The Compendium of Caraka 6.21: ekaviṃśo 'adhyāyaḥ/

Now we shall explain the treatment of erysipelas (visarpa).

Thus spoke the venerable Ātreya.

On Kailāsa, crowded with Kinnaras, having many streams and medicinal herbs,
beautifully adorned on all sides with various sleek trees emitting sweet fragrances

through the constant abundance of blossoms,
to Ātreya, self-controlled, praised by ṛṣis, sporting [there],

surrounded by great sages, devoted to the welfare of all beings,
Agniveśa, in proper time, spoke this with humility:

"O venerable one! A terrible disease comparable to snake poison,
spreading through the bodies of embodied beings, I observe.

Overcome suddenly by this rapid-acting [affliction],
men perish if not treated; regarding this, we have great doubt.

By what name is it to be known? By what reason is it named?
How many varieties? How many tissues [involved]? What is its etiology? What is its site?

Which is to be known as easily curable, difficult to cure, and untreatable?
How, by what characteristics, and what, O venerable one, is its medicine?"

Hearing those words of Agniveśa, Ātreya Punarvasu,
the best of sages, spoke all of it in full and properly.

Because it spreads (sarpati) in various ways, it is known as visarpa, / or by the name parisarpa because of spreading all around.

It should be known as sevenfold according to the doṣas, and involving seven tissues: / three individually, one from the three [combined], and three born of dual doṣas.

Vātika, paittika, kaphaja, and sānnipātika: / these are the four visarpas. The three born of dual doṣas will [now] be stated:

āgneya from vāta and pitta; the one called granthi from kapha and vāta; / and the terrible kardamaka, which arises from pitta and kapha.

Blood, lymph, skin, and flesh are the tissues affected; the doṣas are the three wastes. / These are to be known as the seven elements involved in the arising of visarpas.

From excessive intake of saline, sour, pungent, and hot tastes; / of curd, sour curd-whey, śukta vinegar, surā, and sauvīraka;

from the use of spoiled or excessive wine, hot rāga and ṣāḍava; / from the consumption of vegetables, fresh greens, and substances causing burning digestion;

from eating kūrcikā, kilāṭa, and unformed curd; / from consuming fermented preparations beginning with śāṇḍākī;

from [the excessive use of] sesame, black gram, kulattha, oils, pastry foods, / the meat of domestic, marsh, and aquatic animals, and garlic;

from consuming decomposed, unwholesome, and mutually contradictory foods; / from overeating, daytime sleeping, eating over undigested food, from wounds,

from the falling off of bandages on wounds, excessive exposure to heat and physical exertion, / and from poison, wind, and fire afflictions, the arising of visarpas occurs.

Aggravated by these mixed causes, vāta and the other [doṣas], / corrupting the affected tissues such as blood, spread in those who eat unwholesome food.

Residing externally, residing internally, and residing in both: / their strength should be known as progressively graver.

One should know visarpa residing in the external pathway to be curable; that residing in both to be incurable and dreadful; / and that residing internally to be very difficult to cure.

Internally aggravated doṣas spread in the internal site; / externally aggravated ones spread externally; and those aggravated everywhere spread in both.

From trauma to vital spots, confusion, obstruction of the channels, / excessive heat, the irregular initiation of natural urges,

and from the rapid loss of digestive power, one should recognize the internal visarpa. / By the opposite [of these], and by other specific symptoms, one should recognize the external one.

That which has all the signs, whose cause is strong, / whose complications are distressing, and which has reached a vital spot—that one kills.

Vāta alone, or enveloped by heavy foods, aggravated by dry and hot things, / corrupting the affected tissues, spreads according to its strength.

Its symptoms are: dizziness, burning sensation, thirst, pricking pain, aching, body-ache, cramping, trembling, fever, tamaka cough, bursting and loosening pain in the bones and joints, shaking, anorexia, indigestion, cloudiness of the eyes, shedding of tears, and a sensation like ants crawling over the limbs; and in whichever region the visarpa spreads, that region appears grayish-reddish, is swollen, and is intensely afflicted with pricking, tearing, aching, tension, contracture, horripilation, and twitching; and if untreated, it becomes covered with quickly bursting thin blisters that are reddish or grayish, with a thin, non-slimy, reddish, scanty discharge; there is retention of flatus, urine, and feces; and things described among its causes do not agree with him, while their opposites agree: this is vātavisarpa.

Pitta, accumulated by hot regimens and burning, sour foods, / corrupting the affected tissues and filling the vessels, spreads.

Its symptoms are: fever, thirst, fainting, confusion, vomiting, anorexia, aching of the limbs, excessive sweating, internal burning, delirium, headache, cloudiness of the eyes, sleeplessness, restlessness, dizziness, excessive desire for cold wind and water, green or turmeric-yellow coloration of the eyes, urine, and stool, and seeing things as green or turmeric-yellow; and in whichever region the visarpa spreads, that region takes on one of the colors—coppery, green, turmeric-yellow, blue, black, or red; it becomes covered with raised blisters that are surrounded by intense burning and tearing pain, with discharges of similar color, and taking a long time to suppurate; things described among its causes do not agree with him, while their opposites agree: this is pittavisarpa.

Kapha, accumulated by sweet, sour, salty, unctuous, and heavy foods and sleep, / corrupting the affected tissues, spreads with difficulty in the body.

Its symptoms are: chills, fever with chills, heaviness, sleep, drowsiness, anorexia, sweet taste in the mouth, coating of the mouth, spitting, vomiting, lassitude, numbness, loss of digestive fire, and weakness; and in whichever region the visarpa spreads, that region is swollen, pale, not very red, accompanied by unctuousness, numbness, stiffness, and heaviness, with little pain, and is beset with white-pale blisters that suppurate with difficulty, are chronic, and have thick skin-coverings; when burst, it discharges a white, slimy, thread-like, thick, continuous, unctuous fluid; and subsequently it becomes covered with ulcers that are heavy, firm, spread out like a net, unctuous, with thick skin-coverings, and it becomes persistent; the nails, eyes, face, skin, urine, and stool are white; things described among its causes do not agree with him, while their opposites agree: this is śleṣmavisarpa.

Vāta and pitta, intensely aggravated by their respective causes / and gaining strength from each other, spread, burning the body.

From that burning, the patient feels as though his whole body were being strewn with live coals; he is overwhelmed by vomiting, diarrhea, fainting, burning, confusion, fever, tamaka cough, anorexia, bursting pain in bones and joints, thirst, indigestion, aching of the limbs, and so forth; whichever region the visarpa spreads to, that region looks like extinguished coals or becomes intensely red, and it is covered with blisters resembling burns from fire; due to its swift course, it quickly reaches the vital spots; and when a vital spot is tormented, the excessively powerful vāta causes intense tearing pain in the limbs, utterly deranges consciousness, produces hiccup and dyspnea, and destroys sleep; deprived of sleep, bewildered in consciousness, and anguished in mind, he finds comfort nowhere; overcome with restlessness, he wants to move from standing to sitting to bed; heavily tormented, he falls asleep quickly, becomes weak, and wakes with difficulty; one should know such a patient afflicted by agnivisarpa to be incurable.

Kapha and pitta, aggravated and powerful due to their own causes, / spread in a single part and moisten the body.

Its disorders are: cold fever, heaviness of the head, burning sensation, damp stiffness, prostration of the limbs, sleep, drowsiness, delusion, aversion to food, delirium, loss of digestive fire, debility, bursting pain in the bones, fainting, thirst, coating of the channels, dullness of the sense faculties, sitting motionless, flinging of the limbs, body aches, restlessness, and anxiety arise. It usually spreads in the stomach, is indolent, and occupies a single area. And the region where this visarpa spreads appears strewn with red, yellow, and pale pustules, has a blue-black luster, is black, dirty, greasy, intensely hot, heavy, accompanied by numbing pain, swollen, deeply suppurating, devoid of discharge, quickly putrefies, its skin and flesh become steamed, moist, and foul-smelling, gradually has little pain, and when touched it tears open; when pressed it gives way like mud, sheds softened, putrid flesh, reveals vessels and sinews, smells of a corpse, and destroys consciousness and memory. One should recognize that one afflicted with kardamavisarpa is incurable.

In those who partake of unmoving, heavy, hard, sweet, cold, greasy food and drinks, and channel-clogging substances, who do not exercise and the like, and who are averse to therapeutic courses, phlegm and vāta become aggravated. Both of them, corrupted, intensified, and exceedingly strong, by corrupting the bodily constituents that are liable to corruption, bring about visarpa. There, vāta, its pathways obstructed by phlegm, splitting that very phlegm in many ways, gradually produces a chain of nodules difficult to cure through suppuration in the site of phlegm; or, in one whose blood is elevated, by corrupting the blood located in the vessels, sinews, flesh, and skin, it forms a chain of nodules with acute pain, large or small, oblong, round, and red. From that torment arise complications such as fever, diarrhea, cough, hiccup, dyspnea, wasting, confusion, discoloration, anorexia, indigestion, excessive salivation, vomiting, fainting, breaking pain in the limbs, sleep, restlessness, and debility. Afflicted by these complications, he passes beyond the scope of all medical treatments and is to be abandoned; this is granthivisarpa.

A complication indeed is a condition arising after a disease, based on that disease, and is itself a disease, gross or minute; because it arises after the disease, it is given the name 'complication'.

In that context, the primary disease is primary, and the complication is secondary to the disease; usually, upon the alleviation of the primary one, it too is alleviated.

However, since it arises later in a body already worn out by disease, it is more agonizing; therefore, one should hasten to counteract the complication.

Arising from all causative factors, pervading all symptoms, following all tissues, rapid in action, and with great emergency—thus one should know that sannipāta-visarpa is incurable.

Among these, the three visarpas caused by vāta, pitta, and phlegm are curable. The two called agni and kardama, moreover, if the vital spots are not affected, or if the putrefaction of the vessels, sinews, and flesh has not advanced, both may be pacified when treated with moderate, balanced therapies; but if approached with negligence, either one of the two will kill the body swiftly like a venomous serpent. Likewise, one should begin to treat granthivisarpa before complications have arisen, but should avoid it when beset by complications. Sannipāta-born visarpa, however, because it invades all tissues, is fast-acting, and has mutually conflicting treatments, one should know to be incurable.

Now, we shall explain the management of those that are curable.

Fasting and therapeutic vomiting are recommended, along with the intake of bitter drugs; / when located in the site of kapha and accompanied by āma, one should apply pastes that are dry and cold.

Even when located in the site of pitta and accompanied by āma, one should employ this same treatment, / and particularly bloodletting and purgation.

Even when arising in the site of vāta, there should be drying right from the beginning; / even when associated with raktapitta, oleation at the beginning is not considered beneficial.

When vāta is predominant, bitter ghee is praised, as also in that born of pitta / when the doṣas are slight; when the doṣas are great in that born of pitta, there should be purgation.

Ghee should not be given to one with copious doṣas if it does not purge; / for held back by it, the doṣa would cook the skin, flesh, and blood.

Therefore, one should consider purgation alone to be commended first for one suffering from visarpa, / as well as the evacuation of blood, for that is called its seat.

Thus the treatment that destroys visarpa has been stated in brief; / all of this will now be declared again in detail.

Madana, madhuka, nimba, and the fruits of vatsaka— / an emetic should be administered in kapha-pitta-born visarpa.

With paṭola and picumarda, with pippalī and madana, / and together with indrayava, emesis is commended in visarpa.

And the formulations that I shall declare in the section on pharmaceutics for those with kapha and pitta / are to be applied for patients with visarpa, carrying off the doṣas and auspicious.

Of mustā, nimba, and paṭola, or of candana and utpala, / or of sārivā, āmalaka, uśīra, and mustā, the discerning

physician should administer prepared decoctions that destroy visarpa. / Kirātatikta, lodhra, candana along with durālabhā,

nāgara, filaments of padma, utpala, along with bibhītaka, / madhuka, and nāgapuṣpa one should give for the pacification of visarpa.

Prapauṇḍarīka, madhuka, filaments of padma, utpala, / nāgapuṣpa, and lodhra one should drink according to that very method.

Drākṣā, parpaṭaka, śuṇṭhī, guḍūcī, and dhanvayāsa, / kept overnight, one should give for the relief of thirst and visarpa.

Paṭola, picumarda, dārvī, kaṭukarohiṇī, / yaṣṭyāhvā, and trāyamāṇā one should give for the pacification of visarpa.

Or one should drink the decoction beginning with paṭola together with triphalā; / combined with split lentils of masūra, mixed with ghee, it should be administered.

The juice of paṭola leaves, mudga, and āmalaka, / mixed with ghee, one should cause a man afflicted with visarpa to drink.

And the Mahātikta ghee which has been prescribed / for destroying pitta-born kuṣṭha, that too the wise physician should give for the pacification of visarpa.

The prepared Trāyamāṇā Ghee which was described in the treatment of gulma, / that too the intelligent physician should administer for the alleviation of visarpas.

Having stirred powder of trivṛt with ghee, or with milk, / or combining it with hot water, or with the juice of mṛdvīkā,

it should be employed for purgation, proven to destroy visarpa; / or one should give milk boiled with trāyamāṇā as a purgative.

Ghee combined with the juice of triphalā, along with trivṛt, / should be employed for purgation, destroying visarpa and fever.

Or one should administer the juice of āmalaka mixed with ghee; / that itself, combined with trivṛt powder, is beneficial for a person of sluggish bowel.

When the doṣa has entered the koṣṭha, one should repeatedly perform this treatment; / but when the blood is vitiated through the tissues, one should first of all remove that very blood.

The physician should draw out blood combined with vāta by means of a horn, / that combined with pitta by leeches, and that combined with kapha by gourds.

Or one should swiftly puncture a vein near the lesion, / for maceration of the skin, flesh, and sinews arises indeed from the maceration of blood.

When the interior of the body is cleansed, and the doṣa is lodged in the skin and flesh, / or from the outset in those with slight doṣas, the external treatment will be stated:

Bark of udumbara, madhuka, lotus filaments, utpala, / nāgapuṣpa, and priyaṅgu: a warm poultice with ghee is beneficial.

Tender aerial roots of nyagrodha combined with the pith of kadalī / and lotus rhizome-nodes: there should be an unguent drenched in hundred-times-washed ghee.

Kālīya, madhuka, hema, vanya, candana, padmaka, / cardamom, lotus stem, and phalinī: there should be a cool unguent drenched in ghee.

Śādvala grass, lotus stem, conch shell, candana, utpala, / and roots of vetasa, along with rice: should be a poultice.

Sārivā, lotus filaments, uśīra, blue utpala, / mañjiṣṭhā, candana, lodhra, and abhayā are a cool unguent.

Nalada, hareṇu, lodhra, madhuka, padmaka, / dūrvā, and resin of sarja, with ghee, should be a cool unguent.

Roasted barley groats combined with ghee / are a poultice; madhuka, vīrā, roasted barley groats with ghee,

balā, lotus root, vīrā, aguru, and candana, / and lotus stem along with lotus rhizome: the physician should prepare as an unguent.

Barley powder with madhuka and with ghee is a cool unguent; / hareṇu, lentils, mudga, and white śāli rice,

should each be separate poultices, or all together with ghee; / or cold silt of a lotus pool, or ground pearl,

conch shell, coral, oyster shell, or red ochre drenched in ghee; / prapauṇḍarīka, madhuka, balā, lotus root, utpala,

nyagrodha leaves, and dugdhikā with ghee should be a cool unguent; / and lotus rhizomes, lotus stem, and kaśeruka with ghee,

and the tubers of śatāvarī and vidārī drenched in washed ghee; / water algae, nala roots, gojihvā, vṛṣakarṇikā,

indrāṇīśāka with ghee; bark of śirīṣa, balā, and ghee; / tender shoots of nyagrodha, udumbara, plakṣa, vetasa, and aśvattha,

as paste of barks with abundant ghee, cold, is beneficial as an unguent; / all these poultices are excellent when vāta and pitta are predominant.

When kapha is present, however, I shall declare other beneficial poultices: / triphalā, padmaka, uśīra, samaṅgā, karavīra,

nala roots, and anantā: one should prepare as a poultice; / khadira, saptaparṇa, musta, āragvadha, dhava,

kuraṇṭaka, and devadāru: the physician should apply as an unguent; / leaves of āragvadha and bark of śleṣmātaka,

indrāṇīśāka, kākāhvā, and flowers of śirīṣa; / water algae, nala roots, vīrā, and gandhapriyaṅgu;

triphalā, madhuka, vīrā, and flowers of śirīṣa; / prapauṇḍarīka, hrībera, dārvī bark, madhuka, balā:

one should make an unguent separately, in pairs, or altogether; / all these poultices are to be applied drenched in a small amount of ghee.

Those poultices, however, which are for predominance of vāta and pitta should have abundant ghee; / or one should anoint with hundred-times-washed ghee alone,

or with scum of ghee, cold milk, or madhuka water; / or one should sprinkle with cold decoction of the five barks

a visarpa abounding in vāta, blood, and pitta repeatedly, O physician. / Those very substances which are for sprinkling and for poultices are to be prepared with ghee;

those powder-formulations are dusting powders for the wounds of visarpa; / and ghee prepared with fresh juice of dūrvā heals wounds.

Dārvī bark, madhuka, lodhra, and filaments [of saffron] are a dusting powder; / paṭola, picumarda, triphalā, madhuka, and utpala:

this is a wash, a ghee, a wound-powder, and a cool unguent; / all these poultices should be made soothing.

They should be applied again and again, having removed the previous application; / when the previous one is removed without washing, thin poultices should be applied frequently;

in cases born of kapha, thick poultices should be applied, removed by changing; / an unguent ground into a paste should be the measure of one-third of a thumb's width,

neither too unctuous nor dry, neither a lump nor runny, but uniform; / and one should never apply an unguent that is stale.

And one should never apply again with that very same unguent; / due to its becoming warm, it would provoke moisture, visarpa, and pain.

For an unguent applied over a bandage causes the wound to foment; / pimples born of sweat and itching arise for him.

If an unguent is applied on top of an unguent, / it would produce those very doṣic troubles that one applied over a bandage produces.

If an unguent applied is overly unctuous or overly liquid, / it does not adhere properly to the skin, nor does it pacify the doṣa.

One should not make a thinly smeared application, for when dried it cracks like a shell; / and the essence of the medicine does not reach the disease, and moreover it dries out.

It would severely produce those very faults as with a thinly smeared one; / for when dried out and applied without unctuousness, it torments the disease.

I shall declare foods and drinks for the cessation of visarpa: / for those who have undergone fasting, a dry mantha drink with honey and sugar is beneficial,

sweet or slightly sour, combined with pomegranate and āmalaka, / with parūṣaka and mṛdvīkā, with dates, made with boiled water.

Or an electuary with unctuous substance made of refreshing drinks of barley and śāli; / when that is digested, one should take a meal of aged śāli rice with broths.

One should prepare mudga, lentils, and chick-peas for broth, / non-sour or made sour with pomegranate, along with paṭola and āmalaka.

And one should prepare for him meat soups of wild animals, / dry, combined with parūṣaka, grapes, pomegranate, and āmalaka.

Red, white, and mahāśāli rice along with ṣaṣṭika, / aged and well-strained, are praised for food.

One should administer only what is habitual among barley, wheat, and rice, / for men for whom śāli rice is not very customary, and who have an excess of kapha.

One should avoid foods and drinks causing burning digestion, incompatible diet, sleeping by day, / anger, exercise, the sun, fire, and strong winds.

From these therapies, one should apply mostly cold measures in the paittika type, / mostly dry in the kaphaja, and unctuous in that born of vāta.

Pacification of vāta and pitta is beneficial in agnivisarpa; / pacification of kapha and pitta is generally beneficial in the one named kardamaka.

Observing granthivisarpa to have a predominance of rakta and pitta at the beginning, / by means of drying therapies, fasting, affusions, poultices of the five barks,

venesections, leeches, emesis along with purgation, / and ghees that are astringent and bitter, one who knows the proper time should treat it.

When one has been cleansed upward and downward, and blood has also been drawn, / measures that remove vāta and kapha are beneficial for the patient suffering from granthivisarpa.

A warm poultice with warm cereal pastes is praised, / or with unctuous vesavāra, for those suffering from pain in granthivisarpa.

One should sprinkle it with warm oil prepared with daśamūla, / or with warm kuṣṭha oil mixed with pākyakṣāra.

Or one should sprinkle with cow's urine or warm decoctions of leaves, / or apply a lukewarm poultice of ground aśvagandhā.

With a paste of dried radish, or with naktamāla bark, / or with bibhītaka bark, one should apply a warm paste.

Balā, nāgabalā, pathyā, knot of bhūrja, bibhītaka, / bamboo leaves, and agnimantha: one should make a cool unguent for the knot.

Dantī, citraka root-bark, milk of sudhā and arka, jaggery, / bhallātaka fruit-shell, and kāsīsa: [this] paste would split even a stone,

how much more a knot situated in the external pathway, born of kapha! / Or one should break a long-standing knot with these medicines:

With soups of radishes or kulattha, with kṣāra and pomegranate, / with wheat food or barley food, or with sīdhu, honey, and sugar,

with honey-mixed scum of vāruṇī wine combined with mātuluṅga juice, / and with preparations of triphalā combined with pippalī and honey,

with preparations of mustā and bhallātaka flours and iron pyrite, / and with preparations of devadāru, guḍūcī, and adrijatu,

with smokes, head-evacuations, and the previously taught treatments that break gulma, / and by pressing with iron, salt, stone, gold, or copper.

When, by these various proven procedures, a strong, firm, / stone-hard knot is not pacified at all,

then cauterization of it with alkali, or with arrows or gold, is beneficial; / or having caused it to suppurate with suppuratives, and having split it, one should extract it.

And one should let out its blood repeatedly when it has become aggravated; / and once the blood has been drawn off again, medicine that conquers vāta and kapha [is used].

Smoke, head-evacuation, sudation, and massage [are used]; / and if the doṣa is not pacified, ripening or suppuration is praised.

When it is softened by burning and suppuration, the physician, with cleansing and healing measures, / both external and internal, should treat it like an ulcer.

Kampillaka, viḍaṅga, dārvī, and kārañjaka fruit: / having ground these, an oil should be cooked for the treatment of an ulcerous knot.

And the wise one who knows the divisions of place and time should treat ulcers born of visarpa / with the procedure taught in the chapter on the two types of ulcers.
Thus ends the treatment of granthivisarpa.
That very regimen which has been directed for the relief of knots, / that very one is for the relief of goiters born of kapha.

Goiters that arise from vāta and are accompanied by kapha in men, however, / do not occur from the repeated use of ghee, milk, and decoctions.

Whatever measures are stated here for the relief of visarpas, / all of them are on one side, and bloodletting is on the other.

Indeed, visarpa does not arise without being combined with rakta and pitta; / therefore, all this treatment has been stated in common.

And specific [treatment] due to inequality of the doṣas has not been left unstated in brief; / the wise one should administer the procedure indicated in brief and in detail.

Here are the verses:

The etymology, the classification of names, the doṣas, the tissues affected, the causes, / the seat, the pathways, and the heaviness and lightness of visarpa,

the signs, the complications, the characteristics that define a complication, / curability, incurability, and the cure of the curable ones in due order—

thus, to the wise Agniveśa who was desirous of knowing success, / Punarvasu spoke this treatment of visarpas.

Thus ends the twenty-first chapter, named the Treatment of Visarpa, in the Cikitsāsthāna of the compendium composed by Agniveśa and redacted by Caraka. 21.