Madya and Madatyaya – Alcohol poisoning (Ethanol and Methanol)

Alcohol Poisoning

Madya Visha (मद्य विष)

Derivation (निरुक्ति)

Mada (मद) generally means addiction, lusty or madness.

The word Madya is derived from root word 'mad' (मद्) with suffix 'yat' (यत्) which could be defined as माद्यति जनोनेन इति, means after consumption which makes person to loose his sense is called as madya (wine).

Definition (परिभाषा)

बुद्धि लुम्पति यदि द्रव्यं मदकारि तदुच्यते | तमोगुनप्रधानं च यथा मद्यसुराssदिकम || (शा.स.प्र. ४/२१-२२)

In sharangadhara samhita while defining about the madakari property the madya is also included in the classified drugs i.e drugs possessing tamoguna predominantly and cause derangement of the mind are called Madakari (intoxicants) for example sura and the madya.

Properties of Madya (मद्य गुण)

लघुष्णतिक्ष्णसुक्ष्माम्लव्यवाय्याशुगमेव च |रूक्षं विकसि विशदं मद्यं दशगुणं स्मृतं || (च.चि. २४/३०)

The wine possessing the ten properties such as

  1. Light (लधु)
  2. Hot (उष्ण)
  3. Sharp (तीक्ष्ण)
  4. Finely entering (सूक्ष्म)
  5. Sour (अम्ल)
  6. Quickly absorbed (व्यवायि)
  7. Quick acting (आशु)
  8. Rough (रुक्ष)
  9. Depressant (विकसि)
  10. Non-slimy (विशद)

This wine is having opposite to the ten qualities of Ojus, so if it is taken in an improper manner it will act like an poison.

Madya dosha

मोह, शोक, भय, क्रोध, मृत्यु, मद, मूर्छ, उन्माद, अपस्मार are the doshas caused by madya.

Stages of Mada (मद अवस्था's)

The wine on drinking produces three stages of intoxication - First (प्रथम), Second (मध्यम), Last (अन्तिम). But in Madavanidana four stages are described.

  1. First stage (प्रथमावस्था) :
    1. In first stage the intoxication starts when the heart is stimulated but the ojus is not affected and the person would be more inclined towards sexual acts, there will be an increase in the seminal fluid, more pleasure, loud speech.
    2. In the exerts the features like exhilaration, pleasure, interest in food and drinks, invokes in instrumental and vocal music, humor and stories. It gives sound sleep and fresh awakening, does not affects intellect, memory and perception by senses. Thus it is stage of inducing pleasure.
  2. Second Stage (द्वितीय अवस्था) :
    1. In the middle stage person often recollects and for gets the things, he has indistinct speech and voices, Simultaneously speaks sense and nonsense. His movements, posture, drinking, eating and talking all are incoherent and funny.
  3. Third stage (तृतीय अवस्था) :

In the third stage of intoxication person becomes motionless like a cut wood, his mind becomes narcosis, confusion and he appears as dead. He neither perceives the pleasurable senses nor he recognizes friends. He doesn't get enjoyment for which wine is taken. He becomes incapable in recognizing good and bad, useful and harmful. So no wise person ever like to place himself in such a stage of intoxication. He is condemned and disliked by all and finally he is proned to miserable diseases as a complication. These features were described in the fourth stage of mada by madavakara.

MADATYAYA (मदात्यय)

The disease produces due improper or excessive use of alcohol is called madatyaya.

General features (सामान्य लक्षण)

सामान्य लक्षणं तेषां प्रमोहो हृदये व्यथा | विडभेद: प्रततं तृष्णा सौम्याग्नेयो ज्वरोsरुचि: |

शिर: पार्श्वस्थिरुककम्पो मर्मभेदस्त्रिकग्रह: | उरो विबन्धस्तिमिरं कास: श्वस: प्रजागरः |

स्वेदोsतिमात्रं विष्टंभः श्वयथुश्चित्तविभ्रम : | प्रलपशच्छर्दिरुत्क्लेशो ब्रमो दु:स्वप्न्दर्शनम् || (अ.स.णि. ६/१७-१९)

Their general features are :

Sever delusion, Pain in heart (or disturbances of mind), diarrhea, constant thirst, fever having both heat and cold (rigors), loss of appetite, pain in head, flanks and bones; tremors, cutting pain in vital parts, catching pain in triangle of the back (meeting place of the shoulder, backbone and scapula), obstruction in the chest, blindness or unconsciousness, cough, dyspnea, loss of sleep, excessive perspiration, indigestion and stasis of food inside the abdomen, for long time; swelling, disorders of the mind, irrelevant talk, vomiting excess salivation, giddiness and bad dreams.

Types

  1. Vataja panatyaya/ madatyaya
  2. Pittaja panatyaya/ madatyaya
  3. Kaphaja panatyaya / madatyaya
  4. Sannipataja panatyaya/ madatyaya
  1. Vataja madatyaya features - हिक्का, श्वास, शिर: कम्प, पर्श्वशूल, निद्रानाश, बहुप्रलाप्
  2. Pittaja madatyaya features - तृष्ण, दाह, ज्वर, स्वेद, मूर्छ, अतिसार, विभ्रम, हरित वर्ण.
  3. Kaphaja madatyaya features - वमन, अरुचि, ह्रुल्लास, तन्द्रा, गौरव. शीतता
  4. Sannipataja madatyay features - combined all symptoms.

Treatment

The treatment of madatyaya can be explained in the following ways :

  1. Samanya chikitsa (General management)
  2. Vishishta chikitsa (Specific treatment)

A) Samanya chikitsa

I) Treatment According to Dosha (दोषानुसर चिकित्सा)

All types of alcoholism are tridoshaja, hence the physician should first treat the dosha which is predominant therein. Otherwise in alcoholism the treatment should be started from kapha because it is predominantly situated flanked by pitta and vata.

II) Administration of Madya (मद्य प्रयोग)

  • The diseases which arise from inadequate, improper and excess drinking of liquors, get cured by the same (drinking wine) if administered properly.
  • Charakacharya explains more about the usage of this wine that vayu obstructed in channels due to dosha excited by wine produce intense pain in head, bones and joints. In such cases for liquifying the dosha particularly wine should be given because of its properties like quick absorption, sharpness and hotness unlike of other remedial measures.
  • Wine removes the obstruction of channels, carminates vata, improves relish, stimulates digestive fire and becomes suitable by practice. On removal of obstruction in channels and carmination of vata, pain subsides, disorders are alleviated and narcosis and its complications are pacified.

III) Administration of Milk (दुग्ध प्रयोग)

If by these measures the alcoholism does not subside one should advise the intake of milk leaving the above measures relating to wine. After discontinuing wine, when kapha is diminished, debility and lightness arises due to lightening (langhana, digestives (pachana), evacuative (shodhana) procedures and pacifactory (shamana) measures and vata and pitta becomes predominant in the patient afflicted by wine, so milk administration acts as a boon like reains from the tree which is extreamly dried in summer. After somedays milk also should be withdrawn slowly with substitutes of pathyadravyas.

IV) Psychological Measures (हर्षणक्रिया)

  • Alcohol doesn't cause alcoholism without causing agitation of mind and causing morbidity in the body hence exhilarating measures are necessary.
  • Following measurements may help in fast recovering from madatyaya. Beautiful parks, ponds with lotus flower, good food and drinks, pleasing companions, garlands, perfumes, washed clothes, melodious music, entertaining parties, ample arrangement of talks, jokes and songs and beloved and submissive women etc. alleviate alcoholism.

B) Vishishta Chikitsa

I) Vataja Madatyaya Chikitsa

For controlling the vataja madatyaya चुक्र, मरीच, अर्द्रक, दीप्य and कुष्ठ with a little of सौवर्चल लवण should be taken with wine.

II) Pittaja Madatyaya Chikitsa

Wine should be mixed with the decoction of madhura group of drugs along with मधु, शर्कर and the good flavors is beneficial. After drinking this wine, one should take concentrated sugarcane juice and after waiting for a short while it should be brought out completely by vomiting. Non- sourish meat of lava, aina and tittira or else mudga soup with sugar and ghruta should then be given to drink for benefit.

III) Kaphaja Madatyaya Chikitsa

In case of madtyaya of kaphaja origin, vomiting should be induced (kapha should be eliminated) by using wine mixed with the juice of बिंबी and विडुल.

Meat soup of wild animals with bitter and pungent should be then be given; further (pulse) soups processed with bitter and pungent spices are also beneficial. Various preparations of barley cereal, meat of wild animals as well as other kapha-alleviating articles which are harmless and salutary.

IV) Sannipataja Madatyaya Chikitsa

All the tridoshaja chikitsa is carried out.

Alcohol Poisoning

Alcohol is one of the commonest, oldest and the easiest available intoxication to the human beings. It is an inebriant cerebral neurotoxic poison. Symptoms of alcohol poisoning may result from slight intoxication to deep coma.

Ethyl Alcohol (Ethanol, C2H5OH)

Ethanol is a transparent, colorless, volatile liquid having a spirit-like odor and burning taste. It is the main ingredient of common social beverages like wine, beers, whiskeys and brandies etc. It is both water and lipid soluble. It is obtained by fermentation of sugar, grains, fruit juices and starch etc.

Acute Ethanol Poisoning

Signs and symptoms

I) Stage of Excitement (Blood level 50 - 150 mg %)

II) Stage of in-coordination (Blood level 150-250 mg %)

III) Stage of Coma ( Blood level > 250 mg %)

Fatal Dose (non-addict) :

  • Adult : About 50-250 ml of absolute alcohol
  • Children : About 60 ml of absolute alcohol.

Fatal Period : 12 to 24 hours. Death may be delayed for a weak.

Treatment

  1. Gastric Lavage with alkaline solution (5% sodium bicarbonate in warm water) within 2 hours of indigestion.
  2. The patient should be kept warm.
  3. Isotonic solution with 5% of glucose to deal with hypoglycemia, if present.
  4. Vitamin B6 50-100mg I.V to accelerate the metabolism of alcohol.
  5. Saline purges and I.V hypotonic glucose solutions to treat increased intracranial pressure.
  6. Rest of the treatment is symptomatic e.g - Artificial respiration, hemodialysis.

Post-mortem Appearances

  1. Alcohol odor is perceptible in the stomach, lungs and brain.
  2. Rigor mortis is prolonged and decomposition is delayed.
  3. The mucous membrane of the stomach is red, congested and inflamed.
  4. The liver, lungs and brain are congested.
  5. The blood is like a fluid and dark.

Medico-legal Aspects

  1. Poisoning by alcohol is common but death occurs in very few cases.
  2. Fatal complications such as head injuries, drowning etc. are generally seen after alcohol consumption.
  3. There is a strong relationship between alcohol, crime and violence.
  4. Chronic alcoholism is common cause of sexual jealousy crimes especially of homicidal nature.
  5. A passenger who accepts the lift from drunken driver accepts risk of negligence in case of an accident.

Chronic poisoning (Alcohol addiction)

It results from long continued use of alcoholic liquor. Chronic alcohol drinkers are either psychotic or neurotic and usually take alcohol as a means to escape from realities of life.

Clinical features

Loss of appetite, Nausea and vomiting, Diarrhea, Jaundice and liver cirrhosis, tremors of hands and tongue, Dementia , Impotence and sterility.

Three common clinical syndromes resulting from chronic alcoholism are :

  1. Delirium tremens
  2. Korsakoff's psychosis
  3. Acute hallucinosis

Treatment

  1. Antabuse (Disulfiram) in a dose of 0.25-0.75 gm blocks metabolism of alcohol in liver leading to accumulation of acetyldehyde in blood causing unpleasant symptoms like nausea, vomiting etc. and thus making the patient dislike the alcohol.
  2. Hypnosis and psychotherapy are also very helpful.

Methyl Alcohol (Methanol, CH3OH)

Methyl alcohol is synthesized by destructive distillation of wood. It is colorless liquid having spirit like odor and burning taste.

Signs and Symptoms

  1. Nausea, vomiting, pain in the abdomen followed by headache, dizziness and vertigo.
  2. Marked muscular weakness.
  3. Depressed cardiac action.
  4. Suppression of urine.
  5. Spirit like odor in the breath.
  6. Dyspnea and cyanosis
  7. Atrophy of optic nerve resulting in permanent blindness.
  8. Convulsions
  9. Coma.

Fatal Dose : 60-240 ml

Fatal Period : 24-36 hours

Cause of death - Death in methyl alcohol poisoning occurs due to respiratory failure.

Treatment

  1. Gastric Lavage with 5% sodium bicarbonate in warm water.
  2. Oral administration of sodium bicarbonate 2 gm in 250 ml of water 4 hourly to combat acidosis.
  3. Oral administration of 50 % ethyl alcohol in a dose of 0.75 to 1 ml per kg body weight as a competitive antagonist.
  4. Antidote - 4-methylpyrazole (Fomepizole) blocks the formation of formaldehyde and formic acid.
  5. Rest of the treatment is symptomatic.

Post-mortem Appearances

  1. Marked cyanosis of upper part of the body.
  2. The blood is like a fluid and dark.
  3. Mucous membrane of the stomach and duodenum are congested and inflamed with tiny hemorrhagic points.
  4. Lungs are congested and edematous.
  5. Brain is edematous with focal hemorrhages.
  6. Mucosa of urinary bladder is congested.
  7. Liver shows necrobiosis and fatty changes.
  8. Kidneys show tubular degeneration.

Medico-legal Aspects

  1. Accidental poisoning may occur due to the consumption of methyl alcohol adulterated with cheap liquor.
  2. It is also used as an intoxicating beverage when ethanol is not available.
  3. Suicides and homicides may occur.

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