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=== ''Tattva Vimarsha'' ===  

=== ''Tattva Vimarsha'' ===  

o Seven elements are involved in the pathogenesis of visarpa viz., rakta, lasika, tvak, mamsa, vata, pitta and kapha.  

*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.

*''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 favorable condition for infection or disease phenomenon occurs at first therefore, diet and lifestyle related factors are important preventive measures.

o Excess intake of salt, sour, pungent, hot articles lead to vitiation of rakta first and then lead to visarpa.  

*Excess intake of salt, sour, pungent, hot articles lead to vitiation of ''rakta'' first and then lead to ''visarpa''.  

o Visarpa is manifested externally, internally or in both pathways. Severity of disease increases respectively in these cases.  

*''Visarpa'' is manifested externally, internally or in both pathways. Severity of disease increases respectively in these cases.  

o Classification and pathogenesis of visarpa is based upon involvement of dosha as per their severity. Treatment protocol is designed for primarily involved predominant dosha. If the visarpa is caused with ama dosha (the state of incomplete transformation) and is located in kaphasthana (in thorax and upper body parts), then langhana (fasting therapy), vamana (emesis) therapy, tikta (bitter) drugs internally and application of paste of drugs with dry and cold properties externally is beneficial.  

*Classification and pathogenesis of ''visarpa'' is based upon involvement of ''dosha'' as per their severity. Treatment protocol is designed for primarily involved predominant ''dosha''. If the ''visarpa'' is caused with ''ama dosha'' (the state of incomplete transformation) and is located in ''kaphasthana'' (in thorax and upper body parts), then ''langhana'' (fasting therapy), ''vamana'' (emesis) therapy, ''tikta'' (bitter) drugs internally and application of paste of drugs with dry and cold properties externally is beneficial.  

o The same treatment should be adopted in case of association of ama and location in pitta sthana (abdomen and middle parts of body). In addition, raktamokshana (blood letting) and virechana (therapeutic purgation therapy) are specially indicated.  

*The same treatment should be adopted in case of association of ama and location in pitta sthana (abdomen and middle parts of body). In addition, raktamokshana (blood letting) and virechana (therapeutic purgation therapy) are specially indicated.  

o If sama (with ama dosha) visarpa occurs from vatashaya (pelvis and lower part of body) dry measures are indicated in the beginning. Even in association with rakta-pitta, unction measure is not regarded as beneficial in the beginning.  

*If sama (with ama dosha) visarpa occurs from vatashaya (pelvis and lower part of body) dry measures are indicated in the beginning. Even in association with rakta-pitta, unction measure is not regarded as beneficial in the beginning.  

o In vataja visarpa and paittika visarpa of mild aggravated dosha, tiktaka ghritam is beneficial. But if the pitta dosha is excessively aggravated then virechana should be given.  

*In vataja visarpa and paittika visarpa of mild aggravated dosha, tiktaka ghritam is beneficial. But if the pitta dosha is excessively aggravated then virechana should be given.  

o In the condition of excessively aggravated dosha, ghee should not be given at first, which does not cause virechana. Because non purgating ghee occlude the dosha resulting in decomposed skin, flesh and blood. Hence in visarpa, virechana followed by raktamokshana is recommended because the disorder is located in blood.

*In the condition of excessively aggravated dosha, ghee should not be given at first, which does not cause virechana. Because non purgating ghee occlude the dosha resulting in decomposed skin, flesh and blood. Hence in visarpa, virechana followed by raktamokshana is recommended because the disorder is located in blood.

o If dosha in shakha (body elements) vitiate the blood, then raktamokshana should be administered first. The physician should use vishana (deer horn) in vata dominance, jalauka (Hirudinea medicinalis) in pitta dominance and alabu (lagenaria siceraria) in kapha dominance for blood letting or physician should perform siravyadha (blood letting through vein) promptly from the adjacent vein to the affected part, without which rakta kleda (putrifying blood content) gives rise to decomposed skin, flesh and ligaments.

*If dosha in shakha (body elements) vitiate the blood, then raktamokshana should be administered first. The physician should use vishana (deer horn) in vata dominance, jalauka (Hirudinea medicinalis) in pitta dominance and alabu (lagenaria siceraria) in kapha dominance for blood letting or physician should perform siravyadha (blood letting through vein) promptly from the adjacent vein to the affected part, without which rakta kleda (putrifying blood content) gives rise to decomposed skin, flesh and ligaments.

o External application in the form of pralepa, pradeha and alepana (local applications of pastes) are to be used repeatedly for treatment of external lesions in visarpa.  The guidelines shall be followed for local applications.  

*External application in the form of pralepa, pradeha and alepana (local applications of pastes) are to be used repeatedly for treatment of external lesions in visarpa.  The guidelines shall be followed for local applications.  

o Diet articles with sweet, bitter, cooling and blood pacifying properties is prescribed in the treatment of visarpa.

*Diet articles with sweet, bitter, cooling and blood pacifying properties is prescribed in the treatment of visarpa.

o Vidahi (that causes burning) and viruddha (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds are contraindicated in visarpa.

*Vidahi (that causes burning) and viruddha (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds are contraindicated in visarpa.

o Predominantly shita (cool) measures are prescribed in pitta dominant condition, ruksha in kapha dominant condition and snigdha in vata dominant condition of visarpa. In agni visarpa, vata-pitta pacifying measures are beneficial and in kardama visarpa mostly kapha pitta alleviating measures should be administered.

*Predominantly shita (cool) measures are prescribed in pitta dominant condition, ruksha in kapha dominant condition and snigdha in vata dominant condition of visarpa. In agni visarpa, vata-pitta pacifying measures are beneficial and in kardama visarpa mostly kapha pitta alleviating measures should be administered.

o The granthi visarpa, on inspection is predominant in rakta pitta, the physician experienced in timely management should treat the case with rukshana (de-oleation), langhana (lightening therapy), seka (affusion), and pradeha (external application) of panchavalka, siramoksha (blood letting), jalauka (leech therapy), vamana (emesis therapy), virechana (purgation therapy) and kashaya- tikta (astringent and bitter) ghee preparations. After cleansing of body by vamana and virechana, rakta mokshana should be administered and the measures alleviating vata-kapha are beneficial.

*The granthi visarpa, on inspection is predominant in rakta pitta, the physician experienced in timely management should treat the case with rukshana (de-oleation), langhana (lightening therapy), seka (affusion), and pradeha (external application) of panchavalka, siramoksha (blood letting), jalauka (leech therapy), vamana (emesis therapy), virechana (purgation therapy) and kashaya- tikta (astringent and bitter) ghee preparations. After cleansing of body by vamana and virechana, rakta mokshana should be administered and the measures alleviating vata-kapha are beneficial.

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.

*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'' ===