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Line 49: − === Sanskrit Text, Transliteration and English Translation ===+ Line 66:
Line 66: − + − ==== Agnivesha’s queries on ''visarpa'' ====+ Line 175:
Line 175: − ==== Definition of ''visarpa'' ====+ Line 194:
Line 194: − ==== Classification ====+ Line 243:
Line 243: − ==== Vitiated factors ====+ Line 262:
Line 262: − ==== Etiology ====+ Line 357:
Line 357: − ==== Pathways of spreading the disease ====+ Line 404:
Line 404: − ==== Causes and features of internal and external ''visarpa'' ====+ Line 435:
Line 435: − ==== Bad prognostic features ====+ Line 454:
Line 454: − ==== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ====+ Line 481:
Line 481: − ==== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ====+ Line 510:
Line 510: − ==== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ====+ Line 531:
Line 531: − ==== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ====+ Line 558:
Line 558: − ==== Etio-pathogenesis and clinical features of ''kapha-pitta'' dominant ''kardam visarpa'' ====+ Line 587:
Line 587: − ==== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ====+ Line 604:
Line 604: − ==== ''Upadrava'' (complications) ====+ Line 623:
Line 623: − ==== Severity of ''visarpa'' ====+ Line 636:
Line 636: − ==== Prognosis of ''visarpa'' ====+ Line 649:
Line 649: − ==== Principles of treatment ====+ Line 746:
Line 746: − ==== Formulations used in ''visarpa'' ====+ Line 920:
Line 920: − ==== Formulations for ''dosha'' situated in ''koshtha, pitta'' dominant ''visarpa'' and ''virechana'' ====+ Line 1,015:
Line 1,015: − ==== Formulations for ''dosha'' situated in ''shakha'' and modes of blood letting ====+ Line 1,052:
Line 1,052: − ==== External applications ====+ Line 1,442:
Line 1,442: − ==== Guidelines for local application and its types ====+ Line 1,581:
Line 1,581: − ==== Diet recipes for treatment of ''visarpa'' ====+ Line 1,678:
Line 1,678: − ==== Contra-indications in ''visarpa'' ====+ Line 1,697:
Line 1,697: − ==== General guidelines of treatment ====+ Line 1,730:
Line 1,730: − ==== Treatment of ''granthi visarpa'' ====+ Line 2,019:
Line 2,019: − ==== Treatment of ''galaganda'' ====+ Line 2,052:
Line 2,052: − ==== Importance of ''raktamokshana'' in ''visarpa'' ====+ Line 2,097:
Line 2,097: − ==== Summary ====+ Line 2,186:
Line 2,186: − ==== Causative factors of ''visarpa'' in contemporary era ====+ − ==== Pathophysiology of ''Visarpa'' [flow chart] ====+ − ==== Common clinical conditions considered under ''visarpa'' ====+ Line 2,213:
Line 2,213: − ==== Current clinical practices in management of ''visarpa'' ====+ − ===== Experience based =====+ Line 2,223:
Line 2,223: − ===== Evidence based =====+ − ==== Researches done on ''visarpa'' ====+ Line 2,246:
Line 2,246: − − === Glossary ===
no edit summary
''Kshataja visarpa'' is another variety mentioned additionally in Sushruta Samhita. The later texts followed the same description with addition of some medications.
''Kshataja visarpa'' is another variety mentioned additionally in Sushruta Samhita. The later texts followed the same description with addition of some medications.
== Sanskrit Text, Transliteration and English Translation ==
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Now I shall expound the chapter on the therapeutics of acute spreading disorder known as ''visarpa''. Thus said Lord Atreya. [1]
Now we shall expound the chapter "Visarpa Chikitsa" (Management of acute spreading erysepalas). Thus said Lord Atreya. [1-2]
=== Agnivesha’s queries on ''visarpa'' ===
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Having heard the queries of Agnivesha, Atreya Punarvasu, the foremost among the sages, explained all the relevant details of the disease ''visarpa''. [3-10]
Having heard the queries of Agnivesha, Atreya Punarvasu, the foremost among the sages, explained all the relevant details of the disease ''visarpa''. [3-10]
=== Definition of ''visarpa'' ===
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It spreads in various ways hence known as ''visarpa''. It is also called ''parisarpa'' due to its extensive spreading.[11]
It spreads in various ways hence known as ''visarpa''. It is also called ''parisarpa'' due to its extensive spreading.[11]
=== Classification ===
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The variety due to morbid ''vata-pitta'' is ''agnivisarpa, kapha-vata'' cause ''granthi visarpa'' and ''pitta-kapha'' leads to serious condition known as ''kardamaka visarpa''. [12-14]
The variety due to morbid ''vata-pitta'' is ''agnivisarpa, kapha-vata'' cause ''granthi visarpa'' and ''pitta-kapha'' leads to serious condition known as ''kardamaka visarpa''. [12-14]
=== Vitiated factors ===
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Blood, lymph, skin, flesh and three ''dosha'', these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]
Blood, lymph, skin, flesh and three ''dosha'', these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]
=== Etiology ===
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By combination of above mentioned etiological factors, the provoked ''vatadi dosha'' affect the susceptible body elements such as ''rakta, lasika'' etc. and spread in the body in those indulged in unwholesome diet. [16-22]
By combination of above mentioned etiological factors, the provoked ''vatadi dosha'' affect the susceptible body elements such as ''rakta, lasika'' etc. and spread in the body in those indulged in unwholesome diet. [16-22]
=== Pathways of spreading the disease ===
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The humors provoked in internal regions spreads internally, if provoked in external regions spreads externally and if provoked in both regions spreads all over the body.[23-25]
The humors provoked in internal regions spreads internally, if provoked in external regions spreads externally and if provoked in both regions spreads all over the body.[23-25]
=== Causes and features of internal and external ''visarpa'' ===
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Affliction of vital organs, impaired consciousness, impaired circulation, morbid thirst and impaired natural urges and sudden reduction in digestive as well as immune power of body is known as ''antah-visarpa''. ''Bahih-visarpa'' should be understood by the external manifestations appearing on skin flesh etc. and by their own specific symptoms. [26-27]
Affliction of vital organs, impaired consciousness, impaired circulation, morbid thirst and impaired natural urges and sudden reduction in digestive as well as immune power of body is known as ''antah-visarpa''. ''Bahih-visarpa'' should be understood by the external manifestations appearing on skin flesh etc. and by their own specific symptoms. [26-27]
=== Bad prognostic features ===
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''Visarpa'' manifesting with all signs and symptoms, having strong etiological factors, which is associated with formidable complications and that situates as well as affects vital parts, proves fatal.[28]
''Visarpa'' manifesting with all signs and symptoms, having strong etiological factors, which is associated with formidable complications and that situates as well as affects vital parts, proves fatal.[28]
=== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ===
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Its signs and symptoms are giddiness, burning sensation, excessive thirst, pricking sensation, severe pain, body ache, cramps, shivering, fever, feeling of entering in darkness, cough, breaking and splitting pains in the bones and joints, looseness in joints, trembling, anorexia, indigestion, congestion of the eyes, lacrimation and paresthesia; the region where the inflammation is spreading becomes blackish and reddish in color and edematous. The patient suffers from severe pricking, splitting or aching pain in the part affected as also extension and contractions of the parts, horripilation and quivering. If not treated it gives rise to quick bursting small blackish or reddish blisters with thin clear reddish and scanty discharge. The patient also suffers from the retention of flatus, urine and feces. Etiological factors do not suit and the contrary ones suit the patient, this is ''vata'' dominant ''visarpa''. [29-30]
Its signs and symptoms are giddiness, burning sensation, excessive thirst, pricking sensation, severe pain, body ache, cramps, shivering, fever, feeling of entering in darkness, cough, breaking and splitting pains in the bones and joints, looseness in joints, trembling, anorexia, indigestion, congestion of the eyes, lacrimation and paresthesia; the region where the inflammation is spreading becomes blackish and reddish in color and edematous. The patient suffers from severe pricking, splitting or aching pain in the part affected as also extension and contractions of the parts, horripilation and quivering. If not treated it gives rise to quick bursting small blackish or reddish blisters with thin clear reddish and scanty discharge. The patient also suffers from the retention of flatus, urine and feces. Etiological factors do not suit and the contrary ones suit the patient, this is ''vata'' dominant ''visarpa''. [29-30]
=== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ===
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The etiological factors do no suit and the contrary ones suit the patient. This is ''pitta'' dominant ''visarpa''. [31-32]
The etiological factors do no suit and the contrary ones suit the patient. This is ''pitta'' dominant ''visarpa''. [31-32]
=== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ===
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Its signs and symptoms are chills, fever with chills, heaviness, excess sleep, drowsiness, adherence of sticky material in the mouth, excess spitting, vomiting, lassitude, timidity, loss of appetite and prostration. The region where the disease spreads becomes edematous, pallor or slight red, unctuous, numbness, rigidness, heaviness and slight pain. It suppurates hardly and chronic in nature. It is studded with eruptions which are covered with a thick skin and having white pale color. When burst, they discharge white, slimy, fibrinous, dense, sticky and viscid discharge from it. Thereafter it is followed by the ulcers which are heavy, deep seated, surrounded by capillary network, unctuous and covered with many skin scabs. These ulcers are chronic in nature. The nails, eyes, face, skin, urine and faces of the patient appear pale. The etiological factors do no suit and the contrary ones suit the patient. This is ''kaphaja visarpa''. [33-34]
Its signs and symptoms are chills, fever with chills, heaviness, excess sleep, drowsiness, adherence of sticky material in the mouth, excess spitting, vomiting, lassitude, timidity, loss of appetite and prostration. The region where the disease spreads becomes edematous, pallor or slight red, unctuous, numbness, rigidness, heaviness and slight pain. It suppurates hardly and chronic in nature. It is studded with eruptions which are covered with a thick skin and having white pale color. When burst, they discharge white, slimy, fibrinous, dense, sticky and viscid discharge from it. Thereafter it is followed by the ulcers which are heavy, deep seated, surrounded by capillary network, unctuous and covered with many skin scabs. These ulcers are chronic in nature. The nails, eyes, face, skin, urine and faces of the patient appear pale. The etiological factors do no suit and the contrary ones suit the patient. This is ''kaphaja visarpa''. [33-34]
=== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ===
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The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the ''vata'' which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]
The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the ''vata'' which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]
=== Etio-pathogenesis and clinical features of ''kapha-pitta'' dominant ''kardam visarpa'' ===
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The part where the disease spreads looks as if filled with reddish, yellowish, pale eruptions. The affected part becomes muddy, black, dirty, unctuous, excess hot, heavy, dull aching, edematous, with deep seated suppuration, having no discharge, rapidly become sloughy, sweated suppurated, having putrid flesh and skin, gradual little pain, when touched bursts and gives space on pressing, throws out decomposed and putrefied flesh, shows blood vessels, ligaments and has cadaverous smell and causes disturbed consciousness as well as memory. This is called ''kardam visarpa'' and is incurable. [37-38]
The part where the disease spreads looks as if filled with reddish, yellowish, pale eruptions. The affected part becomes muddy, black, dirty, unctuous, excess hot, heavy, dull aching, edematous, with deep seated suppuration, having no discharge, rapidly become sloughy, sweated suppurated, having putrid flesh and skin, gradual little pain, when touched bursts and gives space on pressing, throws out decomposed and putrefied flesh, shows blood vessels, ligaments and has cadaverous smell and causes disturbed consciousness as well as memory. This is called ''kardam visarpa'' and is incurable. [37-38]
=== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ===
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In a person having aggravated blood, vitiated ''kapha-pitta'' provoke blood giving rise to a series of glandular enlargements which are exceedingly painful, large or small or elongated or round and of red color, located in blood vessels, ligaments, flesh and skin. Being afflicted, complications arise like fever, diarrhea, cough, hiccup, dyspnea, emaciation disturbed consciousness, abnormal complexion, anorexia, indigestion, excess salivation, vomiting, fainting, breaking pain in body , excessive sleep, restlessness, malaise, the patient associated with these complications goes beyond the reach of all remedial measures and as such is rejectable. This is ''granthi visarpa''.[39]
In a person having aggravated blood, vitiated ''kapha-pitta'' provoke blood giving rise to a series of glandular enlargements which are exceedingly painful, large or small or elongated or round and of red color, located in blood vessels, ligaments, flesh and skin. Being afflicted, complications arise like fever, diarrhea, cough, hiccup, dyspnea, emaciation disturbed consciousness, abnormal complexion, anorexia, indigestion, excess salivation, vomiting, fainting, breaking pain in body , excessive sleep, restlessness, malaise, the patient associated with these complications goes beyond the reach of all remedial measures and as such is rejectable. This is ''granthi visarpa''.[39]
=== ''Upadrava'' (complications) ===
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''Upadrava'' (complication) is disorder itself, outsized or undersized manifesting in the later period of a disease and rooted in the same (disease). ''Upadrava'' is so named because it manifests after the disease. Hence the main disease is primary and complication is secondary, it is generally pacified when the main disease gets pacified. It is more troublesome than the main disease itself, because it appears in the later stages of disease when the body is already weakened. Hence, one should treat the complications very promptly.[40]
''Upadrava'' (complication) is disorder itself, outsized or undersized manifesting in the later period of a disease and rooted in the same (disease). ''Upadrava'' is so named because it manifests after the disease. Hence the main disease is primary and complication is secondary, it is generally pacified when the main disease gets pacified. It is more troublesome than the main disease itself, because it appears in the later stages of disease when the body is already weakened. Hence, one should treat the complications very promptly.[40]
=== Severity of ''visarpa'' ===
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The ''visarpa'' which is caused by all etiological factors, manifesting with all signs and symptoms, spreads in all body elements very rapidly and great disastrous is known as ''sannipataja visarpa'' and is not treatable. [41]
The ''visarpa'' which is caused by all etiological factors, manifesting with all signs and symptoms, spreads in all body elements very rapidly and great disastrous is known as ''sannipataja visarpa'' and is not treatable. [41]
=== Prognosis of ''visarpa'' ===
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Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ''dhatus'', very fulminant and refractory to treatment.[42]
Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ''dhatus'', very fulminant and refractory to treatment.[42]
=== Principles of treatment ===
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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.[43-49]
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.[43-49]
=== Formulations used in ''visarpa'' ===
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Physician should administer ''patola patra'' (Trichosanthes dioica Roxb.), ''mudga'' (green gram) and ''amalaki'' juice (Emblica officinalis) mixed with ghee. [54-61]
Physician should administer ''patola patra'' (Trichosanthes dioica Roxb.), ''mudga'' (green gram) and ''amalaki'' juice (Emblica officinalis) mixed with ghee. [54-61]
=== Formulations for ''dosha'' situated in ''koshtha, pitta'' dominant ''visarpa'' and ''virechana'' ===
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When the morbid ''dosha'' are situated in ''kostha'' (internally), these measures should be administered.[62-67]
When the morbid ''dosha'' are situated in ''kostha'' (internally), these measures should be administered.[62-67]
=== Formulations for ''dosha'' situated in ''shakha'' and modes of blood letting ===
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If ''dosha'' in ''shakha'' (body elements) vitiate the blood then ''raktamokshana'' should be administered at 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. [68-70]
If ''dosha'' in ''shakha'' (body elements) vitiate the blood then ''raktamokshana'' should be administered at 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. [68-70]
=== External applications ===
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All these external applications as ''pradeha'' should be used for ''samprasadana'' (cleansing and pacifying the blood). [71-98]
All these external applications as ''pradeha'' should be used for ''samprasadana'' (cleansing and pacifying the blood). [71-98]
=== Guidelines for local application and its types ===
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If the ''pralepa'' is applied without mixing ghee, it produces same but in excess adverse effects as described for thin ''pralepa''. While getting dried up this ''pralepa'' leads to aggravation of disease manifestation. [99-107]
If the ''pralepa'' is applied without mixing ghee, it produces same but in excess adverse effects as described for thin ''pralepa''. While getting dried up this ''pralepa'' leads to aggravation of disease manifestation. [99-107]
=== Diet recipes for treatment of ''visarpa'' ===
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The persons who have predominance of ''kapha'' and not suited to rice should be given the preparation of barley or wheat or ''purana shali'' which is suitable.[108-114]
The persons who have predominance of ''kapha'' and not suited to rice should be given the preparation of barley or wheat or ''purana shali'' which is suitable.[108-114]
=== Contra-indications in ''visarpa'' ===
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The patient should avoid the ''vidahi'' (that causes burning) and ''viruddha'' (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds.[115]
The patient should avoid the ''vidahi'' (that causes burning) and ''viruddha'' (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds.[115]
=== General guidelines of treatment ===
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In ''agni visarpa, vata-pitta'' pacifying measures are beneficial and in ''kardama visarpa'' mostly ''kapha pitta'' alleviating measures should be administered.[116-117]
In ''agni visarpa, vata-pitta'' pacifying measures are beneficial and in ''kardama visarpa'' mostly ''kapha pitta'' alleviating measures should be administered.[116-117]
=== Treatment of ''granthi visarpa'' ===
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Thus ends the description of the treatment of ''granthi visarpa''.[118-138]
Thus ends the description of the treatment of ''granthi visarpa''.[118-138]
=== Treatment of ''galaganda'' ===
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The ''vatika galaganda'' associated with ''kapha'' may be cured by regular use of ghee, milk and decoction preparations.[139-140]
The ''vatika galaganda'' associated with ''kapha'' may be cured by regular use of ghee, milk and decoction preparations.[139-140]
=== Importance of ''raktamokshana'' in ''visarpa'' ===
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''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 ===
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== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
=== 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.
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] ===
[[File:Visarpa1.png]]
[[File:Visarpa1.png]]
=== 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.
''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.
''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.
''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.
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.
''Shodhana'' and ''shamana'' therapy is described for curable ''visarpa'' and maximum ''visarpa'' cases are incurable. This is challenge to the researchers to apply ''shodhana'' and ''shamana'' therapy in incurable emergency cases along with life saving management to cure the incurable ones.
''Shodhana'' and ''shamana'' therapy is described for curable ''visarpa'' and maximum ''visarpa'' cases are incurable. This is challenge to the researchers to apply ''shodhana'' 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.
''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 [[Ayurveda]] 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 [[Ayurveda]] 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.
#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.
#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.
#Septicemia images available from http://www.google.co.in search.
#Septicemia images available from http://www.google.co.in search.
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