अथातो विसर्पचिकित्सितं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound on the chapter-Visarpa chikitsa treatment of herpes; thus said Atreya and other great sages.
Notes: Equating Visarpa with diseases recognised in modern medicine has not yet been settled satisfactorily, some equate it with erysipelas, some others with cellulitis, herpes zoster, skin diseases, cancer, etc. and the varieties of visarpa with plague, gas gangrene, etc.
आदावेव विसर्पेषु हितं लङ्घनरूक्षणम् । रक्तावसेको वमनं विरेकः, स्नेहनं न तु ॥ १ ॥
In visarpa (herpes?) it is beneficial to administer langhana (thinning the body with fasting etc. ) , ruksana (causing dryness ) blood-letting, emesis, and purgation therapies in the beginning of treatment itself, but not snehana (oleation therapy). 1.
प्रच्छर्दनं विसर्पघ्नं सयष्टीन्द्रयवं फलम् । पटोलपिप्पलीनिम्बपल्लवैर्वा समन्वितम् ॥२॥
Emesis done by using phala (madana) together with yasti and indrayava or phala with patola, pippali, and nimba pallava, destroys visarpa. 2.
रसेन युक्तं त्रायन्त्या द्राक्षायास्त्रैफलेन वा । विरेचनं त्रिवृच्चूर्णं पयसा सर्पिषाऽथवा ॥ ३ ॥
योज्यं, कोष्ठगते दोषे विशेषेण विशोधनम् ।
Purgation should be done by using powder of trivrt mixed with the juice/decoction of either trayanti, draksa, triphala; or with milk or ghee especially when the dosas are lodged in the alimentary tract.
अविशोध्यस्य दोषेऽल्पे शमनं चन्दनोत्पलम् ॥ ४ ॥
मुस्तनिम्बपटोलं वा पटोलादिकमेव वा । सारिवामलकोशीरमुस्तं वा क्वथितं जले ॥ ५ ॥
For persons who are unfit for purifactory therapies and when the doshas are slight, samana ( palliative therapy) is ideal; candana, utpala, musta, nimba and patola; or patola and others (patoladi gana ) (vide chapter 15 of sutrasthana); or sariva, amalaka, usira and musta-boiled with water should be consumed. 4b-5.
दुरालभां पर्पटकं गुडूचीं विश्वभेषजम् । पाक्यं शीतकषायं वा तृष्णावीसर्पवान् पिबेत् ॥ ६ ॥
दार्वीपटोलकटुकामसूरत्रिफलास्तथा सनिम्बयष्टीत्रायन्तीः क्वथिता घृतमूर्च्छिताः ॥ ७ ॥
Patient of visarpa having thirst should drink either the decoction or infusion of duralabha, parpataka, guduci, and visvabhesaja; or decoction of darvi, patola, katuka, masura, triphala, nimba, yasti, and trayanti mixed with ghee. 6-7.
शाखादुष्टे तु रुधिरे रक्तमेवादितो हरेत् । त्वड्मांसस्नायुसंक्लेदो रक्तक्लेदाद्धि जायते ॥ ८ ॥
When the blood gets vitiated in the sakhas (dhatus tissues) blood-letting itself should be done, first, because increase of moisture in the skin, muscles, tendons etc., occurs due to increase of moisture in the blood itself. 8.
निरामे श्लेष्मणि क्षीणे वातपित्तोत्तरे हितम् ।
घृतं तिक्तं महातिक्तं शृतं वा त्रायमाणया ॥ ९ ॥
When there are no symptoms of ama, when kapha has decreased but vata and pitta are predominant, then either Tiktaka ghrta, Mahatikta ghrta (chapter 19 of chikitsa sthana) that prepared by the decoction of trayamana, are beneficial.
निर्हतेऽस्त्रे विशुद्धेऽन्तर्दोषे त्वङ्मांससन्धिगे । बहिः क्रिया: प्रदेहाद्याः सद्यो वीसर्पशान्तये ॥ १० ॥
After blood-letting, when the interior ( of the alimentary canal) becomes cleared, and the dosas are found localised in the skin, muscles, and joints, then external treatments such as pradeha (application of warm poultice) etc. subside visarpa soon. 10.
शताह्वामुस्तवाराहीवंशार्तगलधान्यकम्
सुराह्वा कृष्णगन्धा च कुष्ठं चालेपनं चले ॥ ११ ॥
In visarpa arising from cala (vata) application of paste of Satahva, musta, varahi, vamsa, artagala, dhanyaka, surahva, krsnagandha and kustha is ideal. 11.
न्यग्रोधादिगणः पित्ते तथा पद्मोत्पलादिकम् । न्यग्रोधपादास्तरुणाः कदलीगर्भसंयुताः ॥ १२ ॥
बिसग्रन्थिश्च लेपः स्याच्छतधौतघृताप्लुतः । पद्मिनीकर्दमः शीतः पिष्टं मौक्तिकमेव वा ॥ १३ ॥
शङ्खः प्रवालं शुक्तिर्वा गैरिकं वा घृतान्वितम् ।
or In that arising from pitta, paste of either the drugs of nyagrodhadi gana (chapter 15 of sutrasthana) padmotpaladi etc. ( chapter 20 chikitsasthana) of (Astanga sangraha) is beneficial. So also the paste of tender aerial roots of nyagrodha, the pith of kadali, and bisa granthi, mixed with satadhauta ghrta (ghee washed in water for hundred times) or the slush/mud of lotus lake or paste of mauktika (pearls), sankha (conch), pravala ( coral) sukti ( oyster shell) or of gairika (red ochre) mixed with ghee and applied cold are also beneficial. 12-14a.
त्रिपलापद्मकोशीरसमङ्गाकरवीरकम् ।। १४ ।
नलमूलान्यनन्ता च लेपः
Paste of triphala padmaka, usira, samanga, karaviraka, nalamula, and ananta ( applied externally) cures visarpa arising from slesman (kapha). 14b-15a.
श्लेष्मविसर्पहा । धवसप्ताह्वखदिरदेवदारुकुरण्टकम् ॥१५॥
समुस्तारग्वधं लेपो वर्गों वा वरुणादिकः । आरग्वधस्य पत्राणि त्वचः श्लेष्मातकोद्भवाः ॥ १६ ॥
इन्द्राणिशाकं काकाहा शिरीषकुसुमानि च ।
khadira, Application of paste of dhava, satahva, devadaru, kurantaka, musta and aragvadha or of the drugs of varunadi gana (chapter 15 of sutrasthana) or of the leaves of aragvadha, bark of slesmataka, leaves of indrani, kakahva and flower of sirisa (cures visarpa of kapha origin). 15b-17a.
सेकव्रणाभ्यङ्ग्रहविर्लेपचूर्णान् यथायथम् ॥ १७ ॥
एतैरेवौषधैः कुर्याद्वायौ लेपा घताधिकाः ।
Recipes for bathing, anointing, fumigating, topical application of paste and powder for dusting the wound should be prepared by these drugs only. The pastes metioned for the treatment of visarpa of vata origin should be mixed with more quantity of ghee. 17b-18a.
Notes: Arunadatta states that “by this statement it is presumed that the pastes mentioned for visarpa of pitta and kapha origin also should be mixed with ghee”.
कफस्थानगते सामे पित्तस्थानगतेऽथवा ॥ १८ ॥
अशीतोष्णा हिता रूक्षा रक्तपित्ते घृतान्विताः ।
अत्यर्थशीतास्तनवस्तनुवस्त्रान्तरास्थिताः योज्याः क्षणे क्षणेऽन्येऽन्ये मन्दवीर्यास्त एव च । ॥१९॥
When vayu associated with ama is found lodged either in the seat of kapha or of pitta it is beneficial to use it neither cold nor hot (in otherwords, slightly warm ) and dry ( without addition of fats); in case of aggravation of rakta (blood) and pitta, it should be mixed with ghee, made very cold, thin, concealed inside thin cloth, applied fresh, minute after minute (every time), since the same paste applied again and again becomes weak in action. 18b-20a.
संसृष्टदोषे संसृष्टमेतत्कर्म प्रशस्यते ॥ २० ॥
In visarpa arising from the combination of the dosas, it is ideal to combine the treatments suitably. 20b.
Agni visarpa chikitsa
शतधौतघृतेनाग्निं प्रदिह्यात्केवलेन वा । सेचयेद्घृतमण्डेन शीतेन मधुकाम्बुना ॥ २१ ॥
सिताम्भसाऽम्भोदजलैः क्षीरेणेक्षुरसेन वा । पानलेपनसेकेषु महातिक्तं परं हितम् ॥ २२ ॥ ॥
Agni visarpa should be bathed either with satadhauta ghrta ( ghee washed a hundred times ) with plain ghee, with the scum of ghee, decoction of madhuka, solution of sita (sugar), decoction of ambhoda (musta) milk or juice of sugarcane all made cold. Mahatiktaka ghrta (chapter 19 of chikitsa sthana) is best for drinking, external application and bathing the skin. 21-22.
Granthi visarpa chikitsa
ग्रन्थ्याख्ये रक्त पित्तघ्नं कृत्वा सम्यग्यथोदितम् । कफानिलघ्नं कर्मेष्टं पिण्डस्वेदोपनाहनम् ॥ २३ ॥
For granthi visarpa treatments prescribed for raktapitta (chapter 2 of chikitsa sthana) should be done first, followed by treatments which mitigate kapha and anila (vata) such as pinda sveda and upanaha (chapter 17 of sutrasthana).
ग्रन्थिवीसर्पशूले तु तैलेनोष्णेन सेचयेत् ।
दशमूलविपक्क्रेन तद्वन्मूत्रैर्जलेन वा ॥ २४ ॥
In case of pain in granthi visarpa, the skin should bathed with warm oil prepared with dasamula, likewise with cows urine or water boiled with dasamula. 24.
सुखोष्णया प्रदिह्याद्वा पिष्टया कृष्णगन्धया |
नक्तमालत्वचा शुष्कमूलकैः कलिनाऽथवा ॥ २५ ॥
Application of warm paste of either krsnagandha, bark of naktamala, dried mulaka or kali (vibhitaka) should be done. 25.
दन्ती चित्रकमूलत्वक् सौधार्कपयसी गुडः । भल्लातकास्थि कासीसं लेपो भिन्द्याच्छिलामपि ॥ २६ ॥
बहिर्मार्गाश्रितं ग्रन्थिं किं पुनः कफसम्भवम् । दीर्घकालस्थितं ग्रन्थिमेभिर्भिन्द्याच्च भेषजैः ॥ २७ ॥
मूलकानां कुलत्थानां यूषैः सक्षारदाडिमैः। गोधूमान्नैर्यवान्नैर्वा ससीधुमधुशार्करैः ॥ २८ ॥
सक्षौद्रैर्वारुणीमण्डैर्मातुलुङ्गरसान्वितैः । त्रिफलायाः प्रयोगैश्च पिप्पल्याः क्षौद्रसंयुतैः ॥ २९ ॥
देवदारुगुडूच्योश्च प्रयोगैर्गिरिजस्य मुस्तभल्लातसक्तूनां प्रयौगैर्माक्षिकस्य
धूमैर्विरकैः शिरसः पूर्वोक्तैर्गुल्मभेदनैः । तप्तायोहेमलवणपाषाणादिप्रपीडनैः
Paste of danti, bark of citramula, milky sap of sudha and arka, guda; bhallatakasthi, and kasisa breaks even the stone; what then to say of external tumour which arising from kapha; even the tumour which is along standing should be broken up with these; use of soup of either mulaka or kulattha added with ksara and dadima, mess prepared either from godhuma or yava followed by drink of sidhu mixed with honey and sugar; varuni manda mixed with ksaudra (honey) and juice of matulunga; administration of triphala and pippali mixed with honey, of devadaru and guduci with honey, of girija (silajatu) or musta, bhallata and saktu with honey; of maksika (iron pyrites) with honey; by fumigation (of the affected part), sirovireka (purgative therapy) for the head, that is nasya (nasal medication), by toughing the tumour with heated plaque of iron or gold, salt, stone etc.
ग्रन्थिः पाषाणकठिनो यदि नैवोपशाम्यति ॥ ३२ ॥
अथास्य दाहः क्षारेण शरैर्हेम्नाऽपि वा हितः । पाकिभिः पाचयित्वा वा पाटयित्वा तमुद्धरेत् ॥ ३३ ॥
If the hard and deep-rooted tumour does not break even by these different kinds of treatment of proven efficacy and remains stony hard, it should then be burnt (cauterised) either with ksara (alkalies) or red hot arrow or rod of gold; or it should be made to undergo suppuration by drugs which promote pus formation and then excised (removed). 32-33.
मोक्षयेद्बहुशश्चास्य रक्तमुत्क्लेशमागतम् । पुनश्चापहृते रक्ते वातश्लेष्मजिदौषधम् ॥ ३४ ॥
The blood which is vitiated and coming up from the tumour should be removed out in large quantity; after removing the blood, medicaments which mitigate vata and slesman (kapha) should be administered. 34.
प्रक्लिन्ने दाहपाकाभ्यां बाह्यान्तर्व्रणवत्क्रिया । दावविडङ्गकम्पिल्लैः सिद्धं तैलं व्रणे हितम् ॥ ३५ ॥
दुर्वास्वरससिद्धं तु कफपित्तोत्तरे घृतम् ।
When the tumour becomes greatly moist from burning (cauterisation)and suppuration, treatment should be like those of external and internal wound. Oil prepared with darvi, vidanga and kampilla is good for the wound (healing). Ghee prepared with fresh juice of durva is good for the wound which has predominance of kapha and pitta. 35-36a.
एकतः सर्वकर्माणि रक्तमोक्षणमेकतः ॥ ३६ ॥
विसर्पां न ह्यसंसृष्टः सोऽस्त्रपित्तेन जायते । रक्तमेवाश्रयश्चास्य बहुशोऽस्त्रं हरेदतः ॥ ३७ ॥
If all the other treatments are at one side, blood-letting alone is at the other, visarpa does not occur without being associated with rakta-pitta (bleeding disease), blood alone is the seat of it (visarpa) hence blood-letting should be done many times/in large quantities. 36b-37.
न घृतं बहुदोषाय देयं यन्न विरेचनम् । तेन दोषो ह्यपस्तब्धस्त्वग्रक्तपिशितं पचेत् ॥ ३८ ॥
No medicated ghee which is not a purgative should be given to the patient (of visarpa), who has great increase of dosas; if done so, it ( ghee) obstructs the dosas and cooks (destroys) the skin, blood and muscle tissues. 38.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने विसर्पचिकित्सितं
नामाष्टादशोऽध्यायः ॥ १८ ॥
Thus ends the chapter Visarpa chikitsa-the eighteenth in chikitsa shana of Astanga hrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.
