163 - Diseases

Dhanvantari said: 

1. O Sushruta, I shall explain the pathology of Visarpa (Erysipelas-dry spreading itch), please listen. Visarpa may be caused by defiled morbid humours in the same way as swellings (Shotha). The humours are defiled either by the obstruction of the vessels or prevention of the outlet of excreta. 

2-4. This is an external ailment. It may be caused by fright or overwork. These ailments are more and more difficult of cure in the order of enumeration. When the doshas are aggravated by the usual exciting factors especially those parchifying foodstuffs they come out from within due to excessive thirst, or irregular functions of the excretory system or the impairment of the digestive system or physical strength. This brings on an attack of dry spreading itch. 

5. In the Vataja type the pain and disorders are the same as in Vataja fever. A throbbing sensation is experienced, an aching piercing pain and misery of utter exhaustion is felt. It is attended with horripilation too. 

6. In the pittaja type it spreads very rapidly; it is bright, red in colour and exhibits all symptoms of a Pittajvara (fever). In the kaphaja type of dry itch, it is very irritating, glossy and exhibits the symptoms of kaphaja fever and its pain. 

7. Erysipelas of the Sannipataja type exhibit all the symptoms. When neglected it flourishes with all sorts of eruptions. 

8. Due to the combined action of Vayu and Pitta, there is fever vomiting, fainting, diarrhoea, thirst, vertigo, breaking pain in the joints, the gastric fire becomes defunct, nonrelish for food and tamaka Shvasa-all these manifest themselves. 

9. All the body appears to be covered with burning charcoal. Wherever the itch spreads it gives the burning sensation.

10. The place from where the itch has shifted appears black or blue like the burnt cinders or becomes red and grows with eruptions as in the case of a burn. It is very rapid.

11. Hence, it invades the vital principles since the Vayu is very powerful and produces pain all over the body, removes sensibility and sleep and makes him gasp for breath. 

12. The patient has hiccough and does not get any permanent relief on the ground or bed or in seat, since he becomes insatiable. 

13. Turning over sides he endures a lot of pain, experiences stupor and delusion mentally and physically and enters a sleep from which it becomes difficult to wake him up. This is called Agnivisarpa. 

14-16. Vayu obstructed by Kapha, shatters it into pieces. It then vitiates the blood in the vessels in the skin, sinews and flesh of a sanguinous person. A knotty garland (series) of a number of erysipelatic eruptions elongated or round in shape is produced by it. This exudes blood and gives excruciating pain. Dyspnea, cough, dysentery, parchedness of the mouth, hiccough, vomiting, vertigo, fainting, pallor, epileptic fits, breaking pain in the limbs and impaired digestive function-all these accompany it. This is called Granthivisarpa caused by the derangement of Kapha and Vayu. 

17-21. The derangement of Kapha and Pitta produce these--fever, numbness, somnolence, lassitude, headache, weakness and jerky movements of the limbs, delirium, repugnance for food, vertigo, epileptic fits, impaired gastric fire, breaking pain in the bones, thirst, dullness of the sense organs, undigested excreta and smearing of the ducts with slimy mucous. The itch usually starts from any part of the stomach and spreads. It does not pain much. It is surrounded by pustules deep, yellow, red or gray in colour. The main itch is glossy, black or blue in colour, dirty, heavy and has a swelling with hot grave suppurations. When it breaks, the fleshy portion is severed up making the sinews and nerves clearly visible. It emits the foul smell of a dead body. This is called Kardama Visarpa (Miry Visarpa). 

22-23. When a blow or cut affects the body the Vayu becomes aggravated and vitiates the blood and the Pitta. It then produces itches and eruptions resembling the pulse Kulattha¹ (Horse gram). There is swelling, fever, pain and burning sensation. The blood is blackish-red in colour. The erysipelas caused by the doshas severally can be cured. That caused by the doshas in twos can be cured if disorders are not many.

1. Dolichos biftonus.

24. Those itches caused by all the humours in combination, those affecting the vulnerable joints, those in which the sinews, nerves and flesh are shattered and those with pus emitting the foul smell of dead bodies are incurable.