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DISCUSSION

PRACTITIONER’S PROFILE

A total of 22 Vishachikitsa practitioners participated in the survey and their mean age

was 78.5 years. Youngest of them were 43 years and the eldest 90 years old. The mean

period of treatment experience was 57 years with the lowest experience of 20 years and

the highest of 73 years. The highest lineage of Vishachikitsa obtained is the 6th

generation (n=1) and the lowest, 1st generation. Among the 1st generation participants,

85% are above 84 years of age which implies that even though they have no tradition in

treatment, they learned Vishachikitsa which was a service to the society at that time.

50% (n=11) were taught by their immediate relatives and 31% learned from gurus. 18%

learned from both family tradition and gurus. Only 5% (n=1) learned from their spouse.

5 participants are practitioners who are academically qualified from institutions. All of

them have learned the systematic method of treatment from institutions and traditional

methods of Vishachikitsa from their gurus.

The mean learning period is found to be 7.2 years with the lowest term of 1 year and the

highest of 26 years (n=1) of daily learning. 86% (n=19) underwent training daily. 2

participants attended classes once a week whereas one attended class twice a month. One

participant attended classes once a week for 25 years. All got knowledge of

Vishachikitsa free of cost. 22% (n=5) learned along with other students. 100% of the

participants stayed along with their teachers to attain the knowledge of Vishachikitsa. 2

participants studied through verbal communications alone from the guru without the help

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of any manuscripts or books. Regarding the method of teaching, some were taught only

mantras at first and were asked to chant it up to one lakh times to master it. The list of

gurus has been told in table no.67.

Two participants have authored books related to Vishachikitsa. Regarding the tradition

of teachers, two categories are observed, 59% learned as hereditary knowledge (n=13)

and 41% learned from non- hereditary sources. 77% (n=17) have transferred their

knowledge to others. Among them, 53% taught their own progeny. 59% of the students

who received training were BAMS graduates. 82% of the students who received training

are practicing now whereas 18% are not. 18% of participants opined that they are not

following any special routines in daily life in relation to Vishachikitsa.

Several myths are associated with the practice of Vishachikitsa. A popular one among

them is that those who attained siddhi will have the capability to bring back the biter

snake for devenomating the snakebite victim. This opinion was supported by 82% (n=18)

participants of the survey but nobody has evidence of witnessing the practice.

The various reasons to learn Vishachikitsa were told as, out of interest by 59% (n=13)

and 41% to continue their family tradition. One participant was taught as a compliment

from his guru for his knowledge in the identification of rare medicinal plants. Others got

interested after witnessing miraculous treatment successes by their gurus. Some opted

out of compulsion after the death of senior practitioners in the family.

At present, the majority of the Vishachikitsa practitioners have passed the seventh

decade of life. The majority have attained knowledge from a practicing Vishavaidya than

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books. Direct experience-based learning from a teacher is most important. A mean

learning period of 7 years is required to learn all the skills in the management of snake

venom. The teachers were selected mainly based on their reputation in handling

snakebite management.

The teaching pedagogy was assisting the guru while performing treatments in patients.

The eligibility of students to learn was assessed by some teachers by giving the task of

mastering mantras by chanting them up to lakhs of times. Teachers imparted their

knowledge free of cost to their disciples and considered this knowledge with sanctity.

41% of practitioners reached this field to continue the family tradition of Vishachikitsa

or after the death of senior-most family members handling Vishachikitsa and out of

interest. The majority of practitioners reached the field by witnessing the successful

treatment of life-threatening envenomations. Teachers were also trained by family

tradition. So textbook-based learning was of lesser importance.

Among the participants, the lifestyle prescribed in ‘Jyotsnika’ was advocated by 6, while

those who got trained under Kushavas were of stricter lifestyle routines including

offerings, mantras, and ceremonies related to the treatment of every envenomation and

attaining mantra siddhi by chanting one lakh times at sacred places. This may be

considered as a method of selecting an ideal student with sufficient IQ level and who can

withstand the troublesome life of a Vishavaidya. “Vishavaidya padicheedan Vishamichu

padikkanam” is a popular saying in Malayalam which hints to the hardships that one

must face while learning Vishachikitsa.

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In the present study, the participants were willing to pass on the knowledge to the next

generation but the majority (n=9) passed their knowledge to the relatives of the next

generation. The majority of the students represented qualified BAMS graduates and

postgraduates (n=10) and 82% (n=14) among them are still practicing Vishachikitsa in

government or private sector. 18% (n=3) quit this field for more salaried and secure jobs.

This indicates the lack of financial gains from practicing Vishachikitsa and the strenuous

physical exertion required for the practice of Vishachikitsa.

Vishachikitsa is a profession that gets gratitude from society for saving lives. Most of the

participants were honored by the public and local self-governing bodies on various

occasions. One participant was even honored by the state and later by the central

government with the Padmasree award.

Textbook based training was less compared to practical training among practitioners. But

the number of books published in Vishachikitsa up to the 1960s in Kerala would be

probably the highest among all the medical specialties of Ayurveda. Among the

numerous books published on Kerala tradition of Vishachikitsa, ‘Vishavaidya Jyotsnika’

(78%) and ‘Prayogasamucchayam’ (78%) ranked first in its practical utility and

popularity among traditional practitioners, followed by ‘Visha Narayaneeyam’ (32%)

and ‘Lakshanamrutham’ (32%).

Visha utpathi and definition are not explained in Malayalam books but are narrated in the

classical texts of Ayurveda. As time advanced, mantra-tantra prayogas prescribed in

books also came down and medicinal treatment gained importance. Kodasseri margam

uses more Malayalam terms than other popular books. The numerous books published in

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Kerala show some similarities in treatment aspects but are different in their style of

composition. The diversity of Vishachikitsa cases managed by Vishavaidyas is evident

from the types of poisonings explained from snakes and other animals to insects,

poisonous plants, mineral poisons, food toxicity, etc. The divinity attributed to snakes is

indicative of the care and concern given to nature by the authors.

The vast diversity of herbal drugs, formulations, and concepts explained in the books are

indicative of the depth of knowledge they had in this regard. More than 100

formulations, 31 prayogas, 32 symptomatic treatments, and 25 concepts related to

Vishachikitsa are explained exclusively in Keraleeya Vishachikitsa books which cannot

be found in Samhitas.

First-generation books were of Malayalam-Tamil mixed language whereas later books

changed to Malayalam-Sanskrit style and the contents are explained in a poetic and

rhythmic style which is easy to memorize. This is an evidence of the language

proficiency of vaidyas of this region. The mantra-tantra prayogas in the form of ‘karuthu’

and the caste differentiation of snakes given in the books is indicative of the socio-

cultural background of Kerala’s past. The dominance of the upper caste is evident in the

classification of snakes based on appearance and mannerisms.

The Vishavaidya tradition of Kerala was maintained through the last century and before

by imparting knowledge to the next generation through oral traditions and textual

traditions based on the practical use of Vishavaidya textbooks of Kerala like

‘Vishavaidya Jyotsnika’ and ‘Prayogasamucchayam’. The tradition passed mainly

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through familial traditions and to a lesser extent to academically qualified practitioners

attaining knowledge of traditional Vishachikitsa from traditional practitioners.

Vishachikitsa was considered sacred and hence treatment and training were not levied

from those who needed it. The participants opined that since Vishachikitsa aims at

protecting and reclaiming life from death, a tag of price cannot be affixed for life,

Vishachikitsa should be carried on free of cost. Vishachikitsa tradition was confined to a

few families as the desire to learn was not generated in the public may be due to the

myths related to it. The difficult lifestyles to be followed by the practitioners, the lack of

monetary income, and the strenuousness of the job may be the other reasons.

A successful practitioner was molded by several years of dedicated training with ample

clinical exposure. Hence the role of hands-on-training and clinical exposure was equally

important as the text-based learning in the evolution of Vishachikitsa tradition in Kerala.

HISTORY

The interview survey revealed the modern history of Vishachikitsa tradition in the post-

independence era of India about the region of Kerala. Training of Vishavaidya in an

institutionalized way was not prevalent at those times and people used to get trained from the

traditional healers and used to practice. There were no government regulations initially for

such practices. But during the 1960s an organization was made in the northern part of Kerala

by the name ‘Malabar grant-in-aid Vishavaidya sangham’ with almost 65 members and took

steps to institute certifications for such practitioners by conducting examinations in

association with Ayurveda Medical Board. They conducted interviews in the Malabar region

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and ‘Vishavaidya Shiromani’ title was given to those who passed successfully. Later state

government conducted examinations to register as practitioners of the state. The examination

included written and viva and the pass rate was very low due to the strict standards set by the

government examination board for Vishavaidyas. A-class registration and competence

certificate was awarded to all successful candidates. Vishavaidya salas started at different

parts of the state and Vishavaidya sangham promoted its activities by conducting regular

seminars and meetings.

Before setting up of Malabar Vishavaidya sangham, the Vishavaidya tradition was rather

scattered yet popular in some pockets across Kerala. The pioneering work which led to the

popularity of Vishachikitsa came from the famous toxicologist and the member of the

Cochin Royal family, Sri. Kochunni Thampuran who authored the ‘Prayogasamuchayam’

which codified the most useful and practically feasible treatment practices for Vishachikitsa.

There are no other works in Kerala that can compete in the place of Prayogasamuchayam.

The credit of framing the Vishachikitsa system is attributed to Kokkara Namputhiri of

Tripunithura who taught it to the Royal family members. Midukkan Thampuran preached

and practiced that tradition. Thus, Vishachikitsa earned the royal patronage that was essential

for its development. The Kingdom of Cochin conducted certificate programs in

Vishachikitsa under the direct supervision of Midukkan Thampuran for popularizing it in

different parts of Kerala.

The system of treatment devised in Prayogasamuchayam differs vastly from the Samhita

approach and most formulations and prayogas mentioned are different from that of Samhitas

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as tabulated in table no. 103,104 & 105. All these are highlights of the Keraleeya

Vishachikitsa tradition.

The state government introduced grants for the vaidyas to promote the practice of

Vishachikitsa which was confined to small pockets scattered in Kerala as they were the only

healers in this regard. In the 1960s modern facilities for treatment was very minimal. As

institutionalized learning become more prominent, the grant-in-aid system was stopped by

the government for the academically qualified persons to practice Vishachikitsa. The

government machinery was not efficient enough to maintain the class and quality of

Vishachikitsa in government hospitals and dispensaries and the non- uniform teaching

methods in academic institutions led to the decline of Vishachikitsa in the government

sector. After the implementation of a uniform syllabus in Ayurvedic education, local

traditions and practices got sidelined.

Later works in the field of Vishachikitsa came from the contribution of Sri. Kuttikrishna

Menon by compiling all the available Vishachikitsa manuscripts and books to produce the

voluminous ‘Kriyakaumudi’. Eminent personalities involved in the flourishing of

Vishachikitsa in Kerala includes the name of C.P. Kumaran Vaidyar, who took the key role

in the development of Pappinisseri Vishachikitsa Kendra. He took the lead in conducting

meetings and seminars of Vishavaidya sangham and in developing the hospital. Other names

mentioned concerning the Vishachikitsa tradition of Kerala are Nanjundanathar and

Cherullypattar. Their contributions are not specifically known yet they are highly revered by

the Vishavaidyas. Kokkara Namputhiri and Karatu Namputhiri are considered as the masters

of Keraleeya Vishachikitsa tradition. Before their period, Vishachikitsa was referred in a

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scattered manner in many of the works. The knowledge in Vishachikitsa and the proficiency

in Sanskrit language and basic principles of Ayurveda helped them to arrange different

treatment methods mentioned into a systematic manner and to develop a novel approach in

Vishachikitsa.

The books ‘Vishavaidya Jyotsnika’ and ‘Prayogasamuchayam’ revolutionized Vishachikitsa

in Kerala when no other treatment was available for this. These works are thought to have

evolved from the essence of the contents of the palm scripts scattered in different families

throughout Kerala. The literary survey reveals a Dravidian origin of this tradition which

developed and reformed with Sanskrit education and basic principles of Ayurveda. The royal

patronage obtained from the Royal family of Cochin played a key role in establishing

Vishachikitsa in Kerala.

The personalities, Najundanathar, Cherullypattar, Kokkara Namputhiri, and Karattu

Namputhiri played a pivotal role in framing the structure of Vishavaidya tradition in Kerala.

Their knowledge of Sanskrit and other allied sciences contributed greatly to the development

of science. A common platform for the Vishavaidyas was first tried by the formation of

‘Vishavaidya sangham’. It has put efforts for starting certification of Vishavaidyas under the

government of Kerala and State Ayurveda Board to register the practicing Vishavaidyas with

grant-in-aid from the government. This certification provided a uniform quality to all

Vishavaidyas till the beginning of institutionalized learning under CCIM in the Ayurveda

colleges of Kerala. The Diploma program in Agadatantra which was the first specialty

course in Ayurveda in Kerala and later the Postgraduate degree course in Agadatantra started

in 2003 are the two recognized academic qualifications of Vishachikitsa in Kerala. The

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Postgraduate centers of Agadatantra in the state are Government Ayurveda College,

Trivandrum, VPSV Ayurveda College, Kottakkal and MVR Ayurveda College,

Parassinikkadavu.

DIAGNOSIS

Doothalakshana

Participants opine that doothalakshana is 100% accurate and most relevant in the diagnosis

of poisoning even today. All cases should be attended after the assessment of the messenger.

73% (n=16) opine that they are using doothalakshana in diagnosing poisonous bites. For a

dedicated person in the service of Vishachikitsa, doothalakshana will give intuition

regarding the patient, his place of residence, cause, and site of the bite, etc. Many vaidyas are

using other modalities along with doothalakshana.

Visha vaidyas utilize the first word uttered by the messenger, his position, his gestures, etc

as indicative of the condition of the patient and prognosis. Vishavaidya should have the

utmost concern to all such minute features of a messenger to identify correctly and apply

treatment accordingly. Vaidyas count the number of letters uttered by the messenger and

divide it by 8 and the remainder is used for prognosis and diagnosis of snakebites.

Good and bad omens are also explained in the context of doothalakshana in the identification

and prognosis of the bite. The details of such measures are dealt elaborately in Vishachikitsa

textbooks of Kerala. Such methods can only be explained as intuition and cannot be

explained with logic. They consider it as the most important aspect of Vishachikitsa. The

influence of the caste system is also evident in the doothalakshanas. A different approach of

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doothalakshana is mentioned in Prayogasamuchayam. There are Vishavaidyas who are not

utilizing this technique now. But the survey suggests that the utility of doothalakshana is

having more historical importance than practical utility in the present time.

There are references for alternate methods used along with doothalakshana in the

identification and prognosis of bite. Sharasootra is one such method. It is considered that

sharasootra is due to the influence of Yoga sastra on Ayurveda. The survey also showed that

there is an inherent relation between jyotisha and Vishavaidya. Amrithakala and Vishakala

are explained in texts like Vishavaidya jyotsnika and prayogasamucchayam concerning

celestial positions, lunar phases as represented by different body parts.

73% of participants opine that jyotisha is related to Vishachikitsa. Legendary figures in

Vishachikitsa like MidukkanThampuran, KochunniThampuran, Vallur Namputhiri were

eminent practitioners of Jyotisha also for treating Visha. Learning jyotisha is considered as

an ancillary subject to Vishachikitsa as Sanskrit is to Ayurveda. 59% supports the view that

yogasastra is relevant and is practiced while 27% who upheld its relevance are not practicing

it. A beautiful mingling of Ayurveda, Jyotisha, and Yoga sastra is seen while explaining

these concepts of Vishachikitsa. Many of the examples and experiences quoted by the

participants were magical and an element of myth is very prominent in these areas. A keen

observation of the surroundings is required from the side of a Vishavaidya in making out

such conclusions regarding the identification and prognosis in poisonous bite cases.

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The predominance of poisonous snake bites

For the convenience of analyzing the data from the interview, the region from where the

Vishavaidya hailed was classified into 3 major zones. The High land zone, Midland, and

Low land zones. The survey showed the highest prevalence of Mandali Sarpavisha in

midlands and lowlands while the highlands showed the highest prevalence of Rajila

Sarpavisha. The findings from the survey also show the natural habitat of elapid and

viperidae snakes in Kerala and it matches the observations of modern toxicologists.

Presently a greater number of Loothavisha are also reported by Vishavaidyas. The decline of

Vishachikitsa is also evident from the words of Vishavaidyas as they are treating more of

Loothavisha cases than Sarpavisha nowadays. This suggests the dependence of patients on

modern treatment procedures. Many Vishavaidyas could identify the poisonous snakes by

their common names as well as Sanskrit names indicating their level of awareness in

identifying them.

Number of snake bites managed per day

The highest prevalence of bite cases per day was obtained from Kannur district (n=20) for

that being the sole snake bite treatment center with a history for more than 50 years and

having facilities to provide allopathic medical support also to the victims if needed. Another

center from Trivandrum showed a high prevalence of 10 cases per day. This belongs to a

noted Vishavaidya of that district who undertook Vishachikitsa for more than 60 years and is

one of the faculty of specialty courses in Agada tantra at Government Ayurveda College,

Trivandrum. Earlier there used to be referred cases of snake bites even from the Government

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Medical College, Trivandrum. This shows the superior position of traditional Vishachikitsa

in Kerala before the advent of ASV.

From central Kerala, the highest number of cases was reported from Thrissur(n=6). This

belongs to a traditional family of Vishavaidyas who performed Vishachikitsa for the past

five generations. The participant’s forefathers served as honorary physicians at Vishachikitsa

hospital at Thrissur, started by Maharaja of Cochin. The advent of electricity has cast more

light on the surroundings. This has helped pedestrians to identify and avoid snakes. The

conversion of land for construction of concrete structures has ruined the natural habitats of

snakes and maybe their number has come down.

Difficult prognosis

The participants opined that the highest associated complaints are with Mandalivisha. Some

opined that Rajilavisha is most difficult due to less initial symptoms and the condition can

aggravate at any time. Almost all opined that most easy is Darvikaravisha. All these findings

are on par with the observations of modern toxicologists. The participants also suggested

that the curability depends on the site of bite also. In most of the cases, death occurring in

their treatment center was minimal with one or two.

As per the survey participants, the prognosis of bite cases was determined from dootha and

from some specific tests some of which had textual reference while others were methods

transferred orally from teachers to disciples. Among them, Kodasseri gulika was given to the

bitten victim and if no positive results are shown, the bite was considered incurable. The

reference of the said yoga is seen in Kriyakaumudi but its prognostic aspect is not elaborated

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in the text. Any medicine when it is vomited in a case is considered asadya. Jeevaraksha

gulika is also used in this regard and its prognostic aspect is mentioned in textbooks.

Prognosis is also determined by specific symptoms exhibited by the patient. Redness of eyes,

swelling of face, blank face, paradoxical undressing, etc are considered incurable. According

to some, added features of shivering and blackish discoloration indicating cyanosis are

considered very serious conditions and hence incurable. Urine retention, sudden loss of

consciousness and sudden worsening of existing symptoms are also considered to be very

serious signs. If the victim asks for rice or water for drinking, is an extension of

doothalakshana to observations on patients. In doothalakshana, any message of bite while

taking food is indicative of death.

Death confirmation was very difficult during those times and deep coma and death were

differentiated using specific tests using physiological aspects of the body. Absence of pain

on pulling hairs, absence of inflammatory responses on beating with a cane, etc are signs of

death. Specific tests have been mentioned in Kalavanchana prakarana of books like

Prayogasamuchayam has been utilized by some for confirming the death. An incision made

on the vertex of the patient with a pot of coal placed over seven calotropis leaves was

performed over a patient and he showed some signs of life after confirmation of the death

from an allopathic hospital. Though such practices were performed recently up to 1990s, it

attracted severe criticisms from the modern fraternity. But provoking such symptoms in a

death confirmed patient is by the concept of ‘leena jeeva’ explained in Agada tantra

textbooks. In short, the tests described for testing the presence of life in a person employs the

physiological aspects of a human body. We can see that the life tests practiced during the

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early 19th century by European physicians are like what is described in the texts of Agada

tantra. This indicates the scientific validity of textbooks on Agada tantra written centuries

ago which were at par with the modern textbooks of early 19th century. It shows that the

patronage and research in the field of Ayurveda, in general, stopped during this period which

gave an advantage to modern physiology and medicine which advanced gradually by

research.

Identification of poisonous bites

Traditional Vishachikitsa textbooks authoritatively demarcate the symptomatology between

poisonous and non-poisonous bites. Though many of the explanations are not in concurrence

with modern anatomical descriptions of snakes yet they are used to identify and to determine

the prognosis of bite cases. The descriptions regarding the name and type of the fangs are

very uniquely described in traditional Vishachikitsa books of Kerala.

The cardinal symptoms of poisonous bites; inflammation, numbness, rise in temperature at

the site, etc, and the specific symptoms of each venomous snakebites are at par with the

modern descriptions regarding poisonous bite on the features of the bite mark. Several other

interesting diagnostic features are described in traditional Vishachikitsa books of Kerala like

Vishahari lehyam, Ishwari, Kodasseri gulika, etc. The taste perceived by the patient can be

utilized to identify the snake and the prognosis of the bite. No correlation has been made yet

regarding the correctness of the perceived taste and the bitten snake. More than a feature of

identification of bite, it may be a feature of systemic envenomation giving parageusia in

patients. The contents of Vishahari lehyam and even Ishwari are having a significant effect

over snake venom. So, their use as the first line of snakebite management may be justified.

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Some participants held that the diagnosis of snakebite is not relevant in Vishachikitsa and

that the intuition of the healer should work for healing it using the sixth sense by the power

of mantra moorthy. More objective symptoms are used to identify the poisonous bites by

examining the eyes, speech, and physical difficulties. This explanation seems to be more

influenced by knowledge from modern sciences than from textbooks of Vishachikitsa as

Vishachikitsa is explaining this aspect of differentiating features of the bite site only. This

indicates that there have been quite significant modifications in the diagnosis of snakebite

with the incorporation of modern knowledge. The combination of these two streams seems

to be more promising in the management of snake bites. Even though trained traditionally,

some of them are not reluctant to use modern diagnostic tests including blood investigations

for diagnosis of snakebite.

Vishachikitsa as it evolved at times when there were fewer treatment facilities and lesser

accessibility for the public to such treatment centers, the tradition of Vishavaidya was the

sole dependence to treat snakebite envenomation. The Vishavaidyas were scattered and their

workload used to be very high when compared to use their limited resources of time,

manpower, and money. For this, they devised doothalakshana by closely observing the

environmental phenomenons that give intuitions regarding the nature of bite and its

prognosis. Thus, it became the mainstay of Vishachikitsa and a Vaidya proficient in

doothalakshana is considered as the most efficient. As the basic amenities grew, medical

facilities, treatment options, and cost of treatment also declined. Thus, the entity of

doothalakshana lost its glory and its statements became anecdotes.

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The traditional Vishachikitsa system in Kerala is being considered postmodern to Ayurveda.

It incorporated popular sciences of the time like Jyotisha, Yogasastra, etc. The relation of the

human body with lunar phases has been detailed very well in the concept of Amritakala and

Vishakala which serves as vital points of contradicting life forces. From this, several

prognostic tools like ‘sharasootra’ also evolved. The interaction with prana and the life

forces is being utilized for the prognostic evaluation of the patient. The side of the nostril

having a greater airflow is believed to influence the Ida and Pingala, two contradicting nadi

associated with the pivotal structure of Sushumna.

The difference of Keraleeya Vishachikitsa from those mentioned in the Samhita is the

elaborate use of local medicinal herbs for treatment purposes. Textbooks like

Prayogasamuchayam, Jyotsnika utilizes abundantly the rich flora of this region in curing

snake bites. Many such wonderful combinations are also made in this regard. One among

them which is used as a primary treatment procedure in Vishachikitsa is Vishahari lehya.

The medicine is used as a prognostic tool in identifying the snake by the perception of taste

by the patient. It can be considered as the primary medical intervention in a case of

poisoning, provided the patient is conscious and able to swallow the medicine. The utility of

this medicine as a prognostic and diagnostic tool is debatable, yet its usefulness in the

treatment of Visha is undebatable.

The signs and symptoms detailed for poisonous and non-poisonous bites match perfectly

with the explanation in modern texts in differentiating poisonous bite from the non-

poisonous bite. Analyzing the time map of modern treatment modalities in snakebite, until

the implementation of ASV to the snakebite management protocol, the indigenous traditional

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Vishachikitsa system had an upper hand than its modern counterpart. According to a modern

toxicologist, the concepts of traditional practices like nisha jagarana are relevant because it is

essential to monitor the sudden change in symptoms of a snakebite victim.

The survey showed great variations in the predominance of bite due to the geo-climatic

conditions favoring each species in this land. Kerala having three geo-climatic zones of high-

mid-low land, it supports the survival of different species which is evident from the survey.

The predominance of bite arising from species previously unheard-of like pit-viper, hump-

nosed pit-viper indicates the change in the geo-climatic conditions produced by

anthropogenic activities. Similarly, the prevalence of snakebite cases also declined

drastically over the years due to the mushrooming of modern medical care systems

throughout Kerala which provides easy and less time-consuming treatment modalities in

snakebite management. The findings from the above discussions show that traditional

Vishachikitsa was the main line of treatment for snakebite and was more popular and gave

more results than modern modalities till the introduction of ASV which provided more

sudden and easy relief to snakebite victims.

TREATMENT

Mantra prayoga

All the participants in the survey upheld the importance of mantra in the management of

poisonous bites but only very few (n=2) are using it in their current practice. Mantras are the

first taught subject in the management of Visha and are used by practitioners after attaining

mantra siddhi. Different types of mantras are used for specific purposes including the type of

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snakebite and to prevent bite etc. Mantras that are used to bring back the biter snake were

also mentioned by some participants. The correct methodology of mantra prayoga was not

mentioned by any of the participants though few textbooks have mentioned the usage of

mantras specifically on various occasions. The complete attribute of mantra chikitsa is

vested on tantras. With the evolution of Vishachikitsa tradition in the form of oushadha

chikitsa, the importance of tantras diminished with the majority concentrating on oushadha

chikitsa alone. Superstitious claims of bringing back the biter snake to devenomate the

patient with the help of a specific mantra are narrated by some of the participants. But its

practicality and evidence are lacking. It remains as a myth or superstition. The later textbook

of Vishachikitsa like Prayogasamuchayam does not completely neglect the mantra aspect as

the chapters about tantric procedures are retained to a single chapter of ‘Kaalavanchanam’

which can be considered as a compilation of tantric procedures from different texts.

In the present survey, those who had training from Kushavas are more proficient in mantra

chikitsa compared to the rest. They are using the Dravidian style of ‘karuthu’ instead of

conventional Sanskrit mantras with more inclination to Tamil. The social reforms that lead

to the independence of India and the post-independence socio-political scenario in Kerala

contributed immensely to the decline of this tradition and to the emphasis on modern

medical management of snakebite. The influence of Buddhism and Jainism and the evolution

of Vishachikitsa based purely on medicines propounded by ‘Kokkara’ tradition who taught it

to the Royal family of Cochin paved the way to the flourishing of Vishachikitsa in the state

of Cochin with royal patronage from eminent personalities like Keralavarma Midukkan

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Thampuran, Kochunni Thampuran, etc. Prayogasamuchayam is the outcome of this

renaissance period in the field of Vishachikitsa.

Specific treatment modalities in Vishachikitsa

Oothu chikitsa

Among the participants of the survey, 57% utilized oothu chikitsa in snake bite treatment. In

all cases of unconscious or complaints of the heaviness of head and other difficulties in the

head, this blowing therapy is followed. There are clear cut textual references for the

medicines used for oothu and the combination of Shunti, Dusparsha, and Maricha along with

Ishwari is the ideal combination for this therapy. Several modifications have been introduced

in this therapy by substituting various other drugs like Ishwari alone, Trikatu, Dusparsha, or

even Vilwadi or Vishavilwadi agada are utilized. The mode of application of this therapy is

detailed in Prayogasamuchayam as 3 people chewing the drug and blowing simultaneously

on either ear and vertex for 150 times synchronously.

The procedure has immense potential to regain the consciousness of victims as explained by

the participants in the survey. Other benefits of this treatment procedure are that it prevents

complications like respiratory distress arising from poisonous bites, often in cobra poisoning.

The lack of attenders for performing such therapy reduced the application of this procedure

among Vishavaidyas. Lack of institutional support even from Ayurvedic hospitals in the

private and public sector has drawn these treatment procedures into a stage of extinction. A

proper number of personals trained in this treatment procedure are required to revive such

effective treatment modalities.

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There were only a few participants who utilized karuprayoga in their practice. Among them,

most of them had only seen their teachers doing such procedures. Kakapada therapy in the

form of ‘kozhiveppu’ was performed by 2 participants in which an incision made over the

anal part of a cock is placed over the bite site and allowed the venom to diffuse into the flesh

of the cock. 100-200 cocks are required for performing this therapy according to the

participants.

Kalavanchana kriya was performed by one participant for a child after the failure of all other

treatments and this incident has been already reported above. The participant also mentioned

the survival of one victim after doing kalavanchana prayoga by her guru. Thalam was

utilized by the participants with specific drugs like Jeevaraksha gulika for symptoms like

giddiness, respiratory distress, pain, etc. Thooku dhara was done by only two participants

with Nalpamara Kashaya for edema from poisonous bites. Shudhavela prayoga was not

performed by any of the participants. The practical application of these treatment procedures

is now lost as nobody is performing these treatment procedures in bite cases now. The

scientific aspects behind these treatments are yet to be unearthed and need to be popularized.

Dhara therapy is a treatment method in which liquid medicines are gently poured and it has

been extensively used by many of the participants (n=10). Several drugs have been

mentioned for usage in dhara like Vallikanjiram, Durva, Tamboolapatra, Arka, Karanja, etc.

The detailed list of drugs used in Vishachikitsa has been tabulated in table no.101. The

extensively used drugs among dhara are the mistletoe growing on Nuxvomica which is

believed to have antitoxic properties along with the ability to cure the associated symptoms

arising from the snake bite. Gritha-saindhava dhara is very extensively used in extremely

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painful conditions like a scorpion sting. It is a form of dhara which is performed as a home

remedy in cases of scorpion sting. It immediately pacifies the pain and is even used in snake

bite management.

Kizhi is a form of local fomentation with a poultice of antitoxic drug combinations. Different

combinations have been mentioned by the participants(n=10). Shigru, Nimba, Neeli, Ishwari

leaves are used in edema and Arkapatra sweda in the management of pain. The use of kizhi

is a common practice in the Kerala tradition of Ayurveda. Njavarakizhi, Ilakizhi, and many

other poultice therapies are contributions of Kerala to the system of Panchakarma in

Ayurveda. Different forms of kizhi are being used in relieving pain and edema. The utility of

kizhi therapy in Vishachikitsa is also an extension of that treatment modality with changes in

the drugs used.

Kaivisha

Kaivisha treatment is an area associated with a high amount of superstitions and myths.

Vaidyas used to diagnose Kaivisha in all cases where every other treatment fails. But in

Agadatantra textbooks, Kaivisha is detailed and managed in different ways. Nadipareeksha

has been detailed in the diagnosis of Kaivisha. Special diagnostic procedures like the

application of Neeli kalka over the abdomen and a vessel filled with water, covered with a

new cloth kept over the abdomen for one and half hours and looking for any sedimentation

in water which indicates the presence of Kaivisha. Virechana with Shankupushpi root in

milk and colour difference in the stool is also employed by some of the participants as a

method of diagnosing Kaivisha. The participants agreed almost unanimously regarding its

relevance in the present day. In the northern Malabar regions, it is believed to be managed by

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jyotishis and adivasis. ‘Kaivishaparihari gulika’ is the only formulation available for this

which is the combination of Moorvadi choorna and Swarna bhasma mentioned in Samhita.

The participants agreed that shodhana therapy will be ideal in curing Kaivisha. Many

psychological manifestations are also implied in Kaivisha, so the ramifications of Kaivisha

treatment pervaded not only to somatic and psychosomatic diseases but also to pure

psychiatric conditions also. The popularity of Vishavaidyas among the practitioners of

Kerala may be due to the varied diseases being treated by them. Presently, even though the

relevance of Kaivisha has diminished, the participants believe that food poisoning can be

attributed to the concept of Garavisha and Kaivisha treatment can be performed in them.

The evolution of Kaivisha management in traditional Vishachikitsa of Kerala is very much

different when we compare the references of Garavisha in classical textbooks of Ayurveda.

Vishachikitsa system of Kerala concentrated more on intentional poisoning with other

poisonous materials given to harm another person. The concept of contact poisoning and

other poisoning arising from exposure to environmental toxins mentioned in Samhitas are

not being considered by Keraleeya Vishachikitsa. The shodhana procedures adopted for

Kaivisha management were utilized as means to demonstrate Kaivisha in patients with

incurable diseases and that itself was enough to gain the trust of the patient and to give

psychological boosting to take medicines to cure diseases.

Prativisha chikitsa

Among the participants of the survey, 68% were using Prativishaprayoga in the treatment of

Visha. No specific comments were made by any of the participants regarding the types of

Prativisha being externally used as most of the treatments used in Visha are Prativisha itself.

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The lack of clarity regarding the use of Prativisha is seen among the participants. 14% of

non-responders and 18% of responders who said no, maybe due to the lack of clarity

regarding Prativishaprayoga. In all the textbooks, Samhitas and Vishachikitsa textbooks of

Kerala, there is a lack of clarity regarding Prativisha prayoga as the information is scattered

over the texts.

Relevance of Vegalakshana

12 respondents said ‘yes’ to this question while 10 respondents said ‘no’. The results seem to

be due to a lack of clarity on Vishavega as per the narration of some of the respondents. In

Vishachikitsa, the assessment of vegalakshana is impractical. A conglomeration of

symptoms at the time of presentation makes it impossible to assess vega correctly and the

treatments of vega are stated lucidly in Samhitas. Visha being a condition requiring constant

monitoring and evaluation of treatment procedures, treatment based on Samhitas are

difficult. But Vishachikitsa in Kerala approached this condition in a more practical way

providing symptomatic treatments. It is more useful for the practitioners and can be used as a

pocket reference guide in the case of snakebite management. Hence, even though chikitsa

based on vegalakshana has been mentioned in Vishachikitsa textbooks, the practical utility is

very less when compared to the symptomatic treatment mentioned in the instances.

Dooshivisha

Among participants, 64% (n=14) upheld the relevance of Dooshivisha chikitsa while 36%

(n=8) gave ‘don’t know’ responses to this question. The concept of Dooshivisha is well

elaborated in Samhitas and Vishachikitsa textbooks equally and it is being utilized in the

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treatment of snakebite as well as other diseases. 36% is not using this concept in treatment.

In the case of Dooshivisha there seems to be confusion among participants that some

participants confused Dooshivisha with bhinnaVisha, a concept mentioned in Sarpavisha

where incomplete detoxification or excess of toxicity from drugs may manifest as sub-

chronic symptoms ranging from mild fever, arthralgia, edema, etc. Consensually we may

equate bhinnaVisha to Dooshivisha but the two entities are entirely different. Those who

said ‘no’ maybe due to a lack of clarity in this regard. When snakebite incidences declined,

the concept of Dooshivisha has been upheld by many Vishavaidyas to treat other diseases

with the treatment principle of Dooshivisha and this has proved fruitful in many conditions.

Sarpavisha

Questions regarding treatment were asked in the domain of first aid in snakebite, treatment

protocol of snakebite, drugs, and specific formulations used. The results of the survey have

not shown any uniformity in following protocols. But some commonality in the treatment

steps were observed. Two participants used mantra as the first-line management followed by

the application of bhasma or water on the bite site. The rationality of using mantra is to do

bandhana which is believed to decrease the spread of venom from the bite site. The other

group who do not use mantra as first-line management followed the ligature application to

fulfill this purpose. Ligature in the form of thread, rope, or other articles are tightly tied

above the level of bite site and this is followed in almost all bite cases in Kerala. Even

though modern protocols prohibit such application, this measure is lifesaving in a third

world country like India where emergency services to move the patient to the hospital

immediately are lacking. It decreases the mortality at the price of some complications like

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non-healing ulcer, compartment syndrome, etc. as per the textual references, there are set

criteria for using ligatures like the tightness, the material used, and the site of binding, etc.

Particular information in this regard was obtained from the majority of the participants of the

survey. Some other practices are also followed by these Vishavaidyas like the application of

saliva and earwax at the bite site.

Few participants(n=2) fanned the bite site with leaves of Nirgundi and Neem for an hour.

After bandhana, the medicines are given. Usually Jeevaraksha gulika is the first line of

management in snake bite according to all participants except one who used to give

Vishavilwadi gulika along with milk/ghee or wild boar’s fat. The next dosage is given in 20

minutes interval followed by Tarunabhaskaram gulika. This procedure is the most popular

method among the majority of Vishavaidyas.

Some participants opine to use Hridayavarana initially with medicines like plain gritha or

with combinations of Thikthaka gritha, Misraka Sneha based on the diagnosis.

Hridayavarana is considered an important treatment procedure in Visha which has been

detailed with equal importance in Samhita and Keraleeya Vishachikitsa. Importance of

hridaya as the seat of life and utility of gritha in Vishachikitsa due to its inherent properties

of vyavayi, samskara anuvarthana, etc. are the factors which are being used in this context.

The molecular mechanism undergoing in such treatments are yet to be understood.

Nasya and Anjana are the two other routes of drug delivery in Vishachikitsa which have

been extensively used in all types of Visha. Difficulty in administering drugs to an

unconscious patient is a hurdle faced by all Vishachikitsa experts due to the lack of access to

parenteral drug administration measures and instruments. This is resolved to an extension

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using alternative drug delivery portals like the trans-nasal, trans-conjunctival, transdermal

drug delivery, etc. The extensive capillary network in the nasal mucosa and conjunctiva

along with thin mucous membrane over these areas and the proximity to the brain, all makes

these routes more favorable for drug disposal in Vishachikitsa. Firstly, they act as a painful

stimulus to regain consciousness of the patient. Secondly, the easiest route of drug delivery

bypassing the first-pass metabolism in the liver. In this study also, all Vishavaidya experts

followed these two routes for drug delivery and find it very effective in snakebite

management.

Beyond this level, this line of management is purely on a symptomatic basis as detailed in

Jyotsnika and Prayogasamuchayam. All the participants in the survey are following the

same. In contradiction to this, one participant utilized Siddha preparations of ‘kettu’

prayogas which is a fused preparation of natural metallic and non-metallic minerals which

are given in minute quantities along with suitable adjuvants. The use of this type of

treatment is very rare and not followed by the rest of the participants due to the fear of heavy

metal toxicity and lack of practical knowledge in this regard from their guru. They relied

more on polyherbal formulations and very few herbo-mineral drugs like Jeevaraksha gulika,

Mritasanjeevani gulika, and Tarunabhaskaram gulika for life-saving purposes. The rest of

the formulations and single drugs used by the participants in the survey are given in table

nos. 82,83 & 84.

Formulations used

The participants were asked regarding the formulations being prepared by themselves and

those purchased. All participants unanimously replied that more than 90% formulations are

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not available in the market. Only a few are purchased and most of the medicines are

prepared by themselves. Only 3 or 4 formulations are available in the market being

manufactured and supplied by pharmacies. The participants opine that the self-prepared

formulations are more effective than those available in the market and they prefer more self-

prepared ones, but lack of manpower and machinery limit their preparations. The second

debatable question was whether purification was done on toxic minerals and drugs used for

medicine preparation. Participants differed in opinion and 87% favored purification while

13% differed. The rationality behind non-purification of mineral and toxic drugs is based on

the fact that to pacify the potent Visha, the drug used should contain sufficient potent toxic

principles to counteract the effect of poison. This incorporates the principle of Prativisha in a

way according to some participants and for this, unpurified drugs and minerals are ideal. The

majority who favored purification suggest that all toxic minerals and drugs when

administered to the human body should always be purified and this does not affect the

potency of the drug. Scientific validation is required to fix this issue. The list of formulations

used by the participants is listed in table no. 82.

Drugs used

The list of drugs used for treatment in Visha was collected from all participants and are

listed in table no. 83. A good number of drugs are there other than those mentioned in

Samhitas and most prevalent in the southern part of India. This shows that the evolution of

Vishachikitsa tradition in this geographical area was independent of the Samhita tradition.

Many endemic species of the Western Ghats are represented on the list. A few of the drugs

are now restricted in sales like Kasthuri, Mrigasrunga, etc. Few drugs are unavailable today

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due to the scarcity of its source plant. This has seriously affected the practice of Vishavaidya

because many effective formulations containing these ingredients cannot be prepared now.

Bio-informatics department of the University of Kerala has undertaken a study recently to

study the anti-toxic effect of drugs ‘Keeripacha’ and ‘Analivegam’, two drugs traditionally

used for Sarpavisha chikitsa in Kerala. There are another group of drugs whose identity is

not even known to the vaidyas, like ‘Paalakan’, ‘Plachanam’ etc.

Many adulterations are also occurring due to this and it is seriously affecting the efficacy of

treatment. The drugs are usually collected by the tribal population who used to know the

identity of the drugs and their seasonal availability. They used to collect, store, and supply as

required to the vaidyas. This tradition has stopped now because the descendants of the tribal

population are unaware of many of these drugs and they do not have enough customers to

supply and maintain their livelihood. So gradually they moved to different other jobs. The

loss in forest area also contributed to this issue. The forest department has also imposed

serious restrictions on collecting forest products.

Regarding ‘ottamooli’ prayoga, 64% of participants do not use any such, while 22% used

ottamooli and they are willing to reveal its identity. 14% of participants are using ottamooli

but are not willing to reveal. The combination of many commonly known and identified

plants is used by the majority of them but rare drugs like Nagappadam, Koomullu, etc were

also used by experts. The lost tradition of ottamooli prayogas is partly due to the non-

revealing of these drugs and combinations by teachers to the next generation. This caused a

major setback to Ayurveda in general and Vishachikitsa in particular.

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Only 9%(n=2) used Vishakallu in the treatment. Many participants said that their teachers or

forefathers used Vishakallu in treatment, but they are not using it now. They state that it

gave good results but the making of the stone and its use are still not known fully to the

majority. One of the reasons may be that practitioners want to keep it as secret leading to its

vanishing. Vishakallu is not mentioned in Samhita and only a few references are found in

traditional Vishachikitsa books of later origin in Kerala. Many practitioners have used

modified forms of Vishakallu mentioned in Vishachikitsa books of Kerala. The method of

preparation is detailed as very tedious and a lengthy process adhering to which, is difficult to

many. The source of the stones is varied according to the opinions. Some consider it as the

stone itself, while others consider it as the horn of deer being incinerated. Even some

consider it as incinerated wood of trees being used as a stone to adsorb poison. The effect of

stone therapy is miraculous in many instances.

Associated complaints like pain, swelling, vomiting, bleeding, urine, and bowel retention are

common complications seen in snakebites and are being treated by methods suggested in

textbooks. In pain management, a formulation, ‘Eri tailam’ was utilized for external

application which is not mentioned in any of the classical or traditional Vishachikitsa

textbooks of Kerala. It is developed by experienced practitioners of specific regions of

Kerala and this formulation utilizes drugs from various other combinations like

Mritasanjeevani, which are being burnt, and the taila collected is used for external and

internal use.

Majority of the participants observed severe complications in Mandali Sarpavisha and for

stony hard edema, they use kizhi, lepa, varakuzhambu, thookudhara, etc. Specific drug

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combinations to manage bleeding, burning sensation, urine retention, etc. were mentioned by

the experts under the treatment aspects of snakebite.

Mooshikavisha

Majority of participants shared experiences in treating Mooshikavisha. The formulations and

treatment procedures used in Mooshikavisha were taken from textbooks of Vishachikitsa in

Kerala. Specific formulations like Neelikaranjadi Kashaya and gritha preparations were used

from the books of Kerala.

Keetavisha

Loothavisha ranked first among Keetavisha in the number of cases followed by minor bites

like wasp, centipede, ant and bee sting. The management of Keetavisha except Loothavisha

was minimal with one or two formulations and few external applications which were

repeated by almost all participants. Two participants shared experience of treating insect

bites with severe systemic manifestations. Loothavisha is one of the poisonings mentioned in

separate chapters in all textbooks of Vishachikitsa. Specific yogas mentioned in Samhitas as

well as Vishachikitsa textbooks of Kerala had unique formulations that are effective in

managing Loothavisha.

The present study has highlighted the importance of formulations developed by Keraleeya

Vishachikitsa like Neelithulasyadi, Kottamramachadi, Lashunadi gulika, etc. Details

regarding first-aid treatment and management of Loothavisha are mentioned by some

participants. Formulations mentioned in Samhita are rarely used by the participants of the

survey. The formulations generally used are tabulated in table no. 87. Severe neurotoxic

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manifestations of Loothavisha have been mentioned by 4 participants especially for the bite

of tarantula (Urambuli) for which specific treatment has been mentioned.

Vrischikavisha is also one of the commonly encountered envenomations among

Vishachikitsa experts. 12 participants of the survey gave details regarding the management

of Vrischikavisha. Some of the participants opined that scorpion bite can become very

serious with manifestations like snakebite which may require treatment of Sarpavisha.

Otherwise, formulations and management include those mentioned in textbooks only. Study

shows that Vrischikavisha can be effectively managed using the measures mentioned in

Agada textbooks. Also, the lack of fatal species in Kerala may have contributed to this.

Only 9% (n=2) of participants had experienced treatment in rabid dog bite while no details

regarding the procedures and formulations used in the management are revealed by the

participants. In Samhita as well as Vishachikitsa textbooks of Kerala, descriptions regarding

the management of alarkaVisha are minimal and this may be the reason that details regarding

treatment are unavailable. Only a few specific drugs are obtained through the survey like

‘Vanajyotsnika’ prayoga which was said to give promising results for a rabid bite, in a case

rejected from medical college hospital. No data is available regarding statistics of cured

cases in rabid bites. The new treatment protocols in modern medicine, vaccine along with

immunoglobulins has increased the survival of patients from rabid dog bites. This might

have contributed to the lesser number of cases handled by the participants.

Almost all participants have managed Sthavaravisha poisoning and the majority of them

treated bhallathakaVisha which is more prevalent among all Visha. There were references of

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Dhatura, Chitraka, and rarely Anamayakki, Menthonni, etc. The management was also

common as per the practices mentioned in Vishachikitsa textbooks of Kerala.

About 13% of the participants had experience in treating non-healing ulcers of snakebite. It

is a common encounter in all poisoning cases and Vishavaidyas managed effectively this

condition using drugs in Visha prakarana and twakroga. Both herbal and herbo-mineral

preparations are used, and the preparations mentioned in Keraleeya Vishachikitsa books like

Paranthyadi keram is the most extensively used medicine. Specific modalities of treatment

like Thookudhara, Kachudhara, and Papa prayoga are also detailed by the participants. Non-

healing ulcer management uses a very extensive list of medicines with specific indications in

Visha as well as for skin diseases.

54% of the participants used rasayana preparations in Vishachikitsa. Though very few have

revealed the combinations and formulations used. Only one formulation from the context of

Vishachikitsa has been used as rasayana as per the survey. General rasayana yogas are

mentioned by the majority of participants. The use of rasayana therapy in Vishachikitsa is

not popular in the Vishachikitsa tradition of Kerala. There is a lack of clarity regarding

rasayana chikitsa among participants of the survey.

All the participants gave opinions regarding the importance of pathya in Vishachikitsa.

Specific opinions regarding pathya in Visha was stated by six participants only while others

suggested general pathyapathya only. The pathya mentioned was also the textbook reference

of traditional Vishachikitsa of Kerala. Though pathya is very important in the treatment of

Visha, the survey does not reveal many details regarding this aspect.

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37% opined that there is a necessity to combine modern management with traditional

Ayurvedic practices. 29% opposed this opinion while 34% had no comments in this regard.

Those who favored this required support from the modern fraternity in the fields of assisted

therapeutic interventions like ventilation, intubation, catheterization, etc while they opposed

modern medications to be used. One participant opined that in an emergency in very severe

cases, ASV may be used.

82% used Visha line of management in other diseases while 18% does not use it. The

majority used these treatments in conditions of skin diseases, herpes, eczema in children, etc.

The survey doesn’t show any rationality in using such treatment in this type of disease.

In Keraleeya Vishachikitsa the treatment aspect is highly elaborated with more emphasis on

symptom wise management. The variety of drugs used in this tradition are many. The drugs

mentioned in Samhitas and traditional Vishachikitsa books of Kerala are equally utilized

with the majority of drugs being endemic to the southern part of India. Gaining more access

to such formulations indicates the origin of this indigenous system of healing in this part of

the country. Though Vishachikitsa included all types of poisoning from all varieties of

animals and insects, snake bite management shared the highest importance. The traditional

vaidyas utilized treatments for other bites and stings based on the same principle utilizing the

same set of drugs.

Thus, many formulations mentioned for one particular bite or poison find applications in

many other conditions and this versatility of Keraleeya Vishachikitsa helped it to survive till

now even with minimal formulations being available in the market. Specific protocols

against specific snakebites are being made with the general line of management stated with a

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vast array of medicines available to be utilized by the physicians after careful examination of

the patient. This led to the extensive use of certain formulations in specific parts of the state

which later became specific protocols of that region. But they are the same protocol being

followed with a different set of medicines being practiced for long.

Minor envenomation including insects, spider, and scorpion are also dealt with equal

importance and the variety of medicines used across the state in these poisonings are almost

similar. Effective management of such cases was attracted by the general public to

Vishavaidyas for such conditions. The use of Vishachikitsa in other diseases has also been

entertained by most of the participants showing its applicability in all types of diseases in

which a factor of Visha can be identified. Many of the formulations used in Vishachikitsa

have rejuvenating properties which are used to regain the vitality after poisonous encounters.

The term rasayana itself is a misnomer wherein people generally misinterpret it as

formulations for general health and vitality, Vishachikitsa formulations have this inherent

property wherein it rejuvenates the tissues which have been damaged by the chronic effect of

poisons.

The formulations mentioned in Vishachikitsa like Vilwadi gulika is one of the common

medicines which are distributed by the Government of Kerala for immuno-modulation in the

quarantined high-risk population, to reduce the spread of epidemics especially during

COVID -19 attack. Vilwadi gulika is also prescribed along with rasayana drugs in the

convalescence period of COVID-19 to regain health and vitality. As for any treatment,

observance of pathya is very important for preparing the body for the medicines to act

properly and cure the disease. In Visha conditions also, pathya is highly relevant and

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essential to maintaining the homeostasis of the victim. As modern science developed, the

treatment procedures dealt under Vishachikitsa needs to be scrutinized to discard those

procedures which are harmful to the patients in the long run and to adopt those which are

helpful to maintain health. For this, the incorporation of modern techniques and the life-

supporting system is essential and such an integration is crucial for reviving the dying

tradition of Vishachikitsa.

CHALLENGES IN PRACTICE

According to the participants, the major challenges in Vishachikitsa are the unavailability of

drugs and the late arrival of victims at the treatment center. The time for treatment is a

minimum of 3-4 days for a patient to cure completely. Some also opined that the persons

who supply medicines are not available now. Higher stress in managing the patient and

advancing age also contributed to less attending of cases. Lack of infrastructure and

supporting machinery is another major setback in the field of Vishachikitsa. Those who

accompany the patient are a major disturbance many times as they will not allow the

treatment to progress properly. Unavailability of attenders to perform the treatment is also a

major drawback as well as the opposition from counterparts.

Factors contributed by patients include not following the pathya and lack of will power to

withstand the treatment procedures. The majority of Vishavaidyas are undertaking this

treatment free of cost and lack of proper funds to maintain their life is also a hurdle. There is

a belief among people that those who undertake Vishachikitsa are prone to some bad events

in life which stop many in continuing this treatment. The doctor must stay awake the whole

night to observe the patient and to give medicines accordingly. Many of the drugs used for

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Vishachikitsa like Ishwari, Tanduleeyaka are very difficult to procure. Vomiting in patients

is a major hurdle in treatment as most of the medicines are to be given through the oral route.

The challenges faced by the Vishavaidya practitioners in Kerala involves the factors that

contributed to the decline of the system. General factors including the public’s attitude

towards Vishachikitsa and lack of infrastructure is a major challenge. Lack of medicines,

attenders, and raw materials cause challenges in the field of providing care to the patients.

The attitude of the accompanying persons along with the negative propaganda from the

medical counterparts is another group of challenges. The patients brought late for the

treatment is a challenge that is associated with a bad outcome. A thorough evaluation of the

challenges and corrective measures are required for reviving this lost tradition.

MYTHS AND PRACTICES

Snakes are intricately related to human life, culturally in different parts of India. In Kerala, it

is very prominent and temples of snake worship and those linked with myths related to

snakes are more when compared to other states. The worship of snakes is associated with

health, fertility, and fortune. In snakebite treatment also, there are several myths and

practices related to the temple tradition of Kerala. There are temples entirely dedicated to

snake worship- Mannarashala, Pambumekkadu, Ameda, and Peralassery, etc. Several

Vishavaidyas are of the habit of giving offerings to many such temples. As per the present

survey, participants opine that people used to give offerings to temples like Pambumekkadu

to get rid of snakes from the house and some Vishavaidyas perform special offerings once in

every three months. Offerings at Peralassery with eggs are also common. Sarpakavu was

also devised to set aside a place for snakes to dwell and worship. There is a belief among

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people that worshiping snakes will cure many diseases and hence several temples of worship

are places for sarpabali and sarparadhana. Several art forms like Sarpamthullal, Sarpa

Kalam, Pulluvanpaatu, etc are artforms given as offerings by devotees to please snakes.

Sarparadhana is also done for the curing of skin diseases, infertility, and diseases of the

nervous system. There were many unrealistic and superstitious beliefs about sarpakopa

among the participants.

The snake worships, cultural and religious practices related to snake and snake worships are

highly prevalent in different communities in Kerala. Temples devoted to snakes, offerings

from the general public, and those motivated by Vishavaidyas and jyotishis contributed to

the sustenance of these cultural practices in Kerala. Special offerings to pacify the sarpakopa

after bites and to save the patient are commonly practiced by the relatives of the victim.

Vishavaidyas also do regular offerings to get rid of the ill-effects from the snakebite

treatment. The cultural and religious practices are highly interwoven with the Vishachikitsa

tradition in Kerala.

REASONS FOR DECLINE

Vishavaidya does not depend on the fee provided by the victims and hence it was difficult to

maintain the livelihood of Vishavaidya and his family. The well-to-do families only could

afford to such a profession while the middle and lower-middle classes gradually stopped this

profession as the livelihood became difficult, which was later considered as the ill-effect of

snakebite treatment.

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According to the opinion of the survey, the introduction of ASV is also a powerful reason for

the decline of Vishachikitsa. Up to the introduction of ASV, the snakebite treatment in

modern practices had a high mortality rate which was much higher than those occurring

from the hands of Vishavaidya. The declining death rate along with the easiness of treatment

procedure made it more popular among the public.

Lack of medicines is another factor along with the escalating cost of medicines which was

unable to be met by Vishavaidyas of a middle-class family. The poor quality of available

medicines also contributed to the decline. With the increased use of chemical manure, the

composition of soil has changed. This has adversely affected the medicinal properties of

herbs and plants. Some participants opine that the diet restrictions provided in Ayurveda are

difficult to be followed. The modern treatment system does not require such restrictions.

The stoppage of transmission of knowledge to next generation was considered as a cause of

decline by some participants. Two aspects are associated with this:

1. The financial gain is almost nil which does not attract newcomers to this field.

2. Rational thinking and atheism were much developed among the new generation of the

1970s. Hence, they may not be interested in carrying on this profession which is associated

with the mystic religious mantra- tantra practices.

Lack of government aid, financial support, and its insufficiency, the sacrifice of a person,

and all his pleasures of life in the practice of Vishavaidya do not attract a new generation to

this system. Fear of the public about the practice of Vishachikitsa and its mystic practices

and its expensiveness also contributed to the causes of its decline. Misbelieves associated

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with snakebite treatment are also pointed out as causes of decline. The change in educational

style also attributed to the causes of decline.

Vishachikitsa in Kerala had royal patronage and it flourished throughout Kerala through the

hands of several Vishavaidyas practicing across the state. After Independence, the

government aid through the grant-in-aid system maintained this patronage to some extent.

But with the advancement in modern science with more effective and easier treatment

methods, the number of patients opting traditional method was gradually reduced. The other

socio-economic factors also played its role like the lack of facilities, attenders, drugs,

expensive and time-consuming procedures, and lack of fee.

SCOPE OF REVIVAL

The participants of the survey suggested the following measures to revive the Vishachikitsa

tradition of Kerala. The foremost among them is to provide more governmental help to the

practitioners, to protect medicinal plants, and to ensure their availability and quality. Special

thrust is given to popularize the results of Ayurvedic management of snakebites and to gain

the trust of people with evidence from research works. The public should be made aware of

its success rate and procedures. Effective integration of Ayurvedic and Allopathic treatments

should be made and BAMS graduates should be exposed more clinically to manage

snakebites.

Vishachikitsa is to be revived with the active participation of the government system to

empower the human resources and infrastructure and governmental help providing centers

with uniformly qualified and competent health care providers and allied services. Confidence

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gaining effort should be initiated among the public by sensitizing this healing tradition of our

state right from the school curriculum and should not be sidelined as an alternative method

but to be kept as the mainstream treatment with support from the modern counterpart with

proper research to update and modify the treatments accordingly. Proper and genuine drugs

should be made available as the natural resources are being depleted. The lost glory of

Vishachikitsa can be regained slowly by adopting proper corrective measures.