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Chapter 53 – Visphota Nidanam

The 53rd chapter of Madhava Nidana is Visphota Nidanam which deals with Blisters or cold sore.

Etiopathogenesis —

कटु अम्ल – तीक्ष्णोष्ण – विदाहि – रूक्ष – क्षारैरजीर्णाध्यशनातपैश्च |
तथर्तुदोषेण विपर्ययेण कुप्यन्ति दोषाः पवनादयस्तु ||१||
त्वचमाश्रित्य ते रक्त मांसास्थीनि प्रदूष्य च |
घोरान् कुर्वन्ति विस्फोटान् सर्वान् ज्वरपुरःसरान् || २ ||

kaṭu amla – tīkṣṇōṣṇa – vidāhi – rūkṣa – kṣārairajīrṇādhyaśanātapaiśca |
tathartudōṣēṇa viparyayēṇa kupyanti dōṣāḥ pavanādayastu ||1||
tvacamāśritya tē rakta mānsāsthīni pradūṣya ca |
ghōrān kurvanti visphōṭān sarvān jvarapuraḥsarān || 2 ||

Excessive intake of the items that are pungent, sour, heat – producing, hot, instrumental in causing burning sensation during digestion, alkaline, uncooked and in excess quantity, exposure to sun light, effects of seasons that are normal or abnormal lead to the vitiation of the vata and other doshas that in turn affect the skin, blood, muscles and bones and generate vesicles on the skin. This morbidity is preceded by fever. 1-2

Definition —

अग्निदग्धनिभाः स्फोटा सज्वरा रक्तपित्तजाः |
क्वचित् सर्वत्र वा देहे विस्फोटा इति ते स्मृताः || ३ ||  

agnidagdhanibhāḥ sphōṭā sajvarā raktapittajāḥ |
kvacit sarvatra vā dēhē visphōṭā iti tē smr̥tāḥ || 3 ||

The Visphota has been identified as the disease in which there appear vesicles resembling boils formed by the touch of fire, accompanied with fever. There occur in Visphota the features that are usually manifested due to vitiated rakta and pitta. The blisters remain localized in the beginning but later they extend to all the parts of the body. 3

Vataja Visphota —

शिरोरुक् – शूलभूयिष्ठं ज्वरस्तृट् – पर्वभेदनम् |
सकृष्णवर्णता चेति वातविस्फोटलक्षणम् || ४ ||

śirōruk – śūlabhūyiṣṭhaṁ jvarastr̥ṭ – parvabhēdanam |
sakr̥ṣṇavarṇatā cēti vātavisphōṭalakṣaṇam || 4 || 

Features of the Vataja Visphota are —

  • Headache,
  • Severe pain,
  • Fever,
  • Thirst,
  • Pain in the joints and
  • Appearance of vesicles that are blackish in complexion. 4
 Pittaja Visphota —

ज्वर – दाह – रुजा – स्राव – पाक – तृष्णाभिरन्वितम् |
पीत – लोहितवर्णं च पित्तविस्फोटलक्षणम् || ५ ||  

In case of pittaja visphota there appear —

  • Fever,
  • Burning sensation,
  • Pain,
  • Exudation of pus and
  • Thirst.
  • the vesicles that appear in this condition appear as yellow or red in complexion. 5
 Kaphaja Visphota —

छर्द्यरोचक – जाड्यानि कण्डू – काठिन्य – पाण्डुताः |
अवेदनश्चिरात् पाकी स विस्फोटः कफात्मकः || ६||

chardyarōcaka – jāḍyāni kaṇḍū – kāṭhinya – pāṇḍutāḥ |
avēdanaścirāt pākī sa visphōṭaḥ kaphātmakaḥ || 6||

The kaphaja visphota is characterized by —

  • Vomiting,
  • Anorexia,
  • Stiffness,
  • An itching sensation,
  • Hardness, and
  • Absence of pain and
  • Suppuration after a long time.
  • the vesicles that appear in this condition appear as whitish in complexion. 6
 Vata – Pittaja Visphota —

वातपित्तकृतो यस्तु कुरुते तीव्रवेदनाम् |
vātapittakr̥tō yastu kurutē tīvravēdanām |

Vatapittaja variety of Visphota generates severe pain.

Kapha Vataja Visphota —

कण्डू – स्तैमित्य – गुरुभिर्जानीयात् कफवातिकम् || ७ ||

kaṇḍū – staimitya – gurubhirjānīyāt kaphavātikam || 7 ||

The Kapha Vataja variety of Visphota produces Itching, hardness and tightness.

Kapha Pittaja Visphota —

कण्डूर्दाहो ज्वरश्छर्दिरतैस्तु कफपैत्तिकः |

kaṇḍūrdāhō jvaraśchardirataistu kaphapaittikaḥ |

The kapha pittaja variety of Visphota create itching, burning sensation, fever and vomiting. 7

Sannipataja Visphota —

 मध्ये निम्नोन्नतो अन्ते च कठिनो अल्पप्रपाकवान् || ८ ||
दाह – राग – तृषा – मोह – च्छर्दि – मूर्च्छा – रुजा – ज्वराः |
प्रलापो वेपथुस्तन्द्रा सो असाध्यः स्यात् त्रिदोषजः || ९ ||  

The visphota that has been produced by vitiation of all the doshas includes the following features:

  • Appearance of vesicles that are marked with a depression in the centre and elevation in their edges.

Moreover, they are hard and they contain a little amount of pus, burning sensation and redness. The condition is also accompanied with

  • thirst,
  • delusion,
  • Vomiting,
  • Fainting,
  • Pain,
  • Fever,
  • Delirium,
  • Chills, and
  • Drowsiness.

This type of the disease is incurable. 8-9

Raktaja Visphota —

रक्ता रक्तसमुत्थाना गुञ्जा – विद्रुमसन्निभाः |
वेदितव्यास्तु रक्तेन पैत्तिकेन च हेतुना || १० ||
न ते सिद्धिं समायान्ति सिद्धैर्योगशतैरपि |

raktā raktasamutthānā guñjā – vidrumasannibhāḥ |
vēditavyāstu raktēna paittikēna ca hētunā || 10 ||
na tē siddhiṁ samāyānti siddhairyōgaśatairapi |

The Visphota generated by the vitiated rakta will have vesicles that are as red as resembling to a gunja seen or coral bead. Moreover, there would manifest all the features of vitiated pitta. This type of visphota does not respond to treatment even by hundreds of powerful recipes. 10

Prognosis —

एकदोषोत्थितः साध्यः कृच्छ्रसाध्यो द्विदोषजः |
सर्वदोषोत्थितो घोरस्त्वसाध्यो भूर्युपद्रवः || ११ || 

ēkadōṣōtthitaḥ sādhyaḥ kr̥cchrasādhyō dvidōṣajaḥ |
sarvadōṣōtthitō ghōrastvasādhyō bhūryupadravaḥ || 11 ||

The visphota that has been generated by vitiation of a single dosha is known to be curable. The one caused by vitiation of two doshas together is curable with difficulty while the one appearing due to vitiation of all the three doshas are simply incurable. 11

इति श्रीमाधवकरविरचिते माधवनिदाने विस्फोटनिदानं समाप्तम् || ५३ ||

 iti śrīmādhavakaraviracitē mādhavanidānē visphōṭanidānaṁ samāptam || 53 ||

Thus concludes the Chapter on Visphota.

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