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क्षतबन्धप्रपतनाद्धर्मकर्मातिसेवनात् [१] । विषवाताग्निदोषाच्च विसर्पाणां समुद्भवः ॥२१॥
kshatat (traumatic injury), kshata (wounds), bandha (ligatures), prapatana (trauma due to falls) over exposure to sun, strainful work, poisons, poisonous air,burns etc.
english translation
एतैर्निदानैर्व्यामिश्रैः कुपिता मारुतादयः । दूष्यान् सन्दूष्य रक्तादीन् विसर्पन्त्यहिताशिनाम् ॥२२॥
By combination of above mentioned etiological factors, the provoked vatadi dosha affect the susceptible body elements such as rakta, lasika etc. and spread in the body in those indulged in unwholesome diet.
english translation
बहिःश्रितः श्रितश्चान्तस्तथा चोभयसंश्रितः । विसर्पो बलमेतेषां ज्ञेयं गुरु यथोत्तरम् ॥२३॥
[Pathways of spreading the disease] Externally situated (pathogenesis in shakha, rasa dhatuand rakta dhatu), internally situated (pathogenesis in internal organs and other dhatu) and situated in both (externally as well as internally) pathways visarpa is to be known more and more serious consecutively.
english translation
बहिर्मार्गाश्रितं साध्यमसाध्यमुभयाश्रितम् । विसर्पं दारुणं विद्यात् सुकृच्छ्रं त्वन्तराश्रयम् ॥२४॥
Externally situated visarpa is curable, internally situated visarpa is very serious and difficult to cure whereas externally as well as internally situated type is incurable.
english translation
अन्तःप्रकुपिता दोषा विसर्पन्त्यन्तराश्रये । बहिर्बहिःप्रकुपिताः सर्वत्रोभयसंश्रिताः ॥२५॥
The humors provoked in internal regions spreads internally, if provoked in external regions spreads externally and if provoked in both regions spreads all over the body.
english translation