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Line 21: − + − + − + + + + + + + + + + − ==[[Chikitsa Sthana]] Chapter 21, Chapter on the Management of ''Visarpa'' (acute spreading erysepalas)==+ − + − + − − − + − === Introduction ===+ + + − The twenty first chapter is named [[Visarpa Chikitsa]]. The term ''visarpa'' has two parts viz., ''vi'' and ''sarpa''- ''vi'' stands for ''vividha'' meaning ‘various’ (ways) and ''sarpa'' stands for ''sarpan'' means ‘spreading’. Erythematous, pustular, glandular etc. lesions which spread rapidly in localized or generalized pattern are known as ''visarpa'' (Cha.Chi. Chakrapani 21/11). This aliment is also called ''parisarpa''. The prefix ''pari'' stands for ''paritah'' or ''sarvatah'' meaning all over. The disease which spreads all over the body is called ''visarpa''. (Cha.Chi. Chakrapani 21/11) This indicates that ''visarpa'' is an umbrella term used for acute spreading disorders caused due to vitiation of ''rakta''. + − − − + − + − + − + − + + − === Sanskrit Text, Transliteration and English Translation ===+ + + Line 54:
Line 75: + + + − Now I shall expound the chapter on the therapeutics of acute spreading disorder known as ''visarpa''. Thus said Lord Atreya. [1] + − + − ==== Agnivesha’s queries on ''visarpa'' ==== Line 90:
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Line 186: − ==== Definition of ''visarpa'' ====+ + + Line 174:
Line 201: + − ==== Classification ====+ + Line 190:
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Line 244: + − + − + − + − + − ==== Vitiated factors ====+ + + Line 236:
Line 269: + − + − ==== Etiology ====+ + Line 268:
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Line 366: − + − ==== Pathways of spreading the disease ====+ + Line 344:
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Line 415: − ==== Causes and features of internal and external ''visarpa'' ====+ + Line 384:
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Line 442: + − ==== Bad prognostic features ====+ + + Line 416:
Line 461: + − + − ==== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ====+ + Line 426:
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Line 486: − + − ''Vayu'' aggravated by ununctuous and hot ingredients or by the obstruction due to vitiated ''dosha'', impairs the body elements and spreads in proportion to its strength. + + − + − + − ==== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ====+ + Line 450:
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Line 513: − + − + + − + − + − ==== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ====+ + Line 476:
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Line 536: + + + − ''Kapha'' excessively accumulated due to intake of sweet, sour, salt, unctuous and heavy foods, and also by excessive sleep, vitiates the susceptible body elements and spreads with slow speed in the body. + − + − + − + − ==== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ==== Line 494:
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Line 563: − + + − + − + − ==== Etio-pathogenesis and clinical features of ''kapha-pitta'' dominant ''kardam visarpa'' ====+ + Line 518:
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Line 590: − + − + + − + − ==== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ====+ + + + + + − ''Kapha'' and ''vata'' gets vitiated due to the use of firm, heavy, hard, sweet, cold, unctuous, and ''abhishyandi'' (which increase discharges and cause obstruction) ingredients of diet, lack of physical exercise etc. not following preventive seasonal [[Panchakarma]] purification. Deranged excessively, aggravated, powerful both ''kapha'' and ''vata'' vitiates the susceptible body elements giving rise to ''granthi visarpa''. Thereafter the ''vata'' being occluded by ''kapha'' in its progress and disintegrates ''kapha'' in many ways and gradually giving rise to chain of glands, hardly suppurating and difficult to cure, in the habitats of ''kapha''.+ − 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) ==== + Line 564:
Line 630: + − ==== Severity of ''visarpa'' ====+ − + + + − + + − + − ==== Prognosis of ''visarpa'' ====+ + + + + + − 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 ==== Line 614:
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Line 741: + − + − + − + − + − + − + − ==== Formulations used in ''visarpa'' ====+ + Line 698:
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Line 808: + − + + + − In ''visarpa vamana'' is beneficial with ''patola'' (Trichosanthes dioica Roxb), ''pichumarda'' (Azadirachta indica), ''pippali'' (Piper longum linn), ''madana'' (Randia spinosa) and ''indrayava'' (Holarrhena antidysenterica Linn). + + − Further, all those formulations which will be described in ''kalpasthana'' in connection with the disorders of ''kapha pitta'' should be used for the patients of ''visarpa'' as well because they are eliminative of morbid ''dosha'' and are beneficial.[50-53] − Line 770:
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Line 931: − ==== Formulations for ''dosha'' situated in ''koshtha, pitta'' dominant ''visarpa'' and ''virechana'' ====+ + Line 876:
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Line 1,018: − + − + − + − ==== Formulations for ''dosha'' situated in ''shakha'' and modes of blood letting ====+ + Line 952:
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Line 1,059: + − + − ==== External applications ====+ + Line 1,090:
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Line 1,453: − ==== Guidelines for local application and its types ====+ − + + Line 1,399:
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Line 1,592: − ==== Diet recipes for treatment of ''visarpa'' ====+ − + + Line 1,527:
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Line 1,679: + − + − + − ==== Contra-indications in ''visarpa'' ====+ + + Line 1,605:
Line 1,704: + − ==== General guidelines of treatment ====+ + Line 1,617:
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Line 1,735: + − + − + − ==== Treatment of ''granthi visarpa'' ====+ + Line 1,725:
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Line 2,030: − ==== Treatment of ''galaganda'' ====+ − + + Line 1,933:
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Line 2,057: + − + − + − ==== Importance of ''raktamokshana'' in ''visarpa'' ====+ + Line 1,967:
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Line 2,102: + − + − ==== Summary ====+ + Line 2,011:
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Line 2,172: + − + − + − + − + − + − + − + − + − + − + − + − + − + − + − + − ==== Causative factors of ''visarpa'' in contemporary era ====+ − + − ==== Pathophysiology of ''Visarpa'' [flow chart] ====+ − ==== Common clinical conditions considered under ''visarpa'' ====+ Line 2,096:
Line 2,214: − ''Kaphaja visarpa'' appears as progressively but gradually spreading ailment, suggestive of acute skin infection (erysipelas etc.) and is curable. + Line 2,106:
Line 2,224: − ==== Current clinical practices in management of ''visarpa'' ====+ − ===== Experience based =====+ Line 2,116:
Line 2,234: − ===== Evidence based =====+ − + − ==== Researches done on ''visarpa'' ====+ − + − #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. − #Chakrapanidutta, Commnetator. Charaka Samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990; 225. − #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. − #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. − #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. − #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. − #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. − #Vagbhata, Ashtanga Sangraha, Cikitsa Sthana, 11, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005;229. − #Vagbhata, Ashtanga Sangraha, Nidana Sthana, 10, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005; 229. − #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. − #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. − === Further reading ===+ + + + + + + + + + + + − #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.+ − #Chakrapanidutta, Commnetator. Charaka Samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990; 225. − #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. − #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. − #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. − #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. − #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. − #Vagbhata, Ashtanga Sangraha, Cikitsa Sthana, 11, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005;229. − #Vagbhata, Ashtanga Sangraha, Nidana Sthana, 10, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005; 229. − #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. − #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. − +
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{{CiteButton}}
{{#seo:
|title=Visarpa Chikitsa
|titlemode=append
|keywords=Visarpa, Parisarpa, Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections,Ayurveda, Indian system of medicine, charak samhita.
|description=Chikitsa Sthana Chapter 21. Management of Visarpa (acute spreading erysepalas)
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
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<big>'''[[Chikitsa Sthana]] Chapter 21. Management of Visarpa (acute spreading erysepalas)</big>'''
{{Infobox
{{Infobox
|title = Visarpa Chikitsa
|title = Visarpa Chikitsa
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|header3 =
|data6 = Kendre M.
|label7 = Reviewer
|data7 = Ojha S.N.
|label8 = Editors
|data8 = Ojha S.N., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.022 10.47468/CSNE.2020.e01.s06.022]
}}
}}
<big>'''Abstract </big>'''
<p style="text-align:justify;">This chapter deals with detailed description of etiopathogenesis, classification and management principles of ''visarpa''. This is acute disease with a quick spread involving mainly skin, blood, lymph and muscle tissue due to vitiation of all three [[dosha]]. Disease is clinically presented in three pathways viz. external, internal and both. Based on the involvement of dominant [[dosha]], it is classified into seven types. Prognosis and treatment duration of disease is proportionate to degree of involvement of [[dosha]] and affected internal organs. As the basic nature of disease is [[rakta]] and [[pitta]] dominant, management is focused on body purification treatments especially therapeutic purgation, blood letting, fasting therapy, medicated ghee, use of bitter drugs and various external applications having soothing and cooling effect. Guidelines for external application in the form of ''pralepa, pradeha'' and ''alepa'' are enlisted in the chapter. Blood letting is emphasized as most important treatment in ''visarpa''.
=== Abstract ===
<br/>
This chapter deals with detailed description of etiopathogenesis, classification and management principles of ''visarpa''. This is acute disease with a quick spread involving mainly skin, blood, lymph and muscle tissue due to vitiation of all three ''dosha''. Disease is clinically presented in three pathways viz. external, internal and both. Based on the involvement of dominant ''dosha'', it is classified into seven types. Prognosis and treatment duration of disease is proportionate to degree of involvement of ''dosha'' and affected internal organs. As the basic nature of disease is ''rakta'' and ''pitta'' dominant, management is focused on body purification treatments especially therapeutic purgation, blood letting, fasting therapy, medicated ghee, use of bitter drugs and various external applications having soothing and cooling effect. Guidelines for external application in the form of ''pralepa, pradeha'' and ''alepa'' are enlisted in the chapter. Blood letting is emphasized as most important treatment in ''visarpa''.
'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.
'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.
</p>
== Introduction ==
<div style="text-align:justify;">
The twenty first chapter is named [[Visarpa Chikitsa]]. The term ''visarpa'' has two parts viz., ''vi'' and ''sarpa''- ''vi'' stands for ''vividha'' meaning ‘various’ (ways) and ''sarpa'' stands for ''sarpan'' means ‘spreading’. Erythematous, pustular, glandular etc. lesions which spread rapidly in localized or generalized pattern are known as ''visarpa'' [ Cha.Sa. [[Chikitsa Sthana]] 21/11, Chakrapani]. This aliment is also called ''parisarpa''. The prefix ''pari'' stands for ''paritah'' or ''sarvatah'' meaning all over. The disease which spreads all over the body is called ''visarpa''. [Cha. Sa.[[ Chikitsa Sthana]] 21/11, Chakrapani]. This indicates that ''visarpa'' is an umbrella term used for acute spreading disorders caused due to vitiation of [[rakta]].
In this chapter Atreya answers the queries about ''visarpa'' derivation, synonyms, classification, [[dosha]], dushya,'' etiology, habitat, gradation, symptoms, complications, prognosis and treatment of curable ones. The chapter follows that of[ Cha. Sa. [[Chhardi Chikitsa]] ] because suppression of ''chhardi'' (vomiting) causes [[rakta]] dushti(vitiation of blood) leading to ''visarpa'' indicating that [[rakta]] (blood) vitiating factors and vitiation of [[rakta]] is an important basic underlying phenomenon prior to the ''visarpa''.
In this chapter Atreya answers the queries about ''visarpa'' derivation, synonyms, classification, ''dosha, dushya,'' etiology, habitat, gradation, symptoms, complications, prognosis and treatment of curable ones. The chapter follows that of [[Chhardi Chikitsa]] because suppression of ''chhardi'' (vomiting) causes ''rakta dushti'' (vitiation of blood) leading to ''visarpa'' indicating that ''rakta'' (blood) vitiating factors and vitiation of ''rakta'' is an important basic underlying phenomenon prior to the ''visarpa''.
''Visarpa'' is acute, spreading and fatal in nature leading to death if not treated promptly. On location basis this is classified into ''bahih-shrita'' (externally situated), ''antah-shrita'' (internally situated) and ''ubhayasam shrita'' (all over situated). ''Bahih-shrita visarpa'' is fulminant, spreading skin and flesh infection with symptoms and signs of inflammatory edema, blisters, ulcers, fever, pain etc. and is curable. ''Antah-shrita visarpa'' involves internal vital organs with mild septicaemia and is curable before complications. ''Ubhayasamshrita visarpa'' has advanced manifestations of both types spreading all over body with severe septicaemia and is fatal.
''Visarpa'' is acute, spreading and fatal in nature leading to death if not treated promptly. On location basis this is classified into ''bahih-shrita'' (externally situated), ''antah-shrita'' (internally situated) and ''ubhayasam shrita'' (all over situated). ''Bahih-shrita visarpa'' is fulminant, spreading skin and flesh infection with symptoms and signs of inflammatory edema, blisters, ulcers, fever, pain etc. and is curable. ''Antah-shrita visarpa'' involves internal vital organs with mild septicaemia and is curable before complications. ''Ubhayasamshrita visarpa'' has advanced manifestations of both types spreading all over body with severe septicaemia and is fatal.
''Visarpa'' never occurs without association of ''rakta'' and ''pitta'', hence general treatment of ''visarpa'' is described by considering ''rakta'' and ''pitta'' vitiation. Specific treatments are described by considering particular ''dosha'' involvement.
''Visarpa'' never occurs without association of [[rakta]] and [[pitta]], hence general treatment of ''visarpa'' is described by considering [[rakta]] and [[pitta]] vitiation. Specific treatments are described by considering particular [[dosha]] involvement.
Various etiological factors of ''visarpa'' are diet, life style, injury, poison, toxin, burn etc. vitiates ''rakta'' as well as ''dosha'' (''vata, pitta'' and ''kapha'') and other ''dhatu'' (body elements) leading to fulminant disease requiring urgent medical care.
Various etiological factors of ''visarpa'' are diet, life style, injury, poison, toxin, burn etc. vitiates [[rakta]] as well as [[dosha]] ([[vata]], [[pitta]] and [[kapha]]) and other [[dhatu]] (body elements) leading to fulminant disease requiring urgent medical care.
Seven components are involved in the pathogenesis of ''visarpa'' viz., ''rakta'' (blood), ''lasika'' (lymph), ''tvak'' (skin), ''mamsa'' (flesh), ''vata, pitta'' and ''kapha''. Same components are associated with ''kushtha'' (various skin disorders) but clinical presentation of both the diseases is different because etiological factors act different. As ''kushtha'' is chronic in nature and ''visarpa'' is acute in nature(Cha.Chi. Chakrapani 21/15) therefore spreading ''kushtha'' should not be interpreted as ''visarpa''.
Seven components are involved in the pathogenesis of ''visarpa'' viz., [[rakta]] (blood), ''lasika'' (lymph), ''tvak'' (skin), [[mamsa dhatu]] (flesh), [[vata]], [[pitta'' and ''kapha''. Same components are associated with ''kushtha'' (various skin disorders) but clinical presentation of both the diseases is different because etiological factors act different. As ''kushtha'' is chronic in nature and ''visarpa'' is acute in nature[Cha. Sa. [[Chikitsa Sthana]] 21/15,Chakrapani] therefore spreading ''kushtha'' should not be interpreted as ''visarpa''.
It is also classified into ''vatika, paittika, slaishmika, agni visarpa, kardam visarpa, granthi visarpa'' and ''sannipatik'' on ''dosha'' basis. ''Bahih-shrita visarpa'' involves exterior part i.e. Skin, flesh, etc. of the body having symptoms like inflammatory oedema, blisters, ulcers, fever, pain etc. and is curable. ''Agni visarpa'' and ''kardam visarpa'' may be cured with appropriate timely management otherwise negligence leads to death of the patient. ''Granthi visarpa'' should be treated before complications otherwise it becomes incurable. ''Sannipatika visarpa'' is a severe manifestation of the disease leading to death.(Cha.Chikitsa 21/42)
It is also classified into ''vatika, paittika, slaishmika, agni visarpa, kardam visarpa, granthi visarpa'' and ''sannipatik'' on [[dosha]] basis. ''Bahih-shrita visarpa'' involves exterior part i.e. Skin, flesh, etc. of the body having symptoms like inflammatory oedema, blisters, ulcers, fever, pain etc. and is curable. ''Agni visarpa'' and ''kardam visarpa'' may be cured with appropriate timely management otherwise negligence leads to death of the patient. ''Granthi visarpa'' should be treated before complications otherwise it becomes incurable. ''Sannipatika visarpa'' is a severe manifestation of the disease leading to death.[Cha. Sa. [[Chikitsa Sthana]] 21/42]
In ''visarpa, shodhana'' therapy has given prime importance because ''rakta kleda'' (putrificatory ingredient) and ''dosha'' vitiation is at higher level hence ''samana'' (pacification) therapy is not very effective. ''Visarpa'' never occurs without association of ''rakta'' and ''pitta''. Hence general treatment of ''visarpa'' is described by considering ''rakta'' and ''pitta'' vitiation. Specific treatments are described as per the involvement of ''dosha''. Single ''raktamokshana'' (blood letting) treatment is equal to all of other treatments described for ''visarpa''. (Cha.Chikitsa 21/141-143)
In ''visarpa, shodhana'' therapy has given prime importance because ''rakta kleda'' (putrificatory ingredient) and [[dosha]] vitiation is at higher level hence ''samana'' (pacification) therapy is not very effective. ''Visarpa'' never occurs without association of [[rakta]] and [[pitta]]. Hence general treatment of ''visarpa'' is described by considering [[rakta]] and [[pitta]] vitiation. Specific treatments are described as per the involvement of [[dosha]]. Single ''raktamokshana'' (blood letting) treatment is equal to all of other treatments described for ''visarpa''. [Cha. Sa. [[Chikitsa Sthana]] 21/141-143].
''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.
</div>
== Sanskrit Text, Transliteration and English Translation ==
<div class="mw-collapsible mw-collapsed">
अथातो विसर्पचिकित्सितं व्याख्यास्यामः ||१||
अथातो विसर्पचिकित्सितं व्याख्यास्यामः ||१||
इति ह स्माह भगवानात्रेयः ||२||
इति ह स्माह भगवानात्रेयः ||२||
<div class="mw-collapsible-content">
athātō visarpacikitsitaṁ vyākhyāsyāmaḥ||1||
athātō visarpacikitsitaṁ vyākhyāsyāmaḥ||1||
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
</div></div>
<div style="text-align:justify;">
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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कैलासे किन्नराकीर्णे बहुप्रस्रवणौषधे |
कैलासे किन्नराकीर्णे बहुप्रस्रवणौषधे |
यथावदखिलं सर्वं प्रोवाच मुनिसत्तमः ||१०||
यथावदखिलं सर्वं प्रोवाच मुनिसत्तमः ||१०||
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kailāsē kinnarākīrṇē bahuprasravaṇauṣadhē|
kailāsē kinnarākīrṇē bahuprasravaṇauṣadhē|
yathAvadakhilaM sarvaM provAca munisattamaH||10||
yathAvadakhilaM sarvaM provAca munisattamaH||10||
</div></div>
In the Kailas region inhabited by ''kinnaras'', having numerous water streams and medicinal plants with ever emitting sweet pleasant (''ishat gandha'') aroma by their wealth of flowers, Atreya who had great self-control, was surrounded by great sages and engaged in welfare of all creatures. Then Agnivesha choosing the appropriate time asked politely to his enlightened teacher,
In the Kailas region inhabited by ''kinnaras'', having numerous water streams and medicinal plants with ever emitting sweet pleasant (''ishat gandha'') aroma by their wealth of flowers, Atreya who had great self-control, was surrounded by great sages and engaged in welfare of all creatures. Then Agnivesha choosing the appropriate time asked politely to his enlightened teacher,
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'' ===
<div class="mw-collapsible mw-collapsed">
विविधं सर्पति यतो विसर्पस्तेन स स्मृतः |
विविधं सर्पति यतो विसर्पस्तेन स स्मृतः |
परिसर्पोऽथवा नाम्ना सर्वतः परिसर्पणात् ||११||
परिसर्पोऽथवा नाम्ना सर्वतः परिसर्पणात् ||११||
<div class="mw-collapsible-content">
vividhaṁ sarpati yatō visarpastēna sa smr̥taḥ|
vividhaṁ sarpati yatō visarpastēna sa smr̥taḥ|
parisarpo~athavA nAmnA sarvātaH parisarpaNAt||11||
parisarpo~athavA nAmnA sarvātaH parisarpaNAt||11||
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
स च सप्तविधो दोषैर्विज्ञेयः सप्तधातुकः |
स च सप्तविधो दोषैर्विज्ञेयः सप्तधातुकः |
यस्तु कर्दमको घोरः स पित्तकफसम्भवः ||१४||
यस्तु कर्दमको घोरः स पित्तकफसम्भवः ||१४||
<div class="mw-collapsible-content">
sa ca saptavidhō dōṣairvijñēyaḥ saptadhātukaḥ|
sa ca saptavidhō dōṣairvijñēyaḥ saptadhātukaḥ|
yastu kardamako ghoraH sa pittakaphasambhavaH||14||
yastu kardamako ghoraH sa pittakaphasambhavaH||14||
</div></div>
''Visarpa'' is of seven types as per ''dosha'' basis and it involves seven body elements.
''Visarpa'' is of seven types as per [[dosha]] basis and it involves seven body elements.
Three types of ''visarpa'' are due to the morbidity of individual ''dosha''; one variety is due to the morbidity of all the three ''dosha'' and three varieties are due to the morbidity of any of the two ''dosha''.
Three types of ''visarpa'' are due to the morbidity of individual [[dosha]]; one variety is due to the morbidity of all the three [[dosha]] and three varieties are due to the morbidity of any of the two [[dosha]].
''Vatika, paittika, kaphaja'' and ''sannipatik'' these are the four varieties of ''visarpa'' and the remaining three varieties viz., ''vata-pittaja, kapha-vataja'' and ''pitta-kaphaja'' type will now be described.
''Vatika, paittika, kaphaja'' and ''sannipatik'' these are the four varieties of ''visarpa'' and the remaining three varieties viz., [[vata]]-[[pitta]]ja, [[kapha]]-[[vata]]ja and [[pitta]]-[[kapha]]ja type will now be described.
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 ===
<div class="mw-collapsible mw-collapsed">
रक्तं लसीकात्वङ्मांसं दूष्यं दोषास्त्रयो मलाः |
रक्तं लसीकात्वङ्मांसं दूष्यं दोषास्त्रयो मलाः |
विसर्पाणां समुत्पत्तौ विज्ञेयाः सप्त धातवः ||१५||
विसर्पाणां समुत्पत्तौ विज्ञेयाः सप्त धातवः ||१५||
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raktaṁ lasīkā tvaṅmāṁsaṁ dūṣyaṁ dōṣāstrayō malāḥ|
raktaṁ lasīkā tvaṅmāṁsaṁ dūṣyaṁ dōṣāstrayō malāḥ|
visarpANAM samutpattau vij~jeyAH sapta dhAtavaH||15||
visarpANAM samutpattau vij~jeyAH sapta dhAtavaH||15||
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
लवणाम्लकटष्णानां रसानामतिसेवनात् |
लवणाम्लकटष्णानां रसानामतिसेवनात् |
दूष्यान् सन्दूष्य रक्तादीन् विसर्पन्त्यहिताशिनाम् ||२२||
दूष्यान् सन्दूष्य रक्तादीन् विसर्पन्त्यहिताशिनाम् ||२२||
<div class="mw-collapsible-content">
lavaṇāmlakaṭūṣṇānāṁ rasānāmatisēvanāt|
lavaṇāmlakaṭūṣṇānāṁ rasānāmatisēvanāt|
dUShyAn sandUShya raktAdIn visarpantyahitAshinAm||22||
dUShyAn sandUShya raktAdIn visarpantyahitAshinAm||22||
</div></div>
The following are the causative factors of the ''visarpa'':
The following are the causative factors of the ''visarpa'':
Excessive indulgence in ''lavana'' (salt), ''amla'' (sour), ''katu'' (pungent) and ''ushna'' (hot ingredients); as also in ''amla dadhi'' (sour curd), ''dadhi mastu'' (whey), ''shukta'' (vinegars), ''sura'' (type of liquor) and ''sauviraka'' (type of wine); the use of ''vyapanna madya'' (contaminated wine) or excessive liquor or heat inducing ''raga'' (condiments) and ''sadava'' (confectionery), the use of ''vidahi'' (causes burning), ''shaka'' (vegetables) and ''harita'' (''lashunadi harita'' group ''dravya''), ''kilata'' (cheese), ''kurchika'' (inspissated milk) and ''mandaka'' (immature curd), the use of ''sandaki'' (fermented wine), as also of ''paistika'' (one made up of ''pistamai padarth'' or pastries) and oils made of sesame, black gram and horse gram, the use of flesh of domesticated, wet land and aquatic animals and garlic, the use of the ''praklinna'' (putrified food), ''asatmya'' (unwholesome) and ''viruddha'' (mutually contradictory ingredients), over eating, sleeping during day time, ''ajirnashana'' (eating during indigestion), ''adhyashana'' (eating food immediately after the meal); ''kshatat'' (traumatic injury), ''kshata'' (wounds), ''bandha'' (ligatures), ''prapatana'' (trauma due to falls) over exposure to sun, strainful work, poisons, poisonous air,burns etc.
Excessive indulgence in ''lavana'' (salt), ''amla'' (sour), ''katu'' (pungent) and ''ushna'' (hot ingredients); as also in ''amla dadhi'' (sour curd), ''dadhi mastu'' (whey), ''shukta'' (vinegars), ''sura'' (type of liquor) and ''sauviraka'' (type of wine); the use of ''vyapanna madya'' (contaminated wine) or excessive liquor or heat inducing ''raga'' (condiments) and ''sadava'' (confectionery), the use of ''vidahi'' (causes burning), ''shaka'' (vegetables) and ''harita'' (''lashunadi harita'' group ''dravya''), ''kilata'' (cheese), ''kurchika'' (inspissated milk) and ''mandaka'' (immature curd), the use of ''sandaki'' (fermented wine), as also of ''paistika'' (one made up of ''pistamai padarth'' or pastries) and oils made of sesame, black gram and horse gram, the use of flesh of domesticated, wet land and aquatic animals and garlic, the use of the ''praklinna'' (putrified food), ''asatmya'' (unwholesome) and ''viruddha'' (mutually contradictory ingredients), over eating, sleeping during day time, ''ajirnashana'' (eating during indigestion), ''adhyashana'' (eating food immediately after the meal); ''kshatat'' (traumatic injury), ''kshata'' (wounds), ''bandha'' (ligatures), ''prapatana'' (trauma due to falls) over exposure to sun, strainful work, poisons, poisonous air,burns etc.
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 [[vata]]di [[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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बहिःश्रितः श्रितश्चान्तस्तथा चोभयसंश्रितः |
बहिःश्रितः श्रितश्चान्तस्तथा चोभयसंश्रितः |
बहिर्बहिःप्रकुपिताः सर्वत्रोभयसंश्रिताः ||२५||
बहिर्बहिःप्रकुपिताः सर्वत्रोभयसंश्रिताः ||२५||
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bahiḥśritaḥ śritaścāntastathā cōbhayasaṁśritaḥ|
bahiḥśritaḥ śritaścāntastathā cōbhayasaṁśritaḥ|
bahirbahiHprakupitAH sarvatrobhayasaMshritAH||25||
bahirbahiHprakupitAH sarvatrobhayasaMshritAH||25||
</div></div>
Externally situated (pathogenesis in ''shakha, rasa'' and ''rakta dhatu''), internally situated (pathogenesis in internal organs and other ''dhatu'') and situated in both (externally as well as internally) pathways ''visarpa'' is to be known more and more serious consecutively.
Externally situated (pathogenesis in shakha, [[rasa dhatu]]and [[rakta dhatu]]), internally situated (pathogenesis in internal organs and other [[dhatu]]) and situated in both (externally as well as internally) pathways ''visarpa'' is to be known more and more serious consecutively.
Externally situated ''visarpa'' is curable, internally situated ''visarpa'' is very serious and difficult to cure whereas externally as well as internally situated type is incurable.
Externally situated ''visarpa'' is curable, internally situated ''visarpa'' is very serious and difficult to cure whereas externally as well as internally situated type is incurable.
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'' ===
<div class="mw-collapsible mw-collapsed">
मर्मोपघातात् सम्मोहादयनानां विघट्टनात् |
मर्मोपघातात् सम्मोहादयनानां विघट्टनात् |
अतो विपर्ययाद्बाह्यमन्यैर्विद्यात् स्वलक्षणैः ||२७||
अतो विपर्ययाद्बाह्यमन्यैर्विद्यात् स्वलक्षणैः ||२७||
<div class="mw-collapsible-content">
marmōpaghātāt sammōhādayanānāṁ vighaṭṭanāt|
marmōpaghātāt sammōhādayanānāṁ vighaṭṭanāt|
ato viparyayAdbAhyamanyairvidyAt svalakShaNaiH||27||
ato viparyayAdbAhyamanyairvidyAt svalakShaNaiH||27||
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
यस्य सर्वाणि लिङ्गानि बलवद्यस्यकारणम् |
यस्य सर्वाणि लिङ्गानि बलवद्यस्यकारणम् |
यस्य चोपद्रवाः कष्टा मर्मगो यश्च हन्ति सः ||२८||
यस्य चोपद्रवाः कष्टा मर्मगो यश्च हन्ति सः ||२८||
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yasya sarvāṇi liṅgāni balavadyasya kāraṇam|
yasya sarvāṇi liṅgāni balavadyasya kāraṇam|
yasya copadravAH kaShTA marmago yashca hanti saH||28||
yasya copadravAH kaShTA marmago yashca hanti saH||28||
</div></div>
''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]
</div>
=== Etio-pathogeneis and clinical features of [[vata]] dominant ''visarpa'' ===
<div class="mw-collapsible mw-collapsed">
रूक्षोष्णैः केवलो वायुः पूरणैर्वा समावृतः |
रूक्षोष्णैः केवलो वायुः पूरणैर्वा समावृतः |
तस्य रूपाणि- भ्रमदवथुपिपासानिस्तोदशूलाङ्गमर्दोद्वेष्टनकम्पज्वरतमककासास्थिसन्धिभेदविश्लेषणवेपनारोचकाविपाकाश्चक्षुषोराकुलत्वमस्रागमनं पिपीलिकासञ्चार इव चाङ्गेषु, यस्मिंश्चावकाशे विसर्पो विसर्पति [१] सोऽवकाशः श्यावारुणाभासः श्वयथुमान् निस्तोदभेदशूलायामसङ्कोचहर्षस्फुरणैरतिमात्रं प्रपीड्यते, अनुपक्रान्तश्चोपचीयते शीघ्रभेदैः स्फोटकैस्तनुभिररुणाभैः श्यावैर्वा तनुविशदारुणाल्पास्रावैः, विबद्धवातमूत्रपुरीषश्च भवति, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति वातविसर्पः ||३०||
तस्य रूपाणि- भ्रमदवथुपिपासानिस्तोदशूलाङ्गमर्दोद्वेष्टनकम्पज्वरतमककासास्थिसन्धिभेदविश्लेषणवेपनारोचकाविपाकाश्चक्षुषोराकुलत्वमस्रागमनं पिपीलिकासञ्चार इव चाङ्गेषु, यस्मिंश्चावकाशे विसर्पो विसर्पति [१] सोऽवकाशः श्यावारुणाभासः श्वयथुमान् निस्तोदभेदशूलायामसङ्कोचहर्षस्फुरणैरतिमात्रं प्रपीड्यते, अनुपक्रान्तश्चोपचीयते शीघ्रभेदैः स्फोटकैस्तनुभिररुणाभैः श्यावैर्वा तनुविशदारुणाल्पास्रावैः, विबद्धवातमूत्रपुरीषश्च भवति, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति वातविसर्पः ||३०||
<div class="mw-collapsible-content">
rūkṣōṣṇaiḥ kēvalō vāyuḥ pūraṇairvā samāvr̥taḥ|
rūkṣōṣṇaiḥ kēvalō vāyuḥ pūraṇairvā samāvr̥taḥ|
tasya rUpANi- bhramadavathupipAsAnistodashUlA~ggamardodveShTanakampajvaratamaka-kAsAsthisandhibhedavishleShaNavepanArocakAvipAkAshcakShuShorAkulatvamasrAgamanaMpipIlikAsa~jcAra iva cA~ggeShu, yasmiMshcAvakAshe visarpo visarpati [1] so~avakAshaHshyAvAruNAbhAsaH shvayathumAn nistodabhedashUlAyAmasa~gkocaharShasphuraNairatimAtraMprapIDyate, anupakrAntashcopacIyate shIghrabhedaiH sphoTakaistanubhiraruNAbhaiH shyAvairvātanuvishadAruNAlpAsrAvaiH, vibaddhavātamUtrapurIShashca bhavati, nidAnoktAni cAsya nopasherateviparItAni copasherata iti vātavisarpaH||30||
tasya rUpANi- bhramadavathupipAsAnistodashUlA~ggamardodveShTanakampajvaratamaka-kAsAsthisandhibhedavishleShaNavepanArocakAvipAkAshcakShuShorAkulatvamasrAgamanaMpipIlikAsa~jcAra iva cA~ggeShu, yasmiMshcAvakAshe visarpo visarpati [1] so~avakAshaHshyAvAruNAbhAsaH shvayathumAn nistodabhedashUlAyAmasa~gkocaharShasphuraNairatimAtraMprapIDyate, anupakrAntashcopacIyate shIghrabhedaiH sphoTakaistanubhiraruNAbhaiH shyAvairvātanuvishadAruNAlpAsrAvaiH, vibaddhavātamUtrapurIShashca bhavati, nidAnoktAni cAsya nopasherateviparItAni copasherata iti vātavisarpaH||30||
</div></div>
<div style="text-align:justify;">
[[Vayu]] aggravated by ununctuous and hot ingredients or by the obstruction due to vitiated [[dosha]], impairs the body elements and spreads in proportion to its strength.
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]
</div>
=== Etio-pathogeneis and clinical features of [[pitta]] dominant ''visarpa'' ===
<div class="mw-collapsible mw-collapsed">
पित्तमुष्णोपचारेण विदाह्यम्लाशनैश्चितम् |
पित्तमुष्णोपचारेण विदाह्यम्लाशनैश्चितम् |
तस्य रूपाणि- ज्वरस्तृष्णा मूर्च्छा मोहश्छर्दिररोचकोऽङ्गभेदः स्वेदोऽतिमात्रमन्तर्दाहः प्रलापः शिरोरुक् चक्षुषोराकुलत्वमस्वप्नमरतिर्भ्रमः शीतवातवारितर्षोऽतिमात्रं हरितहारिद्रनेत्रमूत्रवर्चस्त्वं हरितहारिद्ररूपदर्शनं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशस्ताम्रहरितहारिद्रनीलकृष्णरक्तानां वर्णानामन्यतमं पुष्यति, सोत्सेधैश्चातिमात्रं दाहसम्भेदनपरीतैः स्फोटकैरुपचीयते तुल्यवर्णास्रावैश्चिरपाकैश्च, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति पित्तविसर्पः ||३२||
तस्य रूपाणि- ज्वरस्तृष्णा मूर्च्छा मोहश्छर्दिररोचकोऽङ्गभेदः स्वेदोऽतिमात्रमन्तर्दाहः प्रलापः शिरोरुक् चक्षुषोराकुलत्वमस्वप्नमरतिर्भ्रमः शीतवातवारितर्षोऽतिमात्रं हरितहारिद्रनेत्रमूत्रवर्चस्त्वं हरितहारिद्ररूपदर्शनं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशस्ताम्रहरितहारिद्रनीलकृष्णरक्तानां वर्णानामन्यतमं पुष्यति, सोत्सेधैश्चातिमात्रं दाहसम्भेदनपरीतैः स्फोटकैरुपचीयते तुल्यवर्णास्रावैश्चिरपाकैश्च, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति पित्तविसर्पः ||३२||
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pittamuṣṇōpacārēṇa vidāhyamlāśanaiścitam|
pittamuṣṇōpacārēṇa vidāhyamlāśanaiścitam|
tasya rUpANi- jvarastRuShNA mUrcchA mohashchardirarocako~a~ggabhedaHsvedo~atimAtramantardAhaH pralApaH shiroruk cakShuShorAkulatvamasvapnamaratirbhramaHshItavātavAritarSho~atimAtraM haritahAridranetramUtravarcastvaM haritahAridrarUpadarshanaM ca,yasmiMshcAvakAshe visarpo~anusarpati so~avakAshastAmraharitahAridranIlakRuShNaraktAnAMvarNAnAmanyatamaM puShyati, sotsedhaishcAtimAtraM dAhasambhedanaparItaiH sphoTakairupacIyatetulyavarNAsrAvaishcirapAkaishca, nidAnoktAni cAsya nopasherate viparItAni copasherata itipittavisarpaH||32||
tasya rUpANi- jvarastRuShNA mUrcchA mohashchardirarocako~a~ggabhedaHsvedo~atimAtramantardAhaH pralApaH shiroruk cakShuShorAkulatvamasvapnamaratirbhramaHshItavātavAritarSho~atimAtraM haritahAridranetramUtravarcastvaM haritahAridrarUpadarshanaM ca,yasmiMshcAvakAshe visarpo~anusarpati so~avakAshastAmraharitahAridranIlakRuShNaraktAnAMvarNAnAmanyatamaM puShyati, sotsedhaishcAtimAtraM dAhasambhedanaparItaiH sphoTakairupacIyatetulyavarNAsrAvaishcirapAkaishca, nidAnoktAni cAsya nopasherate viparItAni copasherata itipittavisarpaH||32||
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The ''pitta'' aggravated by the use of hot regimen, by eating irritant and sour foods vitiates the susceptible body elements and by feeling the vessels, begins to spread.
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The [[pitta]] aggravated by the use of hot regimen, by eating irritant and sour foods vitiates the susceptible body elements and by feeling the vessels, begins to spread.
Its signs and symptoms are fever, morbid thirst, fainting, disturbed consciousness, vomiting, anorexia, breaking body ache, excessive perspiration, burning, delirium, headache, congestion of the eyes, insomnia, restlessness, giddiness, excessive desire for cold air and water. Greenish or yellowish coloration of eyes, urine and feces, objects visualizes green and yellow. In the region where the ''visarpa'' spreads, becomes coppery, greenish, yellowish, bluish, blackish, reddish color. Affected part becomes excessively edematous and full of pustules, having intense burning and tearing pain, suppurating quickly and discharging fluid of similar color.
Its signs and symptoms are fever, morbid thirst, fainting, disturbed consciousness, vomiting, anorexia, breaking body ache, excessive perspiration, burning, delirium, headache, congestion of the eyes, insomnia, restlessness, giddiness, excessive desire for cold air and water. Greenish or yellowish coloration of eyes, urine and feces, objects visualizes green and yellow. In the region where the ''visarpa'' spreads, becomes coppery, greenish, yellowish, bluish, blackish, reddish color. Affected part becomes excessively edematous and full of pustules, having intense burning and tearing pain, suppurating quickly and discharging fluid of similar color.
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]
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=== Etio-pathogeneis and clinical features of [[kapha]] dominant ''visarpa'' ===
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स्वाद्वम्ललवणस्निग्धगुर्वन्नस्वप्नसञ्चितः |
स्वाद्वम्ललवणस्निग्धगुर्वन्नस्वप्नसञ्चितः |
तस्य रूपाणि- शीतकः शीतज्वरो गौरवं निद्रा तन्द्राऽरोचको मधुरास्यत्वमास्योपलेपो निष्ठीविका छर्दिरालस्यं स्तैमित्यमग्निनाशो दौर्बल्यं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशः श्वयथुमान् पाण्डुर्नातिरक्तः स्नेहसुप्तिस्तम्भगौरवैरन्वितोऽल्पवेदनः कृच्छ्रपाकैश्चिरकारिभिर्बहुलत्वगुपलेपैः स्फोटः श्वेतपाण्डुभिरनुबध्यते, प्रभिन्नस्तु श्वेतं पिच्छिलं तन्तुमद्धनमनुबद्धं स्निग्धमास्रावं स्रवति, ऊर्ध्वं च गुरुभिः स्थिरैर्जालावततैः स्निग्धैर्बहुलत्वगुपलेपैर्व्रणैरनुबध्यतेऽनुषङ्गी च भवति, श्वेतनखनयनवदनत्वङ्मूत्रवर्चस्त्वं, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति श्लेष्मविसर्पः ||३४||
तस्य रूपाणि- शीतकः शीतज्वरो गौरवं निद्रा तन्द्राऽरोचको मधुरास्यत्वमास्योपलेपो निष्ठीविका छर्दिरालस्यं स्तैमित्यमग्निनाशो दौर्बल्यं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशः श्वयथुमान् पाण्डुर्नातिरक्तः स्नेहसुप्तिस्तम्भगौरवैरन्वितोऽल्पवेदनः कृच्छ्रपाकैश्चिरकारिभिर्बहुलत्वगुपलेपैः स्फोटः श्वेतपाण्डुभिरनुबध्यते, प्रभिन्नस्तु श्वेतं पिच्छिलं तन्तुमद्धनमनुबद्धं स्निग्धमास्रावं स्रवति, ऊर्ध्वं च गुरुभिः स्थिरैर्जालावततैः स्निग्धैर्बहुलत्वगुपलेपैर्व्रणैरनुबध्यतेऽनुषङ्गी च भवति, श्वेतनखनयनवदनत्वङ्मूत्रवर्चस्त्वं, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति श्लेष्मविसर्पः ||३४||
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svādvamlalavaṇasnigdhagurvannasvapnasañcitaḥ|
svādvamlalavaṇasnigdhagurvannasvapnasañcitaḥ|
tasya rūpāṇi- śītakaḥ śītajvarō gauravaṁ nidrā tandrā'rōcakō madhurāsyatvamāsyōpalēpō niṣṭhīvikāchardirālasyaṁ staimityamagnināśō daurbalyaṁ ca, yasmiṁścāvakāśē visarpō'nusarpati sō'vakāśaḥśvayathumān pāṇḍurnātiraktaḥ snēhasuptistambhagauravairanvitō'lpavēdanaḥkr̥cchrapākaiścirakāribhirbahulatvagupalēpaiḥ sphōṭaḥ śvētapāṇḍubhiranubadhyatē, prabhinnastu śvētaṁpicchilaṁ tantumaddhanamanubaddhaṁ snigdhamāsrāvaṁ sravati, ūrdhvaṁ ca gurubhiḥsthirairjālāvātataiḥ snigdhairbahulatvagupalēpairvraṇairanubadhyatē'nuṣaṅgī ca bhavati,śvētanakhanayanavadanatvaṅmūtravarcastvaṁ, nidānōktāni cāsya nōpaśēratē viparītāni cōpaśērata itiślēṣmavisarpaḥ||34||
tasya rūpāṇi- śītakaḥ śītajvarō gauravaṁ nidrā tandrā'rōcakō madhurāsyatvamāsyōpalēpō niṣṭhīvikāchardirālasyaṁ staimityamagnināśō daurbalyaṁ ca, yasmiṁścāvakāśē visarpō'nusarpati sō'vakāśaḥśvayathumān pāṇḍurnātiraktaḥ snēhasuptistambhagauravairanvitō'lpavēdanaḥkr̥cchrapākaiścirakāribhirbahulatvagupalēpaiḥ sphōṭaḥ śvētapāṇḍubhiranubadhyatē, prabhinnastu śvētaṁpicchilaṁ tantumaddhanamanubaddhaṁ snigdhamāsrāvaṁ sravati, ūrdhvaṁ ca gurubhiḥsthirairjālāvātataiḥ snigdhairbahulatvagupalēpairvraṇairanubadhyatē'nuṣaṅgī ca bhavati,śvētanakhanayanavadanatvaṅmūtravarcastvaṁ, nidānōktāni cāsya nōpaśēratē viparītāni cōpaśērata itiślēṣmavisarpaḥ||34||
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[[Kapha]] excessively accumulated due to intake of sweet, sour, salt, unctuous and heavy foods, and also by excessive sleep, vitiates the susceptible body elements and spreads with slow speed in the body.
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 [[kapha]]ja visarpa''. [33-34]
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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]
=== Etio-pathogenesis and clinical features of [[vata]]-[[pitta]] dominant ''agni visarpa'' ===
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वातपित्तं प्रकुपितमतिमात्रं स्वहेतुभिः |
वातपित्तं प्रकुपितमतिमात्रं स्वहेतुभिः |
तदुपतापादातुरः सर्वशरीरमङ्गारैरिवाकीर्यमाणं मन्यते, छर्द्यतीसारमूर्च्छादाहमोहज्वरतमकारोचकास्थिसन्धिभेदतृष्णाविपाकाङ्गभेदादिभिश्चाभिभूयते, यं यं चावकाशं विसर्पोऽनुसर्पति सोऽवकाशः शान्ताङ्गारप्रकाशोऽतिरक्तो वा भवति, अग्निदग्धप्रकारैश्च स्फोटैरुपचीयते, स शीघ्रगत्वादाश्वेव मर्मानुसारी भवति, मर्मणि चोपतप्ते पवनोऽतिबलो भिनत्त्यङ्गान्यतिमात्रं प्रमोहयति सञ्ज्ञां, हिक्काश्वासौ जनयति, नाशयति निद्रां, स नष्टनिद्रः प्रमूढसञ्ज्ञो व्यथितचेता न क्वचन सुखमुपलभते, अरतिपरीतः स्थानादासनाच्छय्यां क्रान्तुमिच्छति, क्लिष्टभूयिष्ठश्चाशु निद्रां भजति, दुर्बलो दुःखप्रबोधश्च भवति; तमेवंविधमग्निविसर्पपरीतमचिकित्स्यं विद्यात् ||३६||
तदुपतापादातुरः सर्वशरीरमङ्गारैरिवाकीर्यमाणं मन्यते, छर्द्यतीसारमूर्च्छादाहमोहज्वरतमकारोचकास्थिसन्धिभेदतृष्णाविपाकाङ्गभेदादिभिश्चाभिभूयते, यं यं चावकाशं विसर्पोऽनुसर्पति सोऽवकाशः शान्ताङ्गारप्रकाशोऽतिरक्तो वा भवति, अग्निदग्धप्रकारैश्च स्फोटैरुपचीयते, स शीघ्रगत्वादाश्वेव मर्मानुसारी भवति, मर्मणि चोपतप्ते पवनोऽतिबलो भिनत्त्यङ्गान्यतिमात्रं प्रमोहयति सञ्ज्ञां, हिक्काश्वासौ जनयति, नाशयति निद्रां, स नष्टनिद्रः प्रमूढसञ्ज्ञो व्यथितचेता न क्वचन सुखमुपलभते, अरतिपरीतः स्थानादासनाच्छय्यां क्रान्तुमिच्छति, क्लिष्टभूयिष्ठश्चाशु निद्रां भजति, दुर्बलो दुःखप्रबोधश्च भवति; तमेवंविधमग्निविसर्पपरीतमचिकित्स्यं विद्यात् ||३६||
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vātapittaṁ prakupitamatimātraṁ svahētubhiḥ|
vātapittaṁ prakupitamatimātraṁ svahētubhiḥ|
tadupatApAdAturaH sarvasharIrama~ggArairivAkIryamANaM manyate,chardyatIsAramUrcchAdAhamohajvaratamakArocakAsthisandhibhedatRuShNAvipAkA~ggabhedAdibhishcAbhibhUyate,yaM yaM cAvakAshaM visarpo~anusarpati so~avakAshaH shAntA~ggAraprakAsho~atirakto vA bhavati,agnidagdhaprakAraishca sphoTairupacIyate, sa shIghragatvAdAshveva marmAnusArI bhavati, marmaNi copataptepavano~atibalo bhinattya~ggAnyatimAtraM pramohayati sa~jj~jAM, hikkAshvAsau janayati, nAshayati nidrAM, sanaShTanidraH pramUDhasa~jj~jo vyathitacetA na kvacana sukhamupalabhate, aratiparItaH sthAnAdAsanAcchayyAMkrAntumicchati, kliShTabhUyiShThashcAshu nidrAM bhajati, durbalo duHkhaprabodhashca bhavati;tamevaMvidhamagnivisarpaparItamacikitsyaM vidyAt||36||
tadupatApAdAturaH sarvasharIrama~ggArairivAkIryamANaM manyate,chardyatIsAramUrcchAdAhamohajvaratamakArocakAsthisandhibhedatRuShNAvipAkA~ggabhedAdibhishcAbhibhUyate,yaM yaM cAvakAshaM visarpo~anusarpati so~avakAshaH shAntA~ggAraprakAsho~atirakto vA bhavati,agnidagdhaprakAraishca sphoTairupacIyate, sa shIghragatvAdAshveva marmAnusArI bhavati, marmaNi copataptepavano~atibalo bhinattya~ggAnyatimAtraM pramohayati sa~jj~jAM, hikkAshvAsau janayati, nAshayati nidrAM, sanaShTanidraH pramUDhasa~jj~jo vyathitacetA na kvacana sukhamupalabhate, aratiparItaH sthAnAdAsanAcchayyAMkrAntumicchati, kliShTabhUyiShThashcAshu nidrAM bhajati, durbalo duHkhaprabodhashca bhavati;tamevaMvidhamagnivisarpaparItamacikitsyaM vidyAt||36||
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When ''vata-pitta'' vitiated severely due to their respective etiological factors and strengthened mutually, spreads producing severe burning pain in the body.
When ''vata-pitta'' vitiated severely due to their respective etiological factors and strengthened mutually, spreads producing severe burning pain in the body.
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]
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=== Etio-pathogenesis and clinical features of [[kapha]]-[[pitta]] dominant ''kardam visarpa'' ===
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कफपित्तं प्रकुपित्तं बलवत् स्वेन हेतुना |
कफपित्तं प्रकुपित्तं बलवत् स्वेन हेतुना |
तद्विकाराः- शीतज्वरः शिरोगुरुत्वं दाहः स्तैमित्यमङ्गावसदनं निद्रा तन्द्रा मोहोऽन्नद्वेषः प्रलापोऽग्निनाशो दौर्बल्यमस्थिभेदो मूर्च्छा पिपासा स्रोतसां प्रलेपो जाड्यमिन्द्रियाणां प्रायोपवेशनमङ्गविक्षेपोऽङ्गमर्दोऽरतिरौत्सुक्यं चोपजायते, प्रायश्चामाशये विसर्पत्यलसक एकदेशग्राही च, यस्मिंश्चावकाशे विसर्पो विसर्पति सोऽवकाशो रक्तपीतपाण्डुपिडकावकीर्ण इव मेचकाभः कालो मलिनः स्निग्धो बहूष्मा गुरुः स्तिमितवेदनः श्वयथुमान् गम्भीरपाको निरास्रावः शीघ्रक्लेदः स्विन्नक्लिन्नपूतिमांसत्वक् क्रमेणाल्परुक् परामृष्टोऽवदीर्यते कर्दम इवावपीडितोऽन्तरं प्रयच्छत्युपक्लिन्नपूतिमांसत्यागी सिरास्नायुसन्दर्शी कुणपगन्धी च भवति सञ्ज्ञास्मृतिहन्ता च; तं कर्दमविसर्पपरीतमचिकित्स्यं विद्यात् ||३८||
तद्विकाराः- शीतज्वरः शिरोगुरुत्वं दाहः स्तैमित्यमङ्गावसदनं निद्रा तन्द्रा मोहोऽन्नद्वेषः प्रलापोऽग्निनाशो दौर्बल्यमस्थिभेदो मूर्च्छा पिपासा स्रोतसां प्रलेपो जाड्यमिन्द्रियाणां प्रायोपवेशनमङ्गविक्षेपोऽङ्गमर्दोऽरतिरौत्सुक्यं चोपजायते, प्रायश्चामाशये विसर्पत्यलसक एकदेशग्राही च, यस्मिंश्चावकाशे विसर्पो विसर्पति सोऽवकाशो रक्तपीतपाण्डुपिडकावकीर्ण इव मेचकाभः कालो मलिनः स्निग्धो बहूष्मा गुरुः स्तिमितवेदनः श्वयथुमान् गम्भीरपाको निरास्रावः शीघ्रक्लेदः स्विन्नक्लिन्नपूतिमांसत्वक् क्रमेणाल्परुक् परामृष्टोऽवदीर्यते कर्दम इवावपीडितोऽन्तरं प्रयच्छत्युपक्लिन्नपूतिमांसत्यागी सिरास्नायुसन्दर्शी कुणपगन्धी च भवति सञ्ज्ञास्मृतिहन्ता च; तं कर्दमविसर्पपरीतमचिकित्स्यं विद्यात् ||३८||
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kaphapittaṁ prakupittaṁ balavat svēna hētunā|
kaphapittaṁ prakupittaṁ balavat svēna hētunā|
tadvikArAH- shItajvaraH shirogurutvaM dAhaH staimityama~ggAvasadanaM nidrA tandrAmoho~annadveShaH pralApo~agninAsho daurbalyamasthibhedo mUrcchA pipAsA srotasAM pralepojADyamindriyANAM prAyopaveshanama~ggavikShepo~a~ggamardo~aratirautsukyaM copajAyate,prAyashcAmAshaye visarpatyalasaka ekadeshagrAhI ca, yasmiMshcAvakAshe visarpo visarpatiso~avakAsho raktapItapANDupiDakAvakIrNa iva mecakAbhaH kAlo malinaH snigdho bahUShmA guruHstimitavedanaH shvayathumAn gambhIrapAko nirAsrAvaH shIghrakledaH svinnaklinnapUtimAMsatvakkrameNAlparuk parAmRuShTo~avadIryate kardama ivAvapIDito~antaraMprayacchatyupaklinnapUtimAMsatyAgI sirAsnAyusandarshI kuNapagandhI ca bhavati sa~jj~jAsmRutihantAca; taM kardamavisarpaparItamacikitsyaM vidyAt||38||
tadvikArAH- shItajvaraH shirogurutvaM dAhaH staimityama~ggAvasadanaM nidrA tandrAmoho~annadveShaH pralApo~agninAsho daurbalyamasthibhedo mUrcchA pipAsA srotasAM pralepojADyamindriyANAM prAyopaveshanama~ggavikShepo~a~ggamardo~aratirautsukyaM copajAyate,prAyashcAmAshaye visarpatyalasaka ekadeshagrAhI ca, yasmiMshcAvakAshe visarpo visarpatiso~avakAsho raktapItapANDupiDakAvakIrNa iva mecakAbhaH kAlo malinaH snigdho bahUShmA guruHstimitavedanaH shvayathumAn gambhIrapAko nirAsrAvaH shIghrakledaH svinnaklinnapUtimAMsatvakkrameNAlparuk parAmRuShTo~avadIryate kardama ivAvapIDito~antaraMprayacchatyupaklinnapUtimAMsatyAgI sirAsnAyusandarshI kuNapagandhI ca bhavati sa~jj~jAsmRutihantAca; taM kardamavisarpaparItamacikitsyaM vidyAt||38||
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Excessively aggravated ''kapha pitta'' due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.
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Excessively aggravated [[kapha]] [[pitta]] due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.
Its signs and symptoms are fever with chills, heaviness of the head, burning sensation, timidity, prostration, excessive sleep, drowsiness, disturbed consciousness, food dislike, delirium, loss of appetite, weakness, breaking pain in bones, fainting, morbid thirst, adhesions of sticky material in channels, dullness of the senses, mostly seating, abnormal movements of limbs, body pain, restlessness, anxiety, often it spreads to ''amashaya''. It is localized and spreads with slow speed.
Its signs and symptoms are fever with chills, heaviness of the head, burning sensation, timidity, prostration, excessive sleep, drowsiness, disturbed consciousness, food dislike, delirium, loss of appetite, weakness, breaking pain in bones, fainting, morbid thirst, adhesions of sticky material in channels, dullness of the senses, mostly seating, abnormal movements of limbs, body pain, restlessness, anxiety, often it spreads to ''amashaya''. It is localized and spreads with slow speed.
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]
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=== Etio-pathogenesis and clinical features of [[kapha]] [[vata]] dominant ''granthi visarpa'' ===
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स्थिरगुरुकठिनमधुरशीतस्निग्धान्नपानाभिष्यन्दिसेविनामव्यायामादिसेविनामप्रतिक
स्थिरगुरुकठिनमधुरशीतस्निग्धान्नपानाभिष्यन्दिसेविनामव्यायामादिसेविनामप्रतिक
र्मशीलानां श्लेष्मा वायुश्च प्रकोपमापद्यते, तावुभौ दुष्टप्रवृद्धावतिबलौ प्रदूष्य दूष्यान् विसर्पाय कल्पेते; तत्र वायुः श्लेष्मणा विबद्धमार्गस्तमेव श्लेष्माणमनेकधा भिन्दन् क्रमेण ग्रन्थिमालां कृच्छ्रपाकसाध्यां कफाशये सञ्जनयति, उत्सन्नरक्तस्य वा प्रदूष्य रक्तं सिरास्नायुमांसत्वगाश्रितं ग्रन्थीनां मालां कुरुते तीव्ररुजानां स्थूलानामणूनां वा दीर्घवृत्तरक्तानां, तदुपतापाज्ज्वरातिसारकासहिक्काश्वासशोषप्रमोहवैवर्ण्यारोचकाविपाकप्रसेकच्छ
र्मशीलानां श्लेष्मा वायुश्च प्रकोपमापद्यते, तावुभौ दुष्टप्रवृद्धावतिबलौ प्रदूष्य दूष्यान् विसर्पाय कल्पेते; तत्र वायुः श्लेष्मणा विबद्धमार्गस्तमेव श्लेष्माणमनेकधा भिन्दन् क्रमेण ग्रन्थिमालां कृच्छ्रपाकसाध्यां कफाशये सञ्जनयति, उत्सन्नरक्तस्य वा प्रदूष्य रक्तं सिरास्नायुमांसत्वगाश्रितं ग्रन्थीनां मालां कुरुते तीव्ररुजानां स्थूलानामणूनां वा दीर्घवृत्तरक्तानां, तदुपतापाज्ज्वरातिसारकासहिक्काश्वासशोषप्रमोहवैवर्ण्यारोचकाविपाकप्रसेकच्छ
र्दिर्मूर्च्छाङ्गभङ्गनिद्रारतिसदनाद्याः प्रादुर्भवन्त्युपद्रवाः; स एतैरुपद्रुतः सर्वकर्मणां विषयमतिपतितो विवर्जनीयो भवतीति ग्रन्थिविसर्पः ||३९||
र्दिर्मूर्च्छाङ्गभङ्गनिद्रारतिसदनाद्याः प्रादुर्भवन्त्युपद्रवाः; स एतैरुपद्रुतः सर्वकर्मणां विषयमतिपतितो विवर्जनीयो भवतीति ग्रन्थिविसर्पः ||३९||
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sthiragurukaṭhinamadhuraśītasnigdhānnapānābhiṣyandisēvināmavyāyāmādisēvināmapratikarmaśīlānāṁślēṣmā vāyuśca prakōpamāpadyatē, tāvubhau duṣṭapravr̥ddhāvatibalau pradūṣya dūṣyān visarpāyakalpētē; tatra vāyuḥ ślēṣmaṇā vibaddhamārgastamēva ślēṣmāṇamanēkadhā bhindan kramēṇagranthimālāṁ kr̥cchrapākasādhyāṁ kaphāśayē sañjanayati, utsannaraktasya vā pradūṣya raktaṁsirāsnāyumāṁsatvagāśritaṁ granthīnāṁ mālāṁ kurutē tīvrarujānāṁ sthūlānāmaṇūnāṁ vādīrghavr̥ttaraktānāṁ, tadupatāpājjvarātisārakāsahikkāśvāsaśōṣapramōhavaivarṇyārōcakāvipākaprasēkacchardirmūrcchāṅgabhaṅganidrāratisadanādyāḥprādurbhavantyupadravāḥ; sa ētairupadrutaḥ sarvakarmaṇāṁ viṣayamatipatitō vivarjanīyō bhavatītigranthivisarpaḥ||39||
sthiragurukaṭhinamadhuraśītasnigdhānnapānābhiṣyandisēvināmavyāyāmādisēvināmapratikarmaśīlānāṁślēṣmā vāyuśca prakōpamāpadyatē, tāvubhau duṣṭapravr̥ddhāvatibalau pradūṣya dūṣyān visarpāyakalpētē; tatra vāyuḥ ślēṣmaṇā vibaddhamārgastamēva ślēṣmāṇamanēkadhā bhindan kramēṇagranthimālāṁ kr̥cchrapākasādhyāṁ kaphāśayē sañjanayati, utsannaraktasya vā pradūṣya raktaṁsirāsnāyumāṁsatvagāśritaṁ granthīnāṁ mālāṁ kurutē tīvrarujānāṁ sthūlānāmaṇūnāṁ vādīrghavr̥ttaraktānāṁ, tadupatāpājjvarātisārakāsahikkāśvāsaśōṣapramōhavaivarṇyārōcakāvipākaprasēkacchardirmūrcchāṅgabhaṅganidrāratisadanādyāḥprādurbhavantyupadravāḥ; sa ētairupadrutaḥ sarvakarmaṇāṁ viṣayamatipatitō vivarjanīyō bhavatītigranthivisarpaḥ||39||
sthiragurukaThinamadhurashItasnigdhAnnapAnAbhiShyandisevinAmavyAyAmAdisevinAmapratikarmashIlAnAMshleShmA vAyushca prakopamApadyate, tAvubhau duShTapravRuddhAvatibalau pradUShya dUShyAnvisarpAya kalpete; tatra vAyuH shleShmaNA vibaddhamArgastameva shleShmANamanekadhA bhindankrameNa granthimAlAM kRucchrapAkasAdhyAMkaphAshaye sa~jjanayati, utsannaraktasya vA pradUShyaraktaM sirAsnAyumAMsatvagAshritaM granthInAM mAlAM kurute tIvrarujAnAM sthUlAnAmaNUnAM vAdIrghavRuttaraktAnAM, tadupatApAjjvarAtisArakAsahikkAshvAsashoSha-pramohavaivarNyArocakAvipAkaprasekacchardirmUrcchA~ggabha~gganidrAratisadanAdyAHprAdurbhavantyupadravAH; sa etairupadrutaH sarvakarmaNAM viShayamatipatito vivarjanIyo bhavatItigranthivisarpaH||39||
sthiragurukaThinamadhurashItasnigdhAnnapAnAbhiShyandisevinAmavyAyAmAdisevinAmapratikarmashIlAnAMshleShmA vAyushca prakopamApadyate, tAvubhau duShTapravRuddhAvatibalau pradUShya dUShyAnvisarpAya kalpete; tatra vAyuH shleShmaNA vibaddhamArgastameva shleShmANamanekadhA bhindankrameNa granthimAlAM kRucchrapAkasAdhyAMkaphAshaye sa~jjanayati, utsannaraktasya vA pradUShyaraktaM sirAsnAyumAMsatvagAshritaM granthInAM mAlAM kurute tIvrarujAnAM sthUlAnAmaNUnAM vAdIrghavRuttaraktAnAM, tadupatApAjjvarAtisArakAsahikkAshvAsashoSha-pramohavaivarNyArocakAvipAkaprasekacchardirmUrcchA~ggabha~gganidrAratisadanAdyAHprAdurbhavantyupadravAH; sa etairupadrutaH sarvakarmaNAM viShayamatipatito vivarjanIyo bhavatItigranthivisarpaH||39||
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[[Kapha]] and [[vata]] gets vitiated due to the use of firm, heavy, hard, sweet, cold, unctuous, and ''abhishyandi'' (which increase discharges and cause obstruction) ingredients of diet, lack of physical exercise etc. not following preventive seasonal [[Panchakarma]] purification. Deranged excessively, aggravated, powerful both [[kapha]] and [[vata]] vitiates the susceptible body elements giving rise to ''granthi visarpa''. Thereafter the [[vata]] being occluded by [[kapha]] in its progress and disintegrates [[kapha]] in many ways and gradually giving rise to chain of glands, hardly suppurating and difficult to cure, in the habitats of [[kapha]].
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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उपद्रवस्तु खलु रोगोत्तरकालजो रोगाश्रयो रोग एव स्थूलोऽणुर्वा, रोगात् पश्चाज्जायत इत्युपद्रवसञ्ज्ञः|
उपद्रवस्तु खलु रोगोत्तरकालजो रोगाश्रयो रोग एव स्थूलोऽणुर्वा, रोगात् पश्चाज्जायत इत्युपद्रवसञ्ज्ञः|
तत्र प्रधानो व्याधिः, व्याधेर्गुणभूत [१] उपद्रवः, तस्य प्रायः प्रधानप्रशमे प्रशमो भवति |
तत्र प्रधानो व्याधिः, व्याधेर्गुणभूत [१] उपद्रवः, तस्य प्रायः प्रधानप्रशमे प्रशमो भवति |
स तु पीडाकरतरो भवति पश्चादुत्पद्यमानो व्याधिपरिक्लिष्टशरीरत्वात्; तस्मादुपद्रवं त्वरमाणोऽभिबाधेत ||४०||
स तु पीडाकरतरो भवति पश्चादुत्पद्यमानो व्याधिपरिक्लिष्टशरीरत्वात्; तस्मादुपद्रवं त्वरमाणोऽभिबाधेत ||४०||
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upadravastu khalu rōgōttarakālajō rōgāśrayō rōga ēva sthūlō'ṇurvā, rōgāt paścājjāyataityupadravasañjñaḥ|
upadravastu khalu rōgōttarakālajō rōgāśrayō rōga ēva sthūlō'ṇurvā, rōgāt paścājjāyataityupadravasañjñaḥ|
tatra pradhAno vyAdhiH, vyAdherguNabhUta [1] upadravaH, tasya prAyaH pradhAnaprashame prashamobhavati|
tatra pradhAno vyAdhiH, vyAdherguNabhUta [1] upadravaH, tasya prAyaH pradhAnaprashame prashamobhavati|
sa tu pIDAkarataro bhavati pashcAdutpadyamAno vyAdhiparikliShTasharIratvAt; tasmAdupadravaMtvaramANo~abhibAdheta||40||
sa tu pIDAkarataro bhavati pashcAdutpadyamAno vyAdhiparikliShTasharIratvAt; tasmAdupadravaMtvaramANo~abhibAdheta||40||
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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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सर्वायतनसमुत्थं सर्वलिङ्गव्यापिनं सर्वधात्वनुसारिणमाशुकारिणं महात्ययिकमिति सन्निपातविसर्पमचिकित्स्यं विद्यात् ||४१||
सर्वायतनसमुत्थं सर्वलिङ्गव्यापिनं सर्वधात्वनुसारिणमाशुकारिणं महात्ययिकमिति सन्निपातविसर्पमचिकित्स्यं विद्यात् ||४१||
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sarvāyatanasamutthaṁ sarvaliṅgavyāpinaṁ sarvadhātvanusāriṇamāśukāriṇaṁ mahātyayikamitisannipātavisarpamacikitsyaṁ vidyāt||41||
sarvāyatanasamutthaṁ sarvaliṅgavyāpinaṁ sarvadhātvanusāriṇamāśukāriṇaṁ mahātyayikamitisannipātavisarpamacikitsyaṁ vidyāt||41||
sarvAyatanasamutthaM sarvali~ggavyApinaM sarvadhAtvanusAriNamAshukAriNaM mahAtyayikamitisannipAtavisarpamacikitsyaM vidyAt||41||
sarvAyatanasamutthaM sarvali~ggavyApinaM sarvadhAtvanusAriNamAshukAriNaM mahAtyayikamitisannipAtavisarpamacikitsyaM vidyAt||41||
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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]
</div>
=== Prognosis of ''visarpa'' ===
<div class="mw-collapsible mw-collapsed">
तत्र वातपित्तश्लेष्मनिमित्ता विसर्पास्त्रयः साध्या भवन्ति; अग्निकर्दमाख्यौ पुनरनुपसृष्टे मर्मणि अनुपगते वा सिरास्नायुमांसक्लेदे साधारणक्रियाभिरुभावेवाभ्यस्यमानौ प्रशान्तिमापद्येयाताम्, अनादरोपक्रान्तः पुनस्तयोरन्यतरो हन्याद्देहमाश्वेवाशीविषवत्; तथा ग्रन्थिविसर्पमजातोपद्रवमारभेत चिकित्सितुम्, उपद्रवोपद्रुतं त्वेनं परिहरेत्; सन्निपातजं तु सर्वधात्वनुसारित्वादाशुकारित्वाद्विरुद्धोपक्रमत्वाच्चासाध्यं विद्यात् ||४२||
तत्र वातपित्तश्लेष्मनिमित्ता विसर्पास्त्रयः साध्या भवन्ति; अग्निकर्दमाख्यौ पुनरनुपसृष्टे मर्मणि अनुपगते वा सिरास्नायुमांसक्लेदे साधारणक्रियाभिरुभावेवाभ्यस्यमानौ प्रशान्तिमापद्येयाताम्, अनादरोपक्रान्तः पुनस्तयोरन्यतरो हन्याद्देहमाश्वेवाशीविषवत्; तथा ग्रन्थिविसर्पमजातोपद्रवमारभेत चिकित्सितुम्, उपद्रवोपद्रुतं त्वेनं परिहरेत्; सन्निपातजं तु सर्वधात्वनुसारित्वादाशुकारित्वाद्विरुद्धोपक्रमत्वाच्चासाध्यं विद्यात् ||४२||
<div class="mw-collapsible-content">
tatra vātapittaślēṣmanimittā visarpāstrayaḥ sādhyā bhavanti; agnikardamākhyau punaranupasr̥ṣṭēmarmaṇi anupagatē vā sirāsnāyumāṁsaklēdē sādhāraṇakriyābhirubhāvēvābhyasyamānaupraśāntimāpadyēyātām, anādarōpakrāntaḥ punastayōranyatarō hanyāddēhamāśvēvāśīviṣavat; tathāgranthivisarpamajātōpadravamārabhēta cikitsitum, upadravōpadrutaṁ tvēnaṁ pariharēt; sannipātajaṁ tusarvadhātvanusāritvādāśukāritvādviruddhōpakramatvāccāsādhyaṁ vidyāt||42||
tatra vātapittaślēṣmanimittā visarpāstrayaḥ sādhyā bhavanti; agnikardamākhyau punaranupasr̥ṣṭēmarmaṇi anupagatē vā sirāsnāyumāṁsaklēdē sādhāraṇakriyābhirubhāvēvābhyasyamānaupraśāntimāpadyēyātām, anādarōpakrāntaḥ punastayōranyatarō hanyāddēhamāśvēvāśīviṣavat; tathāgranthivisarpamajātōpadravamārabhēta cikitsitum, upadravōpadrutaṁ tvēnaṁ pariharēt; sannipātajaṁ tusarvadhātvanusāritvādāśukāritvādviruddhōpakramatvāccāsādhyaṁ vidyāt||42||
tatra vātapittashleShmanimittA visarpAstrayaH sAdhyA bhavanti; agnikardamAkhyau punaranupasRuShTemarmaNi anupagate vA sirAsnAyumAMsaklede sAdhAraNakriyAbhirubhAvevAbhyasyamAnauprashAntimApadyeyAtAm, anAdaropakrAntaH punastayoranyataro hanyAddehamAshvevAshIviShavat;tathA granthivisarpamajAtopadravamArabheta cikitsitum, upadravopadrutaM tvenaM pariharet;sannipAtajaM tu sarvadhAtvanusAritvAdAshukAritvAdviruddhopakramatvAccAsAdhyaM vidyAt||42||
tatra vātapittashleShmanimittA visarpAstrayaH sAdhyA bhavanti; agnikardamAkhyau punaranupasRuShTemarmaNi anupagate vA sirAsnAyumAMsaklede sAdhAraNakriyAbhirubhAvevAbhyasyamAnauprashAntimApadyeyAtAm, anAdaropakrAntaH punastayoranyataro hanyAddehamAshvevAshIviShavat;tathA granthivisarpamajAtopadravamArabheta cikitsitum, upadravopadrutaM tvenaM pariharet;sannipAtajaM tu sarvadhAtvanusAritvAdAshukAritvAdviruddhopakramatvAccAsAdhyaM vidyAt||42||
</div></div>
<div style="text-align:justify;">
Among all types of ''visarpa vatik'', ''paittik'' and [[kapha]]ja 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 [[dhatu]], very fulminant and refractory to treatment.[42]
=== Principles of treatment ===
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तत्र साध्यानां साधनमनुव्याख्यास्यामः ||४३||
तत्र साध्यानां साधनमनुव्याख्यास्यामः ||४३||
रुधिरस्यावसेकं च तद्ध्यस्याश्रयसञ्ज्ञितम् ||४९||
रुधिरस्यावसेकं च तद्ध्यस्याश्रयसञ्ज्ञितम् ||४९||
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tatra sādhyānāṁ sādhanamanuvyākhyāsyāmaḥ||43||
tatra sādhyānāṁ sādhanamanuvyākhyāsyāmaḥ||43||
rudhirasyAvasekaM ca taddhyasyAshrayasa~jj~jitam||49||
rudhirasyAvasekaM ca taddhyasyAshrayasa~jj~jitam||49||
</div></div>
Now the treatment of the curable varieties of ''visarpa'' will be described.
Now the treatment of the curable varieties of ''visarpa'' will be described.
If the ''visarpa'' is caused with ''ama dosha'' (''dosha'' in 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.
If the ''visarpa'' is caused with ama [[dosha]]([[dosha]] in the state of incomplete transformation) and is located in [[kapha]]sthana (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).
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'' (purgation therapy) are specially indicated.
In addition, [[rakta]]mokshana (blood letting) and [[virechana]] (purgation therapy) are specially indicated.
If ''sama'' (with ''ama dosha'') ''visarpa'' is arouse from ''vatashaya'' (pelvis and lower part of body) ununctuous measures are indicated in the beginning. Even in association with ''rakta-pitta'' uncting measure is not regarded as beneficial in the beginning.
If ''sama'' (with ama [[dosha]]) ''visarpa'' is arouse from ''vatashaya'' (pelvis and lower part of body) ununctuous measures are indicated in the beginning. Even in association with [[rakta]]-[[pitta]] uncting 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.[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 [[rakta]]mokshana is recommended because the disorder is located in blood.[43-49]
=== Formulations used in ''visarpa'' ===
<div class="mw-collapsible mw-collapsed">
इति वीसर्पनुत् प्रोक्तं समासेन चिकित्सितम् |
इति वीसर्पनुत् प्रोक्तं समासेन चिकित्सितम् |
विसर्पिणां प्रयोज्यास्ते दोषनिर्हरणाः शिवाः ||५३||
विसर्पिणां प्रयोज्यास्ते दोषनिर्हरणाः शिवाः ||५३||
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iti vīsarpanut prōktaṁ samāsēna cikitsitam|
iti vīsarpanut prōktaṁ samāsēna cikitsitam|
visarpiNAM prayojyAste dōṣanirharaNAH shivAH||53||
visarpiNAM prayojyAste dōṣanirharaNAH shivAH||53||
</div></div>
Thus the treatment principles of ''visarpa'' have been described in brief. The same is being detailed further.
Thus the treatment principles of ''visarpa'' have been described in brief. The same is being detailed further.
In ''kapha pittaja visarpa'', ''vamana'' should be given with the ''madana'' (Randia spinosa), ''madhuka'' (Glycyrrhiza glabra Linn), ''nimba'' (Azadirachta indica), and fruits of ''vatsaka'' (Holarrhena antidysenterica Linn).
In [[kapha]] [[pitta]]ja visarpa, [[vamana]] should be given with the ''madana'' (Randia spinosa), ''madhuka'' (Glycyrrhiza glabra Linn), ''nimba'' (Azadirachta indica), and fruits of ''vatsaka'' (Holarrhena antidysenterica Linn).
In visarpa [[vamana]] is beneficial with ''patola'' (Trichosanthes dioica Roxb), ''pichumarda'' (Azadirachta indica), ''pippali'' (Piper longum linn), ''madana'' (Randia spinosa) and ''indrayava'' (Holarrhena antidysenterica Linn).
Further, all those formulations which will be described in ''kalpasthana'' in connection with the disorders of [[kapha]] [[pitta]] should be used for the patients of ''visarpa'' as well because they are eliminative of morbid [[dosha]] and are beneficial.[50-53]
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मुस्तनिम्बपटोलानां चन्दनोत्पलयोरपि |
मुस्तनिम्बपटोलानां चन्दनोत्पलयोरपि |
पाययेत घृतोन्मिश्रं नरं वीसर्पपीडितम् ||६१||
पाययेत घृतोन्मिश्रं नरं वीसर्पपीडितम् ||६१||
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mustānimbapaṭōlānāṁ candanōtpalayōrapi|
mustānimbapaṭōlānāṁ candanōtpalayōrapi|
pAyayeta ghRutonmishraM naraM vIsarpapIDitam||61||
pAyayeta ghRutonmishraM naraM vIsarpapIDitam||61||
</div></div>
The skillful physician should administer the decoctions of tested efficacy for the cure of ''visarpa'' made up of ''musta'' (Cyperus rotundus linn), ''nimba'' (Azadirachta indica) and ''patola'' (Trichosanthes dioica Roxb) or ''chandana'' (Santalum album linn) and utpal (Nymphaea nouchali) or ''sariva'' (Hemidesmus indicus), ''amalaki'' (Emblica officinalis), ''ushira'' (Vetiveria zizanioidis Linn) and ''musta'' (Cyperus rotundus linn).
The skillful physician should administer the decoctions of tested efficacy for the cure of ''visarpa'' made up of ''musta'' (Cyperus rotundus linn), ''nimba'' (Azadirachta indica) and ''patola'' (Trichosanthes dioica Roxb) or ''chandana'' (Santalum album linn) and utpal (Nymphaea nouchali) or ''sariva'' (Hemidesmus indicus), ''amalaki'' (Emblica officinalis), ''ushira'' (Vetiveria zizanioidis Linn) and ''musta'' (Cyperus rotundus linn).
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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यच्च सर्पिर्महातिक्तं पित्तकुष्ठनिबर्हणम् |
यच्च सर्पिर्महातिक्तं पित्तकुष्ठनिबर्हणम् |
दोषे कोष्ठगते भूय एतत् कुर्याच्चिकित्सितम् |68|
दोषे कोष्ठगते भूय एतत् कुर्याच्चिकित्सितम् |68|
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yacca sarpirmahātiktaṁ pittakuṣṭhanibarhaṇam|
yacca sarpirmahātiktaṁ pittakuṣṭhanibarhaṇam|
doShe koShThagate bhUya etat kuryAccikitsitam|68|
doShe koShThagate bhUya etat kuryAccikitsitam|68|
</div></div>
The ''mahatikta ghritam'' indicated in ''paittika kustha'' should also be given by the intelligent physician for the alleviation of ''visarpa''.
The ''mahatikta ghritam'' indicated in ''paittika kustha'' should also be given by the intelligent physician for the alleviation of ''visarpa''.
''Trayamana ghritam'' of tested efficacy mentioned in the treatment of ''gulma'' should be administered by the brilliant physician to alleviate ''visarpa''.
''Trayamana ghritam'' of tested efficacy mentioned in the treatment of ''gulma'' should be administered by the brilliant physician to alleviate ''visarpa''.
The powder of ''trivritta'' (Operculina turpethum Linn) mixed with ghee or milk or hot water or ''mridvika'' (Vitis vinifera Linn) juice should be administered for ''virechana'' and is tested to alleviate ''visarpa'' or ''trayamana'' (Gentiana kurroo) decocted with milk should be given for ''virechana''.
The powder of ''trivritta'' (Operculina turpethum Linn) mixed with ghee or milk or hot water or ''mridvika'' (Vitis vinifera Linn) juice should be administered for [[virechana]] and is tested to alleviate ''visarpa'' or ''trayamana'' (Gentiana kurroo) decocted with milk should be given for [[virechana]].
The decoction of ''triphala'' (''Haritaki, Bibhitaki'' and ''Amalaki'') mixed with ghee and ''trivritta'' (Operculina turpethum Linn) and used for ''virechana'' to alleviate ''visarpa'' and ''jwara''.
The decoction of ''triphala'' (''Haritaki, Bibhitaki'' and ''Amalaki'') mixed with ghee and ''trivritta'' (Operculina turpethum Linn) and used for [[virechana]] to alleviate ''visarpa'' and ''jwara''.
The juice of ''amalaki'' (Emblica officinalis) mixed with ghee should be administered in ''visarpa'' patient of heavy bowel the same preparation mixed with ''trivritta'' (Operculina turpethum Linn) powder is beneficial.
The juice of ''amalaki'' (Emblica officinalis) mixed with ghee should be administered in ''visarpa'' patient of heavy bowel the same preparation mixed with ''trivritta'' (Operculina turpethum Linn) powder is beneficial.
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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शाखादुष्टे तु रुधिरे रक्तमेवादितो हरेत् ||६८||
शाखादुष्टे तु रुधिरे रक्तमेवादितो हरेत् ||६८||
त्वङ्मांसस्नायुसङ्क्लेदो रक्तक्लेदाद्धि जायते ||७०||
त्वङ्मांसस्नायुसङ्क्लेदो रक्तक्लेदाद्धि जायते ||७०||
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śākhāduṣṭē tu rudhirē raktamēvāditō harēt||68||
śākhāduṣṭē tu rudhirē raktamēvāditō harēt||68||
tva~gmAMsasnAyusa~gkledo raktakledAddhi jAyate||70||
tva~gmAMsasnAyusa~gkledo raktakledAddhi jAyate||70||
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
अन्तःशरीरे [१] संशुद्धे दोषे त्वङ्मांससंश्रिते |
अन्तःशरीरे [१] संशुद्धे दोषे त्वङ्मांससंश्रिते |
प्रदेहाः सर्व एवैते कर्तव्याः सम्प्रसादनाः [१] ||९८||
प्रदेहाः सर्व एवैते कर्तव्याः सम्प्रसादनाः [१] ||९८||
<div class="mw-collapsible-content">
antaḥśarīrē [1] saṁśuddhē dōṣē tvaṅmāṁsasaṁśritē|
antaḥśarīrē [1] saṁśuddhē dōṣē tvaṅmāṁsasaṁśritē|
etat prakShAlanaM sarpirvraNacUrNaM pralepanam|98|
etat prakShAlanaM sarpirvraNacUrNaM pralepanam|98|
</div></div>
After the body is cleansed internally (systemic) and morbid ''dosha'' remains in the skin and flesh (external tissues), or ''dosha'' morbidity is little, the external treatment to be carried out will now be described.
After the body is cleansed internally (systemic) and morbid [[dosha]] remains in the skin and flesh (external tissues), or [[dosha]] morbidity is little, the external treatment to be carried out will now be described.
The bark of ''udumbara'' (Ficus glomerata), ''madhuka'' (Glycyrrhiza glabra Linn), ''padmakinjalka'' (Prunas cerasoides), ''utpala'' (Nymphaea nouchali), ''nagapuspa'' (Mesua ferrea Linn) and ''priyangu'' (Callicarpa macrophylla) mixed with ghee and applied externally as ''pradeha'' and is beneficial.
The bark of ''udumbara'' (Ficus glomerata), ''madhuka'' (Glycyrrhiza glabra Linn), ''padmakinjalka'' (Prunas cerasoides), ''utpala'' (Nymphaea nouchali), ''nagapuspa'' (Mesua ferrea Linn) and ''priyangu'' (Callicarpa macrophylla) mixed with ghee and applied externally as ''pradeha'' and is beneficial.
The bark of ''sirisa'' (Albizzia lebbeck) and ''bala'' (Sida cordifolia Linn) mixed with ghee. ''Nyagrodha'' (Ficus bengalensis Linn), ''udumbar'' (Ficus glomerata), ''plaksha'' (Ficus sycomorus), ''vetas'' (Salix caprea Linn), ''asvattha'' (Ficus religiosa) leaves and bark mixed with ample ghee used as a cold ''alepan'' is beneficial.
The bark of ''sirisa'' (Albizzia lebbeck) and ''bala'' (Sida cordifolia Linn) mixed with ghee. ''Nyagrodha'' (Ficus bengalensis Linn), ''udumbar'' (Ficus glomerata), ''plaksha'' (Ficus sycomorus), ''vetas'' (Salix caprea Linn), ''asvattha'' (Ficus religiosa) leaves and bark mixed with ample ghee used as a cold ''alepan'' is beneficial.
All these external applications are beneficial in ''vata pitta'' predominant ''visarpa''.
All these external applications are beneficial in [[vata]] [[pitta]] predominant ''visarpa''.
Other external applications useful in ''kapha'' predominant ''visarpa'' will be described here after. ''Triphala'' (''haritaki, bibhitaki'' and ''amalaki''), ''padmaka'' (Prunas cerasoides), ''usir'' (Vetiveria zizanioidis Linn), ''samanga'' (Mimosa pudica), ''karviraka'' (Nerium indicum), root of ''nala'' (Phragmites australis) and ''ananta'' (hemidesmus indicus) should be used externally as a ''pradeha''.
Other external applications useful in [[kapha]] predominant ''visarpa'' will be described here after. ''Triphala'' (''haritaki, bibhitaki'' and ''amalaki''), ''padmaka'' (Prunas cerasoides), ''usir'' (Vetiveria zizanioidis Linn), ''samanga'' (Mimosa pudica), ''karviraka'' (Nerium indicum), root of ''nala'' (Phragmites australis) and ''ananta'' (hemidesmus indicus) should be used externally as a ''pradeha''.
''Khadira'' (Acacia catechu), ''saptaparna'' (Alstonia scholaris), ''musta'' (Cyperus rotundus linn), ''aragvadha'' (Cassia fistula Linn), ''dhava'' (Anogeissus latifolia, Wall). ''Kurantaka'' (Lawsonia inermis) and ''devdaru'' (Cedrus deodar) should be applied externally as a ''pradeha''.
''Khadira'' (Acacia catechu), ''saptaparna'' (Alstonia scholaris), ''musta'' (Cyperus rotundus linn), ''aragvadha'' (Cassia fistula Linn), ''dhava'' (Anogeissus latifolia, Wall). ''Kurantaka'' (Lawsonia inermis) and ''devdaru'' (Cedrus deodar) should be applied externally as a ''pradeha''.
''Aragvadha'' leaves (Cassia fistula Linn.) and ''sleshmantak'' bark (Cordia dichotoma), ''indrani shak'' (Vitex negundo Linn), ''kakahva'' (Canvalia gladiata) and ''sirisa'' flowers (Albizia lebbeck Linn.), ''saivala'' (Spirogyra maxima) root of ''nala'' (Phragmites australis), ''veera'' (Pueraria tuberose) and ''gandpriyangu'' (Callicarpa macrophylla), ''triphala'' (''Haritaki, Bibhitaki'' and ''Amalaki''), ''madhuka'' (Glycyrrhiza glabra Linn), ''prapaundrika'' (nelumbo nucifera), ''hribera'' (Pavonia odorata), bark of ''darvi'' (Berberis aristata), and ''bala'' (Sida cordifolia Linn.) - these should be applied singly, dually or collectively as a ''pradeha''. All these external applications should be mixed with small quantity of ghee. In ''vata pitta'' predominant condition these preparations should be mixed with profuse quantity of ghee.
''Aragvadha'' leaves (Cassia fistula Linn.) and ''sleshmantak'' bark (Cordia dichotoma), ''indrani shak'' (Vitex negundo Linn), ''kakahva'' (Canvalia gladiata) and ''sirisa'' flowers (Albizia lebbeck Linn.), ''saivala'' (Spirogyra maxima) root of ''nala'' (Phragmites australis), ''veera'' (Pueraria tuberose) and ''gandpriyangu'' (Callicarpa macrophylla), ''triphala'' (''Haritaki, Bibhitaki'' and ''Amalaki''), ''madhuka'' (Glycyrrhiza glabra Linn), ''prapaundrika'' (nelumbo nucifera), ''hribera'' (Pavonia odorata), bark of ''darvi'' (Berberis aristata), and ''bala'' (Sida cordifolia Linn.) - these should be applied singly, dually or collectively as a ''pradeha''. All these external applications should be mixed with small quantity of ghee. In [[vata]] [[pitta]] predominant condition these preparations should be mixed with profuse quantity of ghee.
The applications of ''shatdhaut ghrita'' as ''pradeha'' or effuse with cold ghee scum, or cold milk or cold decoction of ''madhuka'' (Glycyrrhiza glabra Linn), or ''panchavalka'' (bark of ''nygrodha, udumbara, asvattha, plaksa'' and ''vetasa''), the physician should use frequently in ''vata, rakta'' and ''pitta'' predominant ''visarpa''.
The applications of ''shatdhaut ghrita'' as ''pradeha'' or effuse with cold ghee scum, or cold milk or cold decoction of ''madhuka'' (Glycyrrhiza glabra Linn), or ''panchavalka'' (bark of ''nygrodha, udumbara, asvattha, plaksa'' and ''vetasa''), the physician should use frequently in [[vata]], [[rakta]] and [[pitta]] predominant ''visarpa''.
The external application mentioned as ''pradeha'' may also be used for sprinkling or for preparation ''ghrita yoga'' or ''churna yoga'' used for dusting in wounds of ''visarpa'', ghee cooked with ''durva'' juice promotes wound healing.
The external application mentioned as ''pradeha'' may also be used for sprinkling or for preparation ''ghrita yoga'' or ''churna yoga'' used for dusting in wounds of ''visarpa'', ghee cooked with ''durva'' juice promotes wound healing.
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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क्षणे क्षणे प्रयोक्तव्याः पूर्वमुद्धृत्य लेपनम् |
क्षणे क्षणे प्रयोक्तव्याः पूर्वमुद्धृत्य लेपनम् |
संशुष्कः पीडयेद्व्याधिं निःस्नेहो ह्यवचारितः ||१०७||
संशुष्कः पीडयेद्व्याधिं निःस्नेहो ह्यवचारितः ||१०७||
<div class="mw-collapsible-content">
pradēhāḥ sarva ēvaitē kartavyāḥ samprasādanāḥ [1] ||98||
pradēhāḥ sarva ēvaitē kartavyāḥ samprasādanāḥ [1] ||98||
saMshuShkaH pIDayedvyAdhiM niHsneho hyavacAritaH||107||
saMshuShkaH pIDayedvyAdhiM niHsneho hyavacAritaH||107||
</div></div>
These ''lepa'' (local applications of pastes) are to be used repeatedly after removing the previous applied ''lepa''.
These ''lepa'' (local applications of pastes) are to be used repeatedly after removing the previous applied ''lepa''.
Thin ''predeha'' should be applied as thick paste repeatedly after removing the previous one, but without washing it.
Thin ''predeha'' should be applied as thick paste repeatedly after removing the previous one, but without washing it.
In ''kaphaja visarpa, pradeha'' should be repeatedly applied as thick paste after removing the previous dried paste.
In [[kapha]]ja visarpa, pradeha should be repeatedly applied as thick paste after removing the previous dried paste.
The ''pralepa'' should be prepared as ''kalka'' (micronized paste) and applied of thickness equal to one third of the thumb.
The ''pralepa'' should be prepared as ''kalka'' (micronized paste) and applied of thickness equal to one third of the thumb.
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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अन्नपानानि वक्ष्यामि विसर्पाणां निवृत्तये |
अन्नपानानि वक्ष्यामि विसर्पाणां निवृत्तये |
येषां नात्युचितः शालिर्नरा ये च कफाधिकाः ||११४||
येषां नात्युचितः शालिर्नरा ये च कफाधिकाः ||११४||
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annapānāni vakṣyāmi visarpāṇāṁ nivr̥ttayē|
annapānāni vakṣyāmi visarpāṇāṁ nivr̥ttayē|
yeShAM nAtyucitaH shAlirnarA ye ca kaphAdhikAH||114||
yeShAM nAtyucitaH shAlirnarA ye ca kaphAdhikAH||114||
</div></div>
The diet regimen helps to alleviate ''visarpa'' is described here after.
The diet regimen helps to alleviate ''visarpa'' is described here after.
In the beginning ''langhana'' (fasting therapy) should be given. There after use of ''mantha'' (roasted flour mixed with water in specific proportion and kept for specific time) is beneficial. The ''mantha'' should be without unctus ingredients and added with honey and sugar. It becomes sweet sour in taste due to mixing of ''dadima'' (Punica granatum Linn.) or ''amalaki'' (Emblica officinalis) and ''parushaka'' or ''mrdvika'' (Vitis vinifera Linn) or ''kharjura'' (Phoenix sylvestris) and boiled water should be used to prepare ''mantha''.
In the beginning [[langhana]] (fasting therapy) should be given. There after use of ''mantha'' (roasted flour mixed with water in specific proportion and kept for specific time) is beneficial. The ''mantha'' should be without unctus ingredients and added with honey and sugar. It becomes sweet sour in taste due to mixing of ''dadima'' (Punica granatum Linn.) or ''amalaki'' (Emblica officinalis) and ''parushaka'' or ''mrdvika'' (Vitis vinifera Linn) or ''kharjura'' (Phoenix sylvestris) and boiled water should be used to prepare ''mantha''.
Thereafter linctus made of the flour of roasted barley and ''shali'' rice and mixed with ghee should be given in the form of ''avalehika''. After digestion of ''avalehika'', one should take old ''shali'' rice with soup of green gram or lentils or Bengal gram, soured or not soured with pomegranates and added with ''patola'' (Trichosanthes dioica Roxb) and ''amalaki''. He may also take meat soup of wild animals without ghee and added with ''parushaka'' or ''draksha'' or ''dadima'' or ''amalaki''. Red or white or extra long variety of ''shastika'' rice, which are old, well boiled and residual water should be completely drained, it is beneficial food.
Thereafter linctus made of the flour of roasted barley and ''shali'' rice and mixed with ghee should be given in the form of ''avalehika''. After digestion of ''avalehika'', one should take old ''shali'' rice with soup of green gram or lentils or Bengal gram, soured or not soured with pomegranates and added with ''patola'' (Trichosanthes dioica Roxb) and ''amalaki''. He may also take meat soup of wild animals without ghee and added with ''parushaka'' or ''draksha'' or ''dadima'' or ''amalaki''. Red or white or extra long variety of ''shastika'' rice, which are old, well boiled and residual water should be completely drained, it is beneficial food.
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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विदाहीन्यन्नपानानि विरुद्धं स्वपनं दिवा |
विदाहीन्यन्नपानानि विरुद्धं स्वपनं दिवा |
क्रोधव्यायामसूर्याग्निप्रवातांश्च विवर्जयेत् ||११५||
क्रोधव्यायामसूर्याग्निप्रवातांश्च विवर्जयेत् ||११५||
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vidāhīnyannapānāni viruddhaṁ svapanaṁ divā|
vidāhīnyannapānāni viruddhaṁ svapanaṁ divā|
krodhavyAyAmasUryAgnipravātaMshca vivarjayet||115||
krodhavyAyAmasUryAgnipravātaMshca vivarjayet||115||
</div></div>
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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कुर्याच्चिकित्सितादस्माच्छीतप्रायाणि पैत्तिके |
कुर्याच्चिकित्सितादस्माच्छीतप्रायाणि पैत्तिके |
कफपित्तप्रशमनं प्रायः कर्दमसञ्ज्ञिते ||११७||
कफपित्तप्रशमनं प्रायः कर्दमसञ्ज्ञिते ||११७||
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kuryāccikitsitādasmācchītaprāyāṇi paittikē|
kuryāccikitsitādasmācchītaprāyāṇi paittikē|
kaphapittaprashamanaM prAyaH kardamasa~jj~jite||117||
kaphapittaprashamanaM prAyaH kardamasa~jj~jite||117||
</div></div>
Of these measures, predominantly ''sheeta'' (cool) measures are prescribed in ''pitta'' dominant condition, ''ruksha'' in ''kapha'' dominant condition and ''snigdha'' in ''vata'' dominant condition of ''visarpa''.
Of these measures, predominantly ''sheeta'' (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.[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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रक्तपित्तोत्तरं दृष्ट्वा ग्रन्थिवीसर्पमादितः |
रक्तपित्तोत्तरं दृष्ट्वा ग्रन्थिवीसर्पमादितः |
इति ग्रन्थिविसर्पचिकित्सा |
इति ग्रन्थिविसर्पचिकित्सा |
<div class="mw-collapsible-content">
raktapittōttaraṁ dr̥ṣṭvā granthivīsarpamāditaḥ|
raktapittōttaraṁ dr̥ṣṭvā granthivīsarpamāditaḥ|
iti granthivisarpacikitsA|
iti granthivisarpacikitsA|
</div></div>
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.
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.
After cleansing of body by [[vamana]] and [[virechana]], [[rakta]] mokshana should be administered and the measures alleviating [[vata]]-[[kapha]] are beneficial.
When there is pain in ''granthi visarpa, upanaha'' (hot poultice) of warm and unctuous ''utkarika'' (medicinal pancake) or ''vesavara'' (medicated meat) application on the affected part is beneficial.
When there is pain in ''granthi visarpa, upanaha'' (hot poultice) of warm and unctuous ''utkarika'' (medicinal pancake) or ''vesavara'' (medicated meat) application on the affected part is beneficial.
The warm oil prepared from ''dashamoola'' (roots of ten plants) should be sprinkled on the affected part. Warm ''kustha'' (costus) oil added with ''pakya kshara'' (prepared medicinal alkali) or warm cow’s urine or decoction of ''vata kaphahar'' leaves should be used as affusion on the affected part.
The warm oil prepared from ''dashamoola'' (roots of ten plants) should be sprinkled on the affected part. Warm ''kustha'' (costus) oil added with ''pakya kshara'' (prepared medicinal alkali) or warm cow’s urine or decoction of [[vata]] [[kapha]]hara leaves should be used as affusion on the affected part.
The warm paste of ''ashvagandha'' (Withania somnifera) should be applied as ''pradeha'' on the affected part.
The warm paste of ''ashvagandha'' (Withania somnifera) should be applied as ''pradeha'' on the affected part.
The warm paste of dried ''mulaka'' (Raphanus sativus) or bark of ''naktamala'' (Pongamia pinnata) or bark of ''bibhitaka'' (Terminalia bellirica) should be applied externally as a ''lepa'' on the affected part. ''Bala'' (Sida cordifolia Linn), ''nagabala'' (Grewia hirsuta), ''pathya'' (Terminalia chebula), ''bhurjagranthi'' (betula bhojpatra), ''bibhitaka'' (Terminalia bellirica), ''vamsha'' leaves (bambusa vulgaris) and ''agnimantha'' (Premna mucronata) should be applied as ''pralepa'' on ''granthi''.
The warm paste of dried ''mulaka'' (Raphanus sativus) or bark of ''naktamala'' (Pongamia pinnata) or bark of ''bibhitaka'' (Terminalia bellirica) should be applied externally as a ''lepa'' on the affected part. ''Bala'' (Sida cordifolia Linn), ''nagabala'' (Grewia hirsuta), ''pathya'' (Terminalia chebula), ''bhurjagranthi'' (betula bhojpatra), ''bibhitaka'' (Terminalia bellirica), ''vamsha'' leaves (bambusa vulgaris) and ''agnimantha'' (Premna mucronata) should be applied as ''pralepa'' on ''granthi''.
''Danti'' (Baliospermum montanum), bark of ''chitraka'' root (Plumbago zeylanica Linn), latex of ''snuhi'' (Euphoria nerrifolia) and ''arka'' (Calatropis gigantean), jaggery, seed of ''bhallataka'' (Semecarpus anacardium linn) and ''kasisa'' (green vitriol) application as a ''lepa'' breaks even a stone, then what to speak of the nodules caused by ''kapha'' and situated in external regions of body. Long standing ''granthi'' should be broken by the use of the internal medications such as ''Yusha'' of ''mulaka'' (Raphanus sativus) and ''kullatha'' (Macrotyloma uniflorum.) added with ''kshara'' (prepared alkali) and ''dadima'' (Punica granatum), food prepared from ''godhum'' and ''yava'' with ''sidhu'', honey and sugar, ''varuni'' scum with honey and ''matulung'' juice (Citrus medica), use of ''triphala'' with ''pippali'' (Piper longum linn) and honey, ''musta'' (Cyperus rotundus linn) or ''bhallataka saktu'' (Semecarpus anacardium linn) and honey, ''devadaru'' (Cedrus deodara), ''guduchi'' (Tinospora cordifolia) and ''girija'' (Asphaltum punjabianum).
''Danti'' (Baliospermum montanum), bark of ''chitraka'' root (Plumbago zeylanica Linn), latex of ''snuhi'' (Euphoria nerrifolia) and ''arka'' (Calatropis gigantean), jaggery, seed of ''bhallataka'' (Semecarpus anacardium linn) and ''kasisa'' (green vitriol) application as a ''lepa'' breaks even a stone, then what to speak of the nodules caused by [[kapha]] and situated in external regions of body. Long standing ''granthi'' should be broken by the use of the internal medications such as ''Yusha'' of ''mulaka'' (Raphanus sativus) and ''kullatha'' (Macrotyloma uniflorum.) added with ''kshara'' (prepared alkali) and ''dadima'' (Punica granatum), food prepared from ''godhum'' and ''yava'' with ''sidhu'', honey and sugar, ''varuni'' scum with honey and ''matulung'' juice (Citrus medica), use of ''triphala'' with ''pippali'' (Piper longum linn) and honey, ''musta'' (Cyperus rotundus linn) or ''bhallataka saktu'' (Semecarpus anacardium linn) and honey, ''devadaru'' (Cedrus deodara), ''guduchi'' (Tinospora cordifolia) and ''girija'' (Asphaltum punjabianum).
''Dhuma, shirovirechana,'' measures described to break the ''gulma'' in [[Gulma Chikitsa]] chapter, as well as iron, salt, stone, gold and copper should be used for ''prapidana'' (compression) of ''granthi''.
''Dhuma, shirovirechana,'' measures described to break the ''gulma'' in [[Gulma Chikitsa]] chapter, as well as iron, salt, stone, gold and copper should be used for ''prapidana'' (compression) of ''granthi''.
If ''granthi'' is strong, firm and stony hard and not responding to all these proven methods of treatment then it is better to be cauterized with ''kshara'' (medicinal alkali) or hot metal arrow or hot gold or after making it suppurate by applying suitable suppurative medications one should open and extract.
If ''granthi'' is strong, firm and stony hard and not responding to all these proven methods of treatment then it is better to be cauterized with ''kshara'' (medicinal alkali) or hot metal arrow or hot gold or after making it suppurate by applying suitable suppurative medications one should open and extract.
Besides, vitiated blood should be eliminated, frequently followed administration of ''vata'' and ''kapha'' pacifying medicines, ''dhuma'' (fumigation therapy), ''shirovechana'' (errhine therapy), ''swedana'' (sudation) and ''parimardana'' (pressure method). If ''dosha'' do not pacify, ''pachana'' (suppuration) treatment is beneficial. When the ''granthi'' is decomposed with ''agni'' and suppuration then physician should treat it with external and internal ''shodhana'' (cleansing) and ''ropana'' (healing) as described in ''Vrana Chikitsa''.
Besides, vitiated blood should be eliminated, frequently followed administration of [[vata]] and [[kapha]] pacifying medicines, ''dhuma'' (fumigation therapy), ''shirovechana'' (errhine therapy), [[swedana]](sudation) and ''parimardana'' (pressure method). If [[dosha]] do not pacify, [[pachana]] (suppuration) treatment is beneficial. When the ''granthi'' is decomposed with ''agni'' and suppuration then physician should treat it with external and internal ''shodhana'' (cleansing) and ''ropana'' (healing) as described in ''Vrana Chikitsa''.
''Kampillaka'' (Mallotus philippinensis), ''vidanga'' (Embelia ribes Burm), ''daruharidra'' (Berberis aristata) and ''karanja'' fruit (Pongamia pinnata), the paste of all these drugs should be used to prepare oil which is indicated in the treatment of ''granthi vrina''.
''Kampillaka'' (Mallotus philippinensis), ''vidanga'' (Embelia ribes Burm), ''daruharidra'' (Berberis aristata) and ''karanja'' fruit (Pongamia pinnata), the paste of all these drugs should be used to prepare oil which is indicated in the treatment of ''granthi vrina''.
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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य एव विधिरुद्दिष्टो ग्रन्थीनां विनिवृत्तये |
य एव विधिरुद्दिष्टो ग्रन्थीनां विनिवृत्तये |
घृतक्षीरकषायाणामभ्यासान्न भवन्ति ते ||१४०||
घृतक्षीरकषायाणामभ्यासान्न भवन्ति ते ||१४०||
<div class="mw-collapsible-content">
ya ēva vidhiruddiṣṭō granthīnāṁ vinivr̥ttayē|
ya ēva vidhiruddiṣṭō granthīnāṁ vinivr̥ttayē|
ghRutakShIrakaShAyANAmabhyAsAnna bhavanti te||140||
ghRutakShIrakaShAyANAmabhyAsAnna bhavanti te||140||
</div></div>
The line of treatment of ''granthi'' should be applied for the treatment of ''kaphaja galganda''.
The 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.[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'' ===
<div class="mw-collapsible mw-collapsed">
यानीहोक्तानि कर्माणि विसर्पाणां निवृत्तये |
यानीहोक्तानि कर्माणि विसर्पाणां निवृत्तये |
समासव्यासनिर्दिष्टां क्रियां विद्वानुपाचरेत् ||१४३||
समासव्यासनिर्दिष्टां क्रियां विद्वानुपाचरेत् ||१४३||
<div class="mw-collapsible-content">
yānīhōktāni karmāṇi visarpāṇāṁ nivr̥ttayē|
yānīhōktāni karmāṇi visarpāṇāṁ nivr̥ttayē|
samAsavyAsanirdiShTAM [1] kriyAM vidvAnupAcaret||143||
samAsavyAsanirdiShTAM [1] kriyAM vidvAnupAcaret||143||
</div></div>
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 ===
<div class="mw-collapsible mw-collapsed">
तत्र श्लोकाः-
तत्र श्लोकाः-
पुनर्वसुरुवाचेदं विसर्पाणां चिकित्सितम् ||१४६||
पुनर्वसुरुवाचेदं विसर्पाणां चिकित्सितम् ||१४६||
<div class="mw-collapsible-content">
tatra ślōkāḥ-
tatra ślōkāḥ-
punarvasuruvAcedaM visarpANAM cikitsitam||146||
punarvasuruvAcedaM visarpANAM cikitsitam||146||
</div></div>
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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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सास्थाने
इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सास्थाने
विसर्पचिकित्सितं नामैकविंशोऽध्यायः ||२१||
विसर्पचिकित्सितं नामैकविंशोऽध्यायः ||२१||
<div class="mw-collapsible-content">
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē
ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē
visarpacikitsitaM nAmaikaviMsho~adhyAyaH||21||
visarpacikitsitaM nAmaikaviMsho~adhyAyaH||21||
</div></div>
Thus ends the twenty first chapter on treatment of ''visarpa'' in [[Chikitsa Sthana]] in the treatise composed by Agnivesha and redacted by Charaka.[21]
Thus ends the twenty first chapter on treatment of ''visarpa'' in [[Chikitsa Sthana]] in the treatise composed by Agnivesha and redacted by Charak.[21]
=== ''Tattva Vimarsha'' ===
== 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'' ===
== 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.
''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.
[[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.
''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 studies ====
''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 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'' ===
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.
=== Further reading ===
=== Further reading ===
#Charak, Chikitsa Sthana, chap 21 Visarpa Chikitsa Adhyaya. In:Vaidya Yadavaji Trikamji Aacharya, Editor, Charak samhita, 2nd edition, Varanasi;Chaukhamba Sanskrit Sansthan,1990;228.
#Chakrapani,Charak,Chikitsa Sthana, Chap 21 Visarpa Chikitsa Adhyaya, 2nd edition,Varanasi; Chaukhamba Sanskrit Sansthan, 1990; 225.
#Charak,Cikitsa Sthana,Chap 21 Visarpa Cikitsitam. In: Pt. Dutta R, editor. Charak Samhita, 2nd ed., 2003 reprint, Varanasi: Chaukhambha Bharti Academy; 2003. p. 231.
#Charak,Chikitsa Sthana, Chap 21 Visarpa Chikitsa Adhyaya,In:Kashiram Shastri and Gorakhnath Chaturvedi, editors. Charak Samhita,(Hindi traslation) Part II. Varanasi: Chaukhambha Bharati Academy; Reprint 2005. p. 235.
#Charak, Chikitsa Sthana, Visarpa Cikitsitam,21, In: Vd. Khushvaha HS,editors,Charak Samhita Ayushi hindi commentary, 1 st edition, Chaukhambha Orientalia Publisher, Varanasi, 2009;224.
#Chakrapani, Charak, Cikitsa Sthana, Chap 21 Visarpa Cikitsitam. In: Vd. Yadavaji T. A.,Editor, Charak Samhita, 1 st edition, Varanasi;Chaukhambha Orientalia Publications, 2001;227.
#Sushruta. Cikitsa Sthana, 17. Visarpanadisthanaroga Chikitsitam Adhyaya In: Vaidya Yadavji Trikamji Acharaya, Narayan Ram Acharaya, editors. Sushruta Samhita,?ed, Varanasi: Chaukhambha Orientalia; 2007. p. 321.
#Susruta, Nidana sthana,cha 10, Visarpanadisthanaroga Nidana In:Kaviraj Ambikadutt Shastri,editor, Sushruta Samhita, 11 th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1998. p. 129.
#Vagbhata, Ashtanga Sangraha, Cikitsa Sthana, 20,Visarpa chikitsitam Adhyaya. translated to English by Prof. Murthy KR, 9 th edition,Varanasi; Chaukhambha Orientalia Publisher,2005;229.
#Vagbhata, Ashtanga Sangraha, Nidana Sthana, 13, Pandurogakamalasophavisarpa Nidanam Adhyaya. translated to English by Prof. Murthy KR, 9 th edition, Varanasi,Chaukhambha Orientalia Publisher, 2005; 229.
#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>
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