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Madatyaya Chikitsa (view source)

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The health effects of liquor consumption are observed in two ways as they appear; short term effects or immediate effects and long term effects or late effects. The ''ojas'' (the vigor), reflects the short term as well as long term effects, if liquor is consumed beyond the prescribed limit. The ''ojas'' is quite dynamic phenomenon of human body, which is said to have similar properties like milk; which indicates the productive benefits to the body. The alcoholic beverages possess exact opposite properties to the ''ojas'', and excess drinking can also cause suppression of ''ojas'' leading to intoxication and death with complete obliteration of ''ojas''. The purpose of describing and discussing ''ojas'' here indicates the importance to conserve the ''ojas'' in the treatment of ''madatyaya'' (alcoholism). Most of the formulations prescribed here directly or indirectly lead to enhancement of ''ojas'' to achieve conscious state.

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=== Sanskrit Text, Transliteration and English Translation ===

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== Sanskrit Text, Transliteration and English Translation ==

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Now we shall expound the chapter ~~on management of state~~ of intoxication ~~(due to excess consumption of liquor~~). Thus said Lord Atreya. [1-2]

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Now we shall expound the chapter "Madatyaya chikitsa" (Management of intoxication). Thus said Lord Atreya. [1-2]

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==== Origin of ''sura'' ====

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Note: The management of states of intoxication due to excess consumption of liquor are described in this chapter.

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=== Origin of ''sura'' ===

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It has several varieties depending upon its specific source material, ''sanskara'' (method of preparation), nomenclature, etc; which is at the same time unitary in character on account of the common features of intoxication.[6]

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==== Various forms of ''sura'' ====

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=== Various forms of ''sura'' ===

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It bestows auspicious par excellence by providing nourishment to the Gods in the form of ambrosia, to the ancestors in the form of ''svadha'' (the term used for offering oblatory to the ancestors), to ''dvijas'' (considered as the twice born) in the form of ''soma''. [7]

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==== Importance of ''sura'' ====

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=== Importance of ''sura'' ===

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Which represents the great luster of the Ashwins, the prowess of ''mantras'', and the supremacy of Indra, who perfected ''soma'' in the ''sautramani'' sacrifice; which eradicates grief, depression, fear and bewilderment; which itself represents the invincible strength, love, voice, nourishment and peace; and which is called ''sura'' by the Gods, ''gandharvas'' (celestial musicians), ''yaksha, rakshasa'' (devils) and human beings should take appropriately (as per the prescription of the ''shashtras'').[8-10]

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==== Procedure of drinking ''madya'' ====

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=== Procedure of drinking ''madya'' ===

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One shall always prefer best liquor to drink along with a variety of apposite fruits, natural green vegetables, salted and veteran seasonal fruits, a variety of roasted meat of terrestrial, aquatic animals and flying birds and different edibles prepared by the group of chefs; after being worshiped by the Gods, with blessings and pouring the liquor mixed with water to be given to the willing persons on this earth.[11-20]

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==== Pre-procedures based on ''dosha'' dominant ''prakriti'' ====

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=== Pre-procedures based on ''dosha'' dominant ''prakriti'' ===

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Appropriate ''madya'' for ''vatika'' person is that which is prepared predominantly by jaggery and flour. For ''kapha'' and ''pitta'' predominant person ''madya'' prepared by grapes and honey is appropriate (to drink) respectively. [21-25]

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==== Pros and cons of drinking ''madya'' ====

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=== Pros and cons of drinking ''madya'' ===

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Liquor prepared by multiple ingredients carry multiple qualities and multiple actions, characterized by advantages and disadvantages. It is like ambrosia; for the one who drinks as per the standard guidelines, in optimum quantity, at suitable time, with advisable diet, as per the capacity and with exhilaration. On the contrary, it will be like poison for the one who indulges in excessive drinking any kind of liquor, and who have excess dryness in body and follows excess exertion. [26-28]

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==== Properties and effects of ''madya'' on ''oja'' ====

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=== Properties and effects of ''madya'' on ''oja'' ===

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The heart is the site for the channels of the ''rasa, vata'' and others, ''sattva'' (mental strength), ''buddhi'' (intellect), ''indriya'' (senses), ''aatman'' (self) and primary ''ojas'' (vital essence). The excess drinking of liquor and gradual impediment of ''ojas'' affects the heart and the ''dhatus'' located at the heart.[29-36]

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==== Stages of ''mada'' (intoxication) ====

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=== Stages of ''mada'' (intoxication) ===

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Consumption of liquor prepared by the flour does not affect ''ojas'' severely due to lack of (harmful) qualities like expanding property, dryness/roughness, and non-sliminess.[37-38]

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==== Characteristic features of ''mada'' ====

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=== Characteristic features of ''mada'' ===

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The heart overwhelmed with the qualities of liquor exhilaration, delight, thirst, sexual pleasure and other ''rajas, tamas'' disorders leads to the state of infatuation and sleep due to over-drinking. This derailment due to liquor is called as ''mada'' (intoxication). [39-40]

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==== Features of different stages of ''mada'' ====

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=== Features of different stages of ''mada'' ===

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He will become hated and non acceptable among the people, and because of addiction will consequently attain a stage of painful diseases afterwards.[41-51]

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==== Overall effects of ''madya'' ====

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=== Overall effects of ''madya'' ===

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But liquor by nature is similar to the food. It causes disorders when consumed improperly; while it is like ''amritam'' (elixir) when consumed properly. Food is like the vitality of life for the human beings; but the same may be fatal if ingested improperly. The poison is fatal, but it can be ''rasayana'' if used sensibly.[52-60]

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==== Benefits of ''madya'' ====

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=== Benefits of ''madya'' ===

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The rain stimulates growth of the crops and fire exposes the nature of the gold. The liquor in humans performs both the functions. Superior, average and inferior is the types of human character, similar to the fire; the liquor expresses the nature of psyche of the human.[68-73]

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==== Behavior of persons of different psyche after consumption of ''madya'' ====

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=== Behavior of persons of different psyche after consumption of ''madya'' ===

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The person who are suffering with hunger and thirst, weak, predominant with ''vata'' and ''pitta'', consuming arid, less and deficient food, harden stool, weak in psyche, wrong in getting angry, emaciated, exhausted, sore due to the intoxication, gets instantly affected by even smaller quantity of the liquor.[80-87]

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==== Etiology and clinical features of ''vata'' dominant ''madatyaya'' ====

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=== Etiology and clinical features of ''vata'' dominant ''madatyaya'' ===

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Hiccups, breathlessness, tremors in head, pain in flanks, sleeplessness, and frequent delirium are the symptoms of vata dominant ''madatyaya''.[88-90]

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==== Etiology and clinical features of ''pitta'' dominant ''madatyaya'' ====

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=== Etiology and clinical features of ''pitta'' dominant ''madatyaya'' ===

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Thirst, burning sensation, fever, sweating, fainting, diarrhea, giddiness and greenish discoloration are the distinct features of pitta dominant type of ''madatyaya''. [92-93]

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==== Etiology and clinical features of ''kapha'' dominant ''madatyaya'' ====

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=== Etiology and clinical features of ''kapha'' dominant ''madatyaya'' ===

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Vomiting, anorexia, nausea, drowsiness, stiffness, heaviness, and sensing cold are the features of ''madatyaya'' predominant with ''kapha''.[95-97]

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==== Clinical features of ''sannipataja madatyaya'' ====

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=== Clinical features of ''sannipataja madatyaya'' ===

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Major physical distress, confusion, cardiac pain, anorexia, persistent thirst, fever, characterized by immense headache, pain in flanks, arthralgia, and joint pain along with yawning, throbbing, tremors , exhaustion, chest congestion, coughing, hiccups, breathlessness, sleeplessness, trembling, disorders of ear, eye, mouth; sacral stiffness, vomiting, diarrhea, nausea, with symptoms of ''vata, pitta, kapha'', giddiness, delirium, hallucinations; self covered by grass, ash, creeper, leaves, and dust; with perverted mind feels assaulted by birds, visualizing fear and inauspicious dreams; are the general symptoms of ''madatyaya''.[101-106]

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==== Management of ''madatyaya'' ====

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=== Management of ''madatyaya'' ===

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It shall be cool, with ''sauvarchala, bida,'' and rock salt along with ''matulunga'', fresh ginger, mixed with water and in appropriate quantity. [107-111]

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==== Treatment of acute ''madatyaya'' ====

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=== Treatment of acute ''madatyaya'' ===

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Liquor is sour with four contributory tastes, such as sweet, astringent, bitter and pungent. These added with the ten qualities described earlier summed to fourteen which exist in the liquor. Among all the sour substances the liquor is superior.[112-116]

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==== Management of ''vata'' dominant ''madatyaya'' ====

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=== Management of ''vata'' dominant ''madatyaya'' ===

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''Vata'' predominant ''madatyaya'' usually gets controlled immediately by various delighting ragas, ''shadavas'', meat preparations, vegetables, flour preparations, barley, wheat, ''shali'' rice; massage, anointing, hot baths, thick swathe, thick ''agaru'' pastes, thick essence of ''agaru'', affectionate hug to women to the bosom with warmth of youthfulness, pleasant touch of their hips, thighs, breasts due to fondling, warm bedding and swaddling with warm comfortable home.[117-135]

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==== Management of ''pitta'' dominant ''madatyaya'' ====

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=== Management of ''pitta'' dominant ''madatyaya'' ===

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Learned physician implement these regimens with consideration of ''matra'' (optimum quantity) and ''kaala'' (appropriate time) to pacify ''pittaja madatyaya''.[136-163]

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==== Management of ''kapha'' dominant ''madatyaya'' ====

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=== Management of ''kapha'' dominant ''madatyaya'' ===

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''Kaphaja madatyaya'' gets quickly pacified with use of heavy and even light weight garments, with ''samvahana'' (deep massage) created contraction (and relaxation) with warmth, pleasurable to the body by well trained female masseur. [164-188]

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==== Management of ''sannipata'' ====

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=== Management of ''sannipata'' ===

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One who understands permutations and combinations of ''dosha'', medicines, and prognosis can differentiate between curable and non-curable diseases and treat. [189-190]

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==== ''Harshana chikitsa'' (Exhileration treatment) ====

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=== ''Harshana chikitsa'' (Exhileration treatment) ===

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Liquor cannot lead to intoxication without distressing mind and affecting the body, therefore exhilaration treatment (by above measures) shall be observed (to stabilize mind and body).[191-194]

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==== Treatment of ''madatyaya'' with milk ====

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=== Treatment of ''madatyaya'' with milk ===

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When the disease is removed by the use of milk and strength is regained the use of milk shall be discontinued and liquor consumption can be resumed in smaller quantities gradually.[195-198]

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==== ''Dwansaka'' and ''Vikshaya'' diseases due to ''madatyaya'' ====

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=== ''Dwansaka'' and ''Vikshaya'' diseases due to ''madatyaya'' ===

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''Basti'', consumption of ghee and milk with ghee, massage, bath suitable food and drink are ''vata'' pacifying. ''Dhwansaka'' and ''Vikshaya'' subside by this regimen. The drinking disorders will not occur in the person who drinks liquor properly.[199-205]

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==== Prevention of diseases ====

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=== Prevention of diseases ===

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Diseases of body and mind do not occur in the person who wisely stays away from all liquors, who has controlled all his senses. [206]

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==== Summary ====

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=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

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==== ''Sura'' and its varieties in present era ====

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=== ''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.

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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.

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==== Qualities of good liquor ====

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=== 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''.

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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 homeostasis.

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==== Features of intoxication ====

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=== 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 condition as shown in table 2 below.

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===== Table 1: Symptoms of hangover =====

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==== Table 1: Symptoms of hangover ====

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===== Table 2: Possible Contributing Factors to Hangover<ref>Alcohol Health and Research World; Mechanisms and Mediators; Robert swift, Dena Davidson; page 54-60</ref> =====

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==== Table 2: Possible Contributing Factors to Hangover<ref>Alcohol Health and Research World; Mechanisms and Mediators; Robert swift, Dena Davidson; page 54-60</ref> ====

#Direct effects of alcohol

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##Family history for alcoholism

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===== Table 3: Dubowski’s stages of Alcoholic influence =====

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==== Table 3: Dubowski’s stages of Alcoholic influence ====

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==== Role of olfaction in intoxication ====

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=== 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.

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The BACs showed in the following tables are the maximum attainable concentrations for a specific amount of alcohol consumed.

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===== Table 4: Factors determining maximum BAC =====

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==== Table 4: Factors determining maximum BAC ====

The calculations are based on Widmark’s Formula:

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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 disorders<ref>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 </ref>.

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===== Table 5: ICD classification (ICD 11 – Alcohol) =====

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==== Table 5: ICD classification (ICD 11 – Alcohol) ====

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==== Effects of alcohol ====

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=== 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.

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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.

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==== Qualities of different types of liquors and uses ====

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=== 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.

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==== Table 6: Types of liquors ====

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=== Table 6: Types of liquors ===

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==== Time needed to absorb and metabolize different amounts of alcohol ====

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=== 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.

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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. [[Need citation]]

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==== Role of fructose and carbohydrates in alcohol absorption ====

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=== 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.

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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 oxidation<ref>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</ref>.

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==== Guidelines for treatment of Alcohol-use disorder ====

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=== Guidelines for treatment of Alcohol-use disorder ===

An alcohol use disorder is a highly prevalent and disabling condition. It is associated with high rates of medical and psychiatric comorbidity as well as early mortality. The psychiatric diagnoses, alcohol abuse and alcohol dependence has been labelled as alcohol use disorder, in DSM-5.

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Criteria for at-risk drinking may be modified by comorbidities, especially in the older population. Increased mortality risk has been demonstrated for older patients who are at-risk drinkers, as defined by the CARET (Comorbidity-Alcohol Risk Evaluation Tool). Any drinking can be considered “at-risk” for pregnant women, for those who take medications that interact with alcohol, or for those with a health condition that can be caused or exacerbated by alcohol (eg, hepatitis C)[15].

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==== Principles of non-pharmacological treatment in Madatyayaya & Satvavajaya ====

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=== Principles of non-pharmacological treatment in Madatyayaya & Satvavajaya ===

In madatyayaya the effects of Madya usually have been observed at physical as well as psychological levels. To treat the ill-effects of alcohol physician has to address Psychological aspects on personal. Familial & social level by various settings of counseling with the patient. As per the concept of mind in [[Ayurveda]], Rajas & Tamas are the Dosha, the pathologies related to the mind or psyche and the imbalances in these two doshas lead to simple psychological disorders to complex psychiatric diseases. Satva, on the other hand is the quality of mind, which if dominated, can control the two Raja & Tama. Therefore, Satvavajaya is one of the treatments for Madatyayaya; where controlling of Dharaneeya vega (Urges to be controlled) is recommended to achieve balance in Raja & Tamo guna; which eventually can achieve the balance of mind in Alcohol withdrawal phase.

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==== Conventional aspects of non-pharmacological treatments ====

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=== Conventional aspects of non-pharmacological treatments ===

Short-term goals of treatment include:

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Research studies suggest that a small but significant proportion of patients may be able to resume normal or controlled drinking. Controlled drinking is probably more likely for people with a mild disorder (or at-risk drinking) and not for a more severe disorder. Advocates for a “harm reduction” approach as an alternative to abstinence may acknowledge that abstinence is the best outcome, but that not every individual achieves this end, and that controlled drinking for some individuals is an achievable aim which reduces risk to patients.

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==== Principles of pharmacological management in Madatyaya ====

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=== Principles of pharmacological management in Madatyaya ===

The qualities of “Oja” are mentioned in this same chapter where the elaboration of ''madya'' has been done. The reasoning behind this if tried to understand with [[Tantrayukti]] suggests that since the ''Oja'' & ''Madya'' are opposite in qualities; the treatment of ''Madatyaya'' should be done on the guidelines of ''Ojo-vardhana''.

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The medicinal plants of pharmacological importance with madhura rasa & vipaka shall be preferred for treatment of Madatyaya, as per the principle, where the treatment with Viruddha Guna has been advised.

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==== Concept of Santarpana & Alcohol related Malnutrition ====

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=== Concept of Santarpana & Alcohol related Malnutrition ===

Alcohol, if consumed in excess, can cause malnutrition which can lead to nutritional disorders as well as organ damage. The initial phase nutritional imbalances particularly depletion can be very well controlled with the concept of Santarpana, as described by Charaka (Cha.Su. 23/31-38). Various pharmacological, dietary products have been discussed here along with use of liquor prepared from Grain for Santarpana. This principle later used in this chapter 24th, where in some cases treatment of Madatyayaya with Madya itself has been described.

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==== Recent Researches ====

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=== Recent Researches ===

* In a study on 38 patients suffering from madatyaya,it is observed that Ashtanga lavana is effective followed by vamana (therapeutic emesis).<ref> Sadalagi Sheetal et.al.Effect of Vamana and Ashtanga Lavana in the management of Madatyaya. AYU;30(4)2009,pp. 463-468. available online from http://www.ayujournal.org/article.asp?issn=0974-8520;year=2009;volume=30;issue=4;spage=463;epage=468;aulast=Sadalagi;type=0 accessed on July 29,2019</ref>

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=== References ===

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== References ==

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