The Diagnosis of Visarpa (Spreading Skin Eruption)

Verse 1 (garuda.1.163.1)

श्रीगरुडमहापुराणम् १६३ धन्वन्तीररुवाच । विसर्पादिनिदानन्ते वक्ष्ये सुश्रुत तच्छृणु । स्याद्विसर्पो विघातात्तु दोषैर्दुष्टैश्च शोथवत्

śrīgaruḍamahāpurāṇam 163 dhanvantīraruvāca visarpādinidānante vakṣye suśruta tacchṛṇu syādvisarpo vighātāttu doṣairduṣṭaiśca śothavat

Dhanvantari said: I shall now tell the causes of visarpa and related conditions, O Sushruta; listen to that. Visarpa arises from injury and from doshas vitiated in the same manner as in shotha.

Verse 2 (garuda.1.163.2)

अधिष्ठानञ्च तं प्राहुर्बाह्यं तत्र भयाच्छ्रमात् । यथात्तरञ्च दुः साध्यस्तत्र दोषो यथायथम्

adhiṣṭhānañca taṁ prāhurbāhyaṁ tatra bhayācchramāt yathāttarañca duḥ sādhyastatra doṣo yathāyatham

Its seat is said to be external, on the skin; it arises from fear and exertion, and it grows harder to cure in proportion to the number of doshas involved.

Verse 3 (garuda.1.163.3)

प्रकोपनैः प्रकुपिता विशेषेण विदाहिभिः । देहे शीघ्रं विशन्तीह तेऽन्तरे हि स्थिता बहिः

prakopanaiḥ prakupitā viśeṣeṇa vidāhibhiḥ dehe śīghraṁ viśantīha te'ntare hi sthitā bahiḥ

Provoked by aggravating causes, especially those that cause burning, the doshas — though seated within — quickly spread outward over the body.

Verse 4 (garuda.1.163.4)

तृष्णाभियोगाद्वेगानां विषमाच्च प्रवर्तनात् । आशु चाग्निबलभ्रंशादतो बाह्यं विसर्पयेत्

tṛṣṇābhiyogādvegānāṁ viṣamācca pravartanāt āśu cāgnibalabhraṁśādato bāhyaṁ visarpayet

From excessive thirst, from the irregular indulgence of natural urges, and from a sudden decline in the strength of the digestive fire, the disease then spreads outward as visarpa.

Verse 5 (garuda.1.163.5)

तत्र वातात्स वीसर्पो वातज्वरसमव्यथः । शोथस्फुरणनिस्तोदभेदायासार्तिहर्षवान्

tatra vātātsa vīsarpo vātajvarasamavyathaḥ śothasphuraṇanistodabhedāyāsārtiharṣavān

There, the visarpa arising from vata causes pain resembling vata-fever, and is accompanied by swelling, throbbing, stinging pain, a bursting sensation, exhaustion, distress, and horripilation.

Verse 6 (garuda.1.163.6)

पित्ताद्द्रुतगतिः पित्तज्वरलिङ्गोऽतिलोहितः । कफात्कण्डूयुतः स्निग्धः कफज्वरसमानरुक्

pittāddrutagatiḥ pittajvaraliṅgo'tilohitaḥ kaphātkaṇḍūyutaḥ snigdhaḥ kaphajvarasamānaruk

Visarpa from pitta spreads swiftly and, bearing the signs of pitta-fever, becomes intensely red; that from kapha is itchy and unctuous, its pain resembling that of kapha-fever.

Verse 7 (garuda.1.163.7)

सन्निपातसमुत्थाश्च सर्वलिङ्गसमन्विताः । स्वदोषलिङ्गैश्चीयन्ते सर्वैः स्फोटैरुपेक्षिताः । तेऽपि स्वेदान्विमुञ्चति बिभ्रतो व्रणलक्षणम्

sannipātasamutthāśca sarvaliṅgasamanvitāḥ svadoṣaliṅgaiścīyante sarvaiḥ sphoṭairupekṣitāḥ te'pi svedānvimuñcati bibhrato vraṇalakṣaṇam

In the sannipataja visarpa all the signs are found together; if neglected, they become covered with pustules marked by the signs of their own doshas, which discharge fluid and take on the character of a wound.

Verse 8 (garuda.1.163.8)

वातपित्ताज्ज्वरच्छर्दिमूर्छातीसारतृड्भ्रमैः । गन्थिभेदाग्निसदनतमकारोचकैर्युतः

vātapittājjvaracchardimūrchātīsāratṛḍbhramaiḥ ganthibhedāgnisadanatamakārocakairyutaḥ

The visarpa from vata-pitta is accompanied by fever, vomiting, fainting, diarrhoea, thirst, and giddiness, together with the bursting of glandular swellings, weak digestion, dimness of vision, and loss of appetite.

Verse 9 (garuda.1.163.9)

करोति सर्वमङ्गञ्च दीप्ताङ्गारावकीर्णवत् । यंयं देशं विसर्पश्च विसर्पति भवेत्ससः

karoti sarvamaṅgañca dīptāṅgārāvakīrṇavat yaṁyaṁ deśaṁ visarpaśca visarpati bhavetsasaḥ

It makes the whole body feel as though strewn with glowing embers; wherever the visarpa spreads, that same sensation follows.

Verse 10 (garuda.1.163.10)

शान्ताङ्गारासितो नीलो रक्तो वासु च चीयते । अग्निदग्ध इव स्फोटैः शीघ्रगत्वाद्द्रुतं स च

śāntāṅgārāsito nīlo rakto vāsu ca cīyate agnidagdha iva sphoṭaiḥ śīghragatvāddrutaṁ sa ca

It resembles smouldering embers, dark or blue or red, gathering thickly; with its blisters it looks as though burnt by fire, and it spreads rapidly owing to its swift motion.

Verse 11 (garuda.1.163.11)

मर्मानुसारी वीसर्पः स्याद्वातोऽतिबलस्ततः । व्यथतेऽङ्गं हरेत्संज्ञां निद्राञ्च श्वासमीरयेत्

marmānusārī vīsarpaḥ syādvāto'tibalastataḥ vyathate'ṅgaṁ haretsaṁjñāṁ nidrāñca śvāsamīrayet

There is a visarpa that advances toward the vital points (marma), in which vata becomes exceedingly strong; it causes pain in the limbs, takes away consciousness, and brings on sleep and breathlessness.

Verse 12 (garuda.1.163.12)

हिक्काञ्च स गतोऽवस्थामीदृशीं लभते नरः । क्वचिन्मर्मारतिग्रस्तो भूमिशय्यासनादिषु

hikkāñca sa gato'vasthāmīdṛśīṁ labhate naraḥ kvacinmarmāratigrasto bhūmiśayyāsanādiṣu

It also produces hiccup — the patient reaches such a state; sometimes, seized by pain at the vital parts, he lies restless upon the ground, bed, or seat.

Verse 13 (garuda.1.163.13)

चेष्टमानस्ततः क्लिष्टो मनोदेहप्रमोहवान् । दुष्प्रबोधोऽश्नुते निद्रां सोऽग्निवीसर्प उच्यते

ceṣṭamānastataḥ kliṣṭo manodehapramohavān duṣprabodho'śnute nidrāṁ so'gnivīsarpa ucyate

Struggling in this way, he becomes distressed, his mind and body grow confounded, and he falls into a sleep from which he is hard to rouse — this is called agni-visarpa (the fiery visarpa).

Verse 14 (garuda.1.163.14)

कफेन रुद्धः पवनो भित्त्वातं बहुधा कफम् । रक्तं वा वृद्धरक्तस्य त्वक्छिरास्नायुमांसगम्

kaphena ruddhaḥ pavano bhittvātaṁ bahudhā kapham raktaṁ vā vṛddharaktasya tvakchirāsnāyumāṁsagam

The wind, obstructed by kapha, pierces through the kapha in many places, or else enters blood that is already increased, and lodges in the skin, veins, sinews, and flesh —

Verse 15 (garuda.1.163.15)

दूषयित्वा तु दीर्घानुवृत्तस्थूलखरात्मिकाम् । ग्रन्थीनां कुरुते मालां सरक्तान्तीव्ररुग्ज्वराम्

dūṣayitvā tu dīrghānuvṛttasthūlakharātmikām granthīnāṁ kurute mālāṁ saraktāntīvrarugjvarām

— and, corrupting them, forms a long, continuous, thick, rough string of glandular swellings, mixed with blood, causing intense pain and fever.

Verse 16 (garuda.1.163.16)

श्वासकासातिसारास्यशोषहिक्कावमिभ्रमैः । मोहवैवर्ण्यमूर्छाङ्गभङ्गग्निसदनैर्युताम् । इत्ययं ग्रन्थिवीसर्पः कफमारुतकोपजः

śvāsakāsātisārāsyaśoṣahikkāvamibhramaiḥ mohavaivarṇyamūrchāṅgabhaṅgagnisadanairyutām ityayaṁ granthivīsarpaḥ kaphamārutakopajaḥ

It is accompanied by breathlessness, cough, diarrhoea, dryness of the mouth, hiccup, vomiting, and giddiness, together with confusion, discoloration, fainting, aching of the limbs, and weak digestion — this is granthi-visarpa, born of the provocation of kapha and vata.

Verse 17 (garuda.1.163.17)

कफपित्ताज्ज्वरः स्तम्भो निद्रा तन्द्रा शिरोरुजा । अङ्गावसादविक्षेंपौ प्रलापारोचकभ्रमाः

kaphapittājjvaraḥ stambho nidrā tandrā śirorujā aṅgāvasādavikṣeṁpau pralāpārocakabhramāḥ

The visarpa from kapha-pitta is accompanied by fever, stiffness, excessive sleep, drowsiness, headache, listlessness and restlessness of the limbs, delirium, loss of appetite, and giddiness.

Verse 18 (garuda.1.163.18)

मूर्छाग्निहानिर्भेदोऽस्थ्नां पिपासेन्द्रियगौरवम् । आमोपवेशनं लेपः स्रोतसां स च सर्पति

mūrchāgnihānirbhedo'sthnāṁ pipāsendriyagauravam āmopaveśanaṁ lepaḥ srotasāṁ sa ca sarpati

There is also fainting, loss of digestive fire, aching of the bones, thirst, and heaviness of the sense-organs; undigested matter (ama) coats the channels, and the eruption keeps spreading.

Verse 19 (garuda.1.163.19)

प्रायेणामाशयं गृह्णन्नेकदेशं न चातिरुक् । पीडकैरवकीर्णोऽतिपीतलोहितपाण्डुरैः

prāyeṇāmāśayaṁ gṛhṇannekadeśaṁ na cātiruk pīḍakairavakīrṇo'tipītalohitapāṇḍuraiḥ

It generally remains confined to the region of the stomach and is not very painful; it is covered with pustules of a deep yellow, red, and pale hue.

Verse 20 (garuda.1.163.20)

स्निध्नोऽसितो मेचकाभो मलिनः शोथवान्गुरुः । गम्भीरपाकः प्रायोष्मस्पृष्टः क्लिन्नोंऽवदीर्यते

snidhno'sito mecakābho malinaḥ śothavānguruḥ gambhīrapākaḥ prāyoṣmaspṛṣṭaḥ klinnoṁ'vadīryate

It is unctuous, dark, of a dusky-blue hue, dirty in appearance, swollen and heavy; it ripens deep within, is generally warm to the touch, and, becoming moist, disintegrates.

Verse 21 (garuda.1.163.21)

पक्ववच्छीर्णमांसश्च स्पष्टस्नायुशिरागणः । सर्वगो लक्षणैः सर्वेः सर्वगत्वक्समर्पणः । शवगन्धी च वीसर्पः कर्दमाख्यमुशन्ति तम्

pakvavacchīrṇamāṁsaśca spaṣṭasnāyuśirāgaṇaḥ sarvago lakṣaṇaiḥ sarveḥ sarvagatvaksamarpaṇaḥ śavagandhī ca vīsarpaḥ kardamākhyamuśanti tam

The flesh decays as in a ripened wound, and the sinews and veins become clearly visible; it spreads everywhere bearing all the signs, covering the whole skin — this corpse-smelling visarpa is called kardama (the muddy one).

Verse 22 (garuda.1.163.22)

बाह्यहेतोः क्षतात्क्रुद्ध्वः सरक्तं पित्तमीरयन् । वीसर्पं मारुतः कुर्यात्कुलत्थसदृशैश्चितम्

bāhyahetoḥ kṣatātkruddhvaḥ saraktaṁ pittamīrayan vīsarpaṁ mārutaḥ kuryātkulatthasadṛśaiścitam

Provoked by an external cause, that is, by a wound, the wind drives forth blood-mixed bile and produces a visarpa studded with eruptions resembling kulattha (horse-gram) seeds —

Verse 23 (garuda.1.163.23)

स्फोटैः शोथज्वररुजादाहाढ्यं श्यावशोणितम् । पथग्दोषैस्त्रयः साध्या द्वन्द्वजाश्चानुपद्रवाः

sphoṭaiḥ śothajvararujādāhāḍhyaṁ śyāvaśoṇitam pathagdoṣaistrayaḥ sādhyā dvandvajāścānupadravāḥ

— abounding in swelling, fever, pain, and burning, and of a dark-red hue. The three kinds arising from the separate doshas, and those arising from two doshas without complications, are curable.

Verse 24 (garuda.1.163.24)

असाध्याः कृतसर्वोत्थाः सर्वे चाक्रान्तमर्मणः । शीर्णस्नायुशिरामांसाः क्लिन्नाश्चशवगन्धयः

asādhyāḥ kṛtasarvotthāḥ sarve cākrāntamarmaṇaḥ śīrṇasnāyuśirāmāṁsāḥ klinnāścaśavagandhayaḥ

But all those arising from all three doshas together, and all those that invade the vital points, are incurable — in these the sinews, veins, and flesh decay, becoming moist and smelling of a corpse.