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Principles of Diagnosis and Management of medical emergencies in Ayurveda

 

'''Principles of Diagnosis and Management of medical emergencies in Ayurveda'''

 

(This article is based on a lecture delivered by Dr. Upendra Dixit, Chief consultant, Dixit Ayurveda, Goa, India., in Prof.M.S.Baghel Memorial Lecture Series on October 09, 2021.)  

(This article is based on a lecture delivered by Dr. Upendra Dixit, Chief consultant, Dixit Ayurveda, Goa, India., in Prof.M.S.Baghel Memorial Lecture Series on October 09, 2021.)  

The Atharvaveda quotes assurance statements by the sages to the person on the death bed.   

The Atharvaveda quotes assurance statements by the sages to the person on the death bed.   

“Do not fear. You won’t die. We will save your life. “[Atharva veda 5.30.8] Ashtanga Hridaya quotes, ‘Ayurveda can save the life of a person from the noose of death by using various measures,. [A.Hr.uttara tantra 44/74] It shows that medical emergency measures were handled successfully in ancient times to save human lives. Though no science can completely assure to prevent death, the physician has to try to save a life until the last breath. Physician is required to study the management of medical emergencies to find better, safe, and cost-effective healthcare solutions to save lives.   

 

References of emergency conditions in Ayurveda texts:  

“Do not fear. You won’t die. We will save your life. “[Atharva veda 5.30.8]  

The word ‘atyaya’ is used to denote destruction or death. [Chakrapani Cha.Sa. Sharira Sthana 1/50] [Dlahana Su. Sha.10/19-20]. The word ‘atyayika’ denotes the quickest possible treatment done to protect life without any delay. [Dallhana Su. Sha. 8/5] [Hemadri A.Hr.Su.2/33] Therefore, the medicines to be used in medical emergencies shall be ready with the physician for first aid emergency treatment, even if the patient is to be referred to higher critical care centers.  

 

Ashtanga Hridaya quotes, ‘[[Ayurveda]] can save the life of a person from the noose of death by using various measures,. [A.Hr.uttara tantra 44/74]  

 

It shows that medical emergency measures were handled successfully in ancient times to save human lives. Though no science can completely assure to prevent death, the physician has to try to save a life until the last breath. The physician is required to study the management of medical emergencies to find better, safe, and cost-effective healthcare solutions to save lives.   

 

==References of emergency conditions in Ayurveda texts:==

 

The word ‘atyaya’ is used to denote destruction or death. [Chakrapani Cha.Sa. [[Sharira Sthana]] 1/50] [Dlahana Su. Sha.10/19-20]. The word ‘atyayika’ denotes the quickest possible treatment done to protect life without any delay. [Dallhana Su.Sa. Sharira Sthana. 8/5] [Hemadri A.Hr.Sutra Sthana 2/33] Therefore, the medicines to be used in medical emergencies shall be ready with the physician for first aid emergency treatment, even if the patient is to be referred to higher critical care centers.  

 

The word niratyaya explains how diet, various activities, and treatments can be performed in such a safe way that complications leading to severe consequences and emergencies can be prevented.   

The word niratyaya explains how diet, various activities, and treatments can be performed in such a safe way that complications leading to severe consequences and emergencies can be prevented.   

Medical emergencies:  

 

American college of emergency physicians has listed 1733 emergency conditions.  It shows the scope of emergencies occurring in various medical fields. From this, we can understand that emergency medicine is a vast field. Ayurveda has a lot of potential to contribute to medical emergencies. However, it is not much explored in the current practices of Ayurveda. Although a few Ayurveda consultants are working in this field.  Recently AVP research foundation, Coimbatore has undertaken a project on Ayurvedic emergency medicine. Not much literature is available to study on the subject of management of emergency conditions through Ayurveda. A series of articles entitled ‘Basic principles of emergency treatment of Ayurveda’, published in AYU Journal written by Vaidya Mhaiskar V.B.  is one of the best sources to learn this topic.  

==Medical emergencies:==

Ayurveda especially Brihat Trayi (texts termed as a great triad) provides lot of references regarding emergency conditions and their treatment. Here are a few examples:

American college of emergency physicians has listed 1733 emergency conditions.  It shows the scope of emergencies occurring in various medical fields. From this, we can understand that emergency medicine is a vast field. [[Ayurveda]] has a lot of potential to contribute to medical emergencies. However, it is not much explored in the current practices of [[Ayurveda]]. Although a few [[Ayurveda]] consultants are working in this field.  Recently AVP research foundation, Coimbatore has undertaken a project on Ayurvedic emergency medicine. Not much literature is available to study the subject of management of emergency conditions through [[Ayurveda]]. A series of articles entitled ‘Basic principles of emergency treatment of [[Ayurveda]]’, published in AYU Journal written by Vaidya Mhaiskar V.B.  is one of the best sources to learn this topic.  

The condition of Vata dominant prameha (obstinate urinary disorders including diabetes) is incurable and has potential of causing emergency conditions. [Cha.Sa. Nidana Sthana 4/38]

[[Ayurveda]] especially Brihat Trayi (texts termed as a great triad) provides lot of references regarding emergency conditions and their treatment. Here are a few examples:

The pitta dominant gulma should be treated as an emergency condition. [Cha.Sa. Chiktsa Sthana 5/114]

 

The cough (kasa) due to chest injury shall be treated as an emergency condition. [Cha.Sa. Chiktsa Sthana 8/134]

The condition of [[Vata]] dominant prameha (obstinate urinary disorders including diabetes) is incurable and has potential of causing emergency conditions. [Cha.Sa. [[Nidana Sthana]] 4/38]

The erysipelas (visarpa) due to vitiation of all dosha is considered as an emergency condition. [Cha.Sa. Chiktsa Sthana 21/41]

 

The physician shall treat weak patients with utmost care to prevent complications. [Cha.Sa. Vimana Sthana 8/94]

The [[pitta]] dominant gulma should be treated as an emergency condition. [Cha.Sa.[[Chiktsa Sthana]] 5/114]

In an emergency condition, one should administer the purification therapies (shodhana) with great care. [Cha.Sa. Vimana Sthana 8/127]

 

The cough (kasa) due to chest injury shall be treated as an emergency condition. [Cha.Sa. [[Chiktsa Sthana]] 8/134]

 

The erysipelas (visarpa) due to vitiation of all [[dosha]] is considered as an emergency condition. [Cha.Sa.[[Chiktsa Sthana]] 21/41]

 

The physician shall treat weak patients with utmost care to prevent complications. [Cha.Sa. [[Vimana Sthana]] 8/94]

 

In an emergency condition, one should administer the purification therapies (shodhana) with great care. [Cha.Sa.[[Vimana Sthana]] 8/127]

For understanding emergency treatment , all such references need to be compiled and thoroughly studied. The author has made efforts in this regard.  

For understanding emergency treatment , all such references need to be compiled and thoroughly studied. The author has made efforts in this regard.  

Causative factors of emergency or life-threatening condition:  

 

==Causative factors of emergency or life-threatening condition:==

 

From all textual references, it can be understood that certain factors cause most emergencies. They are as below:

From all textual references, it can be understood that certain factors cause most emergencies. They are as below:

• Marma (vital organs)

 

• Rakta (blood)

*Marma (vital organs)

• Oja (immunity and essence of body tissues)

 

• Udaka (fluid)  

*[[Rakta]] (blood)

• Prana vayu (a type of vata dosha)

 

• Pranavaha Srotasa (respiratory system transporting vital air)  

*[[Oja]] (immunity and essence of body tissues)

• Agni (digestion and metabolism)

 

• Udana vayu (a type of vata dosha)  

*Udaka (fluid)  

• Dhatu gata avastha (state of the affliction of tissues)

 

• Shulopahatava ( Pain threshold or severity)

*Prana vayu (a type of [[vata dosha]])

• Upadrava jushtata (comorbid conditions or complications of various diseases)

 

• Janapadodhwasa (epidemics and pandemic conditions)

*Pranavaha Srotasa (respiratory system transporting vital air)  

Concept of prana in Ayurveda:

 

*[[Agni]] (digestion and metabolism)

 

*Udana vayu (a type of [[vata dosha]])

*[[Dhatu]] gata avastha (state of the affliction of tissues)

 

*Shulopahatava ( Pain threshold or severity)

 

*Upadrava jushtata (comorbid conditions or complications of various diseases)

 

*Janapadodhwasa (epidemics and pandemic conditions)

 

==Concept of prana in [[Ayurveda]]:==

The term prana is used for the vitality of life or life force. It is essential to understand the concept of prana and its importance in life-threatening emergency conditions.  There are twelve sites of vitality (prana).  Ayurvedic texts use the word ‘Prana’ as a synonym for certain body constituents. Prana is also used as a prefix to the names of certain body constituents.  This indicates these body constituents are most vital, for saving a life.  

The term prana is used for the vitality of life or life force. It is essential to understand the concept of prana and its importance in life-threatening emergency conditions.  There are twelve sites of vitality (prana).  Ayurvedic texts use the word ‘Prana’ as a synonym for certain body constituents. Prana is also used as a prefix to the names of certain body constituents.  This indicates these body constituents are most vital, for saving a life.  

Agni, Soma, Vayu, Sattva, Rajas, Tamas, Atma and Pancha mahabhuta.(Su.Sha.4.3) The two temples, the three vital organs, the throat, rakta dhatu (blood), shukra dhatu (reproductive tissue), oja (the vital essence), and the anus are ten sites of life forces (prana).[Cha.Sa.Sutra Sthana 29/3]   Prana vayu is one of the five types of Vata dosha(Cha.Chi.28.234). Food (anna)(Cha.Chi.24.60), water (udaka)(A.S.Su.6.11), and strength or immunity (balam) are factors influencing vitality(Dalhana on Su.Su.17.13).  

 

The vitality from external sources or nature (bahya prana) and internal vitality (abhyantara prana) sustain human life. The vitality from external sources or nature is converted into internal vitality through channels of transportation and transformation of vitality (pranavaha srotasa)( Su.Su.17.13). The vitality especially depends on blood tissue (rakta)(Cha.Su.24.4), essence (oja) (Chakrapani on Cha.Su.28.4), digestion, and metabolism (agni)(Cha.Chi.15.3,4). It is presented through sensory and motor organs (indriya)(Cha.Su.1.48).  

[[Agni]], Soma, Vayu, Sattva, Rajas, Tamas, [[Atma]] and [[Pancha mahabhuta]].[Su.Sa.Sharira Sthana 4/3]  

Injury to the umbilicus (nabhi)(Su.Sha.7.5), channels carrying nutrient fluid (rasavaha srotasa)(Su.Sha.9.12), blood vessels (sira) can lead to sudden death(Dalhana on Su.Sha.7.5).  

 

The two temples, the three vital organs, the throat, rakta dhatu (blood), shukra dhatu (reproductive tissue), oja (the vital essence), and the anus are ten sites of life forces (prana).[Cha.Sa.[[Sutra Sthana]] 29/3]  

 

Prana vayu is one of the five types of [[Vata dosha]][Cha.Sa. [[Chikitsa  Sthana]]28/234].Food (anna)[Cha.Sa.[[Chikitsa Sthana]].24.60], water (udaka)[A.S.Sutra Sthana.6.11], and strength or immunity (balam) are factors influencing vitality[Dalhana on Su.Sa.[[Sutra Sthana 17/13].  

 

The vitality from external sources or nature (bahya prana) and internal vitality (abhyantara prana) sustain human life. The vitality from external sources or nature is converted into internal vitality through channels of transportation and transformation of vitality (pranavaha srotasa) [Su.Sa.Sutra Sthana 17/13]. The vitality especially depends on blood tissue (rakta)[Cha.Sa.[[Sutra Sthana]] 24/4], essence ([[oja]]) (Chakrapani on Cha.Sa.[[Sutra Sthana]]28/4], digestion, and metabolism ([[agni]])[Cha.Sa.[[Chikitsa Sthana]]15/3,4]. It is presented through sensory and motor organs (indriya)[Cha.Sa.[[Sutra Sthana]]1/48].  

 

Injury to the umbilicus (nabhi)[Su. Sa.[[Sharira Sthana]] 7/5], channels carrying nutrient fluid (rasavaha srotasa)[Su. Sa.[[Sharira Sthana]] 9/12], blood vessels (sira) can lead to sudden death(Dalhana on Su.Sa.[[Sharira Sthana]] 7/5].  

 

Commonly observed clinical features in an emergency:  

Commonly observed clinical features in an emergency:  

• -Acute and severe pain in vital organs like cardiac pain or abdominal pain etc. as observed in trimarmiya chikitsa chapter of charak Samhita. It is mentioned as sahasa daruna marmaruja.   

 

• Acute hemorrhage or excessive bleeding (sahasa atyartha raktasrava)  

* Acute and severe pain in vital organs like cardiac pain or abdominal pain etc. as observed in trimarmiya chikitsa chapter of charak Samhita. It is mentioned as sahasa daruna marmaruja.  

• Dyspnoea (shvasakashta)  

    

• Sudden loss of sensation (sahasa indriyanasha)

* Acute hemorrhage or excessive bleeding (sahasa atyartha raktasrava)

• Unconsciousness (sanjna nasha)  

• Syncope (moorchha)

*Dyspnoea (shvasakashta)  

• Acute organ failure  

 

• Clinical features of the affliction of vital organs can cause death within seven days (sadya pranahara marma) like loss of perception, sudden vomiting, excess perspiration, a sudden feeling of heaviness [A.Sa.Sharira Sthana 7/47]

*Sudden loss of sensation (sahasa indriyanasha)

 

*Unconsciousness (sanjna nasha)  

 

*Syncope (moorchha)

 

*Acute organ failure  

 

*Clinical features of the affliction of vital organs can cause death within seven days (sadya pranahara marma) like loss of perception, sudden vomiting, excess perspiration, a sudden feeling of heaviness [A.Sa.Sharira Sthana 7/47]

 

The clinical features of near-death patients are described in chapters of indriya sthana.  

The clinical features of near-death patients are described in chapters of indriya sthana.  

Diagnostic tools:  

Diagnostic tools:  

• In addition to the above clinical features, arishta or fatal signs observed in the patients are tools to diagnose emergency conditions. These appear suddenly, without any known cause, with the constantly deteriorating condition of the patient.  

 

• Changes in breathing patterns or respiration can indicate emergency conditions. Guidelines about this can be referred from the clinical features of affection of channels of transportation and transformation of prana (pranavaha srotasa). [Cha.Sa. Vimana Sthana 5/8]

*In addition to the above clinical features, arishta or fatal signs observed in the patients are tools to diagnose emergency conditions. These appear suddenly, without any known cause, with the constantly deteriorating condition of the patient.  

The patterns of respiration are described under types of shwasa like maha (a type of shwasa disease), urdhva (a type of shwasa disease) and chhinna (a type of shwasa disease) shwasa [Cha.Chi.17] can be studied to understand emergency conditions resulting into death.

 

• Dehydration status – can be understood from the clinical features of affection of channels of transportation and transformation of udaka (udakavaha srotasa). [Cha.Sa. Vimana Sthana 5/8]

*Changes in breathing patterns or respiration can indicate emergency conditions. Guidelines about this can be referred from the clinical features of affection of channels of transportation and transformation of prana (pranavaha srotasa). [Cha.Sa. [[Vimana Sthana]] 5/8]

• Consequences of excessive emesis and purgation  (atiyoga of vamana and virechana) are described showing emergency conditions. Effects ranging from mild degrees like dryness in the throat to severe effects like dilatation of pupil as precursor to death are described. [A.Sa.Sutra Sthana 27/20]

 

• Status of consciousness and orientation  

The patterns of respiration are described under types of shwasa like maha (a type of shwasa disease), urdhva (a type of shwasa disease) and chhinna (a type of shwasa disease) shwasa [Cha.Sa.[[Chikitsa Sthana]] 17] can be studied to understand emergency conditions resulting into death.

Consequences of the affliction of marma:  

 

*Dehydration status – can be understood from the clinical features of affection of channels of transportation and transformation of udaka (udakavaha srotasa). [Cha.Sa.[[Vimana Sthana]] 5/8]

 

*Consequences of excessive emesis and purgation  (atiyoga of vamana and virechana) are described showing emergency conditions. Effects ranging from mild degrees like dryness in the throat to severe effects like dilatation of pupil as precursor to death are described. [A.Sa.Sutra Sthana 27/20]

 

*Status of consciousness and orientation  

 

==Consequences of the affliction of marma:==

Injury to different vital structures (marma) can have various consequences. Certain marma called ’sadyopranahara marma’  can lead to death instantaneously or within a week. General signs and symptoms can guide about injury to marma, and accordingly the patient can be cared for. The clinical features are numbness of the body ( deha supti), heaviness, confusional state,  desire of cold things, excess perspiration, syncope, vomiting, dyspnoea, [A. Sa. Sharira sthana 7/47]

Injury to different vital structures (marma) can have various consequences. Certain marma called ’sadyopranahara marma’  can lead to death instantaneously or within a week. General signs and symptoms can guide about injury to marma, and accordingly the patient can be cared for. The clinical features are numbness of the body ( deha supti), heaviness, confusional state,  desire of cold things, excess perspiration, syncope, vomiting, dyspnoea, [A. Sa. Sharira sthana 7/47]

Injury to marma causes vasodilatation and profuse bleeding. This may lead to death. [A.Hr.Sharira Sthana 4/65]  

Injury to marma causes vasodilatation and profuse bleeding. This may lead to death. [A.Hr.Sharira Sthana 4/65]