Ayurvedic intervention in the management of Keeta Visha (Wasp Bite)

[Full title: Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) : A Case Report]

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CASE REPORT June 2024 Journal of Ayurveda and Integrated Medical Sciences | June 2024 | Vol. 9 | Issue 6 314 Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) : A Case Report Mitali Verma 1 , Urmila Shukla 2 , Kirti Sisodiya 3 , Shreya Sahu 4 1,3,4 Post Graduate Scholar, Department of Agad tantra Evum Vidhi Vaidyaka, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India. 2 Professor and HOD, Department of Agad Tantra Evum Vidhi Vaidyaka, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India. I NTRODUCTION The term Keeta refers to all living creatures which are small in size but visible, having two or more legs, with or without wings, some living in soil, some moving in air, some in water, some in crevices of buildings, roofs, walls etc. some on trees, possessing different shapes, colours; some crawl, some fly, some swim, some hop etc. As per Acharaya Sushruta , Keeta born from semen, Address for correspondence: Dr. Mitali Verma Post Graduate Scholar, Department of Agad tantra Evum Vidhi Vaidyaka, Pt. Khushilal Sharma Government Ayurveda College and Hospital, Bhopal, Madhya Pradesh, India. E-mail: mitaliverma 143@gmail.com Submission Date: 14/04/2024 Accepted Date: 25/05/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.6.51 excreta, urine, foul smelling (decomposed) carcass and eggs of snakes only; they are of four kinds Vayavya Keeta, Agneya Keeta, Saumya Keeta, Sannipataka Keeta. viz, one each possessing the qualities of individual Dosas separately and one with the qualities of all the doses together [1] Acharya Charaka also said that Keeta born from excreta, they are of two kinds Dushivisha Keeta & Pranahar Keeta. [2] Keeta has the properties of aggravating all the Dosas by their effect finally; though small in size these are dreadful. As per Acharya Sushruta , among 24 Agenya Keeta only 14 have poison in mouth bite. Acharya Sushruta described Kanabha (wasp) under Agneya Keeta [3] while Acharya Charak described Kanabha under Kaphaj Keeta . Kanabha has four types - Trikanta, Karini, Hastikaksa & Aparajita , all severely painful [4] All these Kanabhas are quadruped insects & their poison is curable [4] Acharya Sushruta mentioned the symptoms when bitten by Agneya Keeta as there is slight exudation, severe burning sensation, redness and swelling resembling a ripe fruit of Pilu or Khajura and spreading out. Acharya A B S T R A C T Wasp stings are common, especially in populations living in vicinity to forested areas all over the world. Wasp is insects related to bees and ants. There are more than 20000 species or types of Wasps Acharya Sushruta has explained Keeta Visha under Jangama Visha (Animate poison) and categorized 67 different types of Keeta under mainly 4 groups i.e., Vayavya Keeta, Agneya Keeta, Saumya Keeta, Sannipataka Keeta. viz, one each possessing the qualities of individual Doshas separately and one with the qualities of all the doses together. The main characteristics of insect bite are itching, burning sensation, erythema at the site of bite. Reaction to stings vary depending on the numbers of stings delivered & body`s reaction to venom in the sting. This is a case report of 27 years old female (student) residing in Bhopal, visited the OPD with the complaining of wasp bite on lateral aspect of arm just before 30 minutes prior to her visit. She had sharp pain, itching, redness, burning sensation at bite site. She was treated with Dushivishari Agad (500 mg), Guduchiyadi Kashayam (500 mg) and Yograja Guggul (250 mg) and Lepa of Dushivishari Agad and Shatdhaut Ghrit for local application. The interventions controlled the poisoning, inferring that such cases can be successfully manage with Ayurvedic medicines. Key words: Keeta Visha, Wasp bite, Dushivishari Agad, Kanabha.

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Mitali Verma et al. Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) ISSN: 2456-3110 CASE REPORT June 2024 Journal of Ayurveda and Integrated Medical Sciences | June 2024 | Vol. 9 | Issue 6 315 Sushruta described the symptom of bite by Kanabha (wasp) gives rise to swelling, herpes, vomiting, fever, the site develops a circular ring, oozes bluish blood, heaviness in body appear & the site become black [4] Wasp are insects related to bees and ants. There are more than 20000 species or types of wasps. Yellow jacket and hornet are common names for several wasp species. Wasps belonging to the family vespidae is one of the dangerous hymenopteran when disturbed in its habitat either accidently or purposely. Wasp stings are common, especially in populations living in vicinity to forested areas all over the world. Wasp does not leave their stinger in, but they can sting repeatedly as a result. Wasp stings are quite similar to bee sting. The main difference is that there is no stinger left in the sting site, & the reaction tends to be worse. Wasps are social creatures that typically sting to protect their colony, nest, or hive. Most stings are incited by proximity to the colony. Noisy or vigorous activity, bright or dark colour, & perfumes also may incite stings. Reaction to stings vary depending on the numbers of stings delivered & body`s reaction to venom in the sting. Normal reaction is characterised by a painful, reddened swollen area that may also itch, but dissipates within minutes. More serious local reactions last for days. The pain, swelling, & itching will be more intense in the area directly surrounding the sting site. The most serious reaction is a systemic allergic reaction known as anaphylaxis. This type of reaction generally occurs rapidly after the sting & affects the whole body. A person may feel dizzy, nauseated & weak, experience stomach cramps & diarrhoea. Also coughing, itching, around the eyes, hives, wheezing, difficulty breathing or swallowing, vomiting, low blood pressure, shock, unconsciousness, darkened skin & death can occur in highly sensitive people. This can occur in 5-30 minute [5] Chemically, wasp venom possesses a wide variety of enzymes, proteins, peptides, volatile compounds, and bioactive constituents, which include phospholipase A 2, antigen 5, mastoparan, and decoralin. C ASE R EPORT A 27 years old female (student) residing in Bhopal, visited the OPD with the complaining of wasp bite on lateral aspect of arm just before 30 minutes prior to her visit. She had sharp pain, itching, redness, burning sensation at bite site. Later she noticed swelling and tingling sensation from shoulder to finger tips. She applied iron rust from the iron utensil but did not find any relief. Clinical findings On local examination, one circular small pale whale about 3-4 mm in diameter with a reddish depression in centre observed on the posterior aspect on upper 1/3 rd of the arm. The surrounding skin was inflamed, oedematous and warm to touch. On general examination, the patient was having no fever and was apparently normal during the examination. No lymph node enlargement noted. On systemic examination, Blood pressure- 110/70 mmHg, Pulse- 74/min, Heart rate-74/min were found normal. The patient was having normal bowel habits with no other abnormalities. Ashtavidha Pariksha ▪ Nadi (pulse): Kaphapitta ▪ Mala (stool): Niram ▪ Mutra (urine): Prakrut ▪ Jivha (tongue): Niram ▪ Shabda (Speech): Spashta ▪ Sparsha (Touch): Warm ▪ Drik (Eyes): Prakrut ▪ Akriti (Appearance): Madhyam Diagnosis The patient present with Tivara Ruja (sharp pain), Jhunjhuhata (tingling sensation) indicating the symptoms of Vataja Keeta, Daha (burning sensation) and Rakthabha (red discoloration), which is symptoms of Pittaj Keeta . It was associated with Kandu (Itching), which are symptoms of Kaphaj Keeta . Considering this, the bite was diagnosed as Tridoshaj Damsha . Therapeutic intervention For 0-3 days 1 Dushivishari Agad 2 tablet (500 mg) TDS with honey after food.

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Mitali Verma et al. Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) ISSN: 2456-3110 CASE REPORT June 2024 Journal of Ayurveda and Integrated Medical Sciences | June 2024 | Vol. 9 | Issue 6 316 2 Guduchiyadi Kashayam tablet 2 tablet BD with warm water empty stomach. 3 Yograjaguggul 2 tablet (250 mg) BD with lukewarm water after food. 4 Dushivishari Agad Lepa mix with water for 15 min (till it dry) at affected area twice a day. 5 Shatdhaut Ghrit for local application. For next 4-8 days 1 Dushivishari Agad 2 tablet (500 mg) BD with honey. 2 Guduchiyadi Kashayam tablet 2 tablet BD with water. 3 Yograja guggul 2 tablet (250 mg) BD with water. 4 Dushivishari Agad Lepa mix with water for 15 min (till it dry) at affected area twice a day. 5 Shatdhaut Ghrit for local application. For next 8-15 days 1 Dushivishari Agad 1 tablet (500 mg) OD with honey. Progress of the treatment - Follow up was taken for 0, 4, 8 and 15 days. Observation Day 0 Day 4 Day 8 Day 15 Itching + + + - Burning sensation + - - - Tenderness + + + - Redness + + - - Tingling sensation + - - - Swelling + + - - Pathya - Apathya Sour, spicy, salty, Abhishyandi food such as curd, were strictly prohibited. The patient was advised to take rest and do not scratch at bite site. Follow-up and outcome On 4 th day, there was complete reduction of swelling and tingling sensation, pain and redness were reduced during morning hours, and however, it was increased in afternoon hour. On 8 th day all the symptoms subside. To remove all remaining toxin 1 tablet of Dushivishari Agad given for next 7 days. Throughout the treatment, no adverse reaction was noted. DISCUSSION Keetas are generally accepted as type of Krimi , which can be visualized by naked eye ( Sthoola ) [6] Acharya’s have described Keeta Visha under Jangama Visha and classified under four groups and elucidated 67 different types of Keetda . Their formation is alleged as putrefaction of ‘ Shukra - Vid - Mutra - Pooti - Und - Sambhava’ . In this present case, on the bite site one circular small puncture pen prickle with sharp pain, itching, burning sensation and swelling. After applying Dushivishari Agad externally swelling was decreased within 15 minutes but pain and burning sensation remain the same. After 4-5 hours pain and burning sensation brought down. For the first 3 days swelling, tingling sensation and redness uphold. According to modern medicine firstly torniquet is applied. And area is cleaned with water, soap and antihistamine cream is locally applied. Tetanus immunization is recommended. Glucocorticoids are useful for urticaria and for combat systemic reaction adrenaline is given. Currently Damsha was showing Tridoshaja Keeta Damsha . Dushivishari Agad is given orally along with honey helps in fever, burning sensation, Deepana , Pachana , Srotoshodhana , Raktaprasadana and Rasayana [7] It is also Tridosha shamak in property. Anti-inflammatory action of honey soothes and promotes healing by reducing pain and swelling [8] Honey has been described as having the ability to promote phagocytosis, detoxification and proteolysis all of which assist in cleaning wound. And Lepa of the same mix with water is applied for itching, swelling and burning sensation. Yograj Guggulu flushes out the poison that is prepared in blood vessels. Guduchyadi Kashayam is given for fever and burning sensation [9] Shatdhaut Ghrita Lepa has Shothahara , Dahahara , Vedanasthapana , Vishaghna properties. So, it helps in reducing inflammation caused due to insect bite.

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Mitali Verma et al. Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) ISSN: 2456-3110 CASE REPORT June 2024 Journal of Ayurveda and Integrated Medical Sciences | June 2024 | Vol. 9 | Issue 6 317 CONCLUSION Keeta Visha causes local symptoms to severe systemic manifestation like Shopha , Granthi , Visarpa , Karnika , Kitibha in the human being even death. Tridosha Shaman and Vishahara treatment were given with internal and external application of Ayurvedic formulation. The interventions controlled the poisoning only to the site of the bite, inferring that such cases can be successfully manage with Ayurvedic medicines by giving utmost care for wasp bite. REFERENCES 1 Sushruta Samhita Part-1, Kalpasthana 8/3, Page-80 Dr.Ambikadatta Shastri,2015 2 Charaka Samhita Part-2, Chikitsa Sthana 23/140, Page-588, Kashinatha Pandey, Dr. Gorkhanatha Chaturvedi, 2020 3 Sushruta Samhita. Vol.3, Kalpasthana, Chapter 8/8, page-79, P.V. Sharma, 2014, Chaukhambha Visvabharati, oriental publishers & distributers. 4 Sushruta Samhita. Vol.3, Kalpasthana, Chapter 8/25-27, page- 81, P.V. Sharma, 2014, Chaukhambha Visvabharati, oriental publishers & distributers. 5 Susruta Samhita of Maharsi Susruta Vol.3, Kalpasthana, Chapter 8, page-60, Prof. Dr. Vasant C. Patil, Dr. Rajeshwari N.M. 6 Nitin Urmaliya Text Book Of Agad Tantra Chaukhambha Orientalia Varanasi, Edition 1 st, 2011; p.161 7 Vasant C. Patil, Susruta Samhita with English translation of text and Dalhana’s commentary with critical notes vol. 3 Kalpa Sthana and Uttara tantra Ch. 02, Chaukhambha Publication; 2022 p. 18 8 Vijaya Kumari K, K. Nishteswar, Wound healing activity of honey: A pilot study. AYU/2012/33/3, [cited 2015 August 18], http;//www.ayujournal.org 9 Sreekumar T, editor. Astanga Hridayam of Vagbhata, Sutra Sthana; Ch 15, Ver. 16. 2 nd ed. Thrissur: Publication Department Harisree Hospital; 2008. p.380 Changes in the Wasp Bite Lesions during the course of management (A) 0 day of bite (B) 8 th day of bite (C) 15 th day of bite How to cite this article: Mitali Verma, Urmila Shukla, Kirti Sisodiya, Shreya Sahu. Ayurvedic intervention in the management of Keeta Visha (Wasp Bite) : A Case Report. J Ayurveda Integr Med Sci 2024;6:314-317. http://dx.doi.org/10.21760/jaims.9.6.51 Source of Support: Nil, Conflict of Interest: None declared.

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