Compilation on :

Compilation submitted
Guided by:

..
Dr. Sabbu Thasineku
BAMS (IOM/TU)
Instructor Ayurveda Campus
Kirtipur , Kathmandu, Nepal
Compilation on :- Oleander (

Compilation submitted for partial fulfillment of the BAMS degree.


Ayurveda Campus
Compiled by:

.
Roshan Baskota
Roll no 10
2067 batch (15
th
)


)
partial fulfillment of the BAMS degree.

Acknowledgment

I have taken efforts in this compilation. However, it would not have been possible without the
kind support and help of many individuals. I would like to extend my sincere thanks to all of
them.

I am highly indebted to my respected teacher Dr. Sabbu Thasineku for the guidance and constant
supervision as well as for providing necessary information regarding the compilation & also for
support in completing the compilation.

I would like to express my gratitude towards my parents for their kind co-operation and
encouragement which help me in completion of this compilation.

My thanks and appreciations also go to my colleague in developing the compilation and people
who have willingly helped me out with their abilities.

Roshan Baskota
Bams 2nd Prof. (2067)
Roll 10

Contents

S.N Topics Page No.
1. Introduction to Ayurveda
2. Introduction to Agadhtantra (Toxicology)
3. Types of poison
4. Oleander
5. White Oleander (Nerium odorum)
a. Active principles
b. Use
c. Mode of action
d. Sign and symptoms
e. Fatal dose/ Fatal period
f. Management
i. Modern management
ii. Ayurvedic management
g. Postmortem appearances
h. Medico legal importance
6 Yellow oleander
a. Active principles
b. Sign and symptoms
c. Fatal dose/ Fatal period
d. Management
e. Postmortem appearances
f. Medico legal aspect
7. Case report on Oleander poisoning
8. Historical Incidents on Oleander poisoning.
9. Reference


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Introduction to Ayurveda
Ayurvedic medicine, is one of the oldest systems of medicine in the world. Many Ayurvedic
practices predate written records and were handed down by word of mouth. Two ancient
books, written in Sanskrit more than 2,000 years ago, are considered the main texts on
Ayurvedic medicineCaraka Samhita and Sushruta Samhita. The texts describe eight
branches of Ayurvedic medicine:
1. Internal medicine
2. Surgery
3. Treatment of head and neck disease
4. Gynecology, obstetrics, and pediatrics
5. Toxicology
6. Psychiatry
7. Care of the elderly and rejuvenation
8. Sexual vitality.
Introduction to Agadhtantra (Toxicology)
Agada tantra or toxicology is a branch of Ashtang Ayurveda, which includes the science of
poisons. The tradition of Agada tantra practice is very ancient. It originated from the school
of toxicology, which was founded and run by Kashyapa, also known as Vriddhakashyapa, the
great saint and medical practioner. The students of the Kashyapa School of toxicology later
became royal vaidyas (doctors) in various kingdoms and were meant to protect the
members of the royal families from being poisoned. They were at times also used to
administer poison to their kings enemies. Even now the traditional practice of toxicology is
done by different families of Vishavaidyas (poison doctors) who claim to be specialists in
toxicology.
Damstra or Visha chikitsa, as the Aganda Tantra is popularly known, deals with various
methods of cleaning the poisons out of the body as well as recommends antidotes for
particular poisons. It deals with a wide range of natural toxins originating from wild lives like
animals, birds, insects etc., plants including herbs (belladonna, aconite etc.), vegetables,
minerals (leads, mercury, arsenal etc.) and artificial poisons prepared from poisonous drugs.
This branch also deals with air and water pollution, which are basically the causes of various
dangerous epidemics.
Types of Poisons
There are two types of poisons that have been described in the Agada tantra-
i. The Natural poisons and
ii. The Artificial poisons.
The natural poisons are classified as inanimate (Sthaavara) and animate (Jangama).
Inanimate poisons or the Staavara comprise of poisons that have plant origin and toxic
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minerals, metals or metal ores that are found inside the earth. Animate poisons or Jangama
consist of the venoms of animals like snakes, scorpions, worms, insects etc. Artificial poisons
are the invented poisons which are prepared by combining different kinds of animate and
inanimate poisons.
Apart from the above mentioned poisons, the three samhitas described about this branch of
toxicology, also include the description and disadvantages of food of opposite qualities,
drugs and food causing chronic poisoning symptoms. There are also descriptions of certain
poisons that are used as medicines after proper processing and quantification, precious
stones like diamond, ruby and poisonous minerals like lead and mercury are few of them.
This branch of Ayurveda also has information regarding fatal doses of various poisons.
Oleander ()
Family- Apocynaceae
Sanskrit Synonyms-
1 (Vegetable poison)
4| * ( . . )
According to Sushruta samhita Kalpasthana 2|5; Oleander is in the group of 8 root poisons.
Oleander is a cardiac poison.
It is mainly of two types.
i. Nerium odorum (White Oleander)
ii. Cerebra thevetina or Thevetia nerrifolia (Yellow Oleander)
According to the color of flower it is of 3 types- White , red, and yellow. However,
botanically white flowering and red flowering oleander are similar.
White Oleander (Nerium odorum)
The plant grows wild in all part of country upto 5000ft. Leaves are lanceolate, needle
shaped. Flowers are in clusters and are pinkish or whitish aromatic. Fruit 5-7 inch. Long. It is
latex bearing and 10 feet in height.
All parts of the plants are toxic , particularly leaves and roots.
Active principles-
It contains cardiac glycosides:
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a. Neriin- This is made up of 3 glycosides. They are -: Neriodorin , Neriodorein and
Karabin
Other glycosides are
b. Oleandrin
c. Folinerin
d. Rosagenin
Uses:-
a. It is commonly used by quakes in the treatment of various disease like leprosy,
malaria etc.
b. Illegal abortifacient
Mode of action in the body:-
The active principle neriin is like digitalis acting in the heart. Neriin is a cardiac glycoside.
Cardiac glycoside inhibits Na
+
/K
+
pump by stabilizing it.
In membrane of a cardiac myocyte there are mainly two exchange pumps:-
a. Na
+
/K
+
exchange pump
b. NCX (Na
+
/Ca
++
exchange pump)
In normal cardiac myocyte:
Na
+
/K
+
pump allows the K
+
ion to come inside the myocyte in exchange of Na
+
ion; that goes
outside the cell membrane.
To reoccupy the Na
+
loss from Na
+
/K
+
pump; Na
+
get inside the membrane from Na
+
/Ca
++

exchange pump (NCX). This Na
+
ion further exchange with Ca
++
ion that are present inside
the membrane in the ratio 3Na
+
:1Ca
++
. This process makes cardiac muscle fibres to relax
and thus heart contract rhythematically.
Now; If the cardiac glycosides like Neriin is introduced to the body;

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Fig:- Different pumps in Cardiac myocyte and blocking of Na
+
/K
+
pump by Cardiac glycoside.
Cardiac glycosides inhibits the Na
+
/K
+
pump. This results in raised intracellular Na
+
ion
concentration . Raised intracellular Na
+
ion further blocks the functioning of Na
+
/Ca
++

exchange pump by blocking the incoming Na
+
ion from this pump.
This then leads to an accumulation of intracellular calcium via the Na
+
/Ca
++
exchange
system. In the heart, increased intracellular calcium causes more calcium to be released by
the sarcoplasmic reticulum, thereby making more calcium available to bind to troponin-C,
which increases contractility (inotropy). Inhibition of the Na
+
/K
+
-ATPase in vascular smooth
muscle causes depolarization, which causes smooth muscle contraction and
vasoconstriction.
This faster and powerful contraction disturbs the heart beat rhythm hence cause different
heart related symptoms.
Sign and Symptoms
a. Nausea, Vomiting
b. Trachycardia
c. Ventricular fibrillation
d. AV block and death usually results from cardiac failure
Fatal Dose-
Leaves - 5 to 15
Root 15 gms
Fatal period- Usually dies within 24-36 hrs
Management
a. According to Modern
i. ECG monitoring
ii. Sodium molar lactate transfusion with glucose and 1mg atropine, 2cc
adrenaline and 2mg Noradrenaline can correct cardio vascular abnormalities.
iii. Correction of fluid and electrolyte balance.

b. According to Ayurveda
4 :
( | /)
Buffalo curd mixed with sugar or buffalo milk and also the powder of arkatvaka
mixed with water ; if consumed orally it cures all poisonous effects of Karavira.

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This Ayurveda treatment procedure can be co-related with the modern approach of
management as below:-
i. Buffalo curd and milk contains more concentration of lactose as compared to
cow and other dietary products, so this can be co-related to Sodium molar
lactate solution.
ii. Sugar is a glucose.
iii. Powder of arka (Calotropis procera) twak contains the chemical calotropin,
Calotropin and atropine as they both act on heart and similar cardiac
function, can be regarded as similar. Hence, powder of arka twak (Calotropis
procera) can be co-related with atropine.
In this way; the use of buffalo curd or milk along with sugar and arka twak includes the
modern management procedure.
Postmortem appearances
No specific signs
Patechiae are often seen on heart
Nerium resists putrefaction and even burning and can be detected long after death.
Medico legal importance
a. As it is easily available, it is very often used as a suicidal agent. Usually a decoction of
root is prepared and consumed.
b. Due to the quacks; accidental poisoning may occur.
c. Also useful for the illegal abortion.
Yellow oleander (Cerebra thevetia)
Yellow oleander plants are usually around 12 feet in height. Its leaes are needle shaped.
Flowers are yellowish and bell shaped. Fruits are globulose, light green, 1.5 to 2 in
diameter. Nuts are biconvexed, triangular and grooved on the basal margin. All parts of
plant are toxic esp. fruit.
Active principles-
a. Thevetin (white fibrous glycosides; some found in skin)
b. Cerberin
c. Thevotoxin
d. Peruvoside (a glycoside)
Signs and Symptoms
a. Burning sensation in mouth, dryness, tingling and numbness feeling in mouth ,
tongue and oesophagus.
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b. Vomiting, headache, griddiness, diarrhea etc.
c. Dilated pupils and sense of fainting
d. Rapid irregular weak pulse
e. Low BP , collapse, heart block, pereferal circulatory failure and death.
Fatal dose - 8-10 seeds or 15-20 gms of root.
Fatal period 24-36 hrs; in some case within 1 hrs.
Management
a. Stomach wash for unabsorbed poison.
b. Symptomatic treatment
c. As in white oleander
Postmortem appearences
Nothing specific
Internally; fragment of the seeds or roots may be present in the stomach.
Medicolegal aspect
a. Used as an abortifacient
b. As suicidal poisons as it is easily available.
c. Homicidal is rare due to high fatal dose.
d. Accidental is more in children.
Purification of Oleander
No methods of purification have been mentioned and are only used in external part; for
therapeutic purpose.
Case report on Oleander poisoning
A 37-year-old man ingested a "handful" of N. oleander leaves. Two hours later, he
presented with bradycardia (30 to 45 bpm) with sinoatrial block and junctional escape. He
was treated with a single dose of five vials of digoxin-specific Fab antibody fragment
(Digibind). The pre-treatment apparent digoxin level was 1.5 mcg/L. After treatment the
patient improved, with a sinus bradycardia (56 bpm), and recovered uneventfully (Shumaik
et al., 1988).
Historical Incidents on Oleander poisoning.
Soldiers sleeping on oleander branches were reported to have died according to the
Gardener's Chronicle in 1880.
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In 1989, the Western Journal of Medicine reported the case of an 83 year old woman
who attempted suicide by drinking a tea made of an infusion of Oleander leaves. She
suffered severe bradycardia with a pulse rate of 40 and was treated with atropine to
counteract this. There are other reports in the literature of failed suicide attempts.
In 2005, the Los Angeles Daily News reported the case of Fudgie, a dwarf cow
beloved of the primary school students in its area. Fudgie ate some oleander
branches and suffered cardiac arrest. It was fortunate that the vet called in knew a
senior toxicologist because between them they restarted Fudgie's heart twelve times
over the week that it took for the cow to recover. The vet apparently kicked Fudgie
in the chest to restart his heart.
In August 2009, 23 horses at Rockridge Farm in Rancho Santa Fe near San Diego were
reported to have been poisoned after an intruder broke into the stables during the
night and fed them oleander leaves. When staff opened the barn at 6 am they found
one horse already seriously ill and the others showing the first signs of poisoning.
The workers say they found oleander leaves in the stalls as well as remains of carrots
and apples thought to have been used to disguise the bitter taste of the plant.
Three horses were transferred to a veterinary hospital, though two were well
enough to be released the next day, and the rest were treated at the ranch.
In July 2011, a giraffe died at a zoo in Tucson, Arizona, after being accidentally fed
oleander leaves by an apprentice keeper. Another animal was taken ill but survived
with careful medical attention. The zoo had a long-standing policy of feeding
clippings from its extensive grounds to its browsing animals but, it seems, the
apprentice went against the policy that only material identified by the head grounds'
keeper should be collected.
Reference
1. A text book of Agada Tantra Dr. U.R. Sekhar Namburi
2. ( | 7) . 9
3. Poisonous (VISHA) plants in Ayurveda Dr. L.B. Singh
4. Principles of forensic medicine Apurba Nanda
5. Text book of medical physiology 11
th
Edition Guyton and Hall
6. http://www.thepoisongarden.co.uk/atoz/nerium_oleander.htm
7. http://www.inchem.org/documents/pims/plant/pim366.htm