Visarpa Chikitsa - Revision history

Agnivesha: /* Introduction */

2025-11-18T04:32:24Z

Introduction

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	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 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''.		Seven components are involved in the pathogenesis of ''visarpa'' viz., [[rakta]] (blood), ''lasika'' (lymph), ''tvak'' (skin), [[mamsa dhatu]] (flesh), [[vata]], [[pitta]]<nowiki/>and [[Kapha dosha\|kapha]]. Same components are associated with [[Kushtha Chikitsa\|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. Sa. [[Chikitsa Sthana]] 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]

Agnivesha: /* Introduction */

2025-11-18T04:28:54Z

Introduction

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	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]].		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 [Cha. Sa. [[Chhardi Chikitsa\|Chhardi]] Chikitsa ] because suppression of chhardi (vomiting) causes [[Rakta dhatu\|rakta]] dushti(vitiation of blood) leading to visarpa indicating that [[Rakta dhatu\|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.

Agnivesha at 10:23, 23 February 2024

2024-02-23T10:23:03Z

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	\|data7 = Ojha S.N.		\|data7 = Ojha S.N.
	\|label8 = Editors		\|label8 = Editors
	\|data8 = Ojha S.N.,Deole Y.S., Basisht G.		\|data8 = Ojha S.N., [[Yogesh Deole\|Deole Y.S.]], [[Gopal Basisht\|Basisht G.]]
	\|label9 = Year of publication		\|label9 = Year of publication
	\|data9 = 2020		\|data9 = 2020

Agnivesha at 14:29, 9 March 2023

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	}}		}}

	<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
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	<big>'''Abstract </big>'''		<big>'''Abstract </big>'''
	<~~div~~ style="text-align:justify;">		<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''.
	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''.		<br/>

	'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.		'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.
	</~~div~~>		</p>


	== Introduction ==		== Introduction ==

Agnivesha at 06:42, 20 September 2022

2022-09-20T06:42:46Z

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			{{CiteButton}}
	{{#seo:		{{#seo:
	\|title=Visarpa Chikitsa		\|title=Visarpa Chikitsa

Eganeesh: /* Further reading */

2021-09-23T22:28:55Z

Anaghas: /* Vidhi Vimarsha (Applied Inferences ) */

2021-07-31T06:07:57Z

Vidhi Vimarsha (Applied Inferences )

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

	~~''Kaphaja~~ visarpa'' appears as progressively but gradually spreading ailment, suggestive of acute skin infection (erysipelas etc.) and is curable.		[[Kapha]]ja visarpa appears as progressively but gradually spreading ailment, suggestive of acute skin infection (erysipelas etc.) and is curable.

	''Agni visarpa'' is a serious infection of skin and lead to septicemia like condition. ''Agnivisarpa'' with the signs and symptoms described here is a serious ailment and is incurable. This ailment may be cured if vitals are not involved.		''Agni visarpa'' is a serious infection of skin and lead to septicemia like condition. ''Agnivisarpa'' with the signs and symptoms described here is a serious ailment and is incurable. This ailment may be cured if vitals are not involved.
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	==== Evidence based studies ====		==== Evidence based studies ====

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

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

Anaghas: /* Tattva Vimarsha (Fundamental Principles) */

2021-07-31T06:04:42Z

Tattva Vimarsha (Fundamental Principles)

Anaghas: /* Summary */

2021-07-31T05:56:41Z

Summary

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	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]
	<div class="mw-collapsible mw-collapsed">		<div class="mw-collapsible mw-collapsed">

Anaghas: /* Importance of raktamokshana in visarpa */

2021-07-31T05:54:44Z

Importance of raktamokshana in visarpa

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	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 ===

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	#Vagbhata, Ashtanga Hridyam ,Cikitsa Sthana,18. Visarpa chikitsitam Adhyaya .Translated to English by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.		#Vagbhata, Ashtanga Hridyam ,Cikitsa Sthana,18. Visarpa chikitsitam Adhyaya .Translated to English by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.
	#Vagbhata,Ashtanga Hridyam , Nidana Sthana, Chap 13 Pandurogasophavisarpa Nidana.Translated by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221. </div>		#Vagbhata,Ashtanga Hridyam , Nidana Sthana, Chap 13 Pandurogasophavisarpa Nidana.Translated by Prof. K.R. Shrikanth Murthy, 7 th ed., Vol. 1. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221. </div>

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	== References ==		== References ==

← Older revision		Revision as of 06:04, 31 July 2021
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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 ) ==