Acara Kandha 163-171
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The Nidanam of Erysipelas
1Dhanvantari said: -Hear me, O Susruta, now discourse on the Nidanam of Visarpa (Erysipelas). To some extent, oedema (Shotha) Erysipelas may be attributed, to the same causes; and a wound, in no small number of cases, has been known to bring about an attack of this disease.
2Erysipelas usually attacks those parts of the body which have been already described as the peculiar seats of oedematous swelling; and fright and exhaustion, like the voluntary suppression on any natural urging of the body, may be enumerated as the exciting factors of cases of External Erysipelas.
3-4Of the several (Vataja, Pittaja, Kaphaja, Sannipataja) types of Erysipelas, each preceding type is more difficult to cure than the one immediately following it in the order of enumeration. The morbific principles of the deranged Vayu; Pittam, and Kpham, aggravated through their respective aggravating factors and specially through the ingestion of articles of fare which are followed by a reactionary acidity after digestion in the stomach, penetrate deep into the organism from their locations in the superficial principles of the body. An unappeased thirst, or a voluntary repression of any natural urging of the body, under the circumstance, again throws them up to the surface of the skin, bringing on an attack of external erysipelas.
5-6In the Vataja type of erysipelas, symptoms peculiar to the Vattika fever manifest them-selves, a throbbing sensation is experienced in the blebs, and an aching, piercing pain is felt in the swelling, attended with horripilation. In the Pittaja type, the erysipelas shifts from one place to another, and the patches assume an extremely red colour, attended with fever. In the Kaphaja type of erysipelas, an itching sensation is felt in the affected parts, which assume a glossy aspect, and symptoms peculiar to Kaphaja (catarrhal) fever exhibit themselves.
7In the Sannipatika type of erysipelas, symptoms peculiar to the three above said types manifest themselves in unison, and the belbs are characterized by diverse kinds of pain.
8In the type due to the concerted action of the deranged Vayu and Pittam (Agni Visarpa) fever, vomiting, fainting, diarrhoea, (or dysentery), thirst, and vertigo soon develop themselves.
9-13A breaking pain is experienced in the joints, the· digestion is impaired, all desires for food are gone, and the patient suffers from vanishings of sight and feels as if his whole body had been covered with live charcoal. The erysipelas swiftly shifts from one part of the body to another, leaving blue or black, bum-like, stains at its former seats. The disease gradually invades the vital principles of the body (such as the marrow etc.,) giving rise to an aching pain in the limbs; and unconsciousness, insomnia, dyspnea, and the cough add to the trouble of the patient. The patient finds no relief in any posture whatsoever, and vainly tosses about on the ground in quest of relieving coolness. Stupor or unconsciousness gradually creeps over his mind, out of which the patient can be hardly roused up, until death comes and relieves him of his trouble. This disease is called Agni Visarpa.
14-16The deranged Kapham, obstructed by the aggravated Vayu, is divided into many parts, and gives rise to a kind of round, extensive, painful, thick, rough and confluent patches of erysipelas by vitiating the blood, skin, veins, ligaments, and blood (in the flesh) of a man of sanguineous (temperament) in combination with the aggravated Vayu of his system. The erysipelas thus generated is called Granthi Visarpa. Fever, dyspnea, cough, dysentery, parchedness of the mouth, hiccough, vomiting, vertigo, drowsiness, epileptic fits, dullness of complexion, pain in the limbs, and impaired digestive faculty are the symptoms, which mark this type of Erysipelas, which is due to the action of the deranged Vayu and Kapham.
17The type of Erysipelas, known as Kardarm (sloughing) Visarpa. wpich. is due to the action of the deranged Kapham and Pittam, develops such symptoms as numbness of the body, excessive sleep or somnolence, headache, weak-ness, jerk, movements of the limbs, delirium, vertigo, repugnance for food, epileptic fits, impaired digestion, a breaking pain in the bones, thirst, dullness of the senses, passing of undigested fecal matter, and deposit of mucous in the internal ducts of the body.
18The stomach is the seat of the Kapham and Pittam, hence, the disease (Erysipelas), first originating in the stomach, spreads and confines itself to any particular part of the body.
19A slight pain characterizes this kind of Erysipelas (Kardama) which becomes studded over with red, yellow, or grey coloured pustules.
20The Erysipelas assumes a glossy, black, blackish, or variegated colour. It becomes hot and heavy, marked by much swelling which exudes a slimy secretion, and suppuration take place in its deeper strata.
21The Erysipelas, when bursts, emits an extremely offensive smell, attended with sloughing of flesh which exposes the veins and ligaments in its inside. This kind of erysipelas (Kardama Visarpa) is so called from the fact of its secreting a copious slimy discharge which emits cadaverous smell.
22The Vayu, enraged by a blow or hurt, vitiates the blood. and Pittam in the incidental wound and produces a kind of Erysipelas about its locality which becomes studded with crops of bulbous eruptions, resembling Kulattha pulse.
23-24This kind of erysipeals is called Kshataja Visarpa and is characterized by fever with a pain and burning sensation in its inside. The blood in this type assumes a blackish red colour. A case of Erysipelas, originating through the action of any of the several morbific principles of the deranged Vayu, Pittam and Kapham, is curable; cases at the root of which two such morbific principles lie as their exciting factors, and which are without any complication may yield to medical treatment, while those which are of a Sannipatika origin and emit a cadaverous smell, are situated at any of the Marma, and are attended with sloughing, laying bare the internal veins and ligaments, should be regarded as incurable.