Visarpa Chikitsa

Introduction:

• The specificity or characteristic of this disease is that it spreads like snakes venom (Sarpa Visha). (C.Chi.21/6)
• It is a dreadful (Daarun`a) disease if neglected, hence should be dealt with immediately, (C.Chi.21/6-7)
• In the treatment of Visarpa depending upon the Avasthaa the following treatment should be adopted.

Saamaanya Chikitsaa:

• The first three types of Visarpa are curable, while Sannipaataja and Kshataja Visarpa are considered as incurable.
• In Visarpa the best treatment is Rakta Visraavan`a. (S.Chi.17/16) Bahyopachara (A.H.Chi.18/10)
• Blood letting should be followed by S`hodhana and then procedures such as Pradeha etc. should be adopted for S`hamana of Visarpa.
• Based on the combination of the Dosha the treatment should be decided. (A.H.Chi.18/20)
• If there is predominance of Vaata Dosha, then the Lepa should contain more of ghee. (A.H.Chi.18/18-19)
• In all kinds of Visarpa, when they suppurate treatment should be similar to Vran`a. (S.Chi.17/17)

 

Summary of treatment:

• Tikta Dravya Pradhaana Dravya should be used.
• Among the various formulations advised; such of the formulations which have predominantly S`heeta Gun`a are for Pittaja Visarpa, Rooksha Gun`a for Kaphaja Visarpa, Snigdha Gun`a are for Vaataja Visarpa.
• VaataPitta S`haamaka Chikitsaa for Agni Visarpa is helpful, similarly Kapha – Pitta S`haamaka Chikitsaa in Kardama Visarpa.(C.Chi.21/116-117). (A.H.Chi.18/18-19)

 

Aavasthika Chikitsaa:

• In Kapha Sthaanagata Saama condition:

o Langhana

o Vamana

o Tikta Rasa Sevana and

o Rooks`ha S`heeta Lepa is adviced.(C.Chi.21/44).

Here Kapha Sthaanagata means Oordhva Kaayagata Visarpa.

 

• In Pitta Sthaanagata Saama condition:

o Along with Langhana Tikta Rasa Sevana.

o Vishesha Chikitsaa advised is Rakta Mokshan`a and Virechana.

Here Pitta Sthaanagata means Madhya Kaayagata Visarpa. . (C.Chi.21/45).

 

• In Vaata Sthaanagata Saama condition

o Rooks`han`a Chikitsaa is advised.

o Also Snehana is contraindicated in the initial stage of treatment if there is association (Anubandha) of Rakta or Pitta i.e, Rookshan`a Chikitsaa only has to be employed. . (C.Chi.21/46).

 

• In Bahu Dosha Avastha:

o Medicated ghee that has the purgative action should be used. (The ghee to be used in Bahudoshavasthaa should essentially have Virechana action). If such ghee is not used then the Dosha_s become immovable or rigid (Sthabdha) and settle down in Tvacha, Rakta and Maamsa and bring about suppuration (Paaka) of the same. Hence Virechana should be advised in Visarpa. . (C.Chi.21/48).

o Raktamokshan`a is always advised during the initial stage, because blood (Rakta) being the main seat (Aas`hraya) of Visarpa, hence when vitiated blood is let out it pacifies the disease. (C.Chi21/48-49)

o Mahaatiktaka Ghrita of Kusht`ha and Traayamaan`a Ghrita of Gulma Adhikaara should be used.

S`haakahagata Visarpa Chikitsaa:

• In this Avastha Raktamokshan`a is the treatment of choice as Rakta is mainly vitiated.(S`haakaha implies Raktaadi Dhaatu_s).
• If Rakta is vitiated due to Vaata Dosha, then Raktamokshan`a should be done with Vishaan`a, if by Pitta Dosha then Jalouka should be used, if by Kapha Doshathen by Aalaabu or Siravedhana should be done at the nearest site of Visarpa.
• If Raktamokshan`a if is not done early or at the right time then Rakta attains Kledatva, hence leading to the vitiation of the other Dhatu_s i.e. Tvak, Maamsa,Snaayu.(C.Chi.21/68-70) (A.H.Chi.18/8)

S`hamana Chikitsa:

After Proper S`hodhana (by Virechana,Raktamohshan`a etc.), when the Dosha_s settle in the Tvak and Maamsa OR in condition where the strength of the Dosha_s is mild, in such conditions Baahya (Lepa, Pradeha) Chikitsaa is advised. (C.Chi.21/68-71)

Method of applying Pradeha:

• Pradeha should be applied frequently, the previous one should be removed and a new one should be applied in such a way that it should be neither thick nor thin. But only in case of Kaphaja Visarpa Pradeha should be Ghana (thick). (C.Chi.21/99-100)

o The Lepa should not be stale (Paryushita).

o The Lepa once removed should not be reapplied. (C.Chi.21/101-102) (A.H.Chi.18/18-19)

o The Lepa should not be wrapped in a cloth and applied. If applied then the heat of the body does not get transferred and hence it causes Svedana, causingPidaka(boils) and Kan`d`oo(Itching) at that site. As a result Kleda and S`hoola also develops in Visarpa. (C.Chi.21/103)

o But Vagbhata is of the opinion that the Lepa should be smeared on a cloth and then applied. (A.H.Chi.18/18-19)

o Lepa should not be applied one above the other, it leads to the same sequences as above i.e. it causes Pidaka,Kan`d`oo, Kleda, S`hoola. (C.Chi.21/104).

o Similarly the Lepa should neither be Ati Snigdha (Over Unctuous) nor Ati Drava (very liquid) in nature as it does not remain on the site and hence cannot pacify the Dosha_s. (C.Chi.21/105). {If the Lepa is too much diluted or watery in nature then it dries off quickly, the Rasa and Veerya of the drug does not reach the Vyadhi Moola as it dries of quickly. (C.Chi.21/106).Similarly if the Lepa is devoid of Sneha (unctuous), it also dries off without giving the desired effect. (C.Chi.21/107)}

 

Properties of Pralepa:

Kalka of the Dravya used should be applied. Thickness of Pralepa should be 1/3rd of the Angus`hta and it should be neither too Snigdha (unctuous) nor Rooksha (Dry) orPinda (bolus) nor Drava (liquid). (C.Chi.21/68-70)

 

Granthi Visarpa Chikitsaa:

 

• After Oordhva and Adha S`hodhana ,Raktamoks`han`a should be done,
• Langhana , Rookshan`a Seka ,Pradeha.
• Followed by Vaata and Kapha Shaamaka Chikitsaa. (C.Chi.21/120).
• Daaha Karma and S`halya karma is advised here.
• Treatment similar to Raktapitta should be adopted.
• Pinda Sveda, Upanaahasveda and
• Kapha Vaata Naashaka treatment.(A.H.Chi.18/23)
• Gulma Bhedana Chikitsaa should be adopted.
• Also Peedana with Ushn`a Loha ,Lavana or Paashan`a is also advised.(A.H.Chi.18/31)
• If there is no relief found from the above methods then Daaha Karma should be done with either Kshaara, S`hara or by Hema. S`halya karma is advised as a last resort.Paachana karma is also been mentioned by Vaagbhat.(A.H.Chi.18/32-33)
• Frequent Rakta Moks`han`a, Vaata, Kapha Dosha pacifying measures, Svedana and S`hamana are to be adopted.(A.H.Chi.18/34)
• Along with the other diets advised the individual suffering from Visarpa should consume Yava,Godhuma or S`haali; Which ever is compatible. S`haali should not be advised in Kaphadhika conditions. (C.Chi.21/114)

Importance of Raktamoks`han`a in Visarpa:

 

Just as Basti Chikitsaa is considered as Ardha Chikitsaa in Vaata Vyaadhi, Similarly in this context Raktamoks`han`a is considered as Ardha Chikitsa. (C.Chi.21/141). (A.H.Chi.18/36), (S.Chi.17/16)

Pathyaapathya:

• Pathya

o Rasa- Tikta, Madhura, Alpa Amla

o Gun`a/Karma- Rooksha

o Dhaanya- Jeern`a Yava, Godhooma, S`haalee, Kangoo

o S`himbee- Mudga, Maasha, Tila, Aad`hakee, Chan`aka, Masoora

o Maamsa- Jaangala

o Drava- Navaneeta, Ghrita

o Phala – Daad`ima, Aamalakee, Draakshaa, Gostanee Draakshaa, Nimboo

o Kritaanna– Seedhu, S`harkaraarisht`a, Suraa, Avaleha, Tarpan`a, Yoosha, Jaangala Maamsarasa

o Other- Kaaravellaka, Vetaagra, Pat`ola, Naagakes`hara, S`hireesha, Chandana, Karpoora, Lepa, Raktamokshan`a, Madhu, Pippalee

• Apathya

o Rasa- Amla, Lavan`a, Kat`u

o Gun`a/ karma- Guru, Vidaahee

o S`haaka- Las`hoona

o S`himbee- Kulattha, Maasha, Tila

o Dugdha- Kurchikaa, Dadhi

o Drava- Madya, Sauveeraka

o Other – Vyaayaama, Divaasvaapa, Maithuna, Purovaatasevana, Krodha, S`hoka, Sveda