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→Vidhi Vimarsha
=== ''Vidhi Vimarsha'' ===
=== ''Vidhi Vimarsha'' ===
==== Causative factors of ''visarpa'' in contemporary era ====
Modern point of view ''visarpa'' is generally caused by a variety of infections. As per Punarvasu Atreya, the general etiological factors of ''visarpa'' are diet and lifestyle, 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''. This is confusing to the new scholars. Atreya's understanding of etiology is more specific because favorable 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 favorable 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):
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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:
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.
3. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Cikitsa Sthana, Visarpa Cikitsitam, 21. In: Pt. Dutta R, editor. 2 nd ed., 2003 reprint, Varanasi: Chaukhambha Bharti Academy; 2003. p. 231.
4. Agnivesha, Charaka Samhita, Vidyotini Hindi commentary by Kashiram Shastri and Gorakhnath Chaturvedi, Part II.Cikitsa Sthana, 21. Varanasi: Chaukhambha Bharati Academy; Reprint 2005. p. 235.
5. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chkitsa Sthana, Visarpa Cikitsitam,21, Ayushi hindi commentary Edited by Vd. Khushvaha HS, 1 st edition, Chaukhambha Orientalia Publisher, Varanasi, 2009;224.
6. Chakrapanidatta, Charaka Samhita, Cikitsa Sthana, Visarpa Cikitsitam, 21.Ayurveda Dipika Commentry, Edited by Vd. Yadavaji T. A. 1 st edition, Chaukhambha Orientalia Publications, Varanasi, 2001;227.
7. Sushruta. In: Vaidya Yadavji Trikamji Acharaya, Narayan Ram Acharaya, editors. Sushruta Samhita, Cikitsa Sthana, 17. Varanasi: Chaukhambha Orientalia; 2007. p. 321.
Susruta, Kaviraj Ambikadutt Shastri, Sushruta Samhita, Nidana sthana,10. 11 th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1998. p. 129.
8. Vagbhata, Ashtanga Sangraha, Cikitsa Sthana, 11, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005;229.
9. Vagbhata, Ashtanga Sangraha, Nidana Sthana, 10, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005; 229.
10. Vagbhatta′s Ashtanga Hridyam (text, English translation, notes, appendix, indices). 7 th ed., Vol. 1. Translated by Prof. K.R. Shrikanth Murthy, Cikitsa Sthana,18. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.
11. Vagbhatta′s Ashtanga Hridyam (text, English translation, notes, appendix, indices). 7 th ed., Vol. 1. Translated by Prof. K.R. Shrikanth Murthy, Nidana Sthana, 13. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.
12. Septicemia images available from http://www.google.co.in search.
Glossary:
CODE CLINICAL
TERMS PROBABLE
EQUIVALENT
MEDICAL
TERM DEFINITION / DESCRIPTION
21.1 Visarp
विसर्प Acute spreading disorder in localised or generalised pattern. vividhaṁ sarpati yatō visarpa
Visarpa means erythematous or pustular or glandular etc. lesions which spread rapidly in localised or generalised pattern like erysepalas,gangrene, sepsis, etc.
21.2 Parisarpa
परिसर्प Extensive spreading disorder
parisarpō'thavā nāmnā sarvātaḥ parisarpat
Parisarpa means extensive spreading erythematous or pustular or glandular etc. lesions like erysepalas, gangrene, sepsis, septcaemia etc
21.3 Raga
राग condiments The term originally described for pickled or preserved foods.
21.4 Saḍava
षाडव confectionery Sweets or candy, sweet food products. Confectionery is divided into two broad and somewhat overlapping categories, bakers' confections and sugar confections.
21.5 Haritanaṁ
हरितानां
harita varga dravya ardraka ,lashuna etc. Haritanām iti hārit shāka varga pathitānām ardraka lashunādinām.
21.6 kūrcikanaṁ
कूर्चिकानां inspissated milk
Lactobezoar is a specific type of food bezoar comprising inspissated milk. It is most commonly seen in premature infants receiving formula foods
21.7 Kilaṭanaṁ
किलाटानां
cheese
Nasta kshira pinda is kilaṭ
Cheese is a food derived from milk that is produced in a wide range of flavors, textures, and forms by coagulation of the milk protein casein. It comprises proteins and fat from milk, usually the milk of cows, buffalo, goats, or sheep. During production, the milk is usually acidified, and adding the enzyme rennet causes coagulation. The solids are separated and pressed into final form. Some cheeses have molds on the rind or throughout. Most cheeses melt at cooking temperature.
21.8 Mandakasyaca dadhnaḥ
सेवनान्मन्दकस्य च दध्नः premature curd
Curd has not achieved its normal formation state.
21.9 Saṇḍaki
शाण्डाकि
one made up of fermented wine
Some wines are fermented "on barrel," as opposed to in a neutral container such as a steel or wine-grade HDPE (high density polyethylene)
21.10 Paiṣṭikasya ca
पैष्टिकस्य च pastries
Pastry is a major type of bakers' confectionery. It includes many of the various kinds of baked products made from ingredients such as flour, sugar, milk, butter, shortening, baking powder, and eggs. Small tarts and other sweet baked products are called pastries. Common pastry dishes include pies, tarts, quiches and pasties.
21.11 Praklinnanam
प्रक्लिन्नानाम putrefied food Putrefaction is one of seven stages in the decomposition of the body of a dead animal. It can be viewed, in broad terms, as the decomposition of proteins in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs. It is caused by bacterial or fungal decomposition of organic matter and results in production of noxious odours.
21.12 urdhvaṁ ca
ऊर्ध्वं च
Thereafter or upper part of body This word is used during description of kaphaja visarpa. Meanng can be taken as kaphaja visarpa symptoms occurs on upper part of body or initial subacute symptoms occurs and thereafter severe occurs.
21.13 Pralep
प्रलेपनम्
Thin layer external application Pralepa is cold, thin and non-drying or drying.
Tacrolimus ointment is for external use only and should be applied thinly to affected part. ...
21.14 Pradeha
प्रदेहाः
Thick layer external application Pradeha is hot or cold, thick and nondrying. Pradeha normalises vata and kapha cleanses, heals, normalise swelling and pain. It is used in both open and closed wounds. Pradeha checks discharges, softens, eliminates sloughing flesh, removes inside pus and cleans wonds.
A topical medication is a medication that is applied to a particular place on or in the body ... Some physicians use a thick ointment to replace the waterproof barrier of the inflamed ... It penetrates the stratum corneum outer layer of skin wall. ... viscosity, that is intended for external application to the skin or mucous membranes.
21.15 alepanaṁ
आलेपनं Medium layer external application Alepa is of medium character. Alepa pacifies rakta and pitta.
A cream is an emulsion of oil and water in approximately equal proportions. It penetrates the stratum corneum outer layer of skin wall.. Cream is thicker than lotion, and maintains its shape when removed from its container. It tends to be moderate in moisturizing tendency. For topical steroid products, oil-in-water emulsions are common. Creams have a significant risk of causing immunological sensitization due to preservatives. It has a high rate of acceptance by patients. There is a great variation in ingredients, composition, pH, and tolerance among generic brands.
21.16 Pakyakṣara
पाक्यक्षार Pakya kshar is tikshana kshara and prepared by adding Dantyadi tikshana draya fine powder to mridu kshar.
21.17 Utkarika
उत्कारिका
medicinal pancake oranges; oyster plant; pañcakes & crepes; parsley; pasta & macaroni; pasta .... "Muffin...a term connected with moufflet, an old French word applied to bread, have been employed as food, in the preparation of beverages, and as medicine.
21.18 Upanahaḥ
ऊपनाहः
hot poultice
A poultice, also called cataplasm, is a soft moist mass, often heated and medicated, that is spread on cloth over the skin to treat an aching, inflamed, or painful part of the body. It can be used on wounds such as cuts.
21.19 Ruksana
रूक्षण
Therapeutic measure
inducing dryness One of the six fold therapeutic measures used to induce dryness in the body either internally or externally.
21.20 Kshalana
Cleansing by causing
excessive secretion The term signifies treatment modalities or medicines
having cleansing action by causing excessive secretion of
the bodily fluids.
=== Further reading ===
=== Further reading ===