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<big>'''Abstract </big>'''

<big>'''Abstract </big>'''

 

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''.   

   

   

'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.

'''Keywords''': ''Visarpa, Parisarpa,'' Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections.

 

{{Infobox

{{Infobox

|title = Visarpa Chikitsa

|title = Visarpa Chikitsa

== Introduction ==

== Introduction ==

 

The twenty first chapter is named [[Visarpa Chikitsa]]. The term ''visarpa'' has two parts viz., ''vi'' and ''sarpa''- ''vi'' stands for ''vividha'' meaning ‘various’ (ways) and ''sarpa'' stands for ''sarpan'' means ‘spreading’.  Erythematous, pustular, glandular etc. lesions which spread rapidly in localized or generalized pattern are known as ''visarpa'' (Cha.Chi. Chakrapani 21/11). This aliment is also called ''parisarpa''. The prefix ''pari'' stands for ''paritah'' or ''sarvatah'' meaning all over. The disease which spreads all over the body is called ''visarpa''. (Cha.Chi. Chakrapani 21/11) This indicates that ''visarpa'' is an umbrella term used for acute spreading disorders caused due to vitiation of ''rakta''.  

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''.  

''Kshataja visarpa'' is another variety mentioned additionally in Sushruta Samhita. The later texts followed the same description with addition of some medications.

''Kshataja visarpa'' is another variety mentioned additionally in Sushruta Samhita. The later texts followed the same description with addition of some medications.

 

== Sanskrit Text, Transliteration and English Translation ==

== Sanskrit Text, Transliteration and English Translation ==

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iti ha smAha bhagavAnAtreyaH||2||  

iti ha smAha bhagavAnAtreyaH||2||  

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Now we shall expound the chapter "Visarpa Chikitsa" (Management of acute spreading erysepalas). Thus said Lord Atreya. [1-2]  

Now we shall expound the chapter "Visarpa Chikitsa" (Management of acute spreading erysepalas). Thus said Lord Atreya. [1-2]  

''Visarpa'' manifesting with all signs and symptoms, having strong etiological factors, which is associated with formidable complications and that situates as well as affects vital parts, proves fatal.[28]

''Visarpa'' manifesting with all signs and symptoms, having strong etiological factors, which is associated with formidable complications and that situates as well as affects vital parts, proves fatal.[28]

 

=== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ===

=== Etio-pathogeneis and clinical features of ''vata'' dominant ''visarpa'' ===

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tasya rUpANi- bhramadavathupipAsAnistodashUlA~ggamardodveShTanakampajvaratamaka-kAsAsthisandhibhedavishleShaNavepanArocakAvipAkAshcakShuShorAkulatvamasrAgamanaMpipIlikAsa~jcAra iva cA~ggeShu, yasmiMshcAvakAshe visarpo visarpati [1] so~avakAshaHshyAvAruNAbhAsaH shvayathumAn nistodabhedashUlAyAmasa~gkocaharShasphuraNairatimAtraMprapIDyate, anupakrAntashcopacIyate shIghrabhedaiH sphoTakaistanubhiraruNAbhaiH shyAvairvātanuvishadAruNAlpAsrAvaiH, vibaddhavātamUtrapurIShashca bhavati, nidAnoktAni cAsya nopasherateviparItAni copasherata iti vātavisarpaH||30||

tasya rUpANi- bhramadavathupipAsAnistodashUlA~ggamardodveShTanakampajvaratamaka-kAsAsthisandhibhedavishleShaNavepanArocakAvipAkAshcakShuShorAkulatvamasrAgamanaMpipIlikAsa~jcAra iva cA~ggeShu, yasmiMshcAvakAshe visarpo visarpati [1] so~avakAshaHshyAvAruNAbhAsaH shvayathumAn nistodabhedashUlAyAmasa~gkocaharShasphuraNairatimAtraMprapIDyate, anupakrAntashcopacIyate shIghrabhedaiH sphoTakaistanubhiraruNAbhaiH shyAvairvātanuvishadAruNAlpAsrAvaiH, vibaddhavātamUtrapurIShashca bhavati, nidAnoktAni cAsya nopasherateviparItAni copasherata iti vātavisarpaH||30||

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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.  

''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]

 

=== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ===

=== Etio-pathogeneis and clinical features of ''pitta'' dominant ''visarpa'' ===

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tasya rUpANi- jvarastRuShNA mUrcchA mohashchardirarocako~a~ggabhedaHsvedo~atimAtramantardAhaH pralApaH shiroruk cakShuShorAkulatvamasvapnamaratirbhramaHshItavātavAritarSho~atimAtraM haritahAridranetramUtravarcastvaM haritahAridrarUpadarshanaM ca,yasmiMshcAvakAshe visarpo~anusarpati so~avakAshastAmraharitahAridranIlakRuShNaraktAnAMvarNAnAmanyatamaM puShyati, sotsedhaishcAtimAtraM dAhasambhedanaparItaiH sphoTakairupacIyatetulyavarNAsrAvaishcirapAkaishca, nidAnoktAni cAsya nopasherate viparItAni copasherata itipittavisarpaH||32||  

tasya rUpANi- jvarastRuShNA mUrcchA mohashchardirarocako~a~ggabhedaHsvedo~atimAtramantardAhaH pralApaH shiroruk cakShuShorAkulatvamasvapnamaratirbhramaHshItavātavAritarSho~atimAtraM haritahAridranetramUtravarcastvaM haritahAridrarUpadarshanaM ca,yasmiMshcAvakAshe visarpo~anusarpati so~avakAshastAmraharitahAridranIlakRuShNaraktAnAMvarNAnAmanyatamaM puShyati, sotsedhaishcAtimAtraM dAhasambhedanaparItaiH sphoTakairupacIyatetulyavarNAsrAvaishcirapAkaishca, nidAnoktAni cAsya nopasherate viparItAni copasherata itipittavisarpaH||32||  

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The ''pitta'' aggravated by the use of hot regimen, by eating irritant and sour foods vitiates the susceptible body elements and by feeling the vessels, begins to spread.

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 etiological factors do no suit and the contrary ones suit the patient. This is ''pitta'' dominant ''visarpa''. [31-32]

The etiological factors do no suit and the contrary ones suit the patient. This is ''pitta'' dominant ''visarpa''. [31-32]

 

=== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ===

=== Etio-pathogeneis and clinical features of ''kapha'' dominant ''visarpa'' ===

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tasya rūpāṇi- śītakaḥ śītajvarō gauravaṁ nidrā tandrā'rōcakō madhurāsyatvamāsyōpalēpō niṣṭhīvikāchardirālasyaṁ staimityamagnināśō daurbalyaṁ ca, yasmiṁścāvakāśē visarpō'nusarpati sō'vakāśaḥśvayathumān pāṇḍurnātiraktaḥ snēhasuptistambhagauravairanvitō'lpavēdanaḥkr̥cchrapākaiścirakāribhirbahulatvagupalēpaiḥ sphōṭaḥ śvētapāṇḍubhiranubadhyatē, prabhinnastu śvētaṁpicchilaṁ tantumaddhanamanubaddhaṁ snigdhamāsrāvaṁ sravati, ūrdhvaṁ ca gurubhiḥsthirairjālāvātataiḥ snigdhairbahulatvagupalēpairvraṇairanubadhyatē'nuṣaṅgī ca bhavati,śvētanakhanayanavadanatvaṅmūtravarcastvaṁ, nidānōktāni cāsya nōpaśēratē viparītāni cōpaśērata itiślēṣmavisarpaḥ||34||  

tasya rūpāṇi- śītakaḥ śītajvarō gauravaṁ nidrā tandrā'rōcakō madhurāsyatvamāsyōpalēpō niṣṭhīvikāchardirālasyaṁ staimityamagnināśō daurbalyaṁ ca, yasmiṁścāvakāśē visarpō'nusarpati sō'vakāśaḥśvayathumān pāṇḍurnātiraktaḥ snēhasuptistambhagauravairanvitō'lpavēdanaḥkr̥cchrapākaiścirakāribhirbahulatvagupalēpaiḥ sphōṭaḥ śvētapāṇḍubhiranubadhyatē, prabhinnastu śvētaṁpicchilaṁ tantumaddhanamanubaddhaṁ snigdhamāsrāvaṁ sravati, ūrdhvaṁ ca gurubhiḥsthirairjālāvātataiḥ snigdhairbahulatvagupalēpairvraṇairanubadhyatē'nuṣaṅgī ca bhavati,śvētanakhanayanavadanatvaṅmūtravarcastvaṁ, nidānōktāni cāsya nōpaśēratē viparītāni cōpaśērata itiślēṣmavisarpaḥ||34||  

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''Kapha'' excessively accumulated due to intake of sweet, sour, salt, unctuous and heavy foods, and also by excessive sleep, vitiates the susceptible body elements and spreads with slow speed in the body.  

''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 ''kaphaja visarpa''. [33-34]

 

=== 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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tadupatApAdAturaH sarvasharIrama~ggArairivAkIryamANaM manyate,chardyatIsAramUrcchAdAhamohajvaratamakArocakAsthisandhibhedatRuShNAvipAkA~ggabhedAdibhishcAbhibhUyate,yaM yaM cAvakAshaM visarpo~anusarpati so~avakAshaH shAntA~ggAraprakAsho~atirakto vA bhavati,agnidagdhaprakAraishca sphoTairupacIyate, sa shIghragatvAdAshveva marmAnusArI bhavati, marmaNi copataptepavano~atibalo bhinattya~ggAnyatimAtraM pramohayati sa~jj~jAM, hikkAshvAsau janayati, nAshayati nidrAM, sanaShTanidraH pramUDhasa~jj~jo vyathitacetA na kvacana sukhamupalabhate, aratiparItaH sthAnAdAsanAcchayyAMkrAntumicchati, kliShTabhUyiShThashcAshu nidrAM bhajati, durbalo duHkhaprabodhashca bhavati;tamevaMvidhamagnivisarpaparItamacikitsyaM vidyAt||36||  

tadupatApAdAturaH sarvasharIrama~ggArairivAkIryamANaM manyate,chardyatIsAramUrcchAdAhamohajvaratamakArocakAsthisandhibhedatRuShNAvipAkA~ggabhedAdibhishcAbhibhUyate,yaM yaM cAvakAshaM visarpo~anusarpati so~avakAshaH shAntA~ggAraprakAsho~atirakto vA bhavati,agnidagdhaprakAraishca sphoTairupacIyate, sa shIghragatvAdAshveva marmAnusArI bhavati, marmaNi copataptepavano~atibalo bhinattya~ggAnyatimAtraM pramohayati sa~jj~jAM, hikkAshvAsau janayati, nAshayati nidrAM, sanaShTanidraH pramUDhasa~jj~jo vyathitacetA na kvacana sukhamupalabhate, aratiparItaH sthAnAdAsanAcchayyAMkrAntumicchati, kliShTabhUyiShThashcAshu nidrAM bhajati, durbalo duHkhaprabodhashca bhavati;tamevaMvidhamagnivisarpaparItamacikitsyaM vidyAt||36||  

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When ''vata-pitta'' vitiated severely due to their respective etiological factors and strengthened mutually, spreads producing severe burning pain in the body.  

When ''vata-pitta'' vitiated severely due to their respective etiological factors and strengthened mutually, spreads producing severe burning pain in the body.  

The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the ''vata'' which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]

The patient affected with this type of ''visarpa'' feels as if his body is sprinkled with flaming coals. He suffers from vomiting, diarrhea, fainting, burning sensation, disturbed consciousness, fever, feeling of darkness, anorexia, breaking pain in bones and joints, morbid thirst, indigestion, breaking body pain etc. The part where the disease spreads looks like extinguished charcoal or blood like red, affected region gets covered with blisters like those caused by burns. Due to its rapid progress, it soon spreads to vital regions. When the vital parts gets affected, the ''vata'' which is excessively aggravated causes extensive disintegration of the tissues and leads to disturbed consciousness, produces hiccup, dyspnea and insomnia. That sleepless patient with disturbed consciousness and miserable mind does not get relief anywhere. He becomes restless in standing, seating and desires to lie on bed, thus exceedingly exhausted due to pain soon falls into deep sleep. Being debilitated, he is aroused from this state with difficulty. One suffering from ''agni-visarpa'' is to be regarded as incurable.[35-36]

 

=== 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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tadvikArAH- shItajvaraH shirogurutvaM dAhaH staimityama~ggAvasadanaM nidrA tandrAmoho~annadveShaH pralApo~agninAsho daurbalyamasthibhedo mUrcchA pipAsA srotasAM pralepojADyamindriyANAM prAyopaveshanama~ggavikShepo~a~ggamardo~aratirautsukyaM copajAyate,prAyashcAmAshaye visarpatyalasaka ekadeshagrAhI ca, yasmiMshcAvakAshe visarpo visarpatiso~avakAsho raktapItapANDupiDakAvakIrNa iva mecakAbhaH kAlo malinaH snigdho bahUShmA guruHstimitavedanaH shvayathumAn gambhIrapAko nirAsrAvaH shIghrakledaH svinnaklinnapUtimAMsatvakkrameNAlparuk parAmRuShTo~avadIryate kardama ivAvapIDito~antaraMprayacchatyupaklinnapUtimAMsatyAgI sirAsnAyusandarshI kuNapagandhI ca bhavati sa~jj~jAsmRutihantAca; taM kardamavisarpaparItamacikitsyaM vidyAt||38||  

tadvikArAH- shItajvaraH shirogurutvaM dAhaH staimityama~ggAvasadanaM nidrA tandrAmoho~annadveShaH pralApo~agninAsho daurbalyamasthibhedo mUrcchA pipAsA srotasAM pralepojADyamindriyANAM prAyopaveshanama~ggavikShepo~a~ggamardo~aratirautsukyaM copajAyate,prAyashcAmAshaye visarpatyalasaka ekadeshagrAhI ca, yasmiMshcAvakAshe visarpo visarpatiso~avakAsho raktapItapANDupiDakAvakIrNa iva mecakAbhaH kAlo malinaH snigdho bahUShmA guruHstimitavedanaH shvayathumAn gambhIrapAko nirAsrAvaH shIghrakledaH svinnaklinnapUtimAMsatvakkrameNAlparuk parAmRuShTo~avadIryate kardama ivAvapIDito~antaraMprayacchatyupaklinnapUtimAMsatyAgI sirAsnAyusandarshI kuNapagandhI ca bhavati sa~jj~jAsmRutihantAca; taM kardamavisarpaparItamacikitsyaM vidyAt||38||  

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Excessively aggravated ''kapha pitta'' due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.  

Excessively aggravated ''kapha pitta'' due to their respective etiological factors, spreads in the body causing suppuration of the tissues in particular part.  

The part where the disease spreads looks as if filled with reddish, yellowish, pale eruptions. The affected part becomes muddy, black, dirty, unctuous, excess hot, heavy, dull aching, edematous, with deep seated suppuration, having no discharge, rapidly become sloughy, sweated suppurated, having putrid flesh and skin, gradual little pain, when touched bursts and gives space on pressing, throws out decomposed and putrefied flesh, shows blood vessels, ligaments and has cadaverous smell and causes disturbed consciousness as well as memory. This is called ''kardam visarpa'' and is incurable. [37-38]

The part where the disease spreads looks as if filled with reddish, yellowish, pale eruptions. The affected part becomes muddy, black, dirty, unctuous, excess hot, heavy, dull aching, edematous, with deep seated suppuration, having no discharge, rapidly become sloughy, sweated suppurated, having putrid flesh and skin, gradual little pain, when touched bursts and gives space on pressing, throws out decomposed and putrefied flesh, shows blood vessels, ligaments and has cadaverous smell and causes disturbed consciousness as well as memory. This is called ''kardam visarpa'' and is incurable. [37-38]

 

=== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ===

=== Etio-pathogenesis and clinical features of ''kapha vata'' dominant ''granthi visarpa'' ===

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sthiragurukaThinamadhurashItasnigdhAnnapAnAbhiShyandisevinAmavyAyAmAdisevinAmapratikarmashIlAnAMshleShmA vAyushca prakopamApadyate, tAvubhau duShTapravRuddhAvatibalau pradUShya dUShyAnvisarpAya kalpete; tatra vAyuH shleShmaNA vibaddhamArgastameva shleShmANamanekadhA bhindankrameNa granthimAlAM kRucchrapAkasAdhyAMkaphAshaye sa~jjanayati, utsannaraktasya vA pradUShyaraktaM sirAsnAyumAMsatvagAshritaM granthInAM mAlAM kurute tIvrarujAnAM sthUlAnAmaNUnAM vAdIrghavRuttaraktAnAM, tadupatApAjjvarAtisArakAsahikkAshvAsashoSha-pramohavaivarNyArocakAvipAkaprasekacchardirmUrcchA~ggabha~gganidrAratisadanAdyAHprAdurbhavantyupadravAH; sa etairupadrutaH sarvakarmaNAM viShayamatipatito vivarjanIyo bhavatItigranthivisarpaH||39||  

sthiragurukaThinamadhurashItasnigdhAnnapAnAbhiShyandisevinAmavyAyAmAdisevinAmapratikarmashIlAnAMshleShmA vAyushca prakopamApadyate, tAvubhau duShTapravRuddhAvatibalau pradUShya dUShyAnvisarpAya kalpete; tatra vAyuH shleShmaNA vibaddhamArgastameva shleShmANamanekadhA bhindankrameNa granthimAlAM kRucchrapAkasAdhyAMkaphAshaye sa~jjanayati, utsannaraktasya vA pradUShyaraktaM sirAsnAyumAMsatvagAshritaM granthInAM mAlAM kurute tIvrarujAnAM sthUlAnAmaNUnAM vAdIrghavRuttaraktAnAM, tadupatApAjjvarAtisArakAsahikkAshvAsashoSha-pramohavaivarNyArocakAvipAkaprasekacchardirmUrcchA~ggabha~gganidrAratisadanAdyAHprAdurbhavantyupadravAH; sa etairupadrutaH sarvakarmaNAM viShayamatipatito vivarjanIyo bhavatItigranthivisarpaH||39||  

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''Kapha'' and ''vata'' gets vitiated due to the use of firm, heavy, hard, sweet, cold, unctuous, and ''abhishyandi'' (which increase discharges and cause obstruction) ingredients of diet, lack of physical exercise etc. not following preventive seasonal [[Panchakarma]] purification. Deranged excessively, aggravated, powerful both ''kapha'' and ''vata'' vitiates the susceptible body elements giving rise to ''granthi visarpa''. Thereafter the ''vata'' being occluded by ''kapha'' in its progress and disintegrates ''kapha'' in many ways and gradually giving rise to chain of glands, hardly suppurating and difficult to cure, in the habitats of ''kapha''.

''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''.

The ''visarpa'' which is caused by all etiological factors, manifesting with all signs and symptoms, spreads in all body elements very rapidly and great disastrous is known as ''sannipataja visarpa'' and is not treatable. [41]

The ''visarpa'' which is caused by all etiological factors, manifesting with all signs and symptoms, spreads in all body elements very rapidly and great disastrous is known as ''sannipataja visarpa'' and is not treatable. [41]

 

=== Prognosis of ''visarpa'' ===

=== Prognosis of ''visarpa'' ===

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tatra vātapittashleShmanimittA visarpAstrayaH sAdhyA bhavanti; agnikardamAkhyau punaranupasRuShTemarmaNi anupagate vA sirAsnAyumAMsaklede sAdhAraNakriyAbhirubhAvevAbhyasyamAnauprashAntimApadyeyAtAm, anAdaropakrAntaH punastayoranyataro hanyAddehamAshvevAshIviShavat;tathA granthivisarpamajAtopadravamArabheta cikitsitum, upadravopadrutaM tvenaM pariharet;sannipAtajaM tu sarvadhAtvanusAritvAdAshukAritvAdviruddhopakramatvAccAsAdhyaM vidyAt||42||  

tatra vātapittashleShmanimittA visarpAstrayaH sAdhyA bhavanti; agnikardamAkhyau punaranupasRuShTemarmaNi anupagate vA sirAsnAyumAMsaklede sAdhAraNakriyAbhirubhAvevAbhyasyamAnauprashAntimApadyeyAtAm, anAdaropakrAntaH punastayoranyataro hanyAddehamAshvevAshIviShavat;tathA granthivisarpamajAtopadravamArabheta cikitsitum, upadravopadrutaM tvenaM pariharet;sannipAtajaM tu sarvadhAtvanusAritvAdAshukAritvAdviruddhopakramatvAccAsAdhyaM vidyAt||42||  

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Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ''dhatus'', very fulminant and refractory to treatment.[42]

Among all types of ''visarpa vatik'', ''paittik'' and ''kaphaja'' these three are curable. ''Agni'' and ''kardam visarpa'' not spreading to vital organs and causing no suppuration of the vessels, ligaments and muscles can be pacified by the general treatment of ''visarpa''. When managed with negligence both may cause death of patients like snake venom. ''Granthi visarpa'' should be treated before complications has arisen, otherwise should be rejected. ''Sannipataja visarpa'' should be taken as incurable because of it is spreading to all ''dhatus'', very fulminant and refractory to treatment.[42]

#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, 10, English commentary by Prof. Murthy KR, 9 th edition, Chaukhambha Orientalia Publisher, Varanasi, 2005; 229.   

#Vagbhatta′s Ashtanga Hridyam (text, English translation, notes, appendix, indices). 7 th ed., Vol. 1. Translated by Prof. K.R. Shrikanth Murthy, Cikitsa Sthana,18. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.   

#Vagbhatta′s Ashtanga Hridyam (text, English translation, notes, appendix, indices). 7 th ed., Vol. 1. Translated by Prof. K.R. Shrikanth Murthy, Cikitsa Sthana,18. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.   

#Vagbhatta′s Ashtanga Hridyam (text, English translation, notes, appendix, indices). 7 th ed., Vol. 1. Translated by Prof. K.R. Shrikanth Murthy, Nidana Sthana, 13. Varanasi: Chaukhambha Krishnadas Academy; 2010. p. 221.

#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>

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