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Chapter 52 – Visarpa Nidanam

The 52nd Chapter of Madhava Nidana is Visarpa Nidanam which deals with Erysepelas.

लवणाम्ल – कटु उष्णादिसंसेवादोषकोपतः |
विसर्पः सप्तधा ज्ञेयाः सर्वतः परिसर्पणात || १ ||

 lavaṇāmla – kaṭu uṣṇādisansēvādōṣakōpataḥ |
visarpaḥ saptadhā jñēyāḥ sarvataḥ parisarpaṇāta || 1 ||

Regular and excessive intake of salty, sour, pungent, and warm eatables and such other factors that vitiate the three doshas are instrumental in generating seven types of visarpa.

It is so named because of its nature of spreading speedily all over the body like a snake that is sarpa. 1

Types —

पृथक् त्रयस्त्रिभिश्चैको विसर्पा द्वन्द्वजास्त्रयः |
वातिकः पैत्तिकाश्चैव कफजः सान्निपातिकः || २ ||
चत्वार एते वीसर्पा वक्ष्यन्ते द्वन्द्वजास्त्रयः |
आग्नेयो वात – पित्ताभ्यां ग्रन्थ्याख्यः कफ – वातजः || ३ ||
यस्तु कर्दमको घोरः स पित्त – कफसंभवः | 

 pr̥thak trayastribhiścaikō visarpā dvandvajāstrayaḥ |
vātikaḥ paittikāścaiva kaphajaḥ sānnipātikaḥ || 2 ||
catvāra ētē vīsarpā vakṣyantē dvandvajāstrayaḥ |
āgnēyō vāta – pittābhyāṁ granthyākhyaḥ kapha – vātajaḥ || 3 ||
yastu kardamakō ghōraḥ sa pitta – kaphasambhavaḥ |

The various kinds of visarpa are as follows:

  • Three out of seven types indicated above are produced by the vitiation of each of the three doshas,
  • Another is produced by the vitiation of all the three doshas together while the rest of the three are result of the combination of two doshas.

Thus, the first four of the above are named as Vataja, Pittaja, Kaphaja and the sannipataja.

  • The name Agni visarpa has been given to the case of visarpa that has been caused by due to a combination of the two doshas namely, the vata and pitta.
  • The name Granthi Visarpa has been given to the case of visarpa that has been caused by vitiation of kapha and vata.
  • While the name Kardama visarpa has been given to that case of visarpa which is serious in degree and that has been caused by vitiated pitta and kapha together. 2-3
Involvement of Dosha and Dushya —

रक्तं लसीका त्वङ्ग्मांसं दूष्यं दोषास्त्रयो मलाः || ४ ||
विसर्पणां समुत्पत्तौ विज्ञेयाः सप्त धातवः |

 raktaṁ lasīkā tvaṅgmānsaṁ dūṣyaṁ dōṣāstrayō malāḥ || 4 ||
visarpaṇāṁ samutpattau vijñēyāḥ sapta dhātavaḥ |

The four dushyas, namely

  • The rakta (blood),
  • Lasika (lymph),
  • Tvak (skin),
  • Mamsa (muscles) and the
  • 3 doshas together are the 7 factors involved in the causation of the seven types of visarpa. 4
Vataja Visarpa —

तत्र वातात् स वीसर्पो वातज्वरसमव्यथः || ५ ||
शोथ – स्फुरण – निस्तोद – भेदायासार्ति – हर्षवान् |

tatra vātāt sa vīsarpō vātajvarasamavyathaḥ || 5 ||
śōtha – sphuraṇa – nistōda – bhēdāyāsārti – harṣavān |

Vataja Visarpa has features identical to those found in Vata Jwara (fever)along with —

  • Swelling;
  • Pulsating;
  • Pricking or cutting pain;
  • Tiredness;
  • Body aches; and
  • Horripilation. 5
Pittaja Visarpa —

 पित्तादद्रुतगतिः पित्तज्वरलिङ्गो अतिलोहितः || ६ || 

pittādadrutagatiḥ pittajvaraliṅgō atilōhitaḥ || 6 ||

Pittaja visarpa has features mostly identical to those found in cases of Pittaja Jvara. However, the lesion produced by it is very red in complexion. 6

Kaphaja Visarpa —

 कफात् कण्डूयुतः स्निग्धः कफज्वररसमानरुक् | 

kaphāt kaṇḍūyutaḥ snigdhaḥ kaphajvararasamānaruk |

Itching and smoothiness of the lesion and other features of Kaphaja jvara could be seen in Kaphaja Visarpa.

Sannipataja Visarpa —

 सन्निपातसमुत्थश्च सर्वलिङ्गसमन्वितः || ७ || 

sannipātasamutthaśca sarvaliṅgasamanvitaḥ || 7 ||

And presence of all the features could be seen in Sannipataja Variety of Visarpa. 7

Aagneya Visarpa —

वातपित्ताज्ज्वर – च्छर्दि – मूर्च्छातीसार – तृद् – भ्रमैः |
ग्रन्थि – भेदाग्निसदन – तमकारोचकैर्युतः || ८ ||
करोति सर्वमङ्गं च दीप्ताङ्गारावकीर्णवत् |
यं यं देशं विसर्पश्च विसर्पति भवेत् स सः || ९ ||
शान्ताङ्गारासितो नीलो रक्तो वा आशु च चीयते |
अग्निदग्ध इव स्फोतैः शीघ्रगत्वादद्रुगतं स च || १० ||
मर्मानुसारी वीसर्पः स्याद्वातो अतिबलस्ततः |
व्यथते अङ्गं हरेत् संज्ञां निद्रां च श्वासमीरयेत् || ११ ||
हिक्कां च स गतो अवस्थामीदृशीं लभते न ना |
क्वचिच्छर्मारतिग्रस्तो भूमि – शय्यासनादिषु ||१२ ||
चेष्टमानस्ततः क्लिष्टो मनो – देहप्रमोहवान् |
दुष्प्रबोधो अश्नुते निद्रां सो अग्निवीसर्प उच्यते || १३ || 

vātapittājjvara – cchardi – mūrcchātīsāra – tr̥d – bhramaiḥ |
granthi – bhēdāgnisadana – tamakārōcakairyutaḥ ||8|| 
karōti sarvamaṅgaṁ ca dīptāṅgārāvakīrṇavat |
yaṁ yaṁ dēśaṁ visarpaśca visarpati bhavēt sa saḥ || 9 ||
śāntāṅgārāsitō nīlō raktō vā āśu ca cīyatē |
agnidagdha iva sphōtaiḥ śīghragatvādadrugataṁ sa ca || 10 ||
marmānusārī vīsarpaḥ syādvātō atibalastataḥ |
vyathatē aṅgaṁ harēt sañjñāṁ nidrāṁ ca śvāsamīrayēt || 11||
hikkāṁ ca sa gatō avasthāmīdr̥śīṁ labhatē na nā |
kvaciccharmāratigrastō bhūmi – śayyāsanādiṣu ||12 ||
cēṣṭamānastataḥ kliṣṭō manō – dēhapramōhavān |
duṣprabōdhō aśnutē nidrāṁ sō agnivīsarpa ucyatē || 13||

Visarpa generated by combination of provoked vata and pitta is called agneya visarpa. It manifests the following features:

  • Fever,
  • Vomiting,
  • Swooning,
  •  Diarrhea,
  • Thirst,
  • Dizziness,
  • Splitting pain in the joints,
  • Poor digestion, and
  • Appearance of darkness before the eyes, and
  • Loss of appetite.

In this case, the patient feels as though his body, specially, its affected parts are in contact with burning charcoal. His skin turns black, blue or red. Moreover, blisters develop on his body quickly and various lesions spread to different places in the body fast and get located in vital organs. Because of that, vata becomes over overwhelmingly powerful and it produces pain all over the body, loss of consciousness, sleeplessness, dyspnoea, and hiccough.

The patient, who has reached this stage, does not find relief by any means. He remains restless and attempts to lie down on the ground or sit or adopt any other posture resulting in extreme agony, mental confusion, and bodily inactivity. He ultimately attains that eternal sleep from which one never awakes. This condition has been identified as the Agnivsarpa. 8-13

Granthi (Glandular / Nodular Visarpa) —

कफेन रुद्धः पवनो भित्त्वा तं बहुधा कफम् |
रक्तं वा वृद्धरक्तस्य त्वक् – सिरा – स्नायु – मांसगम् || १४ ||
दूषयित्वा तु दीर्घाणु – वृत्त – स्थूल – खरात्मनाम् |
ग्रन्थीनां कुरुते मालां सरक्तां तीव्ररुग्ज्वराम् || १५ ||
श्वास – कासातिसारास्यशोष – हिक्का – वमि – भ्रमैः |
मोह – वैवर्ण्य – मूर्च्छाङ्गभङ्गाग्निसदनैर्युताम् || १६ ||
इत्ययं ग्रन्थिवीसर्पः कफमारुतकोपजः |

 kaphēna ruddhaḥ pavanō bhittvā taṁ bahudhā kapham |
raktaṁ vā vr̥ddharaktasya tvak – sirā – snāyu – mānsagam || 1 ||
dūṣayitvā tu dīrghāṇu – vr̥tta – sthūla – kharātmanām |
granthīnāṁ kurutē mālāṁ saraktāṁ tīvrarugjvarām || 15 ||
śvāsa – kāsātisārāsyaśōṣa – hikkā – vami – bhramaiḥ |
mōha – vaivarṇya – mūrcchāṅgabhaṅgāgnisadanairyutām || 16 ||
ityayaṁ granthivīsarpaḥ kaphamārutakōpajaḥ |

The Granthi visarpa is caused due to the vata being obstructed by kapha or by provoked blood. As a result, morbid vata associated with vitiated kapha invades the skin, veins, tendons, and muscles. This condition generates chains of tumors that are elongated, small, round, hard, rough, red in color, and very painful.

In Granthi visarpa, these symptoms are associated with —

  • fever,
  • dyspnoea,
  • cough,
  • diarrhoea
  • dryness of mouth,
  • hiccough,
  • vomiting tendency,
  • giddiness,
  • delusion,
  • discoloration and
  • Fainting.

In this morbidity, there occurs pain all over the body and the digestion of patient is lost. This disease is generated by morbid increase of kapha and vata. 14-16

Kardama Visarpa —

कफपित्ताज्ज्वरः स्तम्भो निद्रा तन्द्रा शिरोरुजा || १७ ||
अङ्गावसाद – विक्षेपौ प्रलेपारोचक – भ्रमाः |
मूर्च्छाग्निहानिर्भेदो अस्थ्नां पिपासेन्द्रियगौरवम् || १८ ||
आमोपवेशनं लेपः स्रोतसां स च सर्पति |
प्रायेणामाशयं गृह्न्नेकदेशं न चातिरुक् || १९ ||
पिडकैरवकीर्णो अतिपीत – लोहित – पाण्डुरैः |
स्निग्धो असितो मेचकाभो मलिनः शोथवान् गुरुः || २० ||
गम्भीरपाकः प्राज्योष्मा स्पृष्टः क्लिन्नो अवदीर्यते |
पङ्कवच्छीर्णमांसश्च स्पष्टस्नायु – सिरागणः || २१ ||
शवगन्धि च वीसर्पः कर्दमाख्यमुशान्ति तं |

 kaphapittājjvaraḥ stambhō nidrā tandrā śirōrujā || 17 ||
aṅgāvasāda – vikṣēpau pralēpārōcaka – bhramāḥ |
mūrcchāgnihānirbhēdō asthnāṁ pipāsēndriyagauravam || 18 ||
āmōpavēśanaṁ lēpaḥ srōtasāṁ sa ca sarpati |
prāyēṇāmāśayaṁ gr̥hnnēkadēśaṁ na cātiruk || 19 ||
piḍakairavakīrṇō atipīta – lōhita – pāṇḍuraiḥ |
snigdhō asitō mēcakābhō malinaḥ śōthavān guruḥ || 20 ||
gambhīrapākaḥ prājyōṣmā spr̥ṣṭaḥ klinnō avadīryatē |
paṅkavacchīrṇamānsaśca spaṣṭasnāyu – sirāgaṇaḥ || 21 ||
śavagandhi ca vīsarpaḥ kardamākhyamuśānti taṁ |

The morbid condition identified as the Kardama Visarpa is generated by combined vitiation of kapha and pitta. It could manifest itself through the following symptoms :

  • Fever,
  • Stiffness of the body parts,
  • Sleep,
  • Stupor,
  • Headache,
  • Weakness,
  • Involuntary movement of the body parts,
  • Coating of the tongue,
  • Loss of appetite,
  • Giddiness,
  • Fainting,
  • Loss of digestive function,
  •  Pain in the bones,
  • Excessive thirst, and
  • Dullness of the sense organs.

Moreover, the patient pass faeces that are unprocessed, and there appears coating of thick material in the channels and pores of the body. The Lesions of Kardama Visarpa generally appear over the stomach with a mild pain; it spreads by forming small tumors that are of deep yellow, red, white, black, or blue black in complexion, smooth, dirty, swollen, heavy, forming pus inside, and very hot.

On occasion, it bursts out discharging pus, the muscles having become semi – liquid like silt, falls off exposing the network of tendons and veins and emitting a cadaveric smell. 17 – 21

Kshata (Traumatic) Visarpa —

बाह्याहेतोः क्षतात् क्रुद्धः सरक्तं पित्तमीरयन् || २२ ||
वीसर्पं मारुतः कुर्यात् कुलत्थसदृशैः चितम् |
स्फोतैः शोथ – ज्वर – रुजा – दाहाद्यं श्याव – शोणितं || २३ ||

bāhyāhētōḥ kṣatāt kruddhaḥ saraktaṁ pittamīrayan || 22 ||
vīsarpaṁ mārutaḥ kuryāt kulatthasadr̥śaiḥ citam |
sphōtaiḥ śōtha – jvara – rujā – dāhādyaṁ śyāva – śōṇitaṁ || 23 ||

Another variety of visarpa that is known as Ksata Visarpa is generated due to some external cause or an injury. In this variety of visarpa, the vata becomes irritated, it excites pitta along with rakta and produces a visarpa that is associated with vesicles like kulattha seeds, oedema, fever, pain, and burning sensation. Its complexion is blackish red. 22 – 23

 ज्वरातिसारौ वमथुस्त्वङ्गमांसदरणं क्लमः |
अरोचकाविपाकौ च विसर्पाणामुपद्रवाः || २४ || 

jvarātisārau vamathustvaṅgamānsadaraṇaṁ klamaḥ |
arōcakāvipākau ca visarpāṇāmupadravāḥ || 24 ||

The implications of visarpa include —

  • fever,
  • Diarrhoea,
  • Vomiting
  • depletion of skin and muscles,
  • Exhaustion,
  • Loss of appetite,and
  • Indigestion. 24
Prognosis —

सिध्यन्ति वात – कफ – पित्तकृता वीसर्पाः सर्वात्मकः क्षतकृतश्च न सिद्धिमेति |
पित्तात्मको अञ्जनवपुश्च भवेदसाध्यः कृच्छ्राश्च मर्मसु भवन्ति हि सर्व एव || २५ ||

 sidhyanti vāta – kapha – pittakr̥tā vīsarpāḥ sarvātmakaḥ kṣatakr̥taśca na siddhimēti |
pittātmakō añjanavapuśca bhavēdasādhyaḥ kr̥cchrāśca marmasu bhavanti hi sarva ēva || 25 ||

The cases of Visarpas generated by any one dosha (Vata, kapha or the Pitta) are curable. The kshataja type of visarpa do not respond to treatment while the one generated by pitta and that which makes the body black like the eyeliner (kajjala) are incurable and those appearing on vital spots or organs are difficult to manage. 25

 इति श्रीमाधवकरविरचिते माधवनिदाने विसर्पनिदानं समाप्तम् || ५२ || 

iti śrīmādhavakaraviracitē mādhavanidānē visarpanidānaṁ samāptam || 52 ||

Thus concludes the chapter on Visarpa.