Changes

*''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.  

*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.  

*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.  

*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.  

*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.  

*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.

*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.

*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.  

*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''.

*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''.

*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.

*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.

*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'' ===