Changes

If all the therapeutic measures described here as curative of ''visarpa'' be put on one side and ''raktamokshana'' on other, they will be found equal.  

If all the therapeutic measures described here as curative of ''visarpa'' be put on one side and ''raktamokshana'' on other, they will be found equal.  

''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 ===

=== Summary ===

Now the summing up verses –

Now the summing up verses –

Derivation,synonyms, classification, ''dosha, dushya,'' etiology, the habitat, the severe and mild gradation, symptoms and signs, complications, the nature of complications, prognosis and treatment of curable ones. All these aspects has been explained by Punarvasu Atreya for the inquisitive and intelligent Agnivesha under the treatment of ''visarpa''. [144-146]

Derivation,synonyms, classification, [[dosha]], dushya, etiology, the habitat, the severe and mild gradation, symptoms and signs, complications, the nature of complications, prognosis and treatment of curable ones. All these aspects has been explained by Punarvasu Atreya for the inquisitive and intelligent Agnivesha under the treatment of ''visarpa''. [144-146]

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== Tattva Vimarsha (Fundamental Principles) ==  

== Tattva Vimarsha (Fundamental Principles) ==  

*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 dhatu]], [[vata]], [[pitta]] and [[kapha]].  

*''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.

*''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.

*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''.  

*''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 [[vata]]ja 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 [[rakta]]mokshana 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 [[kapha]]ja galganda''. The ''vatika galaganda'' associated with [[kapha]] may be cured by regular use of ghee, milk and decoction preparations.

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

=== Causative factors of ''visarpa'' in contemporary era ===

=== 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] ===

=== Pathophysiology of ''Visarpa'' [flow chart] ===

''Paittika visarpa'' symptoms are suggestive of severe skin disease (erysipelas, extensive herpes, burns etc.) and are curable with appropriate 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.  

[[Kapha]]ja 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.  

''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.  

==== Evidence based studies ====

==== Evidence based studies ====

''Visarpa'' is acute and fatal in nature and maximum [[Ayurveda]] hospitals have limited facilities for emergency managements. Some of clinicians are treating self limiting minor cases of herpes as a ''visarpa'' following the treatment of ''pittaja visarpa''. A case study on effect of Ayurvedic management in oro-facial herpes was conducted. The diagnosed case of oro-facial herpes in 72-year-old male patient  was treated with medicines of bitter taste (tikta rasa) internally, diet regimen, anulomana variety of therapeutic purgation (virechana) and topical application of cold (sheeta)-dry(ruksha) medicines(lepa). The case is observed symptom free after a total period of 164 days.<ref>Mutnali K, Roopa BJ, Shivaprasad T, Yadav R. Ayurveda management of oro-facial herpes: a case report. J Ayurveda Integr Med. 2020 Jul-Sep;11(3):357-359. doi: 10.1016/j.jaim.2020.06.003. Epub 2020 Aug 4. PMID: 32768346; PMCID: PMC7527852.</ref>

''Visarpa'' is acute and fatal in nature and maximum [[Ayurveda]] hospitals have limited facilities for emergency managements. Some of clinicians are treating self limiting minor cases of herpes as a ''visarpa'' following the treatment of [[pitta]]ja visarpa. A case study on effect of Ayurvedic management in oro-facial herpes was conducted. The diagnosed case of oro-facial herpes in 72-year-old male patient  was treated with medicines of bitter taste (tikta rasa) internally, diet regimen, anulomana variety of therapeutic purgation (virechana) and topical application of cold (sheeta)-dry(ruksha) medicines(lepa). The case is observed symptom free after a total period of 164 days.<ref>Mutnali K, Roopa BJ, Shivaprasad T, Yadav R. Ayurveda management of oro-facial herpes: a case report. J Ayurveda Integr Med. 2020 Jul-Sep;11(3):357-359. doi: 10.1016/j.jaim.2020.06.003. Epub 2020 Aug 4. PMID: 32768346; PMCID: PMC7527852.</ref>

=== Researches done on ''visarpa'' ===

=== Researches done on ''visarpa'' ===

#Vagbhata, Ashtanga Hridyam ,Cikitsa Sthana,18. Visarpa chikitsitam Adhyaya .Translated to English by Prof. K.R. Shrikanth Murthy,  7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.   

#Vagbhata, Ashtanga Hridyam ,Cikitsa Sthana,18. Visarpa chikitsitam Adhyaya .Translated to English by Prof. K.R. Shrikanth Murthy,  7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.   

#Vagbhata,Ashtanga Hridyam , Nidana Sthana, Chap 13 Pandurogasophavisarpa Nidana.Translated by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221. </div>

#Vagbhata,Ashtanga Hridyam , Nidana Sthana, Chap 13 Pandurogasophavisarpa Nidana.Translated by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221. </div>

== References ==  

== References ==