SHRIRAMCHARITMANAS

Balkand 6
There can be no wisdom without company of saints and that is not possible without blessings of Shri Ram. Company of saints is the basis of all bliss and welfare. Achievement of saintly company is the fruit , all else are just flowers.
Even bad people get reformed in saints company like the touch of ‘Paras’ converts iron into gold. When due to hand of God , good people get involved in bad company , even then they follow their good qualities , like the jewel on snake’s head.
Even Brahma , Vishnu , Shiv , Poets and Pandits speech is constrained in describing the significance of saints. How can I describe it ! like a vegetable seller can not describe the qualities of different jewels.
I greet the saints with regards who have equanimity in their heart , who neither have any friend or foe. Like flowers in hands make both hands equally fragrant.
Saints have simple heart and provide welfare to whole world. Knowing their such behavior and affection , I request them to give  me affection in the feet of Shri Ram.

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SHRIRAMCHARITMANAS

Baalkand 5
Immovable faith in own religion is the indestructible tree (Akshyavat) of that pilgrimage king and good deeds its clan. That is available easily to all, , at all times in all places. Paying obeisance to it destroys all sadness.
That pilgrimage king is beyond words and beyond worlds and demonstrates its influence by providing instant gratification.
People who gladly listen and understand significance of the Pilgrimage king Prayag and take dips in it with affection will attain Dharm , Arth , Kaam and Moksh (the 4 Purusharth) , while still in the body (in this life).
The instant effect of taking holy dips in this pilgrimage king is such that a crow becomes a cuckoo and pelican becomes a swan.  Nobody should be surprised on hearing this because the significance of Satsang (proximity with saints) is not hidden from anybody.
Valmiki , Narad and Agastya saints have self described their lives and times. All living and non living  creatures in this world who reside  in water, walk on earth and fly in air…
Of those , whoever , whenever and wherever , with whatever effort have attained wisdom , victory , truth realisation (Sadgati) , intellect and niceties  ,should be  attributable to proximity with saints. There is no other means to achieve these attributes neither in Vedas nor in world.

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SHRIRAMCHARITMANAS

Baalkand 4
The dust from feet of Guru is soft and beautiful application on eyes which destroys the defects of eyes. With that application I clear my eye like intellect and describe the character of Shri Ram , which releases the worldly bondage.
First of all I worship the Gods of  earth , the Brahmins , who take away the doubts created by ignorance. Then with affection and beautiful voice I greet the clan of saints who are the mines of all qualities.
The character of saints is pious like character of cotton whose fruit is devoid of juice , pure white and full of qualifications , which tolerates pain and sorrow to conceal faults of others , because of which they receive reverence in world.
The clan of saints is full of bliss and welfare which is like a moving  pilgrimage king Prayagraj , where  stream of Ganga is like devotion to  Shri Ram and the propagation  of thought of Brahm is goddess Saraswati.
The story of deeds one should do and deeds one should not do is sun’s daughter Yamuna which takes away all the sins of dark age and stories of lord Vishnu and Shankar are like convergence of Ganga , Yamuna and Saraswati at one place (Triveni) . Listening   those stories provides all the bliss and welfare.

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SHRIRAMCHARITMANAS

Baalkand 3
I worship the dust from lotus feet of Guru that is full of good sense of fragrance and affection. That is the essence of the nectar of immortality which destroys the whole family of worldly illnesses.
That dust is the clean covering on the body of pious person Shiva and is the mother of all welfare and bliss , removes the dirt on the mirror like mind of devotee and when placed on forehead , controls a group of qualifications.
The illumination  from the feet nails of Guru is like light from diamonds , by  whose remembrance divine vision is borne in heart. That light destroys the darkness of ignorance. He is a very fortunate person in whose heart that light arrives.
The clean eyes of the heart open up when that light arrives in heart and erases the faults and sorrows of nightlike world and makes  visible the diamonds , concealed and revealed ,  which are like Shri Ram’s character , in whichever mines they are.
Just like the worshipers , enlightened men and knowledgeable persons put on the blessed kajal on eyes and visualize out of curiosity the many mines in mountains , forests and inside the earth.

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SHRIRAMCHARITMANAS

Baalkand 2
May lord Ganesh , remembering whom all deeds are fulfilled , who is lord of the greats and has beautiful face of an elephant , an   epitome of wisdom and house of good qualities , bless me.
By whose grace the dumb becomes a fluent orator and a lame climbs a difficult mountain , he who burns all sins of this dark age , that kind God should be merciful upon me.
He who has the complexion of blue lotus and has eyes like full bloom red lotus and who always reclines in the ocean of milk , that God Narayan may please reside inside my heart.
He who has the fair complexion like kund flower and moon , who is beloved of Parvati and full of mercy and who has affection for the downtrodden , that destroyer of Kaamdev may please bless me.
I worship the lotus feet of Guru , who is the ocean of blessings and is God himself in form of man and whose utterings are like gathering   of sunrays for destruction of dense darkness like great attachments.

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SHRIRAMCHARITMANAS

Baalkand
I worship Sararsvati and Ganesh who are creators of words , sentences , stanzas and emotions and do good to all.
I worship Parvati and Shankar who are embodiment of faith and belief , without whom the wise can not visualize the God situated within themselves.
I worship my Guru who is knowledgeable , eternal and like Shankar , under whose patronage even a curved moon is worshiped everywhere.
I worship the pure scientist and  poet God Valmiki and monkey God Hanuman who roam in the pious forest of qualities of Sita and Ram.
I respectfully greet Sita who is the creator , sustainer and destroyer. She is remover of sorrows and  doer of total welfare and is the beloved of Shri Ramchandra.
I worship God Hari who is called Ram , under whose spell is  whole world , lord Brahma , other lords and demons and in whose power this illusionary world appears true ( just like a rope appears to be a snake ).  His feet only are like boat for those desirous of crossing this oceanlike world.  He is the cause of all reasons and the best of all.
Tulsidas has described this story of Raghunath in extremely pleasant language for his own  bliss after referring to many Puraan , Ved and Shaashtra and those detailed in Ramayana and also those available from other sources.

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SNAKE BITE

Classification of snakes
A . Viperidae :
Mobile front fangs.
1 . Viperinae :
– Russel viper.
– Saw scaled viper.
– Adder.
2 . Crotalinae :
Rattle snake.
They produce cytotoxic venom.
B . Elapidae :
Fixed front fangs.
– Cobras
– Mambas.
– Krait.
They produce neurotoxic venom. King cobra venom also has cytotoxic effects.
C . Colubridae :
Black fangs.
– Boomslang.
– Herald snake.
– Vine snake.
They produce hematoxic venom.
D . Hydrophidae :
Short fixed front fangs.
– Beaked sea snakes.
They produce myotoxic venom.
Clinical features
Children are particularly at risk in areas where snakes are common because of their love for outdoor pursuits together with their curiosity and carelessness.
Majority of bites is not caused by venomous snakes. In these circumstances two distinct puncture marks are not seen and bites are irregular and lacerated with little local swelling or pain.
Even venomous species do not always inflict clinically significant envenomation as bite may be deflected by clothing or venom stores of snake being depleted.
Where envenomation has occurred symptoms tend to be more severe in children because of their smaller size relative to volume of injected venom.
Signs of envenomation seldom occur before 30 minute. Earliest features are those due to fright : shock , pallor , sweating , vomiting , weak pulse and faintness. Severe pain and swelling at site of bite with rapidly spreading edema are first signs in most viperinae and cobra bites. Later large blisters may form around bite and painful lymphadenopathy develops. Sometimes there is excessive bruising in superficial and deeper tissues. Within 6 hours whole limb may become tensely swollen. There is thus profound local cytotoxic effect and subsequent systemic disturbance is due to this tissue damage rather than to circulating venom. Intravascular clotting – fibrinolysis syndrome with resultant hemolytic anemia , hemorrhagic manifestations and hemoglobinuric nephrosis can complicate bite. In heavy envenomation blood stained saliva may be expectorated and circulatory collapse may occur.
Elapidae bites cause less local reaction but have profound systemic effects which are mainly neurotoxic. First symptoms are ptosis , followed by strabismus , slurred speech and dysphagea with drooling saliva. There is confusion and hypersensitivity to tactile stimuli. Respiratory paralysis may result in death in 15 minutes. In survivors there are no neurological sequelae. Hematuria and hemoglobinuria , hemorrhage and menorrhagia may occur.
Sea snake bite may show no local reaction. Initial symptoms due to myotoxin are seen after latent period of 30-120 minutes. There is muscular pain , trismus and stiffness followed by ptosis and progressive weakness which may threaten respiratory function. Myoglobinuria , acute tubular necrosis and acute renal failure may ensue.
Treatment
Anti venom is effective treatment. It carries substantial risk of anaphylaxis and serum sickness.
A . First aid management :
1 . Symptoms developing within first half hour of bite are due to fear and its effects and not to envenomation. Patient should be calmed and reassured and encouraged to lie down quietly so as not to disseminate poison by restless body movements. Affected limb should be kept horizontal and splinted to avoid movements. Mild analgesic should be given.
2 . Bites from non venomous snakes should be thoroughly cleansed with dilute anti septic solution. Any loose teeth removed and tight dressing applied. Tetanus toxoid together with broad spectrum antibiotic should be administered within 24 hours to all cases of snake bite.
3 . Signs of significant envenomation develop from half to two hours after bite. These may be local with swelling and pain or systemic as in case of elapidae. They call for urgent administration of anti venom either intramuscular or intravenous.
4 . Tourniquet :
This should not be applied in case of viper or colubridae bite. Local effects and subsequent complications can be aggravated by compression. However where highly envenomatous snakes with profound systemic manifestations are incriminated eg cobra and especially if there are already signs of systemic toxicity tourniquet should be applied to affected limb above bite to prevent further absorption. It should be broad and tightly applied to constrict arteries and veins. Tourniquet should be completely released for 90 seconds every 15 minutes and finally removed after one hour.
5 . Suction :
It helps in withdrawing venom from fangs puncture.
6 . Incision :
Superficial incisions if made within minutes of bite enhance removal of venom.
7 . Other local measures such as freezing , injection of anti venom , EDTA or other agents into bite have no place and can aggravate tissue damage.
B . Anti venom :
Polyvalent anti sera cover most snake bites. Anti venom is preferably given intravenous but can be given intramuscular when doctor is not available.
Allergic status of patient should be tested with small intra dermal test dose. Adrenaline should be ready. Hydrocortisone should be given before starting anti venom.
Anti venom is best given in intravenous drip , diluted 4 times its volume in normal saline over period of 30 minutes. Initial dose is 40 ml. This should be repeated every 4 hours if response is not good. Upto 200 ml can be given in 24 hours. Venom can be detected in serum by radioimmunoassay.
C . Supportive care :
All severe cases should be hospitalized. If bulbar or respiratory paralysis has developed , airways suction , oxygen and assisted ventilation with or without tracheostomy are required.
Acute renal failure should be managed with adequate intravenous fluid replacements , careful recording of intake and output , urinalysis and plasma urea and electrolytes.
Hemorrhagic manifestations require careful appraisal with coagulation profile as hemorrhagins , fibrinolysins and disseminated intravascular coagulation may be responsible. Intravenous vitamin K , blood transfusion , fresh frozen plasma or fibrinogen , low molecular weight dextran , heparin or epsilon amino caproic acid may be required.
In event of severe local swelling limb should be kept elevated. Bullae should not be burst.
Snake bite death results from :
1 . Victim not being observed for adequate period eg 12-24 hours after bite.
2 . Ant venom being withheld despite clear indication of systemic envenomation.
3 . Wrong anti venom.
4 . Too little anti venom.
Prevention
1 . Treat all snakes with respect.
2 . Endeavour to know snakes in your area.
3 . Watch out in summer months , after rains. Use torch.
4 . Wear boots.
5 . Avoid thickly bushed country and long grass.
6 . Do not panic or run when confronted with snake. Movements will attract attention , whereas snake is likely to move off if you keep still.
7 . Keep appropriate anti snake bite kit you.  

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