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Line 11: − − <big>'''Abstract </big>''' − <div 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''. − − '''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections. − </div> Line 28:
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{{CiteButton}}
{{#seo:
{{#seo:
|title=Visarpa Chikitsa
|title=Visarpa Chikitsa
|titlemode=append
|titlemode=append
|keywords=Visarpa, Parisarpa, Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections
|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)
|description=Chikitsa Sthana Chapter 21. Management of Visarpa (acute spreading erysepalas)
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=charak samhita
|image_alt=charak samhita
|type=article
|type=article
<big>'''[[Chikitsa Sthana]] Chapter 21. Management of Visarpa (acute spreading erysepalas)</big>'''
<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
|data6 = Kendre M.
|label7 = Reviewer
|data7 = Ojha S.N.
|label8 = Editors
|data8 = Ojha S.N.,Deole Y.S., 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>'''
<div 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''.
'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.
</div>
== Introduction ==
== Introduction ==
<div style="text-align:justify;">
<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.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''.
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 [[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[ 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''.
''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.
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== Sanskrit Text, Transliteration and English Translation ==
== Sanskrit Text, Transliteration and English Translation ==
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''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 ===
=== Vitiated factors ===
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Blood, lymph, skin, flesh and three ''dosha'', these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]
Blood, lymph, skin, flesh and three [[dosha]], these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]
=== Etiology ===
=== Etiology ===
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 ===
=== Pathways of spreading the disease ===
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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.
''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]
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=== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ===
=== Etio-pathogeneis and clinical features of [[vata]] dominant ''visarpa'' ===
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[[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]
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=== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ===
=== Etio-pathogeneis and clinical features of [[pitta]] dominant ''visarpa'' ===
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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.
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'' ===
=== Etio-pathogeneis and clinical features of [[kapha]] dominant ''visarpa'' ===
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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 ''kaphaja visarpa''. [33-34]
Its signs and symptoms are chills, fever with chills, heaviness, excess sleep, drowsiness, adherence of sticky material in the mouth, excess spitting, vomiting, lassitude, timidity, loss of appetite and prostration. The region where the disease spreads becomes edematous, pallor or slight red, unctuous, numbness, rigidness, heaviness and slight pain. It suppurates hardly and chronic in nature. It is studded with eruptions which are covered with a thick skin and having white pale color. When burst, they discharge white, slimy, fibrinous, dense, sticky and viscid discharge from it. Thereafter it is followed by the ulcers which are heavy, deep seated, surrounded by capillary network, unctuous and covered with many skin scabs. These ulcers are chronic in nature. The nails, eyes, face, skin, urine and faces of the patient appear pale. The etiological factors do no suit and the contrary ones suit the patient. This is [[kapha]]ja visarpa''. [33-34]
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=== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ===
=== Etio-pathogenesis and clinical features of [[vata]]-[[pitta]] dominant ''agni visarpa'' ===
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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'' ===
=== Etio-pathogenesis and clinical features of [[kapha]]-[[pitta]] dominant ''kardam visarpa'' ===
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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.
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'' ===
=== Etio-pathogenesis and clinical features of [[kapha]] [[vata]] dominant ''granthi visarpa'' ===
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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]
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) ===
=== ''Upadrava'' (complications) ===
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Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ''dhatus'', very fulminant and refractory to treatment.[42]
Among all types of ''visarpa vatik'', ''paittik'' and [[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 ===
=== Principles of treatment ===
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'' ===
=== Formulations used in ''visarpa'' ===
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).
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]
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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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'' ===
=== Formulations for [[dosha]] situated in koshtha, [[pitta]] dominant ''visarpa'' and [[virechana]] ===
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''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 ===
=== Formulations for [[dosha]] situated in ''shakha'' and modes of blood letting ===
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If ''dosha'' in ''shakha'' (body elements) vitiate the blood then ''raktamokshana'' should be administered at first. The physician should use ''vishana'' (deer horn) in ''vata'' dominance, ''jalauka'' (Hirudinea medicinalis) in ''pitta'' dominance and ''alabu'' (lagenaria siceraria) in ''kapha'' dominance for blood letting or physician should perform ''siravyadha'' (blood letting through vein) promptly from the adjacent vein to the affected part, without which ''rakta kleda'' (putrifying blood content) gives rise to decomposed skin, flesh and ligaments. [68-70]
If [[dosha]] in ''shakha'' (body elements) vitiate the blood then ''raktamokshana'' should be administered at first. The physician should use ''vishana'' (deer horn) in [[vata]] dominance, ''jalauka'' (Hirudinea medicinalis) in [[pitta]] dominance and ''alabu'' (lagenaria siceraria) in [[kapha]] dominance for blood letting or physician should perform ''siravyadha'' (blood letting through vein) promptly from the adjacent vein to the affected part, without which ''rakta kleda'' (putrifying blood content) gives rise to decomposed skin, flesh and ligaments. [68-70]
=== External applications ===
=== External applications ===
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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.
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.
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'' ===
=== Contra-indications in ''visarpa'' ===
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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'' ===
=== Treatment of ''granthi visarpa'' ===
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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''.
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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'' ===
=== Importance of ''raktamokshana'' in ''visarpa'' ===
If all the therapeutic measures described here as curative of ''visarpa'' be put on one side and ''raktamokshana'' on other, they will be found equal.
If all the therapeutic measures described here as curative of ''visarpa'' be put on one side and ''raktamokshana'' on other, they will be found equal.
''Visarpa'' never occurs without the association of the ''rakta'' and ''pitta'' hence entirely general treatment has been described. It does not mean that line of treatment as per other ''dosha'' predominance is not explained here. Thus, the therapeutic measures both in general and specific cases are described both in brief and in detail. The expert physician should administer these therapies appropriately.[141-143]
''Visarpa'' never occurs without the association of the [[rakta]] and [[pitta]] hence entirely general treatment has been described. It does not mean that line of treatment as per other [[dosha]] predominance is not explained here. Thus, the therapeutic measures both in general and specific cases are described both in brief and in detail. The expert physician should administer these therapies appropriately.[141-143]
=== Summary ===
=== Summary ===
Now the summing up verses –
Now the summing up verses –
Derivation,synonyms, classification, ''dosha, dushya,'' etiology, the habitat, the severe and mild gradation, symptoms and signs, complications, the nature of complications, prognosis and treatment of curable ones. All these aspects has been explained by Punarvasu Atreya for the inquisitive and intelligent Agnivesha under the treatment of ''visarpa''. [144-146]
Derivation,synonyms, classification, [[dosha]], dushya, etiology, the habitat, the severe and mild gradation, symptoms and signs, complications, the nature of complications, prognosis and treatment of curable ones. All these aspects has been explained by Punarvasu Atreya for the inquisitive and intelligent Agnivesha under the treatment of ''visarpa''. [144-146]
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== Tattva Vimarsha (Fundamental Principles) ==
== Tattva Vimarsha (Fundamental Principles) ==
*Seven elements are involved in the pathogenesis of ''visarpa'' viz., ''rakta, lasika, tvak, mamsa, vata, pitta'' and ''kapha''.
*Seven elements are involved in the pathogenesis of ''visarpa'' viz., [[rakta]], lasika, tvak, [[mamsa dhatu]], [[vata]], [[pitta]] and [[kapha]].
*''Visarpa'' is acute spreading disease and fatal in nature. General etiological factors of ''visarpa'' are diet and life style related, injury, poisons, toxins, burns etc., some of these cause vitiation of ''dosha'' and ''khavaigunya'' (disease prone condition) in ''dhatu'' and some cause direct vitiation of ''dosha'' and ''dhatu'' leading to ''visarpa''. Hence favorable condition for infection or disease phenomenon occurs at first therefore, diet and lifestyle related factors are important preventive measures.
*''Visarpa'' is acute spreading disease and fatal in nature. General etiological factors of ''visarpa'' are diet and life style related, injury, poisons, toxins, burns etc., some of these cause vitiation of [[dosha]] and ''khavaigunya'' (disease prone condition) in [[dhatu]] and some cause direct vitiation of [[dosha]] and [[dhatu]] leading to ''visarpa''. Hence favorable condition for infection or disease phenomenon occurs at first therefore, diet and lifestyle related factors are important preventive measures.
*Excess intake of salt, sour, pungent, hot articles lead to vitiation of ''rakta'' first and then lead to ''visarpa''.
*Excess intake of salt, sour, pungent, hot articles lead to vitiation of [[rakta]] first and then lead to ''visarpa''.
*''Visarpa'' is manifested externally, internally or in both pathways. Severity of disease increases respectively in these cases.
*''Visarpa'' is manifested externally, internally or in both pathways. Severity of disease increases respectively in these cases.
*Classification and pathogenesis of ''visarpa'' is based upon involvement of ''dosha'' as per their severity. Treatment protocol is designed for primarily involved predominant ''dosha''. If the ''visarpa'' is caused with ''ama dosha'' (the state of incomplete transformation) and is located in ''kaphasthana'' (in thorax and upper body parts), then ''langhana'' (fasting therapy), ''vamana'' (emesis) therapy, ''tikta'' (bitter) drugs internally and application of paste of drugs with dry and cold properties externally is beneficial.
*Classification and pathogenesis of ''visarpa'' is based upon involvement of [[dosha]] as per their severity. Treatment protocol is designed for primarily involved predominant [[dosha]]. If the ''visarpa'' is caused with ama dosha (the state of incomplete transformation) and is located in ''kaphasthana'' (in thorax and upper body parts), then [[langhana]] (fasting therapy), [[vamana]] (emesis) therapy, ''tikta'' (bitter) drugs internally and application of paste of drugs with dry and cold properties externally is beneficial.
*The same treatment should be adopted in case of association of ''ama'' and location in ''pitta sthana'' (abdomen and middle parts of body). In addition, ''raktamokshana'' (blood letting) and ''virechana'' (therapeutic purgation therapy) are specially indicated.
*The same treatment should be adopted in case of association of ''ama'' and location in [[pitta]] sthana (abdomen and middle parts of body). In addition, ''raktamokshana'' (blood letting) and [[virechana]] (therapeutic purgation therapy) are specially indicated.
*If ''sama'' (with ''ama dosha'') ''visarpa'' occurs from ''vatashaya'' (pelvis and lower part of body) dry measures are indicated in the beginning. Even in association with ''rakta-pitta'', unction measure is not regarded as beneficial in the beginning.
*If ''sama'' (with ''ama dosha'') ''visarpa'' occurs from ''vatashaya'' (pelvis and lower part of body) dry measures are indicated in the beginning. Even in association with [[rakta]]-[[pitta]], unction measure is not regarded as beneficial in the beginning.
*In ''vataja visarpa'' and ''paittika visarpa'' of mild aggravated ''dosha, tiktaka ghritam'' is beneficial. But if the ''pitta dosha'' is excessively aggravated then ''virechana'' should be given.
*In [[vata]]ja visarpa and ''paittika visarpa'' of mild aggravated [[dosha]], tiktaka ghritam'' is beneficial. But if the [[pitta]] [[dosha]] is excessively aggravated then [[virechana]] should be given.
*In the condition of excessively aggravated ''dosha'', ghee should not be given at first, which does not cause ''virechana''. Because non purgating ghee occlude the ''dosha'' resulting in decomposed skin, flesh and blood. Hence in ''visarpa, virechana'' followed by ''raktamokshana'' is recommended because the disorder is located in blood.
*In the condition of excessively aggravated [[dosha]], ghee should not be given at first, which does not cause [[virechana]]. Because non purgating ghee occlude the [[dosha]] resulting in decomposed skin, flesh and blood. Hence in ''visarpa, virechana'' followed by ''raktamokshana'' is recommended because the disorder is located in blood.
*If ''dosha'' in ''shakha'' (body elements) vitiate the blood, then ''raktamokshana'' should be administered first. The physician should use ''vishana'' (deer horn) in ''vata'' dominance, ''jalauka'' (Hirudinea medicinalis) in pitta dominance and ''alabu'' (lagenaria siceraria) in ''kapha'' dominance for blood letting or physician should perform ''siravyadha'' (blood letting through vein) promptly from the adjacent vein to the affected part, without which ''rakta kleda'' (putrifying blood content) gives rise to decomposed skin, flesh and ligaments.
*If [[dosha]] in ''shakha'' (body elements) vitiate the blood, then [[rakta]]mokshana should be administered first. The physician should use ''vishana'' (deer horn) in [[vata]] dominance, ''jalauka'' (Hirudinea medicinalis) in [[pitta]] dominance and ''alabu'' (lagenaria siceraria) in [[kapha]] dominance for blood letting or physician should perform ''siravyadha'' (blood letting through vein) promptly from the adjacent vein to the affected part, without which ''rakta kleda'' (putrifying blood content) gives rise to decomposed skin, flesh and ligaments.
*External application in the form of ''pralepa, pradeha'' and ''alepana'' (local applications of pastes) are to be used repeatedly for treatment of external lesions in ''visarpa''. The guidelines shall be followed for local applications.
*External application in the form of ''pralepa, pradeha'' and ''alepana'' (local applications of pastes) are to be used repeatedly for treatment of external lesions in ''visarpa''. The guidelines shall be followed for local applications.
*Diet articles with sweet, bitter, cooling and blood pacifying properties is prescribed in the treatment of ''visarpa''.
*Diet articles with sweet, bitter, cooling and blood pacifying properties is prescribed in the treatment of ''visarpa''.
*''Vidahi'' (that causes burning) and ''viruddha'' (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds are contraindicated in ''visarpa''.
*''Vidahi'' (that causes burning) and ''viruddha'' (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds are contraindicated in ''visarpa''.
*Predominantly ''shita'' (cool) measures are prescribed in ''pitta'' dominant condition, ''ruksha'' in ''kapha'' dominant condition and ''snigdha'' in ''vata'' dominant condition of ''visarpa''. In ''agni visarpa, vata-pitta'' pacifying measures are beneficial and in ''kardama visarpa'' mostly ''kapha pitta'' alleviating measures should be administered.
*Predominantly ''shita'' (cool) measures are prescribed in [[pitta]] dominant condition, ''ruksha'' in [[kapha]] dominant condition and ''snigdha'' in [[vata]] dominant condition of ''visarpa''. In ''agni visarpa, [[vata]]-[[pitta]] pacifying measures are beneficial and in ''kardama visarpa'' mostly [[kapha]] [[pitta]] alleviating measures should be administered.
*The ''granthi visarpa'', on inspection is predominant in ''rakta pitta'', the physician experienced in timely management should treat the case with ''rukshana'' (de-oleation), ''langhana'' (lightening therapy), ''seka'' (affusion), and ''pradeha'' (external application) of ''panchavalka, siramoksha'' (blood letting), ''jalauka'' (leech therapy), ''vamana'' (emesis therapy), ''virechana'' (purgation therapy) and ''kashaya- tikta'' (astringent and bitter) ghee preparations. After cleansing of body by ''vamana'' and ''virechana, rakta mokshana'' should be administered and the measures alleviating ''vata-kapha'' are beneficial.
*The ''granthi visarpa'', on inspection is predominant in [[rakta]] [[pitta]], the physician experienced in timely management should treat the case with [[rukshana]] (de-oleation), [[langhana]] (lightening therapy), ''seka'' (affusion), and ''pradeha'' (external application) of ''panchavalka, siramoksha'' (blood letting), ''jalauka'' (leech therapy), [[vamana]] (emesis therapy), [[virechana]] (purgation therapy) and ''kashaya- tikta'' (astringent and bitter) ghee preparations. After cleansing of body by [[vamana]] and [[virechana]], [[rakta]] mokshana should be administered and the measures alleviating [[vata]]-[[kapha]] are beneficial.
*The same line of treatment of ''granthi'' should be applied for the treatment of ''kaphaja galganda''. The ''vatika galaganda'' associated with ''kapha'' may be cured by regular use of ghee, milk and decoction preparations.
*The same line of treatment of ''granthi'' should be applied for the treatment of [[kapha]]ja galganda''. The ''vatika galaganda'' associated with [[kapha]] may be cured by regular use of ghee, milk and decoction preparations.
== Vidhi Vimarsha (Applied Inferences ) ==
== Vidhi Vimarsha (Applied Inferences ) ==
=== Causative factors of ''visarpa'' in contemporary era ===
=== Causative factors of ''visarpa'' in contemporary era ===
Modern point of view ''visarpa'' is generally caused by a variety of infections. As per Punarvasu Atreya, the general etiological factors of ''visarpa'' are diet and lifestyle, injury, poisons, toxins, burns etc; some of these cause vitiation of ''dosha'' and ''khavaigunya'' (disease prone condition) in ''dhatu'' and some cause direct vitiation of ''dosha'' and ''dhatu'' leading to ''visarpa''. This is confusing to the new scholars. Atreya's understanding of etiology is more specific because favorable condition for infection occurs at first then infection therefore diet and lifestyle related factors are described in detail and in the beginning. In treatment plan this concept of favorable environment should be considered. Change in internal body environment is possible by ''shodhana'' therapy and ''aushadha'' along with treatment of infection.
Modern point of view ''visarpa'' is generally caused by a variety of infections. As per Punarvasu Atreya, the general etiological factors of ''visarpa'' are diet and lifestyle, injury, poisons, toxins, burns etc; some of these cause vitiation of [[dosha]] and ''khavaigunya'' (disease prone condition) in [[dhatu]] and some cause direct vitiation of [[dosha]] and [[dhatu]] leading to ''visarpa''. This is confusing to the new scholars. Atreya's understanding of etiology is more specific because favorable condition for infection occurs at first then infection therefore diet and lifestyle related factors are described in detail and in the beginning. In treatment plan this concept of favorable environment should be considered. Change in internal body environment is possible by ''shodhana'' therapy and ''aushadha'' along with treatment of infection.
=== Pathophysiology of ''Visarpa'' [flow chart] ===
=== Pathophysiology of ''Visarpa'' [flow chart] ===
''Paittika visarpa'' symptoms are suggestive of severe skin disease (erysipelas, extensive herpes, burns etc.) and are curable with appropriate management.
''Paittika visarpa'' symptoms are suggestive of severe skin disease (erysipelas, extensive herpes, burns etc.) and are curable with appropriate management.
[[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.
''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 ====
==== 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'' ===
=== Researches done on ''visarpa'' ===
=== Further reading ===
=== Further reading ===
#Agnivesha, Charak, Dridhabala, Charak samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, edited by Vaidya Yadavaji Trikamji Aacharya, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990;228.
#Charak, Chikitsa Sthana, chap 21 Visarpa Chikitsa Adhyaya. In:Vaidya Yadavaji Trikamji Aacharya, Editor, Charak samhita, 2nd edition, Varanasi;Chaukhamba Sanskrit Sansthan,1990;228.
#Chakrapanidutta, Commnetator. Charak Samhita, Chikitsa Sthana, Visarpa Chikitsa Adhyaya, 21, 2nd edition, Chaukhamba Sanskrit Sansthan, Varanasi, 1990; 225.
#Chakrapani,Charak,Chikitsa Sthana, Chap 21 Visarpa Chikitsa Adhyaya, 2nd edition,Varanasi; Chaukhamba Sanskrit Sansthan, 1990; 225.
#Agnivesha, Charak, Dridhabala, Charak Samhita, Cikitsa Sthana, Visarpa Cikitsitam, 21. In: Pt. Dutta R, editor. 2 nd ed., 2003 reprint, Varanasi: Chaukhambha Bharti Academy; 2003. p. 231.
#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.
#Agnivesha, Charak Samhita, Vidyotini Hindi commentary by Kashiram Shastri and Gorakhnath Chaturvedi, Part II.Cikitsa Sthana, 21. Varanasi: Chaukhambha Bharati Academy; Reprint 2005. p. 235.
#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.
#Agnivesha, Charak, Dridhabala, Charak Samhita, Chkitsa Sthana, Visarpa Cikitsitam,21, Ayushi hindi commentary Edited by Vd. Khushvaha HS, 1 st edition, Chaukhambha Orientalia Publisher, Varanasi, 2009;224.
#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.
#Chakrapanidatta, Charak Samhita, Cikitsa Sthana, Visarpa Cikitsitam, 21.[[Ayurveda]] Dipika Commentry, Edited by Vd. Yadavaji T. A. 1 st edition, Chaukhambha Orientalia Publications, Varanasi, 2001;227.
#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. In: Vaidya Yadavji Trikamji Acharaya, Narayan Ram Acharaya, editors. Sushruta Samhita, Cikitsa Sthana, 17. Varanasi: Chaukhambha Orientalia; 2007. p. 321.
#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, Kaviraj Ambikadutt Shastri, Sushruta Samhita, Nidana sthana,10. 11 th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1998. p. 129.
#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, 11, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005;229.
#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, 10, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 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.
#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.
#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.
#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. </div>
#Vagbhata,Ashtanga Hridyam , Nidana Sthana, Chap 13 Pandurogasophavisarpa Nidana.Translated by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221. </div>
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