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Line 1,552: − + − Causative factors of visarpa in contemporary era: − Modern point of view visarpa disease is generally caused by a variety of infections. As per Punarvasu Atreya general etiological factors of vispara are diet and life style related, injury, poisons, toxins, burns etc; some of these cause vitiation of dosa and khavaigunya (disease prone condition) in dhatu and some cause direct vitiation of dosa and dhatu leading to visarpa. This is confusing to the new scholars. Atreyas understanding of aetiology is more specific because favourable condition for infection occurs at first then infection therefore diet and lifestyle related factors are described in detail and in the beginning. In treatment plan this concept of favourable environment should be considered. Change in internal body environment is possible by shodhana therapy and aushadha along with treatment of infection. − − − − Pathophysiology of Visarpa [flow chart]: − − − − Common clinical conditions considered under visarpa: − Visarpa is acute and extensive spreading in nature. As kustha is chronic in nature and visarpa is acute therefore spreading kustha should not be interpreted as visarpa. It is observed that Visarpa interpretation to allopath disorders is very confusing to the scholars. It is difficult to label Visarpa as a single entity. For proper interpretation, experienced intelligent expert in emergency treatments is required and diagnostic research in this direction is challenge to the researchers. − Clinical manifestation of vatik visarpa suggests bahih-srita visarpa and generally observed in acute skin infections (erysipelas etc.) and is curable with prompt management. − Paittik visarpa symptoms are suggestive of severe skin disease (erysipelas, extensive herpes, burns etc.) and are curable with appropriate management. − Clinical picture of kaphaja visarpa is progressive spreading but with slow speed and is suggestive of acute skin infection (erysipelas etc.) and is curable. − Agni visarpa is a serious infection of skin and lead to septicaemia like condition. Agnivisarpa with the signs and symptoms described here is a serious ailment and is incurable. This ailment may be cured if vitals are not involved. − The name kardam visarpa is because the affected part appears like kardam (mud). The clinical picture of kardam described here is serious skin infection, necrotizing the adjacent structures (Necrotizing Fasciitis, gangrene etc.) and is incurable. Curability should be considered like agnivisarpa. − Granthi visarpa clinical picture described here is a serious ailment (B cell lymphoma etc.) and associated with complications is incurable. − Sannipatik visarpa clinical picture described here is a very serious manifestation of visarpa and is ubhaya-samsrita. This is like a very serious manifestation of sepsis and is not treatable. − Images of those conditions (either original or with prior copyright permission obtained): − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − + − + − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − − Current clinical practices in management of visarpa: − Experience based: − Prognostic assessment of disease is very important while treating acute disorders. Majority of visarpa cases are having bad prognosis as per experience of Punarvasu Atreya. Even though some cases of curable bahih-srita visarpa may become incurable and fatal if not treated early and promptly. Quick diagnosis of life threatening conditions and prompt life saving management in intensive care unit is required in visarpa disorder. − It is already stated that there are serious diseases which are curable but they cause death if not treated. Agni and kardam visarpa are curable only by the most effective therapeutic measures. Antah-srita and ubhaysamsrita visarpa are incurable or sometimes may be cured by most experienced, intelligent physician with most appropriate timely approach in intensive care unit. Bahihsrita curable visarpa may convert into ubhayasamsrita if not treated appropriately. − Shodhana and shamana therapy is described for curable visarpa and maximum visarpa cases are incurable. This is challenge to the researchers to apply shodhan and shamana therapy in incurable emergency cases along with life saving management to cure the incurable ones. − Evidence based: − Visarpa is acute and fatal in nature and maximum Ayurveda hospitals are not well equipped for emergency managements. Some of clinicians are treating self limiting minor cases of herpes as a visarpa following the treatment of pittaja visarpa. Hence evidence base knowledge of Ayurvedic treatment for visarpa is lacking in contemporary era. − Researches done on visarpa: − Considerable research work is not carried out on visarpa by Ayurveda researchers. This is due to acute and fatal nature of this disease and Ayurveda research centers are not well equipped for emergency managements. Hence it is necessary to work in the direction to treat such incurable fatal condition. Initially research work on this disease may be carried out in collaboration with well equipped intensive care unit and experts in emergency managements. Researchers may work by combining algorithmic Ayurved treatment with Allopath. Incurable and fatal cases of visarpa experienced by Punarvasu Atreya may be cured with early appropriate management in intensive care unit due to advances in drug research and technology. − − − − − − − − − − − Further reading: Line 1,704:
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→Importance of raktamokshana in visarpa
If all the therapeutic measures described here as curative of visarpa be put on one side and raktamokshana on other, they will be found equal.
If all the therapeutic measures described here as curative of visarpa be put on one side and raktamokshana on other, they will be found equal.
Visarpa never occurs without the association of the rakta and pitta hence entirely general treatment has been described. It does not mean that line of treatment as per other dosha predominance is not explained here. Thus, the therapeutic measures both in general and specific cases are described both in brief and in detail. The expert physician should administer these therapies appropriately.(141-143)
Visarpa never occurs without the association of the rakta and pitta hence entirely general treatment has been described. It does not mean that line of treatment as per other dosha predominance is not explained here. Thus, the therapeutic measures both in general and specific cases are described both in brief and in detail. The expert physician should administer these therapies appropriately.(141-143)
Summary:
==== Summary ====
तत्र श्लोकाः-
तत्र श्लोकाः-
निरुक्तं नामभेदाश्च दोषा दूष्याणि हेतवः |
निरुक्तं नामभेदाश्च दोषा दूष्याणि हेतवः |
visarpacikitsitaM nAmaikaviMsho~adhyAyaH||21||
visarpacikitsitaM nAmaikaviMsho~adhyAyaH||21||
Thus ends the twenty first chapter on treatment of visarpa in cikitsasthana in the treatise composed by Agnivesa and redacted by Charaka.[21]
Thus ends the twenty first chapter on treatment of visarpa in cikitsasthana in the treatise composed by Agnivesa and redacted by Charaka.[21]
Tattva:
=== ''Tattva Vimarsha'' ===
o Seven elements are involved in the pathogenesis of visarpa viz., rakta, lasika, tvak, mamsa, vata, pitta and kapha.
o Seven elements are involved in the pathogenesis of visarpa viz., rakta, lasika, tvak, mamsa, vata, pitta and kapha.
o Visarpa is acute spreading disease and fatal in nature. General etiological factors of visarpa are diet and life style related, injury, poisons, toxins, burns etc., some of these cause vitiation of dosha and khavaigunya (disease prone condition) in dhatu and some cause direct vitiation of dosha and dhatu leading to visarpa. Hence favourable condition for infection or disease phenomenon occurs at first therefore, diet and lifestyle related factors are important preventive measures.
o Visarpa is acute spreading disease and fatal in nature. General etiological factors of visarpa are diet and life style related, injury, poisons, toxins, burns etc., some of these cause vitiation of dosha and khavaigunya (disease prone condition) in dhatu and some cause direct vitiation of dosha and dhatu leading to visarpa. Hence favourable condition for infection or disease phenomenon occurs at first therefore, diet and lifestyle related factors are important preventive measures.
o The same line of treatment of granthi should be applied for the treatment of kaphaja galganda. The vatika galaganda associated with kapha may be cured by regular use of ghee, milk and decoction preparations.
o The same line of treatment of granthi should be applied for the treatment of kaphaja galganda. The vatika galaganda associated with kapha may be cured by regular use of ghee, milk and decoction preparations.
Vidhi vimarsha:
=== ''Vidhi Vimarsha'' ===
=
Work in Progress
=== Further reading ===
1. Agnivesha, Charaka, Dridhabala, Charaka samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, edited by Vaidya Yadavaji Trikamji Aacharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990;228.
1. Agnivesha, Charaka, Dridhabala, Charaka samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, edited by Vaidya Yadavaji Trikamji Aacharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990;228.
2. Chakrapanidutta, Commnetator. Charaka Samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990; 225.
2. Chakrapanidutta, Commnetator. Charaka Samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990; 225.
12. Septicemia images available from http://www.google.co.in search.
12. Septicemia images available from http://www.google.co.in search.
Glossary:
=== Glossary ===
CODE CLINICAL
CODE CLINICAL
TERMS PROBABLE
TERMS PROBABLE