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Line 2,088: − + − − 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:
→Common clinical conditions considered under visarpa
==== Common clinical conditions considered under visarpa ====
==== Common clinical conditions considered under ''visarpa'' ====
''Visarpa'' is acute and extensive spreading in nature. As ''kushtha'' is chronic in nature and ''visarpa'' is acute therefore spreading ''kushtha'' 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 ''vatika visarpa'' suggests ''bahih-srita visarpa'' and generally observed in acute skin infections (erysipelas etc.) and is curable with prompt management.
''Paittika visarpa'' symptoms are suggestive of severe skin disease (erysipelas, extensive herpes, burns etc.) and are curable with appropriate management.
''Kaphaja visarpa'' appears as progressively but gradually spreading ailment, suggestive of acute skin infection (erysipelas etc.) and is curable.
''Agni visarpa'' is a serious infection of skin and lead to septicemia 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. The curable variant should be considered ''agnivisarpa''.
''Granthi visarpa'' is a serious ailment (B cell lymphoma etc.) and associated with complications is incurable.
''Sannipatik visarpa'' is a very serious manifestation of ''visarpa'' and is ''ubhaya-samsrita''. This is like a very serious manifestation of sepsis and is not treatable.
==== 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 ''bahihsrita 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. ''Antahsrita'' 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.
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.