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Visarpa Chikitsa (view source)

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{{#seo:

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|title=Visarpa Chikitsa

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|titlemode=append

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|keywords=Visarpa, Parisarpa, Erysepalas, Gangrene, Septicaemia, Sepsis, Fulminant spreading skin infections

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|description=Chikitsa Sthana Chapter 21. Management of Visarpa (acute spreading erysepalas)

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}}

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<big>'''[[Chikitsa Sthana]] Chapter 21. Management of Visarpa (acute spreading erysepalas)</big>'''

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=== Sanskrit Text, Transliteration and English Translation ===

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अथातो विसर्पचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

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athātō visarpacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

Now I shall expound the chapter on the therapeutics of acute spreading disorder known as ''visarpa''. Thus said Lord Atreya. [1]

==== Agnivesha’s queries on ''visarpa'' ====

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कैलासे किन्नराकीर्णे बहुप्रस्रवणौषधे |

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यथावदखिलं सर्वं प्रोवाच मुनिसत्तमः ||१०||

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kailāsē kinnarākīrṇē bahuprasravaṇauṣadhē|

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yathAvadakhilaM sarvaM provAca munisattamaH||10||

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</div></div>

In the Kailas region inhabited by ''kinnaras'', having numerous water streams and medicinal plants with ever emitting sweet pleasant (''ishat gandha'') aroma by their wealth of flowers, Atreya who had great self-control, was surrounded by great sages and engaged in welfare of all creatures. Then Agnivesha choosing the appropriate time asked politely to his enlightened teacher,

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==== Definition of ''visarpa'' ====

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विविधं सर्पति यतो विसर्पस्तेन स स्मृतः |

परिसर्पोऽथवा नाम्ना सर्वतः परिसर्पणात् ||११||

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vividhaṁ sarpati yatō visarpastēna sa smr̥taḥ|

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parisarpo~athavA nAmnA sarvātaH parisarpaNAt||11||

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</div></div>

It spreads in various ways hence known as ''visarpa''. It is also called ''parisarpa'' due to its extensive spreading.[11]

==== Classification ====

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स च सप्तविधो दोषैर्विज्ञेयः सप्तधातुकः |

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यस्तु कर्दमको घोरः स पित्तकफसम्भवः ||१४||

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sa ca saptavidhō dōṣairvijñēyaḥ saptadhātukaḥ|

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yastu kardamako ghoraH sa pittakaphasambhavaH||14||

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</div></div>

''Visarpa'' is of seven types as per ''dosha'' basis and it involves seven body elements.

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==== Vitiated factors ====

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रक्तं लसीकात्वङ्मांसं दूष्यं दोषास्त्रयो मलाः |

विसर्पाणां समुत्पत्तौ विज्ञेयाः सप्त धातवः ||१५||

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raktaṁ lasīkā tvaṅmāṁsaṁ dūṣyaṁ dōṣāstrayō malāḥ|

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visarpANAM samutpattau vij~jeyAH sapta dhAtavaH||15||

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</div></div>

Blood, lymph, skin, flesh and three ''dosha'', these seven elements are involved in the pathogenesis of ''visarpa'' of all kinds. [15]

==== Etiology ====

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लवणाम्लकटष्णानां रसानामतिसेवनात् |

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दूष्यान् सन्दूष्य रक्तादीन् विसर्पन्त्यहिताशिनाम् ||२२||

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lavaṇāmlakaṭūṣṇānāṁ rasānāmatisēvanāt|

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dUShyAn sandUShya raktAdIn visarpantyahitAshinAm||22||

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</div></div>

The following are the causative factors of the ''visarpa'':

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==== Pathways of spreading the disease ====

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बहिःश्रितः श्रितश्चान्तस्तथा चोभयसंश्रितः |

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बहिर्बहिःप्रकुपिताः सर्वत्रोभयसंश्रिताः ||२५||

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bahiḥśritaḥ śritaścāntastathā cōbhayasaṁśritaḥ|

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bahirbahiHprakupitAH sarvatrobhayasaMshritAH||25||

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</div></div>

Externally situated (pathogenesis in ''shakha, rasa'' and ''rakta dhatu''), internally situated (pathogenesis in internal organs and other ''dhatu'') and situated in both (externally as well as internally) pathways ''visarpa'' is to be known more and more serious consecutively.

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==== Causes and features of internal and external ''visarpa'' ====

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मर्मोपघातात् सम्मोहादयनानां विघट्टनात् |

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अतो विपर्ययाद्बाह्यमन्यैर्विद्यात् स्वलक्षणैः ||२७||

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marmōpaghātāt sammōhādayanānāṁ vighaṭṭanāt|

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ato viparyayAdbAhyamanyairvidyAt svalakShaNaiH||27||

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</div></div>

Affliction of vital organs, impaired consciousness, impaired circulation, morbid thirst and impaired natural urges and sudden reduction in digestive as well as immune power of body is known as ''antah-visarpa''. ''Bahih-visarpa'' should be understood by the external manifestations appearing on skin flesh etc. and by their own specific symptoms. [26-27]

==== Bad prognostic features ====

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यस्य सर्वाणि लिङ्गानि बलवद्यस्यकारणम् |

यस्य चोपद्रवाः कष्टा मर्मगो यश्च हन्ति सः ||२८||

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yasya sarvāṇi liṅgāni balavadyasya kāraṇam|

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yasya copadravAH kaShTA marmago yashca hanti saH||28||

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</div></div>

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

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

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रूक्षोष्णैः केवलो वायुः पूरणैर्वा समावृतः |

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तस्य रूपाणि- भ्रमदवथुपिपासानिस्तोदशूलाङ्गमर्दोद्वेष्टनकम्पज्वरतमककासास्थिसन्धिभेदविश्लेषणवेपनारोचकाविपाकाश्चक्षुषोराकुलत्वमस्रागमनं पिपीलिकासञ्चार इव चाङ्गेषु, यस्मिंश्चावकाशे विसर्पो विसर्पति [१] सोऽवकाशः श्यावारुणाभासः श्वयथुमान् निस्तोदभेदशूलायामसङ्कोचहर्षस्फुरणैरतिमात्रं प्रपीड्यते, अनुपक्रान्तश्चोपचीयते शीघ्रभेदैः स्फोटकैस्तनुभिररुणाभैः श्यावैर्वा तनुविशदारुणाल्पास्रावैः, विबद्धवातमूत्रपुरीषश्च भवति, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति वातविसर्पः ||३०||

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rūkṣōṣṇaiḥ kēvalō vāyuḥ pūraṇairvā samāvr̥taḥ|

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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||

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</div></div>

''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.

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

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पित्तमुष्णोपचारेण विदाह्यम्लाशनैश्चितम् |

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तस्य रूपाणि- ज्वरस्तृष्णा मूर्च्छा मोहश्छर्दिररोचकोऽङ्गभेदः स्वेदोऽतिमात्रमन्तर्दाहः प्रलापः शिरोरुक् चक्षुषोराकुलत्वमस्वप्नमरतिर्भ्रमः शीतवातवारितर्षोऽतिमात्रं हरितहारिद्रनेत्रमूत्रवर्चस्त्वं हरितहारिद्ररूपदर्शनं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशस्ताम्रहरितहारिद्रनीलकृष्णरक्तानां वर्णानामन्यतमं पुष्यति, सोत्सेधैश्चातिमात्रं दाहसम्भेदनपरीतैः स्फोटकैरुपचीयते तुल्यवर्णास्रावैश्चिरपाकैश्च, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति पित्तविसर्पः ||३२||

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pittamuṣṇōpacārēṇa vidāhyamlāśanaiścitam|

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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||

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</div></div>

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

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

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स्वाद्वम्ललवणस्निग्धगुर्वन्नस्वप्नसञ्चितः |

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तस्य रूपाणि- शीतकः शीतज्वरो गौरवं निद्रा तन्द्राऽरोचको मधुरास्यत्वमास्योपलेपो निष्ठीविका छर्दिरालस्यं स्तैमित्यमग्निनाशो दौर्बल्यं च, यस्मिंश्चावकाशे विसर्पोऽनुसर्पति सोऽवकाशः श्वयथुमान् पाण्डुर्नातिरक्तः स्नेहसुप्तिस्तम्भगौरवैरन्वितोऽल्पवेदनः कृच्छ्रपाकैश्चिरकारिभिर्बहुलत्वगुपलेपैः स्फोटः श्वेतपाण्डुभिरनुबध्यते, प्रभिन्नस्तु श्वेतं पिच्छिलं तन्तुमद्धनमनुबद्धं स्निग्धमास्रावं स्रवति, ऊर्ध्वं च गुरुभिः स्थिरैर्जालावततैः स्निग्धैर्बहुलत्वगुपलेपैर्व्रणैरनुबध्यतेऽनुषङ्गी च भवति, श्वेतनखनयनवदनत्वङ्मूत्रवर्चस्त्वं, निदानोक्तानि चास्य नोपशेरते विपरीतानि चोपशेरत इति श्लेष्मविसर्पः ||३४||

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svādvamlalavaṇasnigdhagurvannasvapnasañcitaḥ|

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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||

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</div></div>

''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.

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==== Etio-pathogenesis and clinical features of ''vata-pitta'' dominant ''agni visarpa'' ====

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वातपित्तं प्रकुपितमतिमात्रं स्वहेतुभिः |

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तदुपतापादातुरः सर्वशरीरमङ्गारैरिवाकीर्यमाणं मन्यते, छर्द्यतीसारमूर्च्छादाहमोहज्वरतमकारोचकास्थिसन्धिभेदतृष्णाविपाकाङ्गभेदादिभिश्चाभिभूयते, यं यं चावकाशं विसर्पोऽनुसर्पति सोऽवकाशः शान्ताङ्गारप्रकाशोऽतिरक्तो वा भवति, अग्निदग्धप्रकारैश्च स्फोटैरुपचीयते, स शीघ्रगत्वादाश्वेव मर्मानुसारी भवति, मर्मणि चोपतप्ते पवनोऽतिबलो भिनत्त्यङ्गान्यतिमात्रं प्रमोहयति सञ्ज्ञां, हिक्काश्वासौ जनयति, नाशयति निद्रां, स नष्टनिद्रः प्रमूढसञ्ज्ञो व्यथितचेता न क्वचन सुखमुपलभते, अरतिपरीतः स्थानादासनाच्छय्यां क्रान्तुमिच्छति, क्लिष्टभूयिष्ठश्चाशु निद्रां भजति, दुर्बलो दुःखप्रबोधश्च भवति; तमेवंविधमग्निविसर्पपरीतमचिकित्स्यं विद्यात् ||३६||

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vātapittaṁ prakupitamatimātraṁ svahētubhiḥ|

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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||

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</div></div>

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

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==== Etio-pathogenesis and clinical features of ''kapha-pitta'' dominant ''kardam visarpa'' ====

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कफपित्तं प्रकुपित्तं बलवत् स्वेन हेतुना |

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तद्विकाराः- शीतज्वरः शिरोगुरुत्वं दाहः स्तैमित्यमङ्गावसदनं निद्रा तन्द्रा मोहोऽन्नद्वेषः प्रलापोऽग्निनाशो दौर्बल्यमस्थिभेदो मूर्च्छा पिपासा स्रोतसां प्रलेपो जाड्यमिन्द्रियाणां प्रायोपवेशनमङ्गविक्षेपोऽङ्गमर्दोऽरतिरौत्सुक्यं चोपजायते, प्रायश्चामाशये विसर्पत्यलसक एकदेशग्राही च, यस्मिंश्चावकाशे विसर्पो विसर्पति सोऽवकाशो रक्तपीतपाण्डुपिडकावकीर्ण इव मेचकाभः कालो मलिनः स्निग्धो बहूष्मा गुरुः स्तिमितवेदनः श्वयथुमान् गम्भीरपाको निरास्रावः शीघ्रक्लेदः स्विन्नक्लिन्नपूतिमांसत्वक् क्रमेणाल्परुक् परामृष्टोऽवदीर्यते कर्दम इवावपीडितोऽन्तरं प्रयच्छत्युपक्लिन्नपूतिमांसत्यागी सिरास्नायुसन्दर्शी कुणपगन्धी च भवति सञ्ज्ञास्मृतिहन्ता च; तं कर्दमविसर्पपरीतमचिकित्स्यं विद्यात् ||३८||

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kaphapittaṁ prakupittaṁ balavat svēna hētunā|

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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||

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</div></div>

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

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

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स्थिरगुरुकठिनमधुरशीतस्निग्धान्नपानाभिष्यन्दिसेविनामव्यायामादिसेविनामप्रतिक

र्मशीलानां श्लेष्मा वायुश्च प्रकोपमापद्यते, तावुभौ दुष्टप्रवृद्धावतिबलौ प्रदूष्य दूष्यान् विसर्पाय कल्पेते; तत्र वायुः श्लेष्मणा विबद्धमार्गस्तमेव श्लेष्माणमनेकधा भिन्दन् क्रमेण ग्रन्थिमालां कृच्छ्रपाकसाध्यां कफाशये सञ्जनयति, उत्सन्नरक्तस्य वा प्रदूष्य रक्तं सिरास्नायुमांसत्वगाश्रितं ग्रन्थीनां मालां कुरुते तीव्ररुजानां स्थूलानामणूनां वा दीर्घवृत्तरक्तानां, तदुपतापाज्ज्वरातिसारकासहिक्काश्वासशोषप्रमोहवैवर्ण्यारोचकाविपाकप्रसेकच्छ

र्दिर्मूर्च्छाङ्गभङ्गनिद्रारतिसदनाद्याः प्रादुर्भवन्त्युपद्रवाः; स एतैरुपद्रुतः सर्वकर्मणां विषयमतिपतितो विवर्जनीयो भवतीति ग्रन्थिविसर्पः ||३९||

+

sthiragurukaṭhinamadhuraśītasnigdhānnapānābhiṣyandisēvināmavyāyāmādisēvināmapratikarmaśīlānāṁślēṣmā vāyuśca prakōpamāpadyatē, tāvubhau duṣṭapravr̥ddhāvatibalau pradūṣya dūṣyān visarpāyakalpētē; tatra vāyuḥ ślēṣmaṇā vibaddhamārgastamēva ślēṣmāṇamanēkadhā bhindan kramēṇagranthimālāṁ kr̥cchrapākasādhyāṁ kaphāśayē sañjanayati, utsannaraktasya vā pradūṣya raktaṁsirāsnāyumāṁsatvagāśritaṁ granthīnāṁ mālāṁ kurutē tīvrarujānāṁ sthūlānāmaṇūnāṁ vādīrghavr̥ttaraktānāṁ, tadupatāpājjvarātisārakāsahikkāśvāsaśōṣapramōhavaivarṇyārōcakāvipākaprasēkacchardirmūrcchāṅgabhaṅganidrāratisadanādyāḥprādurbhavantyupadravāḥ; sa ētairupadrutaḥ sarvakarmaṇāṁ viṣayamatipatitō vivarjanīyō bhavatītigranthivisarpaḥ||39||

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

+

</div></div>

''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''.

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==== ''Upadrava'' (complications) ====

+

उपद्रवस्तु खलु रोगोत्तरकालजो रोगाश्रयो रोग एव स्थूलोऽणुर्वा, रोगात् पश्चाज्जायत इत्युपद्रवसञ्ज्ञः|

तत्र प्रधानो व्याधिः, व्याधेर्गुणभूत [१] उपद्रवः, तस्य प्रायः प्रधानप्रशमे प्रशमो भवति |

स तु पीडाकरतरो भवति पश्चादुत्पद्यमानो व्याधिपरिक्लिष्टशरीरत्वात्; तस्मादुपद्रवं त्वरमाणोऽभिबाधेत ||४०||

+

upadravastu khalu rōgōttarakālajō rōgāśrayō rōga ēva sthūlō'ṇurvā, rōgāt paścājjāyataityupadravasañjñaḥ|

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tatra pradhAno vyAdhiH, vyAdherguNabhUta [1] upadravaH, tasya prAyaH pradhAnaprashame prashamobhavati|

sa tu pIDAkarataro bhavati pashcAdutpadyamAno vyAdhiparikliShTasharIratvAt; tasmAdupadravaMtvaramANo~abhibAdheta||40||

+

</div></div>

''Upadrava'' (complication) is disorder itself, outsized or undersized manifesting in the later period of a disease and rooted in the same (disease). ''Upadrava'' is so named because it manifests after the disease. Hence the main disease is primary and complication is secondary, it is generally pacified when the main disease gets pacified. It is more troublesome than the main disease itself, because it appears in the later stages of disease when the body is already weakened. Hence, one should treat the complications very promptly.[40]

==== Severity of ''visarpa'' ====

−

+

+

सर्वायतनसमुत्थं सर्वलिङ्गव्यापिनं सर्वधात्वनुसारिणमाशुकारिणं महात्ययिकमिति सन्निपातविसर्पमचिकित्स्यं विद्यात् ||४१||

+

sarvāyatanasamutthaṁ sarvaliṅgavyāpinaṁ sarvadhātvanusāriṇamāśukāriṇaṁ mahātyayikamitisannipātavisarpamacikitsyaṁ vidyāt||41||

sarvAyatanasamutthaM sarvali~ggavyApinaM sarvadhAtvanusAriNamAshukAriNaM mahAtyayikamitisannipAtavisarpamacikitsyaM vidyAt||41||

−

+

</div></div>

+

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'' ====

+

तत्र वातपित्तश्लेष्मनिमित्ता विसर्पास्त्रयः साध्या भवन्ति; अग्निकर्दमाख्यौ पुनरनुपसृष्टे मर्मणि अनुपगते वा सिरास्नायुमांसक्लेदे साधारणक्रियाभिरुभावेवाभ्यस्यमानौ प्रशान्तिमापद्येयाताम्, अनादरोपक्रान्तः पुनस्तयोरन्यतरो हन्याद्देहमाश्वेवाशीविषवत्; तथा ग्रन्थिविसर्पमजातोपद्रवमारभेत चिकित्सितुम्, उपद्रवोपद्रुतं त्वेनं परिहरेत्; सन्निपातजं तु सर्वधात्वनुसारित्वादाशुकारित्वाद्विरुद्धोपक्रमत्वाच्चासाध्यं विद्यात् ||४२||

+

tatra vātapittaślēṣmanimittā visarpāstrayaḥ sādhyā bhavanti; agnikardamākhyau punaranupasr̥ṣṭēmarmaṇi anupagatē vā sirāsnāyumāṁsaklēdē sādhāraṇakriyābhirubhāvēvābhyasyamānaupraśāntimāpadyēyātām, anādarōpakrāntaḥ punastayōranyatarō hanyāddēhamāśvēvāśīviṣavat; tathāgranthivisarpamajātōpadravamārabhēta cikitsitum, upadravōpadrutaṁ tvēnaṁ pariharēt; sannipātajaṁ tusarvadhātvanusāritvādāśukāritvādviruddhōpakramatvāccāsādhyaṁ vidyāt||42||

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

+

</div></div>

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

==== Principles of treatment ====

+

तत्र साध्यानां साधनमनुव्याख्यास्यामः ||४३||

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रुधिरस्यावसेकं च तद्ध्यस्याश्रयसञ्ज्ञितम् ||४९||

+

tatra sādhyānāṁ sādhanamanuvyākhyāsyāmaḥ||43||

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rudhirasyAvasekaM ca taddhyasyAshrayasa~jj~jitam||49||

+

</div></div>

Now the treatment of the curable varieties of ''visarpa'' will be described.

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==== Formulations used in ''visarpa'' ====

+

इति वीसर्पनुत् प्रोक्तं समासेन चिकित्सितम् |

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विसर्पिणां प्रयोज्यास्ते दोषनिर्हरणाः शिवाः ||५३||

+

iti vīsarpanut prōktaṁ samāsēna cikitsitam|

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visarpiNAM prayojyAste dōṣanirharaNAH shivAH||53||

+

</div></div>

Thus the treatment principles of ''visarpa'' have been described in brief. The same is being detailed further.

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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]

−

+

+

मुस्तनिम्बपटोलानां चन्दनोत्पलयोरपि |

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पाययेत घृतोन्मिश्रं नरं वीसर्पपीडितम् ||६१||

+

mustānimbapaṭōlānāṁ candanōtpalayōrapi|

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pAyayeta ghRutonmishraM naraM vIsarpapIDitam||61||

+

</div></div>

The skillful physician should administer the decoctions of tested efficacy for the cure of ''visarpa'' made up of ''musta'' (Cyperus rotundus linn), ''nimba'' (Azadirachta indica) and ''patola'' (Trichosanthes dioica Roxb) or ''chandana'' (Santalum album linn) and utpal (Nymphaea nouchali) or ''sariva'' (Hemidesmus indicus), ''amalaki'' (Emblica officinalis), ''ushira'' (Vetiveria zizanioidis Linn) and ''musta'' (Cyperus rotundus linn).

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==== Formulations for ''dosha'' situated in ''koshtha, pitta'' dominant ''visarpa'' and ''virechana'' ====

+

यच्च सर्पिर्महातिक्तं पित्तकुष्ठनिबर्हणम् |

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दोषे कोष्ठगते भूय एतत् कुर्याच्चिकित्सितम् |68|

−

+

+

yacca sarpirmahātiktaṁ pittakuṣṭhanibarhaṇam|

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doShe koShThagate bhUya etat kuryAccikitsitam|68|

+

</div></div>

The ''mahatikta ghritam'' indicated in ''paittika kustha'' should also be given by the intelligent physician for the alleviation of ''visarpa''.

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==== Formulations for ''dosha'' situated in ''shakha'' and modes of blood letting ====

+

शाखादुष्टे तु रुधिरे रक्तमेवादितो हरेत् ||६८||

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त्वङ्मांसस्नायुसङ्क्लेदो रक्तक्लेदाद्धि जायते ||७०||

+

śākhāduṣṭē tu rudhirē raktamēvāditō harēt||68||

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tva~gmAMsasnAyusa~gkledo raktakledAddhi jAyate||70||

+

</div></div>

If ''dosha'' in ''shakha'' (body elements) vitiate the blood then ''raktamokshana'' should be administered at first. The physician should use ''vishana'' (deer horn) in ''vata'' dominance, ''jalauka'' (Hirudinea medicinalis) in ''pitta'' dominance and ''alabu'' (lagenaria siceraria) in ''kapha'' dominance for blood letting or physician should perform ''siravyadha'' (blood letting through vein) promptly from the adjacent vein to the affected part, without which ''rakta kleda'' (putrifying blood content) gives rise to decomposed skin, flesh and ligaments. [68-70]

==== External applications ====

+

अन्तःशरीरे [१] संशुद्धे दोषे त्वङ्मांससंश्रिते |

Line 1,091: Line 1,168:

प्रदेहाः सर्व एवैते कर्तव्याः सम्प्रसादनाः [१] ||९८||

+

antaḥśarīrē [1] saṁśuddhē dōṣē tvaṅmāṁsasaṁśritē|

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etat prakShAlanaM sarpirvraNacUrNaM pralepanam|98|

+

</div></div>

After the body is cleansed internally (systemic) and morbid ''dosha'' remains in the skin and flesh (external tissues), or ''dosha'' morbidity is little, the external treatment to be carried out will now be described.

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==== Guidelines for local application and its types ====

−

+

+

क्षणे क्षणे प्रयोक्तव्याः पूर्वमुद्धृत्य लेपनम् |

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संशुष्कः पीडयेद्व्याधिं निःस्नेहो ह्यवचारितः ||१०७||

+

pradēhāḥ sarva ēvaitē kartavyāḥ samprasādanāḥ [1] ||98||

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saMshuShkaH pIDayedvyAdhiM niHsneho hyavacAritaH||107||

+

</div></div>

These ''lepa'' (local applications of pastes) are to be used repeatedly after removing the previous applied ''lepa''.

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==== Diet recipes for treatment of ''visarpa'' ====

−

+

+

अन्नपानानि वक्ष्यामि विसर्पाणां निवृत्तये |

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येषां नात्युचितः शालिर्नरा ये च कफाधिकाः ||११४||

+

annapānāni vakṣyāmi visarpāṇāṁ nivr̥ttayē|

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yeShAM nAtyucitaH shAlirnarA ye ca kaphAdhikAH||114||

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</div></div>

The diet regimen helps to alleviate ''visarpa'' is described here after.

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==== Contra-indications in ''visarpa'' ====

+

विदाहीन्यन्नपानानि विरुद्धं स्वपनं दिवा |

क्रोधव्यायामसूर्याग्निप्रवातांश्च विवर्जयेत् ||११५||

+

vidāhīnyannapānāni viruddhaṁ svapanaṁ divā|

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krodhavyAyAmasUryAgnipravātaMshca vivarjayet||115||

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</div></div>

The patient should avoid the ''vidahi'' (that causes burning) and ''viruddha'' (mutually contradictory or incompatible) diet, day sleep, anger, exercise, exposure to sun heat, fire and fast winds.[115]

==== General guidelines of treatment ====

+

कुर्याच्चिकित्सितादस्माच्छीतप्रायाणि पैत्तिके |

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कफपित्तप्रशमनं प्रायः कर्दमसञ्ज्ञिते ||११७||

+

kuryāccikitsitādasmācchītaprāyāṇi paittikē|

Line 1,634: Line 1,724:

kaphapittaprashamanaM prAyaH kardamasa~jj~jite||117||

+

</div></div>

Of these measures, predominantly ''sheeta'' (cool) measures are prescribed in ''pitta'' dominant condition, ''ruksha'' in ''kapha'' dominant condition and ''snigdha'' in ''vata'' dominant condition of ''visarpa''.

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==== Treatment of ''granthi visarpa'' ====

+

रक्तपित्तोत्तरं दृष्ट्वा ग्रन्थिवीसर्पमादितः |

Line 1,726: Line 1,818:

इति ग्रन्थिविसर्पचिकित्सा |

+

raktapittōttaraṁ dr̥ṣṭvā granthivīsarpamāditaḥ|

Line 1,898: Line 1,991:

iti granthivisarpacikitsA|

+

</div></div>

The ''granthi visarpa'', on inspection is predominant in ''rakta pitta''; the physician experienced in timely management should treat the case with ''rukshana'' (de-oleation), ''langhana'' (lightening therapy), ''seka'' (affusion), and ''pradeha'' (external application) of ''panchavalka, siramoksha'' (blood letting), ''jalauka'' (leech therapy), ''vamana'' (emesis therapy), ''virechana'' (purgation therapy) and ''kashaya- tikta'' (astringent and bitter) ghee preparations.

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==== Treatment of ''galaganda'' ====

−

+

+

य एव विधिरुद्दिष्टो ग्रन्थीनां विनिवृत्तये |

Line 1,934: Line 2,029:

घृतक्षीरकषायाणामभ्यासान्न भवन्ति ते ||१४०||

+

ya ēva vidhiruddiṣṭō granthīnāṁ vinivr̥ttayē|

Line 1,950: Line 2,046:

ghRutakShIrakaShAyANAmabhyAsAnna bhavanti te||140||

+

</div></div>

The line of treatment of ''granthi'' should be applied for the treatment of ''kaphaja galganda''.

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==== Importance of ''raktamokshana'' in ''visarpa'' ====

+

यानीहोक्तानि कर्माणि विसर्पाणां निवृत्तये |

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समासव्यासनिर्दिष्टां क्रियां विद्वानुपाचरेत् ||१४३||

+

yānīhōktāni karmāṇi visarpāṇāṁ nivr̥ttayē|

Line 1,992: Line 2,091:

samAsavyAsanirdiShTAM [1] kriyAM vidvAnupAcaret||143||

+

</div></div>

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

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==== Summary ====

+

तत्र श्लोकाः-

Line 2,012: Line 2,113:

पुनर्वसुरुवाचेदं विसर्पाणां चिकित्सितम् ||१४६||

+

tatra ślōkāḥ-

Line 2,040: Line 2,142:

punarvasuruvAcedaM visarpANAM cikitsitam||146||

+

</div></div>

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]

+

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते चिकित्सास्थाने

विसर्पचिकित्सितं नामैकविंशोऽध्यायः ||२१||

+

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē cikitsāsthānē

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visarpacikitsitaM nAmaikaviMsho~adhyAyaH||21||

+

</div></div>

Thus ends the twenty first chapter on treatment of ''visarpa'' in [[Chikitsa Sthana]] in the treatise composed by Agnivesha and redacted by Charak.[21]

Agnivesha

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