Suśruta on Determining Envenomation Status of a Patient

The most common argument doctors, herpetologists, and global health authorities use against traditional medicine is that it only seems to work because most of the time the snake doesn’t inject a lethal amount of venom.  The implication, of course, is that traditional doctors are completely ignorant of this fact, or know it and don’t let on in order to trick their patients with false success stories.  Unfortunately this initially persuasive argument has little basis in reality and can easily be turned around by saying that antivenom only seems to work because most of the time a lethal amount of venom is not injected.  I am well aware that in an ideal world the doctor will only use antivenom when signs of envenomation are present, when the snake species is identified as one treatable by the available antivenom, and when it has been determined that the patient will not have an acute allergic response to the antivenom.  Unfortunately we don’t live in such an ideal world.  A recent report on snakebite in Cambodia (linked) revealed the shocking news that NONE of the antivenom available and IN USE in Cambodia as of 2009 is valid for Cambodian snakes.  The article also featured a chart on the outcomes of snakebite cases in the few hospitals in Cambodia keeping records of it, and usually the death rate was fairly low (<10%) to medium (20%).  Since they were using the wrong antivenom in many cases, and the doctors were often unsure about how to use the antivenom, how many of the deaths might be attributed to allergic reaction to the “medicine”?  Not an ideal world at all.

My point here is NOT to argue that one shouldn’t go to the hospital for antivenom treatment, but at the same time we cannot accept invalid arguments from a medical industry in which things like the Cambodia example can happen.  Dismissing traditional medicine out of hand, which is to say without having any knowledge of it, is unscientific. Scrupulous scientists will agree and desire to test the various medicines used in a given traditional pharmacology.  See my preliminary list of some such evaluations here.

For my part, let me start by pointing out a striking passage in the Suśrutasaṃhitā, dating back at least 1,800 years and still in use among physicians of Āyurveda.  This passage nicely illustrates the awareness of determining envenomation status in a spiderbite victim:

5.8.75| lūtāviṣaṃ ghoratamaṃ durvijñeyatamaṃ ca tat |
            duścikitsyatamaṃ cāpi bhiṣagbhirmandabuddhibhiḥ ||
5.8.76| saviṣaṃ nirviṣaṃ caitadityevaṃ pariśaṅkite |
             viṣaghnameva kartavyamavirodhi yadauṣadham ||
5.8.77| agadānāṃ hi saṃyogo viṣajuṣṭasya yujyate |
             nirviṣe mānave yukto ‘gadaḥ saṃpadyate ‘sukham ||
5.8.78| tasmāt sarvaprayatnena jñātavyo viṣaniścayaḥ |
             ajñātvā viṣasadbhāvaṃ bhiṣagvyāpādayennaram ||

“Spider venom is extremely vehement and difficult to diagnosis, and it is nearly impossible for dim-witted doctors to cure it. Thinking ‘Is the patient envenomed or not?’ he wavers on which poison-destroying medicine could be used without causing problems.  Indeed, the use of antidotes is indicated for one who is envenomed, [but] an antidote used on a person that is not envenomed will cause trouble. Therefore all efforts should be used to settle the diagnosis of envenomation.  If the doctor does not know the true state of envenomation, he might kill the man.”

Posted in Gāruḍam

2 Responses to Suśruta on Determining Envenomation Status of a Patient

  1. Wavatar Elisa Freschi says:

    Funny and inspiring post (thanks!) especially insofar as it points out that the alleged scientificity of allopathic medicine is far from being uncontroversial. I just have a minor question: you say that before dismissing traditional medicine one should test it. However, an objector might argue that it is unfair to test traditional medicine through the tests of the allopathic one. Traditional medicine, in fact, more often than not implies a longer period of treatment, personalised remedies, etc., and is hence less liable to be verified in a laboratory test.

  2. Wavatar Michael says:

    You are right that traditional medicine has unique approaches that would need to be taken into consideration for a judgment of “valid” or “invalid” to be issued. But the way I see it, the more acute a condition, the less gray area there is in determining validity. If you have been bitten and heavily envenomed by a deadly snake, for example, the treatment has to work fast to be able to save your life. Many of the studies I cite show that in their lab experiments with mice, certain herbs used in traditional pharmacologies are effective in preventing death. That is clear. However, the more the scientist departs from traditional usage and real life circumstances, the less valuable that research will be for determining the validity of traditional treatments. For example, in several of the articles I linked to, the scientists inject the purified herbal extract *before* injecting the venom. It seems like they must have a reason for doing so, but they do not explain it. This is clearly not how the plant remedies are being used on the ground. Likewise the scientist should take into account the traditional method of preparing the remedy. Is the plant dried and powdered and extracted with a solvent in the village? Probably not. Chemical structures often change when a plant is dried or is subjected to heat and so on, so these are definitely factors the scientist needs to pay attention to. But to sum up, I agree with the objection if the medical condition being evaluated is chronic, but for life-threating emergencies, the lab should be able to accurately determine efficacy with some care to real life usage.

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