difficulty in coordination, or impaired ability to cooperate
Y91.3
Very severe alcohol intoxication
Very severe disturbance in functions and responses, very severe difficulty in coordination, or loss of ability to cooperate
Y91.4
Alcohol involvement, not otherwise specified
Suspected alcohol involvemen
Effects of alcohol:
Alcohol consumption can interfere with the function of all parts of the gastrointestinal tract. Acute alcohol ingestion induces changes in the motility of the esophagus and stomach that favor gastro-esophageal reflux and, probably, the development of reflux esophagitis.
Alcohol abuse may lead to damage of the gastric mucosa, including hemorrhagic lesions. Beverages with low alcohol content stimulate gastric acid secretion, whereas beverages with high alcohol content do not. In the small intestine, alcohol inhibits the absorption of numerous nutrients. The importance of these absorption disorders for the development of nutritional disturbances in alcoholics, however, is unclear. In alcoholics with other digestive disorders (e.g., advanced liver disease or impaired pancreatic function), impaired digestion likely is more significant. Acute alcohol consumption also damages the mucosa in the upper region of the small intestine and may even lead to the destruction of the tips of the villi.
Qualities of different types of liquors and uses:
The Ashtang Hridaya has elaborated peculiarities of liquor prepared by various sources. The superiority though has been mentioned; the liquor prepared by respective components have specific qualities, which can be considered therapeutically important.
Table 6: Types of liquors Name of liquor Main Quality Indication Correlation
Sura Snehani (Unctous) Gulma, Udara, Arsha, Grahani, Lactating, Diuretic Tumor, Ascitis, Hemorrhoids, Colitis and digestive disorders
Varuni Agile, Sharp, Hridya Shool, Kasa, Vomitting, Asthma, Vibandha, Adhmana, Peenasa Gasric erosions, Cough, Bloating, Rhinitis,
Baibhitaki Agile, Pathya Wounds, Anemia, Skin diseases
Yava-sura Guru, Arid, Vishtambhi
Mardwika Sweet, Sara, Lekhana, not to hot Anemia, Meha, Worms All types of Urine disorders
Kharjura Vatala, Guru
Sharkara Sweet, Hridya, Agile
Gaudika Tarpana, Deepana Diuresis, Laxative
Seedhu Stimulates Vata, Pitta Obesity, Anasarca, Ascitis, Hemorrhoids
Madhwasava Chhedana Meha, Peenas, Kasa Urinary disorders, Rhinitis, Cough
Shuktam Utkledi, Hot, sharp, Sour, Palatable, Laxative, Cool on touch Anemia, Visual disorders, Worms
Time needed to absorb and metabolize different amounts of alcohol:
Factors such as food intake and its constituent profile, gender and age have been reported to influence the kinetics of alcohol absorption and metabolism.
It is widely accepted that the rate of alcohol absorption can be decreased by consuming food along with the alcoholic drink. The rate at which alcohol is absorbed depends on how quickly the stomach empties its contents into the intestine.
The higher the dietary fat content, the more time this emptying will require and the longer the process of absorption will take.
One study found that subjects who drank alcohol after a meal that included fat, protein, and carbohydrates, absorbed the alcohol about three times more slowly than when they consumed alcohol on an empty stomach. Ref???
Role of fructose and carbohydrates in alcohol absorption:
Rogers et al, showed that carbohydrates significantly increased the rate of alcohol metabolism in fasting humans while protein and fat failed to show the same effect. In this context it is interesting to mention that for a long time (prior to controlled scientific interventions) a common nonscientific experience existed claiming that consumption of honey may shorten the period of alcohol intoxication (honey is an excellent rich source of nutritional fructose). The honey significantly increased blood alcohol disappearance and elimination rates by 32.4 and 28.6 percent, respectively, and reduced the intoxication time (that is, the time taken to attain zero blood alcohol level) and its degree (the peak blood alcohol level) by 30 and 4.4 percent.
Fructose, also known as “fruit Sugar”, is naturally-occurring, is characterized by “clean” non-lingering sweet taste. Fructose is highly soluble, and is characterized by a Relative Sweetening Value (RSV) of 1.1-1.7 (where sucrose = 1.0), depending on temperature and pH.
With regards to the possible mechanism by which fructose accelerates ethanol metabolism, a literature review indicates a possible shift in the metabolism of fructose in the presence of alcohol. This shift has been linked to the production in the liver of NAD+ which facilitates alcohol oxidation. Therefore, in the presence of alcohol, the metabolism of fructose in the liver is diverted from NAD+ to NADH requiring pathways, which in turn generates the NAD+ needed for alcohol oxidation9.
Treatment of acute alcoholism: ??
Treatment of chronic alcoholism: ??
Refrences:
1. Charaka Samhita; Chaukhamba, Bhagwan Das, R K Sharma
2. Charaka Samhita; Chaukhamba, Bhagwan Das, Sharma
3. Alcohol Health and Research World; Mechanisms and Mediators; Robert swift, Dena Davidson; page 54-60
4. Frontiers in Psychology; Olfaction in alcohol dependence: a neglected yet promising research field; Maurage et al; Jan 2014, Vol.4. Article 1007
5. Journal of Neurosciences, May 1, 2002, 22(9), 3332-3337; Behavioural Neurobiology of Alcohol addiction; Weiss and Porrino
6. Journal of Plosone; August 2011, Vol.6, Issue 8; Olfactory Impairment Is Correlated with Confabulation in Alcoholism: Towards a Multimodal Testing of Orbito-frontal Cortex
Pierre Maurage et al
7. Alcohol Health and Research World; Alcohol’s role in Gastrointestinal disorders; Chirstian Bode & J. Christian Bode
8. Biological Psychology, Vol. 88, Issue 1; Sep 2011. 28-36; Chemosensory event-related potentials in alcoholism: A specific impairment for olfactory function; Maurage et al
9. Agro Food Industry hi tech Sep-Oct2009, Vol. 20 No.5; Fructose and its effect on alcohol elimination from blood following alcohol consumption; Fernando Schved
10. Charak Sutrasthana 1/ 44.
11. Sushrut sutrasthana 2:
Gunaha ye ukta dravyeshu sharireshu api te tathaI
sthana vriddhi kshayah tasmad dehino dravyahetukaII
12. Ashtang Hridaya Sutrasthana 11/37-38 commentary by Arundatta
13. Ashtang Hridaya Chilitsasthana 7 Madatyayachikitsa – Hemadri & Arundatta
14. Alcohol, the body and health effects; The Alcohol Advisory Council, NZ
Index 1:
Verse no. Name as per Charaka Lattin name Useful Part Rasa
23 Yava
23 Godhum Triticum sativum Phal
23 Marich Piper nigrum Phal
111 Matulung Celastrus paniculatus Willd Beeja
111 Aadrak Zingiber officinale Swaras
121 Bijpurak Citrus medica Linn Phal
121 Vrukshamla Garcinia indica Chois Phal
121 Kol Zizyphus jujuba Lam Phal
121 Dadim Punica granatum Linn Phal-Twak, Moola-twak
121 Yawani Hyoscyamus niger Linn Beeja
121 Hapusha Juniperus communis Linn Phal
121 Ajjaji Cuminum cyminum Linn Phal
121 Shrungwer
125 Godhum
126 Mash Phaseolus mungo Linn Phal
127 Marich
127 Adrak
127 Dadim
128 Marich
128 Adrak
129 Dadim
129 Panchmul
130 Dhanya Coriandrum sativum Linn Phal
130 Nagar Zingiber officinale Roscoe Moola
136 Kharjur Phoenix sylvestris Roxb Phal
136 Mrudhwika Vitis vinifera Linn Phal
136 Parushak Grewia asiatica Linn Phal
137 Mardik
138 Shalishashtik Oryza sativa Linn Phal
139 Patol Trichosanthes dioics Roxb Patra, Mool
139 Mudag Phaseolus aureus Roxb Beej, phal
139 Dadim
139 Aamlak Phyllanthus emblica Linn Phal
140 Draksha
140 Aamlak
140 Kharjur
140 Parushak
145 Guduchi Tinosphora cardifolia Panchang
145 Bhadramusta Cyperus rotundus Linn Kand
145 Patol
145 Nagar
146 Draksha
149 Parushak
149 Pilu Salvadora persica Linn patra, beeja, Moola
150 Musta Cyperus scariosus R.Br kanda
150 Dadim
150 Laja
151 Kol
151 Dadim
151 Vrukshamla
151 Churika Tamarindus indica Linn phal, beeja, patra, pushpa
153 Padam Prunus puddum Roxb Kashtha
153 Utpal Saussurea lappa, Mool Katu, madhur, tikta
153 Chandan Santalum album, Linn Kashthasar Tikta
155 Chandan
156 Kumud Nymphaea alba, Linn moola, pushap
156 Utpal
156 Chandan
159 Phalini Callicarpa macrophylla vahl phul, patra
159 Sevya Andropogon muricatus Retz Moola Tikta, madhur
159 Lodhra Symplocos racemosa, Roxb Twaka Kashay
159 Ambu
Index 2:
(www.alcoholservices-ateam.org)
Work in Progress
Work in Progress