अथातः पाण्डुशोफविसर्पनिदानं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the chapter called Pandu, Sopha and Visarpa Nidana – diagnosis of Anaemia, Dropsy and Herpes; thus said atreya and other great sages. (1)
Pandu roga samprapti – pathogenesis of anaemia
पित्तप्रधानाः कुपिता यथोक्तैः कोपनैर्मलाः । तत्रानिलेन बलिना क्षिप्तं पित्तं हृदि स्थितम् ॥ २ ॥
धमनीर्दश सम्प्राप्य व्याप्नुवत्सकलां तनुम् । श्लेष्मत्वग्रक्तमांसानि प्रदूष्यान्तरमाश्रितम् ॥ ३ ॥
त्वङ्मांसयोस्तत् कुरुते त्वचिवर्णान्पृथग्विधान् । पाण्डुहारिद्रहरितान् पाण्डुत्वं तेषु चाधिकम् ॥४॥ यतोऽतः पाण्डुरित्युक्तः स रोगः
The tridoshas, pitta being predominant among them, getting aggravated (increased) by their exciting causes, directed by the powerful vata, displace the pitta present in the hridaya (heart), through the ten dhamani ( arteries / blood vessels), spreading it to all the parts of the body; then they (doshas) bring about vitiation of the slesma ( kapha), skin, blood and muscles; getting localised in between the skin and muscles produce different colours in the skin, such as pandu (yellowish white), haridra (turmeric-like deep yellow) harita(green); of these pandutva (yellowish-white), being more predominant, the disease is called as Panduroga. ( 2-4 )
Lakshana clinical features of Anemia
तेन गौरवम् । धातूनां स्याच्च शैथिल्यमोजसश्च गुणक्षयः ॥५॥
ततोऽल्परक्तमेदस्को निःसार: स्याच्छ्लथेन्द्रियः । मृद्यमानैरिवाङ्गैर्ना द्रवता हृदयेन च ॥६॥
शूनाक्षिकूटवदनः कोपनः ष्ठीवनोल्पवाक् | अन्नद्विशिशिरद्वेषी शीर्णरोमा हतानलः ॥७॥
सन्नसक्थी ज्वरी श्वासी कर्णक्ष्वेडी श्रमी भ्रमी । स पञ्चधा पृथग्दोषैः समस्तैर्मृत्तिकादनात् ॥८॥
From this, develops heaviness and looseness (weakness) of the dhatus (tissues) and impoverishment of the qualities of the ojas; then the person suffers from poor quantity of rakta (blood) and medas (fat) lack of essence / vigour (debility), looseness (weakness) of the Indriyas though the body is being squeezed, increased rate of the heart, swelling of the eye-socketing and face, anger, expectoration, speaks very little has aversion to food and cold, there is loss of hairs, very poor digestive activity, weakness of the thighs, fever, dyspnoea noise in the ears, fatigue and giddiness,
This (disease) is of five kinds one from each dosha, one from the combination all the three and one from eating mud. (5-8)
Purvarupa
प्राग्रूपमस्य हृदयस्पन्दनं रूक्षता त्वचि । अरुचिः पीतमूत्रत्वं स्वेदाभावोऽल्पवह्निता ॥९॥
Its prodromal symptoms are-increased throbbing of the heart, dryness (roughness ) of the skin, anorexia, yellow colour of the urine, absence of sweating, poor digestive activity, debility and fatigue. (9)
Lakshana – clinical features
सादः श्रमोऽनिलात्तत्र गात्ररुक्तोदकम्पनम् । कृष्णरूक्षारुणसिरानखविण्मूत्रनेत्रता ॥ १० ॥
शोफानाहास्यवैरस्यविशोषाः पार्श्वमूर्धरुक् । पित्ताद्धरितपीताभसिरादित्वं ज्वरस्तमः ॥११॥
तृद्स्वेदमूर्च्छा शीतेच्छा दौर्गन्ध्यं कटुवक्त्रता । वर्चो भेदोऽम्लको दाहः कफाच्छुक्लसिरादिता ॥ १२ ॥
तन्द्रा लवणवक्त्रत्वं रोमहर्षः स्वरक्षयः । कासश्छर्दिश्च निचयान्मिश्रलिङ्गोऽतिदुस्सहः ॥१३॥
In that caused by vata the symptoms are; pain all over the body, pricking and tremors, dull blackish – red colouration of the veins, nails, faeces, urine and eyes; swelling, distention of the abdomen, bad taste in the mouth, dryness of the faeces and pain in the flanks and head.
In that caused by pitta, there is green or deep yellow colouration of the veins and others, fever, dyspnoea, thirst, perspiration, fainting, desire for cold things, bad smell of the body, bitter taste in the mouth, looseness of bowels (diarrhoea), sourness and burning sensation internally.
In that caused by kapha, these is white colouration of the veins etc, stupor, salt taste in the mouth, horripilations, decrease of voice, cough and vomiting.
In that caused by the combination of all the doshas, there is mixture of all the symptoms which are difficult to tolerate. (10-13)
मृत् कषायानिलं पित्तमूषरा मधुरा कफम् । दूषयित्वा रसादींश्च रौक्ष्याद्भुक्तं विरूक्ष्य च ॥१४॥
स्त्रोतांस्यपक्कैवापूर्य कुर्याद्रुध्वा च पूर्ववत् । पाण्डुरोगं ततः शूननाभिपादास्यमेहनः ॥१५॥ पुरीषं कृमिवन्मुञ्चेद्भिन्नं सासृक्कफं नरः ।
Mud which is astringent in taste causes increase of vata, that which is salty and alkaline increases pitta, that which is sweet increases kpaha; these bring about abnormalities in the rasa and others dhatus, the mud by its dry qualities creates more dryness in the ingested food, being undigesteable, it blocks the channels and produces Panduroga as described earlier. The person has swelling of the umbilicus, feet, face and the genitals, eliminates faeces containing worms, loose (fluid in constistence) and mixed with blood. (14-16a)
Kamala roga – Jaundice
यः पाण्डुरोगी सेवेत पित्तलं तस्य कामलाम् ॥१६॥
कोष्ठशाखाश्रयं पित्तं दग्ध्वासृड्मांसमावहेत् । हारिद्रनेत्रमूत्रत्वङ्नखवक्त्रशकृत्तया ॥१७॥
दाहाविपाकतृष्णावान् भेकाभो दुर्बलेन्द्रियः । भवेत्पित्तोल्बणस्यासौ पाण्डुरोगादृतेऽपिच ॥ १८ ॥
The patient of panduroga who indulges in foods which increase pitta, gets the increase of pitta which is located in the kostha ( alimentary tract) and sakha (dhatus), which burns up the blood and muscles and produces (the disease) Kamala. It is characterised by deep-yellow colouration of the eyes, urine, skin, nail, face and faeces; burning sensation, indigestion and thirst, resembles a frog (in the colour of the skin), and weakness of the sense organs (and organs of work also). It (kamala) also occurs, even without Panduroga in persons who have great increase of pitta. (16b-18)
उपेक्षया च शोफाढ्या सा कृच्छ्रा कुम्भकामला ।
If neglected, it becomes Kumbha-kamala, which has profound swelling and is difficult to cure. (19a)
हरितश्यावपीतत्वं पाण्डुरोगे यदा भवेत् ॥१९॥
वातपित्ताद्भ्रमस्तृष्णा स्त्रीष्वहर्षो मृदुज्वरः । तन्द्राबलानलभ्रंशोः लोढरं तं हलीमकम् ॥२०॥ अलसं चेति शंसन्ति तेषां पूर्वमुपद्रवाः ।
When a patient of panduroga, the colour (of the body) changes into green or bluish-yellow due to increase of vata and pitta together, accompanied with giddiness, thirst, lack of desire for women (sex), mild fever, stupor, lassitude, and weakness of digestion then the disease is called Lodhara, Halimaka and Alasa. (19b-21a)
शोफप्रधानाः कथिताः स एवातो निगद्यते ॥२१॥
Upadrava(complications/secondary diseases) of these (all the varieties of panduroga) are only those which have been enumerated previously, commecing with the words ‘sopha pradhana’ (verse No. 23, chapter 11 of Sharira sthana). Hence the description of it (sopha) herein. (21b)
Sopha samprapti – pathogenesis of Oedema
पित्तरक्तफान् वायुर्दुष्टो दुष्टान् बहि: सिराः । नीत्वा रुद्धगतिस्तैर्हि कुर्यात् त्वङ्मांससंश्रयम् ॥२२॥
उत्सेधं संहतं शोफं तमाहुर्निचयादतः । सर्वम्
Vayu (vata) which has undergone aggravation (increase ) brings the aggravated pitta, rakta and kapha to the bahisiras (external veins or other channels) and getting obstructed there, by these, produces swelling localised in the skin and muscles, known differently as Utsedha, Sarmhata and Sopha; hence all of them (all its kinds) are caused by all the three doshas. (22-23a)
हेतुविशेषैस्तु रूपभेदान्नवात्मकम् ॥ २३ ॥
दोषैः पृथग्द्वयैः सर्वैरभिघाताद्विषादपि । द्विधा वा निजमागन्तुं सर्वाङ्गैकाङ्गजं च तम् ॥२४॥ पृथून्नतग्रथितताविशेषैश्च त्रिधा विदुः ।
Based on the different causes and different kinds of symptoms, it is of 9 kinds, viz, one from each dosha seperately, from the combination of any two doshas, from the combination of all three doshas, one from poison and one from trauma; it is again of two kinds, nija (organic) and agantu ( from external causes); sarvanga (found all over the body, generalised) and ekanga (found in any one part). Further, it is of three types, viz. prthu ( thick), unnata ( raised, elevated), and gratitha (knotty, hard). (23b-24)
Sotha Karana – causes of Oedema
शोफानां दोषजानां विशेषतः ॥२५॥
सामान्यहेतुः व्याधिकर्मोपवासादिक्षीणस्य भजतो द्रुतम् । अतिमात्रमथान्यस्य गुर्वम्लस्निग्धशीतलम् ॥ लवणक्षारतीक्ष्णोष्णशाकाम्बुस्वप्नजागरम्॥२६॥
मृद्ग्राम्यमांसवल्लूरमजीर्णश्रममैथुनम् । पदातेर्मार्गगमनं यानेन क्षोभिणापि च ॥२७॥
श्वासकासातिसारार्शोजठरप्रदरज्वराः। विषूच्यलसकच्छर्दिगर्भवीसर्पपाण्डवः ॥ २८ ॥
अन्ये च मिथ्योपक्रान्तास्तैर्दोषा वक्षसि स्थिताः । ऊर्ध्वं शोफमधो बस्तौ मध्ये कुर्वन्ति मध्यगाः ॥२९
सर्वाङ्गगाः सर्वगतं प्रत्यङ्गेषु तदाश्रयाः । तत्पूर्वरूपं दवथुः सिरायामोऽङ्गगौरवम् ॥३०॥
The causes of sopha (oedema) are the same as those of the doshas generally; some special causes are, the person who has become weak by diseases, therapies, fasting etc, indulging suddenly in large amount of food or those foods which are heavy (hard to digest) sour, fatty, cold (causing cold), salty, alkaline, penetrating (into the tissues) and hot (heat producing), excess use of vegetables, water and sleep, keeping awake at nights, eating mud, fatigue, sexual intercourses, walking long distances holding flags and banners, riding on vehicle and such other streneous acts, persons who have been debilitated by (diseases such as) dyspnoea, cough, diarrhoea, haemorrhoids, enlargement of abdomen, menorrhagia, fever, visuchika, (vomiting and diarrhoea together) alasaka (severe form of indigestion), vomiting, pregnancy, herpes, anaemia etc; even others who indulge in unhealthy foods and activities (become afflicted by sopha).
The doshas localised in the chest, cause swelling in the upper parts of the body; localised in the urinary bladder they cause swelling in the lower parts of the body and localised in the middle produces (swelling) in the middle parts; located all over the body they (doshas) produce swelling in the entire body; those localised in any one part cause swelling of that part only. Its prodromal symptoms are – burning sensation of the eyes, and other sense organs, dilatations of veins and feeling of heaviness of the body. (25-30)
Sopha Lakshana – clinical features of oedema
वाताच्छोफश्चलो रूक्षः खररोमारुणासितः । सङ्कोचस्पन्दहर्षार्तितोदभेदप्रसुप्तिमान् ॥ ३१ ॥
क्षिप्रोत्थानशमः शीघ्रमुन्नमेत् पी डेतस्तनुः । स्निग्धोष्णमर्दनैः शाम्येद्रात्रावल्पो दिवा महान् ॥ ३२ ॥
त्वक्च सर्षपलिप्तेव तस्मिंश्चिमिचिमायते । पीतरक्तासिताभासः पित्तादाताम्ररोमकृत् ॥३३॥
शीघ्रानुसार प्रशमो मध्ये प्रा जायते तनोः । सतृड्दाहज्वरस्वेददवक्लेदमदभ्रमः॥३४॥
शीताभिलाषी विड्भेदी गन्धी स्पर्शासहो मृदुः । कण्डूमान् पाण्डुरोमत्वक्कठिनः शीतलो गुरुः ॥ ३५ ॥
स्निग्धः शुक्ष्णः स्थिरस्त्यानोनिद्राच्छर्द्यग्निसादकृत् । आक्रान्तो नोन्नमेत्कृच्छ्रशमजन्मा निशाबलः ॥३६॥
स्त्रवेन्नासृक् चिरात् पिच्छां कुशशस्त्रादिविक्षतः। स्पर्शोष्णकाङ्क्षी च कफाद्यथास्वंद्वन्द्वजास्त्रयः ॥३७॥
सङ्कराद्धेतुलिङ्गानां निचयान्निचयात्मकः । अभिघातेन शस्त्रादिच्छेदभेदक्षतादिभिः ॥३८॥
हिमानिलोदध्यनिलैर्भल्लातकपिकच्छुजैः । रसैश्शूकैश्चसंस्पर्शाच्छ्रवयथुः स्याद्विसर्पवान् ॥३९॥
भृशोष्मा लोहिताभासः प्रायशः पित्तलक्षणः ॥४०॥
In sopha caused by vata, the swelling is moveable, rough, has course hairs, mild reddish-black colour, pains such as constricting pulsating, hyper-sensitivity, severe degree of pricking, cutting pain or even numbness, is quick in exacerbation and mitigation, pit caused by pressure fills up quick, swelling subsides by warm massage with fatty materials, (oil, ghee, fat etc) less at nights and more during day.
In sopha caused by pitta – the skin over the swelling has mild burning sensation as covered with the paste of sarsapa (mustard), is yellowish-red or black in colour, the hairs are coppery-red, quick in exacerbation and mitigation, commences first in the middle parts of the body, is accompanied with thirst, burning sensation, fever, perspiration, burning sensation in the mouth, lips and palate, increase of moisture ( exudation), toxicity, giddiness, the person desires cold comforts, has loose motions, bad smell, the swelling does not allow touching and is soft.
In sopha caused by kapha– the swelling has itching, whitish hairs and skin, is hard, cold, heavy, oily, smooth, immovable, solid causes more of sleep, vomiting, weakness of digestive activity, the pit caused by pressure does not fill up, difficult (slow) to subside and commence (develop), prominent at nights, when cut by the blade of kusa grass or sharp instrument blood does not flow out but thick slimy fluid comes out after sometime, desires touching and warmth.
In that due to combination of two doshas or that of all the three together, there will be combination of causes and symptoms. Abhighataja sopha (traumatic swelling) develops due to injury such as puncturing, cutting, laceration etc, caused by sharp instruments, cold breeze, sea breeze, contact with products of bhallata and kapikachchu such as the juice, and thorns (bristles) respectively; swelling which is spreading in nature, has very high temperature, resembles blood in colour and having the features of pitta (increase of). (31-40)
विषजः सविषप्राणिपरिसर्पणमूत्रणात् । दंष्ट्रादन्तनखापातादविषप्राणिनामपि ॥४१॥
विण्मूत्रशुक्रोपहतमलवद्वस्त्रसङ्करात् । विषवृक्षानिलस्पर्शाद्गरयोगावचूर्णनात् ॥ ४२ ॥
मृदुश्चलोऽवलम्बी च शीघ्रदाहरुजाकरः । नवोऽनुपद्रवः शोफः साध्योऽसाध्यः पुरेरितः ॥४३॥
Visaja sopha (swelling due to poison) develops due to crawling, urinating, injury by canine teeth, biting teeth and nails of poisonous animals, by contact with excreta, semen, urine and cloth contaminated by these or of even non-poisonous animals, contact with breeze of poisonous tree and by ingestion of artificial poisons. The swelling is soft, moveable, drooping down, producing burning sensation and cause pain very quickly.
Any kind of swelling which is of recent onset and and with no complications is curable and those described previously (verse 24-27 in chapter 11 of Sharira sthana) are incurable. (41-43)
Visarpa nidana – diagnosis of Herpes
स्याद्विसर्पोऽभिघातान्तैर्दोषैर्दूष्यैश्च शोफवत् । त्र्यधिष्ठानं च तं प्राहुर्बाह्यान्तरु भयाश्रयात् ॥४४॥
यथोत्तरं च दुःसाध्यास्तत्र दोषा यथायथम् ।
Visarpa is similar in respect of doshas and dusyas (dhatus and malas) with sopha ending with “that due to injury” in other words, excluding abhighataja and visaja. Some opine that it (visarpa) has three sites, viz, exterior (external), interior (internal) and both, incurable in successive order; it is caused by doshas which get aggravated by their respective causative factors especially by those foods which produce burning sensation during digestion; these spread quickly in the body; the internal ones are produced by the doshas which are localised inside the alimentary tract, the external ones by doshas localised outside (the alimentary tract and in the dhatus) and the one which develops at both places by doshas localised at both. (44-45a)
प्रकोपणैः प्रकुपिता विशेषेण विदाहिभिः ॥४५॥
शीघ्रं विसर्पति तेऽन्तरन्तः स्थिताः बहिः । बहिःस्था द्वितये द्विस्थाः – विद्यात्तत्रान्तराश्रयम् ॥ ४६॥
मर्मोपतापात्सम्मोहादयनानां विघट्टनात् । तृष्णातियोगाद्वेगानां विषमं च प्रवर्तनात् ॥४७॥ आशु चाग्निबलभ्रंशादतो बाह्यं विपर्ययात् ।
Internal ones are to be recognised by disorders of marmas (vital organs) delusion, unusual (abnormal, violent) movement (friction, injury) of the passages (orifices, channels, pores, ducts etc) severe thirst (and consequent dehydration), abnormal initiation of the urges sudden loss of digestive capacity and also of the (strength) body, the external is to be recognised by the opposite systems. (45b-48a.)
Lakshana – clinical features of Herpes
तत्र वातात् परीसर्पो वातज्वरसमव्यथः ॥४८॥
शोफस्फुरणनिस्तोदभेदयामार्तिहर्षवान् । पित्ताद्व्रतुगतिः पित्तज्वरलिङ्गोऽतिलोहितः ॥४९॥
कफात्कण्डूयुतः स्त्रिग्धः कफज्वरसमानरुक् । स्वदोषलिङ्गैश्चीयन्ते सर्वे स्फोटैरुपेक्षिताः ॥५०॥
ते पक्वभिन्नाः स्वं स्वं च बिभ्रति व्रणलक्षणम् ।
That caused by vata, is spread out (to wider area), associated with symptoms similar to fever of vata origin, the swelling has pains such as throbbing, intermittant, cutting, dilating (expanding), knawing and tingling in nature. That caused by pitta, spreads quickly, has all the features of (increase of) pitta, is angry-red. That caused by kapha has itching, oily touch and symptoms similar to fever of kapha origin. All of them, if neglected, will lead to the development of sphotas (vescicles, papules) having features, of the respective doshas and when they (vesicles) mature and burst, become ulcers with features of the respective doshas. (48b-51a.)
Agni visarpa
वातपित्ताज्ज्वरच्छर्दिमूर्छातीसारतृड्भ्रमैः ॥५१॥
अस्थिभेदाग्निसदनतमकारोचकैर्युतः । करोति सर्वमङ्गं च दीप्ताङ्गारावकीर्णवत् ॥५२॥
यं यं देशं विसर्पश्च विसर्पति भवेत्स सः । शान्ताङ्गारासितो नीलो रक्तो वाशु च चीयते ॥५३॥
अग्निदग्ध इव स्फोटैः शीघ्रगत्वाद्भुतञ्च सः । मर्मानुसारी वीसर्पः स्याद्वातोऽतिबलस्ततः॥५४॥
व्यथेताङ्गं हरेत्संज्ञां निद्रां च श्वासमीरयेत् । हिमां च स गतोऽवस्थामीदृशीं लभते न ना ॥५५॥
क्वचिच्छर्मारतिग्रस्तो भूमिशय्यासनादिषु । चेष्टमानस्ततः क्लिष्टो मनोदेहश्रमोद्भवाम् ॥५६॥
दुष्प्रबोधोऽश्रुते निद्रां सोऽग्निवीसर्प उच्यते ॥५७॥
Visarpa produced by vata and pitta together, is characterised by fever, vomiting, fainting, diarrhoea, thirst, giddiness, cutting pain in the bones, poor digestion, darkness (coma, loss of consciousness) and anorexia, makes all the organs feel as though covered with burning coal, the places which are affected turnto either black like extinguished coal (black colour), blue or red, becomes studded soon with bleds similar to those formed by burn by fire, spreads fast, affecting vital organs, because of the powerful vata (being involved) it causes severe pain in the body (or the affected parts), loss of consciousness, loss of sleep, increased respiration and hiccup; the patient getting into this restless condition does not get comfort by lieing on the floor or on the bed, furnitures etc, does all actions with difficulty and with exertion to the mind and body, enters into that sleep from which can be awakened with great difficulty (in other words the death). This is spoken of as Agni Visarpa. (51b-57)
Granthi Visarpa
कफेन रुद्धः पवनो भित्वा तं बहुधा कफम् । रक्तं वा वृद्धरक्तस्य त्वक्सिरास्त्रावमांसगम् ॥५८ ॥
दूषयित्वा च दीर्घाणुवृत्तस्थूलखरात्मनाम् । ग्रन्थीनां कुरुते मालां रक्तानां तीव्ररुग्ज्वराम्॥५९॥
श्वासकासातिसारास्यशोषहिध्मावमिभ्रमैः । मोहवैवर्ण्यमूर्च्छाङ्गभङ्गाग्निसदनैर्युताम् ॥६०॥
इत्ययं ग्रन्थिवीसर्पः कफमारुतकोपजः ॥६१॥
Pavana (vata) obstructed by kapha, breaks it into many parts, similarly, it breaks the rakta (blood), in those who are having increase of rakta and then vitiating the skin, veins and tendons present in the muscles, produces a chain of glands ( tumors), which are red in colour, elongated, small, round, a static (immovable), rough (hard), and highly painful, accompanied with high fever, dyspnoea, cough, diarrohea, dryness of the mouth, hiccup, vomiting, giddiness, delusion, discolouration, fainting, cutting pain in the body parts, weak digestive function, this is Granthi Visarpa, caused by aggravation (increase) of kapha and maruta (vata) together. (58-61)
Kardama visarpa
कफपित्तात् ज्वरः स्तम्भो तन्द्रानिद्राशिरोरुजः । अङ्गावसादविक्षेपप्रलापारोचकभ्रमाः ॥६२॥
मूर्छाग्निहानिर्भेदोऽस्थां पिपासेन्द्रियगौरवम् । आमोपवेशनं लेपः स्त्रोतसां स च सर्पति ॥६३॥
प्रायेणामाशये गृह्णन्त्रेकदेशञ्च नातिरुक् । पिटकैरवकीर्णोऽतिपीतलोहितपाण्डुरैः ॥६४॥
मेचकाभोऽसितः स्निग्धो मलिनः शोफवान् गुरुः । गम्भीरपाकः प्राज्योष्मा स्पृष्टः क्लिन्नोऽवदीर्यते ॥६५॥
पङ्कवच्छीर्णमांसश्च स्पष्टस्नायुसिरागणः । शवगन्धी च वीसर्पः कर्दमाख्यमुशन्ति तम् ॥६६॥
Kapha and pitta together (undergoing increase) produce fever, stiffness (inactivity) stupor, sleep, headache, weakness of the body, involuntary movements of the body parts, delerium, anorexia, giddiness, faintings, loss of digestive activity, cutting pain in the bones, severe thirst, heaviness of the indriyas (poor functioning of five sense organs, five organs of work and the mind), production of ama (undigested remnants of food) and adhreing inside the srotas (channels, passages); it (visarpa), generally starts from the (areas of the) amasaya (stomach) and spreads to other parts is not very painful, studded with pitakas (papules, eruptions) which are of deep yellow, red white, blakish brown or shining black in colour, dirty, swollen, heavy, forming pus deep inside, increased warmth, when touched it breaks (crumbles, yeilds) like slush, due to presence of fluid, loss of decomposition of the muscles exposing clearly the bunches of tendons and veins, and emission of the smell of a cadaver. This is known as Kardama Visarpa. (62-65)
Ksataja visarpa
All the doshas together produce Ksataja visarpa having all the symptoms and invading spreading to all the dhatus. (66)
सर्वजो लक्षणैः सर्वैः सर्वधात्वभिसर्पणः । बाह्यहेतोः क्षतात् क्रुद्धः सरक्तं पित्तमीरयन् ॥६७॥
विसर्पं मारुतः कुर्यात् कुलत्थसदृशैश्चितम् । स्फोटैः शोफज्वररुजादाहाढ्यं श्यावलोहितम् ॥६८॥
Maruta (vata) gives rise to visarpa due to injury and other external causes, undergoing increase along with rakta (blood) and pitta, studded with sphotas (vesicles) resembling kulatha (horsegram); accompanied with swelling, fever, pain, severe burning bluish-red in colour, this is known as Ksataja Visarpa. (67-68)
पृथग्दोषैस्त्रयः साध्या द्वन्द्वजाश्चानुपद्रवाः । असाध्यौ क्षतसर्वोत्थौ सर्वे चाक्रान्तमर्मकाः ॥६९ ॥
The three arising from the doshas seperately, the three arising from the combination of two doshas having no complications (secondary diseases) are all curable; Ksata Visarpa and that arising from all the three doshas are incurable, so also those which have invaded the vital organs, produces loss of tendons, veins and muscles, which have too much of fluid (putrified, decomposed, gangrenous) and those emitting cadaveric smell. (69-70)
॥ इति त्रयोदशोऽध्यायः ॥ Thus ends the Thirteenth chapter.
