Issue : 01 DOI : 10.5281/zenodo.8147277

INTERNATIONAL

JOURNAL

DIAGNOSTICS

AND

RESEARCH

Volume : 01

Page 29

Corresponding author : Dr.Bhargav Thakor

Article Info : Published on : 02 /01/2024

Abstract

Ayurvedaa a traditional system of medicine practiced in the Indian subcontinent is usually considered to be

devoid of adverse reactions.In this case study we are reporting an adverse reaction occurred due to overdose

of Shwasakuthar rasa. A 34 year old man with Tamak Shwas consumed Ayurveda rasa for almost a year in a

dosage of 2 tab BDs along with water as Anupana. Later there developed blackish discolouration of skin all

over the body.Misconception about full safety of Ayurvedaic medicine leads many patients to consume them

for years without any monitoring/prescription from vaidya.Inorganic mercury as observed leads to corrosive

effect of skin,eyes,GIT and nephrotoxicity and also hyper/hypo pigmentation all over the body.This makes

vaidya to think of multiple and life threatening diseases like Addison’s disease ,Albinism,primary biliary

cholangitis , primary biliary cirrhosis when detailed Nidan analysis is not done.Hyperpigmentation can also be

caused by heavy metals poisoning like mercury ,silver ,gold etc which are considered as Adverse Drug

Reactions (ADRs). This happens commonly due to injudicious intake of medicines prepared out of these

heavy metals or even due to wrong method of preparation.So a stringent monitoring to avoid such

consequences is a need of an hour.Further in full paper we will be discussing regarding a case developed due

to adverse drug reaction.

Keywords : Parada(Mercury),ADR, Shwasakuthar rasa.

ISSN No. : xxxx-xxxx

Volume : 01

Publisher

ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION

FOR PATHOLOGY AND RADIODIGNOSIS

Issue

DOI

: 02

: 1 0 . 5 2 8 1 / z e n o d o . 1 0 4 5 1 2 5 8

Reg. No. : MAHA-703/16(NAG)

Year of Establishment – 2016

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

An Incidence Of Suspected Adverse Drug Reaction: A Single Case Study

Dr.Bhargav Thakor

, Dr.Sachin Deva

First Year PG Scholar, Department of PG & Ph.D. Studies in Roganidana Evum Vikriti Vigyan ,

Parul institute of Ayurved ,Parul University,Vadodara, Gujarat.

Professor, Department of PG & Ph.D. Studies in Roganidana Evum Vikriti Vigyan ,

Parul Institute of Ayurved ,Parul University,Vadodara, Gujarat.

Cite this article as : - Dr.Bhargav Thakor (2024) ; An Incidence Of Suspected Adverse Drug Reaction: A Single Case Study;

Inter.J.Dignostics and Research 1(2), 29-32, https:/doi.org/10.5281/zenodo.10451258

Introduction-

A 34 years old man was brought by his relative to

the OPD.Clinical examination revealed blackish

discolouration of all over body ,mild itching

occasionally History was taken in brief the probable

cause finding like a taking of Ayurveda rasa since

last 6 month so there is chances of the ADR of

Shwasakuthara rasaMode of action of Ayurveda

Rasa Shwasakuthara Rasa acts on Shwasa Roga due

to the action of its ingredients which directly act on

pranavaha Srotas. Its most of the ingredients are

Vatakaphashamaka and mainly Kapha- Nihsaraka

with Laghu, Ruksha and Ushna Guna, means mainly

acts on Agnimandhya and breaks the Kapha Dosha

Pradhan Samprapti. It is contraindicated in pleural

effusion, cardiac involvement and Paittik Kasa. Its

role is limited as it increases the Ushna guna in

many patients which was also observed in this study.

Black pepper is a major constituent, which stimulate

mucous membrane of the respiratory system. It helps

in mucous drainage and imparts strength to alveolar

mucous membrane. Aconitum ferox is antispasmodic

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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Volume : 01

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in nature, hot and stimulant for mucous membrane.

Shunthi and Pippali release the sputum.

Realgar absorbs excessive secretion from the alveoli.

Purified borax is antispasmodic and removes kapha.

Materials & Methods-

Composition of Shwas Kuthar Rasa

SR.

Ingredients

Latin

name/Englis

h Name

Part used

Quantity

Sh Shuddha

Parada

Mercury

1 tanka

Shuddha

Gandhak

Sulpher

1 tanka

Shuddha

Vatsanabha

Aconitum

Ferox

Rhizome

1 tanka

Tankana

Bhasma

Borex

1 tanka

Manahashila

Red Arsenic

1 tanka

Sunthi

Zingiber

officeinale

Rhizome

Maricha

Piper

Longum

Fruit

8 tanka

Pippali

Piper

Longum

Fruit root

Dosage - 2 Rati(125mg-250mg)

Anupana-Madhu

1. Shuddha Parada Parada is one of the pure and

auspicious metal. it has not only spiritual and

religious significance, but has extensive healing

properties also. When Parada, which is impure is

purified and consecrated by various processes, it

become solid and known as Shuddha Parad. It is one

of the important core ingredients in Rasa ausadhies.

Rasapanchak of Parada Rasa- shadarasa Guna –

snigdha, sara, Virya – Ushna Vipak – Madhura

,Effect of Dosha-Tridoshaghn. Important properties

of parada are described as-(Tridoshaghna).

(Rasayana).(Yogavahi).(Mahavrishya).(Sadadrishtib

ala Parada).ACTION Mercury binds with sulfhydryl

groups resulting in enzyme inhibition and

pathological alteration of cellular membranes

Inorganic mercury salts are corrosive to the skin,

eyes, and GIT, and nephrotoxic.

2. Shuddha Gandhak Rasapanchak Rasa (taste)-

Katu, Tiktta, Kashaya. (property)-Sara

Veerya(Potency)- UshnaVipaka-Madhura.

3. Shuddha vatsanabha Rasapanchak Rasa

Madhura Guna-Ruksha, Teekshna, Laghu, Vyavayi,

Vikasi Veerya-Ushna Vipaka-Madhura

4. Manahashila Rasapanchak Rasa(taste)- Katu,

Tikta. Guna(property)-Snigdha, Guru, Sara. Veerya-

Ushna

5. Shuddha Tankan - Rasapanchak Rasa-Madhura

Guna-Ruksha, Teekshna, Laghu, Vyavayi, Vikasi

Veerya-Uashna Vipaka-Madhura

6. Sunthi- Rasa Panchak Rasa(taste)-Katu Guna

(Property)- Laghu, Snigdha, Teekshna. Veerya

(potency)-Anuashna. Vipaka-Madhura

7. Maricha- Rasapanchak Rasa(taste)-Katu Guna

(property)- Laghu, Teekshna Veerya (Potency)-

Ushna Vipaka-Katu

8. Pippali- Rasapanchak Rasa (taste)- Katu Guna

(Property)- Laghu, Snigdha, Teekshna. Veery a

(potency)-Anushna. Vipaka - Madhura

9. Discussion & Conclusion-

In this case, patient of Tamak Shwas treated in past

history.So the Physician advised to the patient

consume Shwaskuthar rasa 2 tab BDs in Dose for a 1

month with Ardraka swara as anupana.But patient

consumed 2 BD for a year without any consultation

by the physician or even without any

monitoring.Gradually patient notice mild blackish

discolouration of the skin. After his family members

reported regarding the same to him. Initially he

neglected the same but after few months the

condition worsened and blackish pigmentation

became extensive throughout the body.Intake of

Shwaskuthar rasa for a long time which has

Inorganic mercury as observed leads to corrosive

effect of skin,eyes,GIT and nephrotoxicity and also

hyper/hypo pigmentation all over the body. This

makes physician to think of multiple and life

threatening diseases like Addison’s disease

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,Albinism, Primary biliary cholangitis , Primary

biliary cirrhosis when detailed Nidan analysis is not

done. Hyperpigmentation also caused by heavy

metals like mercury ,silver ,gold which can

poisonous. Also leads by certain NSAIDs

,barbiturates. So after that we approached to lab

investigations like RFT S.cortisol but the

Investigative values were normal. So we excluded the

Addison’s disease. There is no specific finding which

indicates primary biliary cholangitis & primary

biliary cirrhosis and patient had no history of taking

NSAIDs since last 1 year. so these diagnosis were

also excluded. So after excluding above said disease

like like Addison’s disease ,Albinism, Primary biliary

cholangitis , Primary biliary cirrhosis When

thorough and detailed nidan analysis was done we

notice injudicious , unprescribed intake of

shwasakuthara rasa for almost a 1 year. Further

when literature review also supported to same and

also different articles were referred we came to

conclusion that the blackish pigmentation was

developed might be due to adverse reaction of

shwasakuthar rasa .So it becomes primary

responsibility of any practicener to analyze proper

history followed by Nidana. Adverse Drug Reactions

(ADRs) significantly cause morbidity and mortality

worldwide .As a result ,proper Adverse Drug

Reactions monitoring is required.Every ayurveda

practitioner’s responsibility is to detect ADR.

The study revealed that patient consuming medicine

for long time without any guidance of physician

.And it lead to adverse drug reaction of shwaskuthar

rasa one of the ingredient is parada(Mercury). So it

is heavy metal and poisons so consuming parad for

long time can leads mercury poisoning and leads

blackish discolouration of all over body. Before that

lots of drugs had ADRs issue but this is the one of

the example of ADR .So Always consume medicine

under the guidance of physician, he knows the

proper mechanism of drug their dose duration and

side effects.The Adverse drug reactions are depends

on timing, the pattern of illness, the results of

investigations, and rechallenge. So for Prevention of

adverse effects to drugs Adverse drug effects can be

minimized but not altogether eliminated by

observing the following practices.1)Avoid all

inappropriate use of drugs in the context of patient's

clinical condition.2)Use appropriate dose, route and

frequency of drug administration based on patient's

specific variables.3)Rule out possibility of drug

interactions when more than one drug is

prescribed.4)Adopt correct drug administration

technique 5)Carry out appropriate laboratory

monitoring.

Reference :

1. https://www.msdmanuals.com/en-in/home/skin-

disorders/pigment-disorders/hyperpigmentation

2. https://www.jcdr.net/article_fulltext.asp?issn=09

73709x&year=2023&month=february&volume=

17&issue=2&page=kc01-kc04&id=17503

3. https://irjay.com/index.php/irjay/article/view/198

4. Bhaisajya Ratnavali.Hikkaswasarogaadhikara

16/44-45.

5. Essential Medical Pharmacology,Kd Tripathi 6th

Edition, Chapter-6, Adverse Drug

Effects,Prevention Of Adverse Effects To Drugs

Page.Number-79.

6. A Textbook Of Rasasastra, Dr.Ravindra

Angadi(Iatro Chemistry And Ayurveda

Pharmaceutics) ,Chapter-25,Ausadh

Yoga(Compound Formulations), Khalviya

Rasayan, Swashakuthar Rasa.

7. Bhavaprakash Nighantu,’Padmashree’

Prof.K.C.Chunekar, Haritakyadi

Vagaha,Sunthi,Maricha,Pippali, Page Number-

10,12,13.

8. 17th Edition Harrison’s Principles Of Internal

Medicine,Fauci,Braunwald,Kasper,Hauser,Long

o,Jameson, Loscalzo, Part 15-Endocrinology

And Metabolism, Section 1 Endocrinology

Disorders Of The Adrenal Cortex,Addison’s

Disease Page Number-2263.

9. 17th Edition Harrison’s Principles Of Internal

Medicine,Fauci,Braunwald,Kasper,Hauser,Long

o,Jameson,Loscalzo, Part 17-Poisoning, E34

Heavy Metal Poisoning

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DOI : 10.5281/zenodo.10451258

Dr. Bhargav Thakor Inter. J.Digno. and Research

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