The 13th chapter of Nidanasthanam of Ashtanga Hridayam is named as Udara Nidanam Adhyayah. This chapter deals with the explanation of ‘anemia, dropsy and herpes’.

The topics covered in this chapter include –

–       Vataja, Pittaja, Panduroga Nidana, Samprapti – causes and pathogenesis of anemia
–       Kaphaja, Sannipataja and Mrit Bhakshanaja Pandu
–       Kamala – Jaundice
–       Shopha Nidana – diagnosis and pathogenesis of swelling / edema / dropsy / anasarca
–       Shopha Bheda – types of swelling
–       Purvarupa – premonitory symptoms of Shopha,
–       Rupa – clinical features of Vataja, Pittaja, Kaphaja, Dwidoshaja, Tridoshaja, Abhighataja, Vishaja Shopha
–       Sadhyasadhyata – prognosis of Shopha
–       Visarpa – Herpes – its causes, adhishtana i.e. places of manifestation, pathogenesis, causes,
–       Clinical features of Doshaja Visarpa
–       Agni Visarpa, Granthi Visarpa, Kardama Visarpa, Sannipata Visarpa, Kshataja Visarpa
–       Sadhyasadhyata – prognosis of Herpes

Pledge by the author(s)

अथात: पाण्डुरोगशोफविसर्पनिदानं व्याख्यास्याम ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘diagnosis of enlargement of anemia, dropsy and herpes’. Thus say (pledge) atreya and other sages.

Panduroga Nidana, Samprapti: Causes and pathogenesis of anemia

पित्तप्रधानः कुपित यथोत्त्कैः कोपनैर्मळाः ।
तत्रानिखेन बलिना क्षित्तं हदि स्थितम् ॥१॥
धमनीर्दश सम्प्रश्य ज्याप्रुवत्सकलां तनुम् ।
श्र्लेष्मत्वग्रक्त्तमांसानि प्रदूष्यान्तरमाश्रितम् ॥२॥
त्वख्यांसयोस्तत्कुरुते त्वचि चर्णानू पृग्विधान् ।
पाण्डुहारिद्रहरितान् पाण्डुत्वं तेषु चाधिकम् ॥३॥
यतोऽतः पाण्डुरित्युक्त्तः स रोगः
Doshas among which pitta is predominate, get aggravated by indulgence in their respective causative factors; pitta that is present in the heart is forced into the ten Dhamanis -arteries and veins, attached to the heart, by the powerful Vata Dosha and made to spread throughout the body; pitta then vitiates the kapha, the skin, blood, and muscles, by residing within them and produce in the skin and muscles different kinds of colors such as pandu – yellowish-white, Harida -turmeric, deep-yellow and Harita -green; Pandu-yellowish- white being more common among these, such a disease is called as Pandu roga itself.

Pandu Rupa (Clinical features)

तेन गौरवम् ।
धातूनां स्याच्च शैथिल्यमोजसश्च गुणक्षयः ॥ ४ ॥
ततोऽल्परक्तमेदस्को निःसारः स्याच्छ्लथेन्द्रियः ।
मृद्यमानैरिवाङ्गैर्ना द्रवता हृदयेन च ॥ ५ ॥
शूनाक्षिकूटः सदनः कोपनः ष्ठीवनोऽल्पवाक् ।
अन्नद्विट् शिशिरद्वेषी शीर्णरोमा हतानलः ॥ ६ ॥
सन्नसक्थो ज्वरी श्वासी कर्णक्ष्वेडी भ्रमी श्रमी ।
स पञ्चधा पृथग्दोषैः समस्तैर्मृत्तिकादनात् ॥ ७ ॥
By this, the tissues become heavy fragile, loose, the qualities of ojas become diminished, hen the person becomes poor in blood and fat tissues, the person loses excellence health of the tissues; the body and sense organs becomes flabby (flaccid) has a feeling of the body being squeezed, heart rate increases, swelling of the eye sockets- area surrounding the eyes, debility, anger, expectoration of sputum and diminution in speech appear; the person hates food and cold things, falling of body hairs, loss of digestive activity, weakness of the thighs, fever, dyspnea, constant noise in the ears, dizziness and exertion. Pandu is five types; from each dosha separately, from all of them together and from eating of mud.

Purvarupa (Premonitory symptoms)

प्राग्रूपमस्य हृदयस्पन्दनं रूक्षता त्वचि ।
अरुचिः पीतमूत्रत्वं स्वेदाभावोऽल्पवह्निता ॥ ८ ॥
Its premonitory symptoms arethrobbing pulsating pain in the heart – palpitation, dryness of skin, loss of taste/ appetitive, yellow colored urine, absence of sweating, poor digestion strength

Vataja Panduroga

सादः श्रमोऽनिलात्तत्र गात्ररुक्तोदकम्पनम् ।
कृष्णरूक्षारुणसिरानखविण्मूत्रनेत्रता ॥ ९ ॥
शोफानाहास्यवैरस्यविट्शोषाः पार्श्वमूर्धरुक् ।
In Pandu caused by vata, there is weakness and tiredness, bodyache, pricking pain, tremors blackish, dry, reddish discoloration of the veins, nails, faeces, urine and eyes; swelling, flatulence, bad taste in the month-astringent taste, dryness of the feces and pain in the flanks and head.

Pittaja Panduroga

पित्ताद्धरितपीताभसिरादित्वं ज्वरस्तमः ॥ १० ॥
तृट्स्वेदमूर्छाशीतेच्छा दौर्गन्ध्यं कटुवक्त्रता ।
वर्चोभेदोऽम्लको दाहः
In Pandu by pitta, there is green, yellowish discoloration of veins etc., fever, unconsciousness, thirst, perspiration, fainting, desire for cold things, bad smell-of the body, mouth etc. pungent taste, loose bowels, sourness, acidity and burning sensation.

Kaphaja Panduroga

कफाच्छुक्लसिरादिता ॥ ११ ॥
तन्द्रा लवणवक्त्रत्वं रोमहर्षः स्वरक्षयः ।
कासश्छर्दिश्च
In that caused by Kapha, there is white color of the veins etc. stupor, saline taste in the mouth, horripilation, loss of voice, cough and vomiting.

Sannipataja Panduroga

निचयान्मिश्रलिङ्गोऽतिदुःसहः ॥ १२ ॥
In that caused by the combination of all the doshas, there is mixed of symptoms and the disease is difficult to bear.

Mrit Bhakshanaja Panduroga

मृत्कषायानिलं पित्तमूषरा मधुरा कफम् ।
दूषयित्वा रसादींश्च रौक्ष्याद्भुक्तं विरूक्ष्य च ॥ १३ ॥
स्रोतांस्यपक्वैवापूर्य कुर्याद्रुद्ध्वा च पूर्ववत् ।
पाण्डुरोगं ततः शूननाभिपादास्यमेहनः ॥ १४ ॥
पुरीषं कृमिमन्मुञ्चेद्भिन्नं सासृक्कफं नरः ।
In persons who eat mud- habitually for a long time, astringent mud aggravates vata, alkaline mud aggravates pitta and sweet mud aggravates kapha, mud vitiates rasa and other tissues by its dryness and produces dryness in the food without undergoing digestion itself, the mud fills and blocks the channels of the tissues and produces panduroga as before. The person develops swelling of the umbilicus, feet, face and genitals, expels feces containing worms, feces is broken, not well formed, mixed with blood and kapha.

Kamala Roga: Jaundice

यः पाण्डुरोगी सेवेत पित्तलं तस्य कामलाम् ॥ १५ ॥
कोष्ठशाखाश्रयां पित्तं दग्ध्वासृङ्मांसमावहेत् ।
हारिद्रनेत्रमूत्रत्वङ्नखवक्त्रशकृत्तया ॥ १६ ॥
दाहाविपाकतृष्णावान् भेकाभो दुर्बलेन्द्रियः ।
भवेत्पित्तोल्बणस्यासौ पाण्डुरोगादृतेऽपि च ॥ १७ ॥
उपेक्षया च शोफाढ्या सा कृच्छ्रा कुम्भकामला ।
हरितश्यावपीतत्वं पाण्डुरोगे यदा भवेत् ॥ १८ ॥
वातपित्ताद्भ्रमस्तृष्णा स्त्रीष्वहर्षो मृदुर्ज्वरः ।
तन्द्रा बलानलभ्रंशो लोढरं तं हलीमकम् ॥ १९ ॥
अलसं चेति शंसन्ति
That patient of pandu- anemia who indulges in Pitta increasing diet and activities, the pitta gets increased, burns up the blood and muscles and produces Kamala roga, localized in the alimentary tract and the tissues, by producing deep yellow coloration of the eyes, urine, skin, nails, mouth and feces; burning sensation, indigestion, excessive thirst, greenish brown color of the skin resembling a frog, and weakness of the sense organs. Kamala can happen even without panduroga – anemia in persons who have aggravation of pitta; neglecting Kamala can lead to Kumbha Kamala, having profound swelling which is difficult to cure. When in a patient of panduroga- anaemia, there occurs green, brown and yellowish discoloration, dizziness, excessive thirst, lack of desire in women- sex, mild fever, stupor, weakness of the body and of digestion due to increase of vata and pitta then the disease is named as Lodhara or Halimaka or Alasa.

Complications of Shopha

तेषां पूर्वमुपद्रवाः ।
शोफप्रधानाः कथिताः स एवातो निगद्यते ॥ २० ॥
Of all the complications of Pandu diseae, Shopha – inflammation is the chief complication. Hence, Shopha is explained in further verses. Thus ends the diagnosis of Pandu – Anemia, initial stages of liver diseases.

Shopha Samprapti: Pathogenesis of edema

पित्तरक्तकफान्वायुर्दुष्टो दुष्टान् बहिःसिराः ।
नीत्वा रुद्धगतिस्तैर्हि कुर्यात् त्वङ्मांससंश्रयम् ॥ २१ ॥
उत्सेधं संहतं शोफं तमाहुर्निचयादतः ।
सर्वं
Vata getting vitiated, brings the vitiated pitta rakta- blood and kapha, out into the external channels leads to obstruction, causes swelling localized in the skin and muscles, this condition is called as shopha. All shophas are caused by vitiation of all three doshas.

Shopha Bheda: Types of swelling

हेतुविशेषैस्तु रूपभेदान्नवात्मकम् ॥ २२ ॥
दोषैः पृथग्द्वयैः सर्वैरभिघाताद्विषादपि ।
Based on different causes and symptoms, Shopha is of nine types from each dosha separately, from the combination of two doshas, from the combination of all three Doshas, due to injury, from poison.

Shopha Bheda: 2 and 3 types of swelling

द्विधा वा निजमागन्तुं सर्वाङ्गैकाङ्गजं च तम् ॥ २३ ॥
पृथून्नतग्रथितताविशेषैश्च त्रिधा विदुः ।
Again Shopha is two types; Nija -organic and Agantu -traumatic sarvanga- Shopha afflicting all parts of the body and Ekanga- Shopha afflicting only one part; it is known to be of three kinds-viz – prthu – broad, unnata – raised and grathita – knotted/ glandular.

Shopha Nidana: Causes of swelling

सामान्यहेतुः शोफानां दोषजानां विशेषतः ॥ २४ ॥
व्याधिकर्मोपवासादिक्षीणस्य भजतो द्रुतम् ।
अतिमात्रमथान्यस्य गुर्वम्लस्निग्धशीतलम् ॥ २५ ॥
लवणक्षारतीक्ष्णोष्णशाकाम्बु स्वप्नजागरम् ।
मृद्ग्राम्यमांसवल्लूरमजीर्णश्रममैथुनम् ॥ २६ ॥
पदातेर्मार्गगमनं यानेन क्षोभिणापि वा ।
श्वासकासातिसारार्शोजठरप्रदरज्वराः ॥ २७ ॥
विषूच्यलसकच्छर्दिगर्भविसर्पपाण्डवः ।
अन्ये च मिथ्योपक्रान्तास्तैर्दोषा वक्षसि स्थिताः ॥ २८ ॥
ऊर्ध्वं शोफमधो वस्तौ मध्ये कुर्वन्ति मध्यगाः ।
सर्वाङ्गगाः सर्वगतं प्रत्यङ्गेषु तदाश्रयाः ॥ २९ ॥
General causes of Shopha – swelling, specifically those caused by the doshas are –
those which occur in persons who are debilitated by diseases, aggressive therapies, fasting etc. suddenly indulging in large quantity of food and improper way; foods which are heavy, sour, unctuous -fatty, cold, salty, alkaline, penetrating, heat producing and leafy vegetables; drinking more water, excess of sleeping or of keeping awake, eating mud, meat of domestic animals, dry meat and uncooked dishes; indigestion, exertion and excessive copulation, walking long distances, or strenuous riding on animals or vehicles; effect of diseases such as dyspnea, cough diarrhea, piles, enlargement of the abdomen, menorrhagia, fever,  simultaneously diarrhea and vomiting due to severe indigestion, long stasis of undigested food in the stomach, vomiting, pregnancy, herpes, Anemia, pandu -and such others diseases are improperly treated; Doshas localized in the chest produce swelling in the upper parts of the body; Doshas localized in the region of the urinary bladder produce swelling in the lower parts of the body, doshas located in the middle parts of the body produce swelling in the middle parts; Doshas, localized all over the body, produce swelling of the whole body and localized in any one part, Doshas cause swelling of that part only.

Purvarupa: Premonitory symptoms

तत्पूर्वरूपं दवथुः सिरायामोऽङ्गगौरवम् ।
Its premonitory symptoms are – feeling of burning sensation in places like eyes etc. dilatation of the veins at the site of swelling, and feeling of heaviness of the affected body part.

Rupa: Clinical features

Vataja Shopha

वाताच्छोफश्चलो रूक्षः खररोमारुणासितः ॥ ३० ॥
सङ्कोचस्पन्दहर्षार्तितोदभेदप्रसुप्तिमान् ।
क्षिप्रोत्थानशमः शीघ्रमुन्नमेत् पीडितस्तनुः ॥ ३१ ॥
स्निग्धोष्णमर्दनैः शाम्येद्रात्रावल्पो दिवा महान् ।
त्वक्च सर्षपलिप्तेव तस्मिंश्चिमिचिमायते ॥ ३२ ॥
In Shopha caused by vata, the swelling is moveable, dry, with rough hair, crimson or black in color, associated with pains such as constricting, pulsating, tingling, pricking, puncturing, and cutting type of pain, or having no sensation at all; swelling increases and subsides quickly, swelling quickly spreads and afflicts other parts of the body, subsides by massage with unctuous and hot materials; symptoms are mild at nights and severe during day time; there is mild tingling- burning sensation on the skin, as though skin is coated with mustard seed paste.

Pittaja Shopha

पीतरक्तासिताभासः पित्तादाताम्ररोमकृत् ।
शीघ्रानुसारप्रशमो मध्ये प्राग्जायते तनुः ॥ ३३ ॥
सतृड्दाहज्वरस्वेददवक्लेदमदभ्रमः ।
शीताभिलाषी विड्भेदी गन्धी स्पर्शासहो मृदुः ॥ ३४ ॥
In Shopha caused by pitta, the swelling is yellow, reddish- black in color, hair turns coppery red; swelling increases and subsides quickly, appears first in the middle parts of the body; is accompanied with thirst, burning sensation, fever, perspiration, raised heat, increased moisture component in the body, intoxication and dizziness; the person desires cold things, has diarrhea, the swelling is foul smelling, intolerant to touch and soft.

Kaphaja Shopha

कण्डूमान् पाण्डुरोमत्वक्कठिनः शीतलो गुरुः ।
स्निग्धः श्लक्ष्णः स्थिरः स्त्यानो निद्राछर्द्यग्निसादकृत् ॥ ३५ ॥
आक्रान्तो नोन्नमेत्कृच्छ्रशमजन्मा निशाबलः ।
स्रवेन्नासृक् चिरात्पिच्छां कुशशस्त्रादिविक्षतः ॥ ३६ ॥
स्पर्शोष्णकाङ्क्षी च कफात्
In Shopha caused by kapha, the swelling has itching, pale, white discoloration of hair and skin; is hard, cold, heavy, unctuous, smooth, static and thick, accompanied with excessive sleep, vomiting, causes weakness of digestion; upon pressing it, a pit is formed, which does not even out easily, swelling pacifies and forms with difficulty, and is predominantly present at night, when pricked with grass or knife, doesn’t discharge blood; gradually discharges slimy fluid, the patient of Kaphaja Shotha desires touching and warmth.

Dwidoshaja and Tridoshaja Shopha

यथास्वं द्वन्द्वजास्त्रयः ।
सङ्कराद्धेतुलिङ्गानां निचयान्निचयात्मकः ॥ ३७ ॥
Similarly, the Shopha caused by two doshas will have their own set of causes and symptoms, and that caused by all the doshas will have their respective symptoms appearing simultaneously.

Abhighataja shopha: Traumatic swelling

अभिघातेन शस्त्रादिच्छेदभेदक्षतादिभिः ।
हिमानिलोदध्यनिलैर्भल्लातकपिकच्छुजैः ॥ ३८ ॥
रसैः शूकैश्च संस्पर्शाच्छ्वयथुः स्याद्विसर्पवान् ।
भृशोष्मा लोहिताभासः प्रायशः पित्तलक्षणः ॥ ३९ ॥
Abhighataja swelling is that, caused by cutting, splitting, hitting etc, by sharp and other kinds of weapons; by exposure to snow, cold breeze, sea breeze, exposure to juice of bhallataka- marking nut and bristles / hairs of kapikacchu etc. swelling spreads from place to place, is very hot to touch, resembles red blood color and usually has symptoms of pitta.

Vishaja Shopha: Swelling caused by poison

विषजः सविषप्राणिपरिसर्पणमूत्रणात् ।
दंष्ट्रादन्तनखापातादविषप्राणिनामपि ॥ ४० ॥
विण्मूत्रशुक्रोपहतमलवद्वस्त्रसङ्करात् ।
विषवृक्षानिलस्पर्शाद्गरयोगावचूर्णनात् ॥ ४१ ॥
मृदुश्चलोऽवलम्बी च शीघ्रो दाहरुजाकरः ।
Vishaja shopha – swelling caused by poison is produced by exposure to crawling (direct body touch) or urine of poisonous animals / insects, injuring by tusks, teeth or claws by poisonous animals or even by the contact of excreta, urine or semen; or cloth contaminated by these of even non- poisonous animals; touch of poisons trees, gas, smoke, poisonous fumes, and rubbing / dusting of artificial poisons etc. such a swelling is soft, movable, drooping down, quick to manifest and causes burning sensation and pain.

Sadhyasadhyata: Prognosis

नवोऽनुपद्रवः शोफः साध्योऽसाध्यः पुरेरितः ॥ ४२ ॥
Swelling which is of recent onset and not having complications is curable, those described previously are not curable. Thus ends the diagnosis of oedema/ dropsy

अथ विसर्पनिदानम् ।
Thus ends Visarpa Nidanam.

Visarpa: Herpes

Nidana: Diagnosis of herpes

स्यात् विसर्पो अभिघात अन्तैर्दोषै: दूष्यैश्च शोफवत् ।
Visarpa – Herpes, spreading skin disease is similar in respect of doshas, Dushyas and kinds with shopha. Types of visarpa is similar to types of Shopha, which ends with Abhighataja variety – caused due to trauma.

Notes:
Like shopha-oedema visarpa is caused by each Dosha, separately, by the combination of any two or all three and by trauma – injury; the pathogenesis of both are also same.

Adhishtana: Place of manifestation of herpes

त्र्यधिष्ठानं च तं प्राहुर्बाह्यान्तरुभयाश्रयात् ॥ ४३ ॥
यथोत्तरं च दुःसाध्या: |
Its place of manifestation is said to be three – external, internal and both; these are difficult to cure in their succeeding order.

Samprapthi: Pathogenesis

तत्र दोषा यथायथम् ।
प्रकोपणैः प्रकुपिता विशेषेण विदाहिभिः ॥ ४४ ॥
देहे शीघ्रं विसर्पन्ति तेऽन्तरन्तःस्थिता बहिः ।
बहिःस्था द्वितये द्विस्था
The doshas getting aggravated by their respective causes, especially so, by foods which cause burning sensation, doshas spread quickly in the body, those localized inside spread to all the internal parts; those localized outside spread to all the external parts, and those localized in both to all the parts, both internal and external.

Nidana: Causes

विद्यात् तत्रान्तराश्रयम् ॥ ४५ ॥
मर्मोपतापात् सम्मोहादयनानां विघट्टनात् ।
तृष्णातियोगाद्वेगानां विषमं च प्रवर्तनात् ॥ ४६ ॥
आशु चाग्निबलभ्रंशादतो बाह्यं विपर्ययात् ।
The internal type of Visarpa is to be understood as arising from diseases of vital organs such as heart, head, urinary bladder etc. loss of consciousness, severe injury to the sense organs, due to profound thirst, improper elimination of natural urges of the body; quick destruction of digestion strength, the external type of Visarpa arises from causes opposite of the above.

Rupa: Clinical features

तत्र वातात्परीसर्पो वातज्वरसमव्यथः ॥ ४७ ॥
शोफस्फुरणनिस्तोदभेदायामार्तिहर्षवान् ।
पित्ताद्द्रुतगतिः पित्तज्वरलिङ्गोऽतिलोहितः ॥ ४८ ॥
कफात्कण्डूयुतः स्निग्धः कफज्वरसमानरुक् ।
स्वदोषलिङ्गैश्चीयन्ते सर्वे स्फोटैरुपेक्षिताः ॥ ४९ ॥
ते पक्वभिन्नाः स्वं स्वं च बिभ्रति व्रणलक्षणम् ।
In the herpes caused by vata, the symptoms are similar to those of Vatajvara (vide chapter2 verses 10-17) in addition there is swelling; throbbing, intermittent, piercing types of pains, dilating, cutting and tingling types of pain due to Vata Dosha. In Visarpa caused by pitta, the spreading is quick, has symptoms similar to those of pitta Jwara (verses 18-20 of chapter of chapter 2) and Visarpa is very red. In that caused by kapha, there is itching, unctuous- greasy and has symptoms similar to those of kaphajvara (verses 21-22 of chapter2). When neglected, each kind develops eruption- blebs, vesicles having symptoms of the respective dosha. These eruptions burst after ripening- suppuration, leading to ulcers having their own respective symptoms.

Agni Visarpa Rupa

वातपित्ताज्ज्वरच्छर्दिमूर्छातीसारतृड्भ्रमैः ॥ ५० ॥
अस्थिभेदाग्निसदनतमकारोचकैर्युतः ।
करोति सर्वमङ्गं च दीप्ताङ्गारावकीर्णवत् ॥ ५१ ॥
यं यं देशं विसर्पश्च विसर्पति भवेत्स सः ।
शान्ताङ्गारासितो नीलो रक्तो वाशु च चीयते ॥ ५२ ॥
अग्निदग्ध इव स्फोटैः शीघ्रगत्वाद्द्रुतं च सः ।
मर्मानुसारी वीसर्पः स्याद्वातोऽतिबलस्ततः ॥ ५३ ॥
व्यथेताङ्गं हरेत्सञ्ज्ञां निद्रां च श्वासमीरयेत् ।
हिध्मां च स गतोऽवस्थामीदृशीं लभते न ना ॥ ५४ ॥
क्वचिच्छर्मारतिग्रस्तो भूमिशय्यासनादिषु ।
चेष्टमानस्ततः क्लिष्टो मनोदेहश्रमोद्भवाम् ॥ ५५ ॥
दुष्प्रबोधोऽश्नुते निद्रां सोऽग्निविसर्प उच्यते ।
Visarpa arising from the combination of vata and pitta, accompanied with fever, vomiting, fainting, diarrhea, thirst, dizziness, splitting pain in the bones, weak digestion, blindness, and loss of taste/appetite; makes the entire body as though filled with burning coal; all the parts to which the herpes spreads, becomes black like coal which has been extinguished; blue or red in color; grows quickly. Blister eruptions develop in those parts resembling as though burnt by fire and spreads quickly due to the powerful influence of Vata Dosha. This visarpa invades vital organs, causes severe pain in those parts, leads to loss of consciousness and sleep, produces dyspnoea and hiccup; having reached this stage, the person does not find even little comfort by lying on the ground or on the cot or by sitting; the patient makes difficult painful movements constantly, due to exertion of the mind and body; attains sleep from which he can be aroused with great difficulty – similar to death. This disease is known as Agni visarpa

Granthi Visarpa

कफेन रुद्धः पवनो भित्त्वा तं बहुधा कफम् ॥ ५६ ॥
रक्तं वा वृद्धरक्तस्य त्वक्सिरास्नावमांसगम् ।
दूषयित्वा च दीर्घाणुवृत्तस्थूलखरात्मनाम् ॥ ५७ ॥
ग्रन्थीनां कुरुते मालां रक्तानां तीव्ररुग्ज्वराम् ।
श्वासकासातिसारास्यशोषहिध्मावमिभ्रमैः ॥ ५८ ॥
मोहवैवर्ण्यमूर्छाङ्गभङ्गाग्निसदनैर्युताम् ।
इत्ययं ग्रन्थिवीसर्पः कफमारुतकोपजः ॥ ५९ ॥
Vata getting obstructed by Kapha, breaks the kapha into many parts or vitiates the blood in the skin, veins, tendons and muscles in those having excessively aggravated blood tissue, produces a chain of tumors of blood, which are either long, small, round, thick or rough; associated with severe pain , fever, dyspnoea, cough diarrhea, dryness of the Mouth, hiccup, vomiting, dizziness, delusion, discoloration, fainting, cutting pain in the body and weak digestion; this disease is Granthi visarpa caused by aggravation of kapha and vata.

Kardama Visarpa

कफपित्ताज्ज्वरः स्तम्भो निद्रातन्द्राशिरोरुजः ।
अङ्गावसादविक्षेपप्रलापारोचकभ्रमाः ॥ ६० ॥
मूर्छाग्निहानिर्भेदोऽस्थ्नां पिपासेन्द्रियगौरवम् ।
आमोपवेशनं लेपः स्रोतसां स च सर्पति ॥ ६१ ॥
प्रायेणामाशये गृह्णन्नेकदेशं न चातिरुक् ।
पिटिकैरवकीर्णोऽतिपीतलोहितपाण्डुरैः ॥ ६२ ॥
मेचकाभोऽसितः स्निग्धो मलिनः शोफवान् गुरुः ।
गम्भीरपाकः प्राज्योष्मा स्पृष्टः क्लिन्नोऽवदीर्यते ॥ ६३ ॥
पङ्कवच्छीर्णमांसश्च स्पष्टस्नायुसिरागणः ।
शवगन्धिश्च वीसर्पं कर्दमाख्यमुशन्ति तम् ॥ ६४ ॥
Caused by the aggravation of Kapha and pitta, accompanied with fever, stiffness of the body, sleep, stupor, headache, debility of the body, tremors, irrelevant speech, loss of appetite or taste; dizziness, fainting, loss of digestive capacity, spitting pain in the bones, severe thirst, feeling or heaviness of sense organs, elimination of feces containing Ama – Mucus coating of the channels – of rasa by Ama (undigested food metabolites). It generally starts by afflicting one region at the site of Amasaya – stomach and then spreads to other parts, it is studded with eruption which are not very painful, its color varies from deep yellow, red, yellowish white, with colour resembling eye of peacock’s tain, deep blue or black; it is greasy, dirty, swollen and heavy; undergoes ulceration from deep inside; with increased heat the muscles of the affected part become very moist, fall of like slush when touched, exposing the underneath bundles of tendons and veins emitting cadaveric smell – these being the signs of gangrene; this is called as Kardama Visarpa.

Sannipataja Visarpa

सर्वजो लक्षणैः सर्वैः सर्वधात्वतिसर्पणः ।
That caused by all the doshas presents with symptoms of all the doshas simultaneously and spreads greatly to all the tissues.

Kshataja Visarpa

बाह्यहेतोः क्षतात्क्रुद्धः सरक्तं पित्तमीरयन् ॥ ६५ ॥
विसर्पं मारुतः कुर्यात् कुलत्थसदृशैश्चितम् ।
स्फोटैः शोफज्वररुजादाहाढ्यं श्यावलोहितम् ॥ ६६ ॥
Vata aggravated by trauma due to external causes, aggravates blood and pitta and causes visarpa, studded with boils resembling kulattha- horse gram associated with severe swelling, fever, pain and burning sensation, its color being blackish-red.

Sadhya asadhyata (Prognosis)

पृथग्दोषैस्त्रयः साध्या द्वन्द्वजाश्चानुपद्रवाः ।
असाध्यौ क्षतसर्वोत्थौ सर्वे चाक्रान्तमर्मकाः |
शीर्णस्नायुसिरामांसाः प्रक्लिन्नाः शवगन्धयः ॥ ६७ ॥
Those caused by each dosha separately, and those by any two doshas but devoid of any complications, are curable. Those caused by trauma, or by all the three doshas, those which are invading all vital organs/marmas, which have caused loss of tendons, veins and muscles, which are highly moist and emitting cadaveric smell are incurable.

Notes: As can gathered from the above descriptions, Visarpa – Herpes, spreading skin disease is an infectious disease spreads from place quickly, involving the blood, skin, muscles and tendons, having painful eruptions on the skin, lead on to suppuration tumors, gangrene and multation of the body. It has been identified with several diseases like erysipelas, cellulites, herpes zoster, gangrene, eczema, some kinds of dermatitis, cancer of the skin, plague etc. by modern scholars.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थानेपाण्डुरोगशोफविसर्पनिदानं नाम त्रयोदशोऽध्याय: ।। १३॥
Thus ends the chapter Panduroga-shopha-visarpa Nidana the thirteenth in Nidanasthana of Astangahrdaya Samhita composed by Srimad Vagbhata, son of Vaidyapati Simhagupta.