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{{#seo:

|title=Kushtha Chikitsa

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|keywords=Skin diseases,ayurveda, dermatology, discoloration, itching, saptaka dravya, kotha, Kandu, kapala, udumbara, maṇḍala, rishyajihva, puṇḍarika, sidhma, kakaṇaka, ekakushtha, charmakhya, kitibha, vipadika, alasaka, dadru, charmadala, pama, visphotaka, shataru, vicharchika, kshudrakushtha, mahakushtha, matsyashakalopamam, hasticharmavat, kinakharasparsham, lelitaka, madhvasava, shvetakaraviradya tailam, tiktekshvakvadi taila, kanakakshiritaila, tiktaṣaṭpalakam ghrita, mahatiktakam ghritam, mahakhadiram ghrita, shvitra, daruna, charunam, kilasa, psoriasis, scabies, ringworms, eczema, Ayurveda, charak samhita, Indian system of medicine.

|description=Chikitsa Sthana Chapter 7. Management of Kushtha (Skin Diseases)

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|image=http://www.carakasamhitaonline.com~~/mediawiki-1.32.1~~/resources/assets/ogimgs.jpg

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|type=article

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'''<big>[[Chikitsa Sthana]] Chapter 7. Management of Kushtha (Skin Diseases)</big>'''

{{Infobox

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|label7 = Reviewer

|data7 = Chandola H.M.

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|label8 = ~~Editor~~

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|label8 = Editors

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|data8 = Baghel M.S.

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|data8 = Baghel M.S., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

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|label9 = ~~Date~~ of publication

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|label9 = Year of publication

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|data9 = ~~December 17, 2018~~

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|data9 = 2020

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|label10 = ~~DOI~~

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|label10 = Publisher

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|data10 =

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.008 10.47468/CSNE.2020.e01.s06.008]

}}

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<big>'''Abstract'''</big>

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<~~div~~ style="text-align:justify;">

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<p style="text-align:justify;">[[Kushtha Chikitsa]] is a compendium of various skin diseases, divided into two groups i.e. major (''maha kushtha'') and ii. minor (''kshudra kushtha''). Seven types of major and eleven types of minor skin disorders or dermatosis are described here as guidelines to understand diagnosis and treatment principles of various skin disorders. Etiological factors including antagonistic food, suppression of natural urges especially vomiting, quick change in temperature, exposure to excess heat, and sudden biological changes in fluid volume and muscle mass cause ''kushtha''. Clinical features of skin disorders, their diagnosis according to dominance of ''[[dosha]]'' as well as their prognosis and treatment is described in detail. [[Panchakarma]] (five body purification procedures) are emphasized for management of skin diseases and prevention of recurrence. Local scrapping method for bloodletting in smaller lesions and venesection for large lesions, therapeutic purgation are important treatment measures in ''kushtha''. Medicinal preparations including ghee, formulations for internal administration and external application on skin lesions are described.

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[[Kushtha Chikitsa]] is a compendium of various skin diseases, divided into two groups i.e. major (''maha kushtha'') and ii. minor (''kshudra kushtha''). Seven types of major and eleven types of minor skin disorders or dermatosis are described here as guidelines to understand diagnosis and treatment principles of various skin disorders. Etiological factors including antagonistic food, suppression of natural urges especially vomiting, quick change in temperature, exposure to excess heat, and sudden biological changes in fluid volume and muscle mass cause ''kushtha''. Clinical features of skin disorders, their diagnosis according to dominance of ''dosha'' as well as their prognosis and treatment is described in detail. [[Panchakarma]] (five body purification procedures) are emphasized for management of skin diseases and prevention of recurrence. Local scrapping method for bloodletting in smaller lesions and venesection for large lesions, therapeutic purgation are important treatment measures in ''kushtha''. Medicinal preparations including ghee, formulations for internal administration and external application on skin lesions are described.

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'''Keywords''': Skin diseases,dermatology, discoloration, itching, saptaka dravya, kotha, Kandu, kapala, udumbara, maṇḍala, rishyajihva, puṇḍarika, sidhma, kakaṇaka, ekakushtha, charmakhya, kitibha, vipadika, alasaka, dadru, charmadala, pama, visphotaka, shataru, vicharchika, kshudrakushtha, mahakushtha, matsyashakalopamam, hasticharmavat, kinakharasparsham, lelitaka, madhvasava, shvetakaraviradya tailam, tiktekshvakvadi taila, kanakakshiritaila, tiktaṣaṭpalakam ghrita, mahatiktakam ghritam, mahakhadiram ghrita, shvitra, daruna, charunam, kilasa, psoriasis, scabies, ringworms, eczema </p>

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'''Keywords''': Skin diseases,dermatology, discoloration, itching, saptaka dravya, kotha, Kandu, kapala, udumbara, maṇḍala, rishyajihva, puṇḍarika, sidhma, kakaṇaka, ekakushtha, charmakhya, kitibha, vipadika, alasaka, dadru, charmadala, pama, visphotaka, shataru, vicharchika, kshudrakushtha, mahakushtha, matsyashakalopamam, hasticharmavat, kinakharasparsham, lelitaka, madhvasava, shvetakaraviradya tailam, tiktekshvakvadi taila, kanakakshiritaila, tiktaṣaṭpalakam ghrita, mahatiktakam ghritam, mahakhadiram ghrita, shvitra, daruna, charunam, kilasa, psoriasis, scabies, ringworms, eczema </~~div~~>

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==Introduction==

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Skin is the largest organ of the body constituting the integumentary system, comprising of skin, hair and nails etc. It constitutes 16% of body weight. Skin has the total surface area varying 1.2-2.2 sq.m. It is a combined product of ectoderm as well as of mesoderm. ''Kushtha'' (skin disorder or dermatosis) is a chronic disease which presents with ugly colors / complexion/ texture and altered tactile perceptions of the skin. The word ''kushtha'' is derived from ''kushnati vapuh'' meaning that which alters complexion of body by extracting.

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All the types of ''kushtha'' are caused due to vitiation of ''tridosha'' with involvement of skin, blood, lymph and muscular issue. ''Kushtha'' is often translated in English as leprosy, which is not correct because of absence of Mycobacterium leprae, though the appearance of skin lesions of ''mahakushtha'' resemble leprosy. Etiological factors of ''kushtha'' are antagonistic food, toxins released from suppressed natural urges, and practices harmful to the blood and skin. It is ''tridoshaja'' disease, but because of variable proportion of one specific ''dosha'', causes variation in features and prognosis. Variable doshic impact on skin, gives different color, complexion, pain sensitivity, texture, deformities, discharge, and tactile perception. Generalized symptoms appear only in prodromal stage.

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All the types of ''kushtha'' are caused due to vitiation of ''tridosha'' with involvement of skin, blood, lymph and muscular issue. ''Kushtha'' is often translated in English as leprosy, which is not correct because of absence of Mycobacterium leprae, though the appearance of skin lesions of ''mahakushtha'' resemble leprosy. Etiological factors of ''kushtha'' are antagonistic food, toxins released from suppressed natural urges, and practices harmful to the blood and skin. It is ''tridoshaja'' disease, but because of variable proportion of one specific ''[[dosha]]'', causes variation in features and prognosis. Variable doshic impact on skin, gives different color, complexion, pain sensitivity, texture, deformities, discharge, and tactile perception. Generalized symptoms appear only in prodromal stage.

In the context of ''kushtha'', four aspects of skin are important. First is that it consists of six layers as described in [Cha. Sa.[[Sharira Sthana]] chapter 4], and each layer is seat of specific type of gradually progressing ''kushtha''.

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Second aspect is that it is a sensory organ too, and is seat of ''vata dosha''. In case of ''kushtha'' vitiated ''vata'' in skin manifests as, horripilations, numbness, and loss of tactile perceptions.

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Second aspect is that it is a sensory organ too, and is seat of ''[[vata dosha]]''. In case of ''kushtha'' vitiated ''[[vata]]'' in skin manifests as, horripilations, numbness, and loss of tactile perceptions.

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Third aspect, skin is the sub-tissue or ''upadhatu'' of ''~~mansadhatu~~'', texture of skin depends upon muscle texture, so the dermal deformities spread upto the ~~mansa~~ dhatu or musculature and skin texture causing ugly shape of skin lesions. Lastly, affliction of deeper layers of skin deteriorates the ulcer healing ability of skin and damages the defense mechanisms against enormous pathological invasions. Thus, the ''kushtha'' stands for long time with more and more uglier shape.

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Third aspect, skin is the sub-tissue or ''upadhatu'' of ''[[mamsa dhatu]]'', texture of skin depends upon muscle texture, so the dermal deformities spread upto the [[mamsa dhatu]] or musculature and skin texture causing ugly shape of skin lesions. Lastly, affliction of deeper layers of skin deteriorates the ulcer healing ability of skin and damages the defense mechanisms against enormous pathological invasions. Thus, the ''kushtha'' stands for long time with more and more uglier shape.

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This chapter is placed after [[Prameha Chikitsa]], because one of the complications of ''prameha'' is carbuncle, which penetrates deeper into the muscles and is very similar to ''kushtha'' but the etio-pathogenesis is very different. Indulging in heavy to digest food products is responsible for increase of ''kleda'' (excess moisture) in the body. Such ''kleda'' is carried by ''mutra'' and leads to increase in quantity and frequency of ''mutra'' leading to pathogenesis of ''prameha''. When same ''kleda'' spreads throughout the body causes ''shaithilyata'' (looseness of body tissue) and also vitiates ''meda dhatu''. Vitiated ''kleda'' and ''meda'' are responsible for ''~~mansa~~ dusti'' which is responsible for ''pidika'' genesis and manifest as change in color, texture and sensation of ''tvacha'' (skin). This leads to various skin diseases.

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This chapter is placed after [[Prameha Chikitsa]], because one of the complications of ''prameha'' is carbuncle, which penetrates deeper into the muscles and is very similar to ''kushtha'' but the etio-pathogenesis is very different. Indulging in heavy to digest food products is responsible for increase of ''kleda'' (excess moisture) in the body. Such ''kleda'' is carried by ''[[mutra]]'' and leads to increase in quantity and frequency of ''[[mutra]]'' leading to pathogenesis of ''prameha''. When same ''kleda'' spreads throughout the body causes ''shaithilyata'' (looseness of body tissue) and also vitiates ''[[meda dhatu]]''. Vitiated ''kleda'' and ''[[meda]]'' are responsible for ''[[mamsa]] dusti'' which is responsible for ''pidika'' genesis and manifest as change in color, texture and sensation of ''tvacha'' (skin). This leads to various skin diseases.

Another disease named ''visarpa'' is explained later in 21st chapter of this section also has these components commonly, but due to prominence of impurity in blood that is a rapidly spreading disease whereas ''kushtha'' is slow progressing disease. Whereas ''visarpa'' advances into the visceral parts, ''kushtha'' spreads horizontally and limited to skin only.

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</div></div>

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The vitiated three ''~~doshas~~''- ''vata, pitta, kapha'' along with impaired ''tvak, rakta, mamsa'' and ''ambu'' together constitute seven essential entities which play role in pathogenesis of ''kushtha''. ''Kushtha'' can be classified into seven ''mahakushtha'' (major skin disorders) and eleven ''kshudrakushtha'' (eleven minor skin disorders). Single ''dosha'' cannot cause ''kushtha'' on its own i.e. ''kushtha'' is not an ''nanatmaja'' (disease caused by single specific ''dosha'') disease. [9-10]

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The vitiated three ''[[dosha]]s''- ''[[vata]], [[pitta]], [[kapha]]'' along with impaired ''tvak, [[rakta]], [[mamsa]]'' and ''ambu'' together constitute seven essential entities which play role in pathogenesis of ''kushtha''. ''Kushtha'' can be classified into seven ''mahakushtha'' (major skin disorders) and eleven ''kshudrakushtha'' (eleven minor skin disorders). Single ''[[dosha]]'' cannot cause ''kushtha'' on its own i.e. ''kushtha'' is not an ''nanatmaja'' (disease caused by single specific ''[[dosha]]'') disease. [9-10]

=== Premonitory signs and symptoms ===

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'''Nature''' – thin

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'''Associated symptom''' – particles resembling dust are observed, it is located mostly on chest [due to dominance of ''kapha'' on ''ura pradesh'' ~~Ca.Ci~~.7/19 Chakrapani].

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'''Associated symptom''' – particles resembling dust are observed, it is located mostly on chest due to dominance of ''[[kapha]]'' on ''ura pradesh'' [Cha.Sa [[Chikitsa Sthana]] 7/19 Chakrapani].

==== 7.''Kakanaka Kushtha'' ====

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'''Nature''' – does not get suppurated

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'''Associated symptoms''' – Pain and incurable, all the three ''~~doshas~~'' are present

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'''Associated symptoms''' – Pain and incurable, all the three ''[[dosha]]s'' are present

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This ends the explanation of 11 ''ksudrakuṣṭha''.[21-26]

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=== ''Dosha'' dominance in types of ''kushtha'' ===

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=== ''[[Dosha]]'' dominance in types of ''kushtha'' ===

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</div></div>

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The ''dosha'' dominance in types of ''kushtha'' is as enlisted below:

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The ''[[dosha]]'' dominance in types of ''kushtha'' is as enlisted below:

{| class="wikitable" style="text-align: center;

|-

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! scope="col"| Predominant Dosha

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! scope="col"| Predominant [[Dosha]]

! scope="col"| Disease

|-

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| ''Vata''

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| ''[[Vata]]''

| ''Kapala''

|-

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| ''Kapha''

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| ''[[Kapha]]''

| ''Mandala, Vicharchika''

|-

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| ''Pitta''

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| ''[[Pitta]]''

| ''Udumbara''

|-

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| ''Kakanaka''

|-

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| ''Vata-Pitta''

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| ''[[Vata]]-[[Pitta]]''

| ''Rishyajihva''

|-

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| ''Kapha-Pitta''

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| ''[[Kapha]]-[[Pitta]]''

| ''Pundarika''

|-

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| ''Vata-Kapha''

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| ''[[Vata]]-[[Kapha]]''

| ''Siddhma, Carmākhya, Ekkuṣṭha, Kiṭibha, Vipādikā, Alasaka''

|-

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| ''Pitta-Kapha''

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| ''[[Pitta]]-[[Kapha]]''

| ''Pāmā, Śatāru, Visphōṭaka, Dadru, Charmadala''

|}

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</div></div>

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''Tridosha'' are involved in pathogenesis of all types of ''kushtha''. Depending on ''dosha'' predominant symptoms are manifested and treatment should be decided on the basis of symptoms shown in specific ''kushtha''. The ''dosha'' presenting important and specific symptoms should be alleviated firstly followed by the treatment of associated ''dosha''.[31-32]

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''Tridosha'' are involved in pathogenesis of all types of ''kushtha''. Depending on ''[[dosha]]'' predominant symptoms are manifested and treatment should be decided on the basis of symptoms shown in specific ''kushtha''. The ''[[dosha]]'' presenting important and specific symptoms should be alleviated firstly followed by the treatment of associated ''[[dosha]]''.[31-32]

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</div></div>

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Specific ''kushtha'' determine the predominance of specific ''dosha'' and vice versa is also true i.e. predominance of ''dosha'' determines the specific type of ''kushtha''. Similarly specific symptoms determine the causative factors vice versa causative factors determine the specific symptoms.[33]

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Specific ''kushtha'' determine the predominance of specific ''[[dosha]]'' and vice versa is also true i.e. predominance of ''[[dosha]]'' determines the specific type of ''kushtha''. Similarly specific symptoms determine the causative factors vice versa causative factors determine the specific symptoms.[33]

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=== ''Dosha'' specific features of diagnosis of ''dosha'' dominance in ''kushtha'' ===

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=== ''[[Dosha]]'' specific features of diagnosis of ''[[dosha]]'' dominance in ''kushtha'' ===

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</div></div>

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Symptoms due to ''dosha'' predominance include dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of ''vata dosha''.

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Symptoms due to ''[[dosha]]'' predominance include dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of ''[[vata dosha]]''.

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Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of ''pitta dosha''.

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Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of ''[[pitta dosha]]''.

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''Kapha dosha'' is responsible for symptoms like whitish discoloration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented along with maggot’s formation and stickiness like symptoms.[34-36]

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''[[Kapha dosha]]'' is responsible for symptoms like whitish discoloration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented along with maggot’s formation and stickiness like symptoms.[34-36]

=== Prognosis ===

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</div></div>

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If all the symptoms are simultaneously observed, in weak (immune-compromised) patient, suffering from morbid thirst, burning sensation, loss of digestive power and presence of maggots then the intelligent person should avoid treatment (as it is incurable). Further ''vata kapha'' predominated ''kushtha'' and single ''dosha'' predominated ''kushtha'' are not so difficult to treat. Whereas ''kapha pitta'' and ''vata pitta'' dominated ''kushtha'' are ''krichchra sadhya'' i.e. curable, but with efforts. [37-38]

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If all the symptoms are simultaneously observed, in weak (immune-compromised) patient, suffering from morbid thirst, burning sensation, loss of digestive power and presence of maggots then the intelligent person should avoid treatment (as it is incurable). Further ''[[vata]] [[kapha]]'' predominated ''kushtha'' and single ''[[dosha]]'' predominated ''kushtha'' are not so difficult to treat. Whereas ''[[kapha]] [[pitta]]'' and ''[[vata]] [[pitta]]'' dominated ''kushtha'' are ''krichchra sadhya'' i.e. curable, but with efforts. [37-38]

=== Principles of management ===

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</div></div>

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In ''~~vataja~~ kushtha'', firstly administer ''ghritapana'', whereas in ''~~kaphaja~~ kushtha vamana'' procedure should be done and in ''~~pittaja~~ kushtha, virechana'' along with ''raktamokshana'' should be first line of treatment.[39]

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In ''[[vata]]ja kushtha'', firstly administer ''ghritapana'', whereas in ''[[kapha]]ja kushtha [[vamana]]'' procedure should be done and in ''[[pitta]]ja kushtha, [[virechana]]'' along with ''[[raktamokshana]]'' should be first line of treatment.[39]

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</div></div>

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For ''vamana'' and ''virechana'' drugs mentioned in [[Kalpa Sthana]] should be used. ''Prachhana karma'' i.e. blood letting by rubbing with coarse device should be carried out if ''dushya dushti'' is less and venesection should be carried out in condition where ''dosha dusya dusti'' is strong.[40]

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For ''[[vamana]]'' and ''[[virechana]]'' drugs mentioned in [[Kalpa Sthana]] should be used. ''Prachhana karma'' i.e. blood letting by rubbing with coarse device should be carried out if ''[[dushya]] dushti'' is less and venesection should be carried out in condition where ''[[dosha]] [[dusya]] dusti'' is strong.[40]

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</div></div>

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Patients with excessive vitiated ''dosha'' should be given ''shodhana'' therapy repeatedly; taking care about their ''prana'' (strength). Excessive elimination of ''dosha'' may increase ''vata dosha'' which may bring about weakness and in rare condition endanger the life of patient.[41]

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Patients with excessive vitiated ''[[dosha]]'' should be given ''[[shodhana]]'' therapy repeatedly; taking care about their ''prana'' (strength). Excessive elimination of ''[[dosha]]'' may increase ''[[vata dosha]]'' which may bring about weakness and in rare condition endanger the life of patient.[41]

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</div></div>

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After ''shodhana'' and letting of blood, ''sneha'' should be administered since after ''shodhana'', ''vata dosha'' enters the ''shuddha koshtha'' of patient and is cause for immediate ''bala kshaya''.[42]

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After ''[[shodhana]]'' and letting of blood, ''sneha'' should be administered since after ''[[shodhana]]'', ''[[vata dosha]]'' enters the ''shuddha koshtha'' of patient and is cause for immediate ''bala kshaya''.[42]

=== Various formulations ===

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</div></div>

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If ''dosha'' are ''utklishta'' and located in ''hridaya'' or ''kushtha'' is manifested in the upper part of body, then ''vamana'' should be administered with help of fruit of ''kuthaja, madanaphala'' and ''madhuka'' along with juice of ''patola'' and ''nimba''. ''Sheeta rasa'' (cold effusion), ''pakva rasa''(decoction), honey and ''madhuka'' should be used for ''vamana''.[43]

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If ''[[dosha]]'' are ''utklishta'' and located in ''hridaya'' or ''kushtha'' is manifested in the upper part of body, then ''[[vamana]]'' should be administered with help of fruit of ''kuthaja, madanaphala'' and ''madhuka'' along with juice of ''patola'' and ''nimba''. ''Sheeta rasa'' (cold effusion), ''pakva rasa''(decoction), honey and ''madhuka'' should be used for ''[[vamana]]''.[43]

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</div></div>

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''Trivrita, danti'' and ''triphala'' are to be used for ''virechana'' in ''kushtha''. ''Sauviraka, tushodaka, alodhana, asava, sidhu'' are types of ''aushadi kalpana'' to be used in ''virechana''. Further ''sansarjana karma'' should be followed as per order. [44-45]

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''Trivrita, danti'' and ''triphala'' are to be used for ''[[virechana]]'' in ''kushtha''. ''Sauviraka, tushodaka, alodhana, asava, sidhu'' are types of ''aushadi kalpana'' to be used in ''[[virechana]]''. Further ''sansarjana karma'' should be followed as per order. [44-45]

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</div></div>

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''Darvi, brihati, patola, pichumarda, madanphala, kritamala, kalinga, yava'' and ''musta'' should be used along with ''sneha'' for ''asthapana''. After ''virechana'' and ''asthapana basti'' still if there is excess of ''vata'' than give ''anuvasana basti'' should be given. In such condition ''sneha'' fortified with ''madanaphala, madhuka, nimba, kutaja,'' and ''patola'' should be used. [46-47]

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''Darvi, brihati, patola, pichumarda, madanphala, kritamala, kalinga, yava'' and ''musta'' should be used along with ''sneha'' for ''asthapana''. After ''[[virechana]]'' and ''asthapana [[basti]]'' still if there is excess of ''[[vata]]'' than give ''anuvasana [[basti]]'' should be given. In such condition ''sneha'' fortified with ''madanaphala, madhuka, nimba, kutaja,'' and ''patola'' should be used. [46-47]

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</div></div>

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''Saindhava, dantī, maricha, phaṇijjhaka, pippali,'' fruit of ''karanja'' and ''vidanga'' should be used for ''nasya'' especially in case of ''krimi'' and ''kapha pradhan kushtha''.

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''Saindhava, dantī, maricha, phaṇijjhaka, pippali,'' fruit of ''karanja'' and ''vidanga'' should be used for ''[[nasya]]'' especially in case of ''krimi'' and ''[[kapha]] pradhan kushtha''.

Drugs mentioned in [[Sutra Sthana]] for ''vairechanika dhuma'' should be used in ''krimija kushtha'' and ''kilasa'' and also disease affecting the upper part of the body. [48-49]

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</div></div>

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If the patches are stable and hard, then give fomentation by ''prastara sweda'' or ''nadi sweda'' method and later on with the help of ''kurcha'' (a surgical instrument) scrub the patches so that there is increased flow of ''rakta'' in that specific area along with blood letting.[50]

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If the patches are stable and hard, then give fomentation by ''prastara sweda'' or ''nadi sweda'' method and later on with the help of ''kurcha'' (a surgical instrument) scrub the patches so that there is increased flow of ''[[rakta]]'' in that specific area along with blood letting.[50]

=== Local treatments ===

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</div></div>

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If the patches are elevated then ''swedana'' with lukewarm poultice of meat of aquatic animals should be followed by scrubbing with sharp edge surgical instrument for blood letting. For blood letting ''shringa'' (horn), ''alabu'' (gourd) may be used. Especially in ''alpa kushtha, prachana, virechana'' and/or use of ''jaluka'' should be done.

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If the patches are elevated then ''[[swedana]]'' with lukewarm poultice of meat of aquatic animals should be followed by scrubbing with sharp edge surgical instrument for blood letting. For blood letting ''shringa'' (horn), ''alabu'' (gourd) may be used. Especially in ''alpa kushtha, prachana, [[virechana]]'' and/or use of ''jaluka'' should be done.

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''Lepa'' explained in ''kushtha'' become efficient if applied after ''raktamokshana'' and other ''shodhana'' procedures. [51-53]

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''Lepa'' explained in ''kushtha'' become efficient if applied after ''[[raktamokshana]]'' and other ''[[shodhana]]'' procedures. [51-53]

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</div></div>

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When there is loss of sensation and/or surgical interventions is prohibited, ''kshara'' should be used after ''rakta'' and ''dosha'' are eliminated.

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When there is loss of sensation and/or surgical interventions is prohibited, ''kshara'' should be used after ''[[rakta]]'' and ''[[dosha]]'' are eliminated.

If ''kushtha'' is hard like stone with numbness, it is stable (not spreading) and chronic in such cases antidotes should be given internally prior to the application of poison in the form of ''lepa'' followed by application of antidote.

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</div></div>

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In ''~~pittaja~~ kushtha'' line of treatment followed in ''~~vāta kaphaja~~ kushtha'' should be followed along with ''kapha, pitta'' and ''rakta'' should be eliminated and ''tikta'' (bitter), ''kashaya'' (astringent) drugs are to be used for pacifying the ''dosha''. Ghee fortified with ''tikta'' (bitter) drugs and line of treatment of ''raktapitta'' should be followed internally and externally for treatment of ''~~pittaja~~ kushtha''. [58-59]

+

In ''[[pitta]]ja kushtha'' line of treatment followed in ''[[vata]] [[kapha]]ja kushtha'' should be followed along with ''[[kapha]], [[pitta]]'' and ''[[rakta]]'' should be eliminated and ''tikta'' (bitter), ''kashaya'' (astringent) drugs are to be used for pacifying the ''[[dosha]]''. Ghee fortified with ''tikta'' (bitter) drugs and line of treatment of ''raktapitta'' should be followed internally and externally for treatment of ''[[pitta]]ja kushtha''. [58-59]

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</div></div>

−

Treatment of different ''kushtha'' categorized on basis of aggravated ''dosha'' has been explained henceforth treatment for pacifying of ''kushtha'' is being explained wherein defect in skin is general symptom. [60]

+

Treatment of different ''kushtha'' categorized on basis of aggravated ''[[dosha]]'' has been explained henceforth treatment for pacifying of ''kushtha'' is being explained wherein defect in skin is general symptom. [60]

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</div></div>

−

One ''pala'' of root of ''patola'' and ''gavakshi'', contents of ''triphala'' (''haritaki, bibhataki'' and ''amalaki'') taken separately in one ''pala'' quantity each. ''Trayamana'' and ''katuki'' in quantity of 6 ''sanas'' and 4 ''sana'' of ''sunthi'', should be taken together. One ''pala'' of this combination should be boiled in water and administered for elimination of ''dosha''.

+

One ''pala'' of root of ''patola'' and ''gavakshi'', contents of ''triphala'' (''haritaki, bibhataki'' and ''amalaki'') taken separately in one ''pala'' quantity each. ''Trayamana'' and ''katuki'' in quantity of 6 ''sanas'' and 4 ''sana'' of ''sunthi'', should be taken together. One ''pala'' of this combination should be boiled in water and administered for elimination of ''[[dosha]]''.

After the combination has been digested by ''jatharagni'' of patient, soup of animal and birds residing in arid land along with old ''shali'' type of rice should be given. The preparation when administered for 6 days cures ''kushtha, shotha, grahani, arsha, mutrakricha, halimaka,'' chest pain and pain in bladder region along with ''vishama jwara''. [62-64]

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</div></div>

−

In ghee smeared jar one ''drona'' of decoction of ''khadira'' should be added. To these 6 ''palas'' each of powdered ''triphala, trikatu, viḍaṅga, haridra, musta, vāsā, indrayava,'' bark of ''sauvarni'' (''dāruharidra''), and ''guduchi'' should be added. The jar should be kept for one month inside a heap of grains. Every morning if this preparation is taken then in one month ''mahakuṣṭha'' gets cured and within 15 days ''ksudrakuṣṭha'' is cured. It is also useful ''arśa, śvāsa, bhagandar, kasa, kilasa, prameha'' and ''shosha''. Skin achieves golden complexion after having ''kanakabindu''. This ends explanation of ''kanakabindvariṣṭa''. It is useful in all ''~~vātaja~~, ~~pittaja~~'' and ''~~kaphaja~~ kushtha''.

+

In ghee smeared jar one ''drona'' of decoction of ''khadira'' should be added. To these 6 ''palas'' each of powdered ''triphala, trikatu, viḍaṅga, haridra, musta, vāsā, indrayava,'' bark of ''sauvarni'' (''dāruharidra''), and ''guduchi'' should be added. The jar should be kept for one month inside a heap of grains. Every morning if this preparation is taken then in one month ''mahakuṣṭha'' gets cured and within 15 days ''ksudrakuṣṭha'' is cured. It is also useful ''arśa, śvāsa, bhagandar, kasa, kilasa, prameha'' and ''shosha''. Skin achieves golden complexion after having ''kanakabindu''. This ends explanation of ''kanakabindvariṣṭa''. It is useful in all ''[[vata]]ja, [[pitta]]ja'' and ''[[kapha]]ja kushtha''.

Especially in ''kaphaja kuṣṭha, kritmalaka'' decoction should be used in place of ''khadira''.[76-80]

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Powder of ''musta, madanphala, triphala, karañja, āragvadha, kaliṅgaka, yava, dārvi, saptaparna'' are boiled in water and used for bath. This preparation is called as ''siddhārthaka snana''.

−

Decoction of above combination is useful for ''vamana'' and ''virechana'' procedures. It helps in promotion of color and complexion. It is also useful in ''tvagdōṣa, kuṣṭha, śōpha'' and ''panduroga''.[91-92]

+

Decoction of above combination is useful for ''[[vamana]]'' and ''[[virechana]]'' procedures. It helps in promotion of color and complexion. It is also useful in ''tvagdōṣa, kuṣṭha, śōpha'' and ''panduroga''.[91-92]

=== External applications ===

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</div></div>

−

In ''kaphaja-pittaja kuṣṭha, triphala, nimba, paṭōla, mañjiṣṭhā, rōhiṇī, vacā, rajani'' should be regularly taken in the form of decoction. The same medicine, when used to fortify ''ghr̥ita'' helps in curing ''~~vātaja~~ kuṣṭha''.

+

In ''kaphaja-pittaja kuṣṭha, triphala, nimba, paṭōla, mañjiṣṭhā, rōhiṇī, vacā, rajani'' should be regularly taken in the form of decoction. The same medicine, when used to fortify ''ghr̥ita'' helps in curing ''[[vata]]ja kuṣṭha''.

''Khadira, asana, devadāru'' and ''nimba'' together when used like above has similar benefits.[100-101]

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Seeds of bitter variety of ''alābu,'' both varieties of ''tuttha'' (''mayura'' and ''kharparika tuttha'') ''gorōcanā, haridra, dāruharidra,'' fruit of ''br̥hatī, ēraṇḍa, viśāla, citraka, murva, kāsīsa, hiṅgu, śigru, trikatu suradāru, tumburu, viḍaṅga, lāṅgāli,'' bark of ''kuṭaja, katukarōhiṇī'' are pasted together and mustard oil is fortified with above medicines and cow’s urine taken in quantity four times of oil.

−

Application of ''tikta ekṣvākvādi tailam'' is useful in itching, ''kuṣṭha'' and ''~~vāta~~ kapha'' dominated diseases. [108-110]

+

Application of ''tikta ekṣvākvādi tailam'' is useful in itching, ''kuṣṭha'' and ''[[vata]] [[kapha]]'' dominated diseases. [108-110]

=== ''Kanakaksheeri tailam'' ===

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#lākṣā, rasāñjana , ela, punarnava

−

The above six combinations when mixed separately with ''dadhimaṇḍa'' and applied in the form of ''lepa'' cures ''kuṣṭha'' having predominance of ''~~vāta~~'' and ''kapha dosha''.[124-125]

+

The above six combinations when mixed separately with ''dadhimaṇḍa'' and applied in the form of ''lepa'' cures ''kuṣṭha'' having predominance of ''[[vata]]'' and ''[[kapha dosha]]''.[124-125]

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Application of ''ēḍagaja'' or ''sarjarasa'' or seeds of ''mūlaka'' prepared by adding ''kāñji'' should be used as ''udvartana'' or in the form of ''lepa'' it cures ''sidhma''.[127]

−

=== Management of ''pitta-kapha'' dominant ''kushtha'' ===

+

=== Management of ''[[pitta]]-[[kapha]]'' dominant ''kushtha'' ===

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Application of water (one part), ''vāpya'' (''kuṣṭha'' herb) (2 part), ''lōha'' (''agaru'') (3 part) ''kēśara'' (4 part), ''patra'' (5 part), ''plava'' or ''kaivartamusta'' (6 part), ''chāndana, mr̥ṇāla'' (8 part) is useful in ''pitta-kapha'' type of ''kuṣṭha''.[130]

−

=== Management of ''pitta'' dominant ''kushtha'' ===

+

=== Management of ''[[pitta]]'' dominant ''kushtha'' ===

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</div></div>

−

Decoction of ''yaṣṭyāhva, lōdhra, padmaka, paṭōla, pichumarda'' and ''chandana'' may be used externally for bathing and internal use. It has cooling effect and is beneficial in ''~~pittaja~~ kuṣṭha''.[131]

+

Decoction of ''yaṣṭyāhva, lōdhra, padmaka, paṭōla, pichumarda'' and ''chandana'' may be used externally for bathing and internal use. It has cooling effect and is beneficial in ''[[pitta]]ja kuṣṭha''.[131]

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</div></div>

−

If there is excessive secretions from skin lesion, sloughing of body parts, burning sensation, eruptions and exfoliation of skin then ''shitā pradēha'' (application of ''lepa'' with ''shitā dravya''), ''sēkā, ~~virēchana~~'' and use of ''tikta ghr̥ita'' should be done.[134]

+

If there is excessive secretions from skin lesion, sloughing of body parts, burning sensation, eruptions and exfoliation of skin then ''shitā pradēha'' (application of ''lepa'' with ''shitā dravya''), ''sēkā, [[virechana]]'' and use of ''tikta ghr̥ita'' should be done.[134]

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</div></div>

−

''Khandiraghr̥ta, nimbaghr̥ta, dārvighr̥ta'' and ''paṭōlaghr̥ta'' are among the best to be used in ''rakta'' and ''pitta pradhana kuṣṭha''.[135]

+

''Khandiraghr̥ta, nimbaghr̥ta, dārvighr̥ta'' and ''paṭōlaghr̥ta'' are among the best to be used in ''[[rakta]]'' and ''[[pitta]] pradhana kuṣṭha''.[135]

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</div></div>

−

''Triphala'' fruit pulp in quantity of ½ ''pala'' each, ''paṭōla patra'' ½ ''pala'' quantity, one ''karsa'' each of ''katurōhiṇī, nimba, yaṣṭyāhva'' and ''trāyamāṇa'' and two ''pala'' of dehusked seeds of ''masūra'' which should be boiled in one ''āḍhaka'' of water and reduced to 1/8th. The decoction should be filtered and to this eight ''pala'' of decoction, four ''pala'' of ghee should be added and cooked till 8 ''palas'' remain and this medicated ghee should be administered lukewarm. It is useful in ''~~vāta~~ pitta kuṣṭha, visarpa, vātarakta, jwara, daha, gulma, vidradhi,'' giddiness and ''visphōṭaka''. [136-139]

+

''Triphala'' fruit pulp in quantity of ½ ''pala'' each, ''paṭōla patra'' ½ ''pala'' quantity, one ''karsa'' each of ''katurōhiṇī, nimba, yaṣṭyāhva'' and ''trāyamāṇa'' and two ''pala'' of dehusked seeds of ''masūra'' which should be boiled in one ''āḍhaka'' of water and reduced to 1/8th. The decoction should be filtered and to this eight ''pala'' of decoction, four ''pala'' of ghee should be added and cooked till 8 ''palas'' remain and this medicated ghee should be administered lukewarm. It is useful in ''[[vata]] [[pitta]] kuṣṭha, visarpa, vātarakta, [[jwara]], daha, gulma, vidradhi,'' giddiness and ''visphōṭaka''. [136-139]

=== ''Tikta shatpala'' ghee ===

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</div></div>

−

''Nimba, paṭōla, dārvi, duralabha, tiktarōhiṇī, triphala, parpaṭaka'' and ''trāyamāṇa'' are taken in half ''pala'' quantity and boiled with water in quantity of one ''āḍhaka'' and reduced to 1/8th. The decoction should be filtered and to it paste of ''chandana, kirātatiktaka, pippali, trāyamāṇa, musta,'' seeds of ''vatsaka'' in quantity of half ''karsa'' should be added along with 6 ''palas'' of ''ghr̥ita'' and ''sneha siddhi'' should be carried out. This ''tiktaṣaṭpala ghr̥ita'' is useful in ''kuṣṭha, jwara, gulma, arśa, grahani, pāṇḍu, śvayathu, pāmā, visarpa, piḍakā, kaṇḍū, mada'' and ''galagaṇḍa''. [140-143]

+

''Nimba, paṭōla, dārvi, duralabha, tiktarōhiṇī, triphala, parpaṭaka'' and ''trāyamāṇa'' are taken in half ''pala'' quantity and boiled with water in quantity of one ''āḍhaka'' and reduced to 1/8th. The decoction should be filtered and to it paste of ''chandana, kirātatiktaka, pippali, trāyamāṇa, musta,'' seeds of ''vatsaka'' in quantity of half ''karsa'' should be added along with 6 ''palas'' of ''ghr̥ita'' and ''sneha siddhi'' should be carried out. This ''tiktaṣaṭpala ghr̥ita'' is useful in ''kuṣṭha, [[jwara]], gulma, arśa, grahani, pāṇḍu, śvayathu, pāmā, visarpa, piḍakā, kaṇḍū, mada'' and ''galagaṇḍa''. [140-143]

=== ''Mahatiktaka'' ghee ===

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</div></div>

−

''Saptacchada, prativiṣā, śampāka (āragvada), tiktarōhiṇī, pāṭhā, musta, uśīra, triphala, paṭōla, picumarda, parpaṭaka, dhanvayavās, candana, upakulyā (pippali), padmaka haridra, dāruharidra, ṣaḍgrantha, viśālā, śatāvarī,'' both the type of ''sāriva'' (''Krsna'' and ''sveta''), seeds of ''vatsaka, yāsa, mūrvā, amr̥tā, kirātatikta, yastimadhu'' and ''trayamana'' are taken together and paste is prepared in quantity of one fourth of ''ghr̥ita''. To this water should be added in quantity of 8 times of ghee along with juice of ''amr̥taphala'' (''amalaki'') in quantity of twice of ''ghr̥ita'' and ''siddha ghr̥ita'' should be prepared. It is beneficial in ''kuṣṭha, raktapitta,'' serious type of bleeding piles, ''vīsarpa, amlapitta, vātarakta, pāṇḍurōga, visphōṭakaka, pāmā, unmāda, kāmalā, jwara, kaṇḍū, hr̥drōga, gulma, piḍakā, raktapradar, gaṇdamālā.'' This ghee should be administered at recommended time and dose according to the strength of patient. This ''mahātiktakaghr̥ita'' is useful in above mentioned disease conditions where hundred of other preparations do not cure above diseases. [144-150]

+

''Saptacchada, prativiṣā, śampāka (āragvada), tiktarōhiṇī, pāṭhā, musta, uśīra, triphala, paṭōla, picumarda, parpaṭaka, dhanvayavās, candana, upakulyā (pippali), padmaka haridra, dāruharidra, ṣaḍgrantha, viśālā, śatāvarī,'' both the type of ''sāriva'' (''Krsna'' and ''sveta''), seeds of ''vatsaka, yāsa, mūrvā, amr̥tā, kirātatikta, yastimadhu'' and ''trayamana'' are taken together and paste is prepared in quantity of one fourth of ''ghr̥ita''. To this water should be added in quantity of 8 times of ghee along with juice of ''amr̥taphala'' (''amalaki'') in quantity of twice of ''ghr̥ita'' and ''siddha ghr̥ita'' should be prepared. It is beneficial in ''kuṣṭha, raktapitta,'' serious type of bleeding piles, ''vīsarpa, amlapitta, vātarakta, pāṇḍurōga, visphōṭakaka, pāmā, unmāda, kāmalā, [[jwara]], kaṇḍū, hr̥drōga, gulma, piḍakā, raktapradar, gaṇdamālā.'' This ghee should be administered at recommended time and dose according to the strength of patient. This ''mahātiktakaghr̥ita'' is useful in above mentioned disease conditions where hundred of other preparations do not cure above diseases. [144-150]

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</div></div>

−

After ''shodhana'' of ''dosha'', blood letting, external and internal ''shamana'' therapies and administration of ghee at appropriate time helps in curing skin diseases and also prevents recurrence. [151]

+

After ''[[shodhana]]'' of ''[[dosha]]'', blood letting, external and internal ''shamana'' therapies and administration of ghee at appropriate time helps in curing skin diseases and also prevents recurrence. [151]

=== ''Maha khadira'' ghee ===

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</div></div>

−

In case of ''śvitrā, shodhana'' is the specific treatment especially purgation with ''malapūrasa'' along with jaggery is the best treatment for leucoderma. The patient must be firstly oleated and should take the above mentioned combination as per his ''bala'' and disease ''bala'' and later on expose to sunlight. Purgation will be started and whenever patient feels thirsty ''pēyā'' should be given for next three days. [162-163]

+

In case of ''śvitrā, [[shodhana]]'' is the specific treatment especially purgation with ''malapūrasa'' along with jaggery is the best treatment for leucoderma. The patient must be firstly oleated and should take the above mentioned combination as per his ''bala'' and disease ''bala'' and later on expose to sunlight. Purgation will be started and whenever patient feels thirsty ''pēyā'' should be given for next three days. [162-163]

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</div></div>

−

After ''shodhana'' therapy ''~~raktamōkṣana~~'' and also intake of ununctuous food like ''saktū'' (roasted corn flour) leucoderma is cured only in few who are free from effects of sinful deeds. [172]

+

After ''[[shodhana]]'' therapy ''[[raktamoksana]]'' and also intake of ununctuous food like ''saktū'' (roasted corn flour) leucoderma is cured only in few who are free from effects of sinful deeds. [172]

=== Various stages of ''shwitra'' ===

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</div></div>

−

''Dāruṇa, chāruṇa,'' and ''kilāsa'' are the various synonyms for ''śvitrā''. It is of 3 types and generally all the ''tridosha'' are involved. If the ''dosha'' responsible for ''śvitrā'' are seated in the ''rakta dhatu'' then the color of hypo-pigmentation is red. It is copper-colored if ''dosha'' are seated in ''~~māṁsa~~ dhatu'' and whitish in color if located in ''meda dhatu''. The subsequent ones are more difficult to treat than earlier ones.[173-174]

+

''Dāruṇa, chāruṇa,'' and ''kilāsa'' are the various synonyms for ''śvitrā''. It is of 3 types and generally all the ''tridosha'' are involved. If the ''[[dosha]]'' responsible for ''śvitrā'' are seated in the ''[[rakta dhatu]]'' then the color of hypo-pigmentation is red. It is copper-colored if ''[[dosha]]'' are seated in ''[[mamsa dhatu]]'' and whitish in color if located in ''[[meda dhatu]]''. The subsequent ones are more difficult to treat than earlier ones.[173-174]

=== Prognosis of vitiligo ===

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</div></div>

−

Etiology, ''dravya'' (''tridosha, rasa, rakta, ~~māṁsa~~, ambu''), various signs and symptoms, predominance of ''dosha'' in various ''kushtha'' and symptoms as per type of vitiated ''dosha,'' curable and difficult to cure types of ''kushtha,'' preparation useful in ''kushtha''. Similarly etiology, symptoms, curable and incurable symptoms and treatment of ''śvitrā'' have been explained.

+

Etiology, ''dravya'' (''tridosha, [[rasa]], [[rakta]], [[mamsa]], ambu''), various signs and symptoms, predominance of ''[[dosha]]'' in various ''kushtha'' and symptoms as per type of vitiated ''[[dosha]],'' curable and difficult to cure types of ''kushtha,'' preparation useful in ''kushtha''. Similarly etiology, symptoms, curable and incurable symptoms and treatment of ''śvitrā'' have been explained.

The above detailed description has been given by Lord Punarvasu with a view of sharpening the memory and intellect of disciple Agnivesha.

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*Important etiological factors for skin diseases include: Diet and beverages with antagonistic properties, excess intake of liquid, unctuous, heavy to digest food, suppression of natural urges specially that of emesis, excess exercise, exposure to excess heat, excessive eating, quick change in environmental temperature, inappropriate follow up of purification procedures, eating new grains, curd, fish, sesame, excessive salty and sour food, black gram, radish, milk, sugar products, following daytime sleep, and bad thoughts and deeds towards venerable people.

−

*These factors vitiate water component of skin, blood, muscular layer and other layers of skin and localize three ''dosha'' in the skin to cause ''kushtha'', layer by layer.

+

*These factors vitiate water component of skin, blood, muscular layer and other layers of skin and localize three ''[[dosha]]'' in the skin to cause ''kushtha'', layer by layer.

−

*Variable skin manifestations of ''kushtha'' depend upon degree of involvement of three vitiated ''dosha'' and their effect on four ''~~dhatus~~'' i.e. ''rasa, rakta, ~~mansa~~'' and ''lasika''.

+

*Variable skin manifestations of ''kushtha'' depend upon degree of involvement of three vitiated ''[[dosha]]'' and their effect on four ''[[dhatu]]s'' i.e. ''[[rasa]], [[rakta]], [[mamsa]]'' and ''lasika''.

*With involvement of first and second layer, prodromal symptoms appear. Third and fourth layer involvement results in minor ''kushtha''. Fifth and sixth layer involvement causes ''mahakushtha''.

−

*Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of ''vata dosha''. Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of ''pitta dosha''. ''Kapha dosha'' is responsible for symptoms like whitish discoloration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented along with maggot’s formation and stickiness like symptoms.

+

*Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of ''[[vata dosha]]''. Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of ''[[pitta dosha]]''. ''[[Kapha dosha]]'' is responsible for symptoms like whitish discoloration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented along with maggot’s formation and stickiness like symptoms.

−

*Different degree of ''doshic'' involvement determines the color, shape, size, symptoms and discharge from the lesions. The treatment differs as per dominance of ''dosha''.

+

*Different degree of ''doshic'' involvement determines the color, shape, size, symptoms and discharge from the lesions. The treatment differs as per dominance of ''[[dosha]]''.

{| class="wikitable" style="text-align: center;

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|-

| 1

−

| ''Vata''

+

| ''[[Vata]]''

| Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color

|Ghee

|-

| 2

−

| ''Pitta''

+

| ''[[Pitta]]''

| Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts

−

| ''Virechana'' (therapeutic purgation), ''raktamokshana'' (bloodletting)

+

| ''[[Virechana]]'' (therapeutic purgation), ''[[raktamokshana]]'' (bloodletting)

|-

| 3

−

| ''Kapha''

+

| ''[[Kapha]]''

| Whitish discolouration, cold in touch, pruritus, non-progressive/ slow progression of disease, elevated; heaviness and oiliness, stickiness, maggot infestation

−

| ''Vamana'' (therapeutic emesis)

+

| ''[[Vamana]]'' (therapeutic emesis)

|}

−

*If all symptoms appear simultaneously, then the ''kushtha'' is untreatable. Similarly, immune-compromised patients and those suffering from morbid thirst, burning sensation, loss of digestive power and lesions have maggots then the prognosis is bad. ''Vata kapha'' dominant and single ''dosha'' predominated ''kushtha'' are easily curable. Whereas ''kapha pitta'' and ''vata pitta'' dominated ''kushtha'' are ''kricchra sadhya'' i.e. curable with difficulty.

+

*If all symptoms appear simultaneously, then the ''kushtha'' is untreatable. Similarly, immune-compromised patients and those suffering from morbid thirst, burning sensation, loss of digestive power and lesions have maggots then the prognosis is bad. ''[[Vata kapha]]'' dominant and single ''[[dosha]]'' predominated ''kushtha'' are easily curable. Whereas ''[[kapha]] [[pitta]]'' and ''[[vata]] [[pitta]]'' dominated ''kushtha'' are ''kricchra sadhya'' i.e. curable with difficulty.

*If the skin lesion is small, then ''prachchanna'' (bloodletting by rubbing with coarse device) should be done. If the skin lesions are large and spread all over body, ''siravyadha'' (venesection) should be done for bloodletting.

*Frequent body purification procedures are needed in treatment of skin diseases. The treatment includes internal purification in the form of therapeutic emesis, purgation etc. and external purification in the form of local applications of ''lepa'' of purifying herbs.

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==== 1. ''Kapāla kushtha'' ====

−

It is ''rūkṣa, paruṣa, khara'' in nature which signifies the increase of ''rūkṣa, khara guna'' at the level of skin. Roughness, dryness increases when there is destruction of sweat glands (''dusti'' of ''ambu dhatu''), decrease in essential fatty acids (reduce ''snigdhata'' of ''meda'', in turn, of ''kapha''), proliferation of keratinocytes. Primary lesion manifest in the form of dry, rough and blackish brownish color. Secondary lesion includes loss of sensation (due to degeneration of nerve endings or less nutrition to the nerve tissue due to atherosclerosis or reduce blood supply) severe pricking pain (''nistoda'') itching, burning sensation and pustular presentation. Thus conditions of non erythematous eczema, keratosis, atrophic actinic keratosis, non hypertrophic keratosis, seborrhic conditions can be understood in ''kapāla kushtha''.

+

It is ''rūkṣa, paruṣa, khara'' in nature which signifies the increase of ''rūkṣa, khara guna'' at the level of skin. Roughness, dryness increases when there is destruction of sweat glands (''dusti'' of ''ambu [[dhatu]]''), decrease in essential fatty acids (reduce ''snigdhata'' of ''[[meda]]'', in turn, of ''[[kapha]]''), proliferation of keratinocytes. Primary lesion manifest in the form of dry, rough and blackish brownish color. Secondary lesion includes loss of sensation (due to degeneration of nerve endings or less nutrition to the nerve tissue due to atherosclerosis or reduce blood supply) severe pricking pain (''nistoda'') itching, burning sensation and pustular presentation. Thus conditions of non erythematous eczema, keratosis, atrophic actinic keratosis, non hypertrophic keratosis, seborrhic conditions can be understood in ''kapāla kushtha''.

==== 2. ''Udumbara kushtha'' ====

−

It is ''pitta'' dominated ''kushtha''. Hyper-pigmentation, increased vaso-congestion, burning, pain and pus formation are the symptoms and signs.

+

It is ''[[pitta]]'' dominated ''kushtha''. Hyper-pigmentation, increased vaso-congestion, burning, pain and pus formation are the symptoms and signs.

−

Primary lesion manifests as red in color associated with pus, burning sensation caused mainly due to ''pitta'' and ''rakta''. ''Ushna'' and ''tikshna guna'' is responsible for the same.

+

Primary lesion manifests as red in color associated with pus, burning sensation caused mainly due to ''[[pitta]]'' and ''[[rakta]]''. ''Ushna'' and ''tikshna [[guna]]'' is responsible for the same.

−

Secondary lesion includes ''kleda, kotha,'' body hair attains brownish color, excessive secretion due to ''sasneha, sara'' and ''drava guna'' of ''pitta'' and ''rakta''.

+

Secondary lesion includes ''kleda, kotha,'' body hair attains brownish color, excessive secretion due to ''sasneha, sara'' and ''drava [[guna]]'' of ''[[pitta]]'' and ''[[rakta]]''.

The infectious and inflammatory phase can be explained thus:

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==== 3. ''Mandala kushtha'' ====

−

It is predominated by ''kapha dosha''. The ''sthira, snigdha guna'' brings about ''sthirata'' and ''snigdhata'' to the ''kushtha''.

+

It is predominated by ''[[kapha dosha]]''. The ''sthira, snigdha [[guna]]'' brings about ''sthirata'' and ''snigdhata'' to the ''kushtha''.

Therefore the lesion is granulomatous in presentation. The early and indeterminate leprosy , especially lepromatous leprosy, is a skin condition consisting of pale macules. It results from failure of Th1 cell activation which is necessary to eradicate the mycobacteria. In Lepromatous Leprosy Th2 response is turned on and because of reciprocal inhibition the cell mediated response is depressed.

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==== 4. ''Rishyajivha kushtha'' ====

−

It is dominated by ''~~vāta~~'' and ''pitta dosha''. ''Vata dosha'' brings roughness, pain whereas pitta is responsible for the discoloration, burning sensation whereas both the ''dosha'' are responsible for ''ashugati'' and ''samuthana''.

+

It is dominated by ''[[vata]]'' and ''[[pitta dosha]]''. ''[[Vata dosha]]'' brings roughness, pain whereas [[pitta]] is responsible for the discoloration, burning sensation whereas both the ''[[dosha]]'' are responsible for ''ashugati'' and ''samuthana''.

Thus inflammatory and degenerative changes dominate the condition. Pathogenesis involving infectious origin or allergic origin may be included. Diseases such as Lyme disease may be included. Expanding redness known as ''erythema migrans'' begins at the site of bite after a period of one week. There is no much itching i.e. ''alpa kandu'' but the rash is red and warm but generally painless.

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==== 5. ''Pundarika kushtha'' ====

−

It is dominated by ''pitta'' and ''kapha''. ''Pitta'' is responsible for redness, burning sensation, ''pāka'' (..), pus formation whereas ''kapha'' is responsible for whitish nature, itching and ''kr̥mi''.

+

It is dominated by ''[[pitta]]'' and ''[[kapha]]''. ''[[Pitta]]'' is responsible for redness, burning sensation, ''pāka'' (..), pus formation whereas ''[[kapha]]'' is responsible for whitish nature, itching and ''kr̥mi''.

Primary lesion manifest as ''rakta rāji sirā santata utsedavanti'' i.e. vessel are inflamed and are palpable. Systemic vasculitis may affect the skin and vascular damage may be the main feature in several skin diseases. The histological features that are common are:- Vessel wall damage , red cell extravasation, and invasion of inflammatory cells into vessel walls.

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==== 6. ''Sidhma kushtha'' ====

−

It is dominated by ''vata kapha dosha'', fine powder falls after scratching and resembles color similar to flower of ''alābū''. The specialty of disease is that it is mainly seen in ''urabhāga'' i.e. trunk. ''Tinea versicolar'' is a condition characterized by a skin eruption on the trunk and proximal extremity. The symptoms of this condition include; fine scaling of the skin producing a very superficial ash like scale. Pale (''sveta''), dark tan (''arun''), pink in color (''shukla rakta avabhasani'') with a reddish undertone (''tamra'') that can darken when the patient is overheated, such as in a hot shower or during/ after exercise, tanning typically makes the affected areas contrast more starkly with the surrounding skin leading to sharp borders. In people with dark skin tones, pigmentary changes such as hypo-pigmentation (loss of color) are common while in those with lighter skin color hyper-pigmentattion (increase in skin color) is more common. The yeast is thought to feed on skin oils (lipids) as well as dead skin cells.

+

It is dominated by ''[[vata]] [[kapha]] [[dosha]]'', fine powder falls after scratching and resembles color similar to flower of ''alābū''. The specialty of disease is that it is mainly seen in ''urabhāga'' i.e. trunk. ''Tinea versicolar'' is a condition characterized by a skin eruption on the trunk and proximal extremity. The symptoms of this condition include; fine scaling of the skin producing a very superficial ash like scale. Pale (''sveta''), dark tan (''arun''), pink in color (''shukla rakta avabhasani'') with a reddish undertone (''tamra'') that can darken when the patient is overheated, such as in a hot shower or during/ after exercise, tanning typically makes the affected areas contrast more starkly with the surrounding skin leading to sharp borders. In people with dark skin tones, pigmentary changes such as hypo-pigmentation (loss of color) are common while in those with lighter skin color hyper-pigmentattion (increase in skin color) is more common. The yeast is thought to feed on skin oils (lipids) as well as dead skin cells.

==== 7.''Kakanaka kushtha'' ====

−

It is predominated by all the three ''dosha''. Thus symptoms of all three ~~dōṣha~~ are observed. The presentation is similar to ''gunja'' i.e bright red with black spot. In [[Nidana Sthana]], it has been explained to be of different colors and it is ''asadhya''.

+

It is predominated by all the three ''[[dosha]]''. Thus symptoms of all three [[dosha]] are observed. The presentation is similar to ''gunja'' i.e bright red with black spot. In [[Nidana Sthana]], it has been explained to be of different colors and it is ''asadhya''.

Squamous cell carcinoma or squamous cell cancer or epidermoid carcinoma or squamous cell epithelioma is a cancer of a kind of epithelial cell, the squamous cell. These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of the skin cancer. However, squamous cells also occur in the lining of the digestive tract, lungs and other areas of body and squamous cell carcinoma occurs as a form of cancer in diverse tissue such as lips, mouth, esophagus, urinary bladder, prostrate, lung, vagina and cervix. Despite sharing the name squamous cell carcinoma there may be tremendous differences in presenting symptoms, natural history, prognosis and response to treatment. It arises from the uncontrolled multiplication of cells of epithelium, or cells showing particular cytological or tissue architectural characteristic of squamous cell differentiation, such as the presence of keratin, tonofilament bundles or dermosomes structures involved in cell to cell adhesion. This non melanoma skin cancer may appear as a firm red nodule, a scaly growth that bleeds or develops a crust or a sore that does not heal.

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==== 1.''Eka kushtha'' ====

−

It is a skin disease caused due to ''~~vāta~~ kapha'' predominance. As discussed previously ''vata dosha'' is responsible for the degenerative or destructive changes whereas ''kapha'' is responsible for obstructive changes.

+

It is a skin disease caused due to ''[[vata]] [[kapha]]'' predominance. As discussed previously ''[[vata dosha]]'' is responsible for the degenerative or destructive changes whereas ''[[kapha]]'' is responsible for obstructive changes.

−

''Aswēdana'' (Anhidrosis) may be caused by destruction of sweat glands and or integumetary system it may be due to autoimmune process or infection or anhidrosis may be due to obstruction (''kapha'') in the outlet or blood supply as in micro-angiopathy.

+

''Aswēdana'' (Anhidrosis) may be caused by destruction of sweat glands and or integumetary system it may be due to autoimmune process or infection or anhidrosis may be due to obstruction (''[[kapha]]'') in the outlet or blood supply as in micro-angiopathy.

Stimulation of acetylcholine and further ionic changes caused thereafter are responsible for sweating. Lack of such impulse also causes reduced sweating. ''Astanga Sangrahakara'' has explained role of ''vyana vāyu'' in ''sweda'' which when hampered leads to anhidrosis.

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Research shows that in diabetic patient thickness of skin is observed reason being collagen bundles become large, disorganized and separated by clear spaces. Small amount of acid mucopolysachrides may be present in upper reticular dermis. Presence of active fibroblast and extensive collagen polymerization in the rough endoplasisic reticulam may be the pathogenesis for thick skin.

−

Calcium deposition may also be cause for tough and thick skin. ''Rūkṣata, kharata, guna'' of ''~~vāta~~'' and ''shita guna'' of ''~~vāta~~'' and ''kapha'' along with increase of ''guruta, manda'' and ''sthira guna'' of ''kapha'' contribute to thickening of skin. ''Khara'' is also property of ''asthi dhatu'' which is generated by interplay between ''prithvi, agni'' and ''~~vāyu~~''. Here calcium is representative of ''prithvi mahabhuta''. So ''prithvi mahabhuta bhuyista āhara'' or increased ''parthivagni'' can lead to increased absorption of calcium from gastrointestinal tract.

+

Calcium deposition may also be cause for tough and thick skin. ''Rūkṣata, kharata, [[guna]]'' of ''[[vata]]'' and ''shita [[guna]]'' of ''[[vata]]'' and ''[[kapha]]'' along with increase of ''guruta, manda'' and ''sthira [[guna]]'' of ''[[kapha]]'' contribute to thickening of skin. ''Khara'' is also property of ''[[asthi dhatu]]'' which is generated by interplay between ''[[prithvi]], [[agni]]'' and ''[[vayu]]''. Here calcium is representative of ''[[prithvi mahabhuta]]''. So ''[[prithvi mahabhuta]] bhuyista āhara'' or increased ''parthivagni'' can lead to increased absorption of calcium from gastrointestinal tract.

==== 3. ''Kitibha kushtha'' ====

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Granulation tissue appearance is light red or dark pink in color (''śyāva''), being perfused with new capillary loops or buds granular in appearance. Formation of extracellular matrix gives it hard touch and abnormal productions of skin cells (especially during wound repair) leading to overabundance of skin cells. Premature maturation of keratinocytes induced by an inflammatory cascade in the dermis also contributes for the same.

−

''~~Vāta~~, rakta, ~~māṁsa~~, kapha''- all take part in healing of wound but whenever abnormality at the level of these factors takes place granulation process is hampered which gives the ''kiṇakharasparśa''.

+

''[[Vata]], [[rakta]], [[mamsa]], [[kapha]]''- all take part in healing of wound but whenever abnormality at the level of these factors takes place granulation process is hampered which gives the ''kiṇakharasparśa''.

==== 4. ''Vaipadika kushtha'' ====

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Prurigo nodularis, Hyde’s diseases, picker nodules, lichen corneus obtusus, nodular lichen simplex chronicus, nodular neurodematitis circumscripta are various synonyms. The constant scratching leads to development of discrete, excoriated nodular hyperpigmented / purpuric lesion with crusted or scaly surfaces.

−

The wart like plaque may be observed in dermatosis neglecta; an skin condition in which accumulation of sebum, keratin, sweat, dirt and debris lead to localized patch of skin. Dryness is the main cause for the above pathogenesis and role of ~~vāta~~ and kapha in causing dryness is already been discussed.

+

The wart like plaque may be observed in dermatosis neglecta; an skin condition in which accumulation of sebum, keratin, sweat, dirt and debris lead to localized patch of skin. Dryness is the main cause for the above pathogenesis and role of [[vata]] and [[kapha]] in causing dryness is already been discussed.

==== 6.''Vichārchikā''====

−

It is caused by ''kapha'' dominated condition. ''Kapha'' by its ''snigdha, guru, mridu'' and ''sheeta guna'' when increased above normal condition it leads to obstructive changes at the integumentary system. Reduced blood supply causes blackish brown discoloration. Further obstructive changes reduce the local immunity and give a chance for dermatophytes to penetrate the skin barrier. It results in eruptions and thereby causing excessive exudation. Secondary infection and reduced blood supply is cause for pruritus. It can be compared with wet eczema.

+

It is caused by ''[[kapha]]'' dominated condition. ''[[Kapha]]'' by its ''snigdha, guru, mridu'' and ''sheeta [[guna]]'' when increased above normal condition it leads to obstructive changes at the integumentary system. Reduced blood supply causes blackish brown discoloration. Further obstructive changes reduce the local immunity and give a chance for dermatophytes to penetrate the skin barrier. It results in eruptions and thereby causing excessive exudation. Secondary infection and reduced blood supply is cause for pruritus. It can be compared with wet eczema.

Table 2. Comparison of Ksudhra kustha with its Modern resemblance:

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#Internal and external application of sneha (medicated ghee or oil)

−

#Shodhana (purification therapies)

+

#[[Shodhana]] (purification therapies)

−

#Raktamokshana (blood letting)

+

#[[Raktamokshana]] (blood letting)

====Principal drugs====

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! scope="col"| Anupama

|-

−

| ''Vata'' dominant (''Kapala'')

+

| ''[[Vata]]'' dominant (''Kapala'')

| ''Swatambhu guggulu''

| 500-1000 mg

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| Ghee + Sugar

|-

−

| ''Pitta'' dominant(''Audumbara'')

+

| ''[[Pitta]]'' dominant(''Audumbara'')

| ''Tala bhasma'' mixture

| 120-250 mg

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| Ghee + Honey

|-

−

| ''Vata- Pitta'' dominant(''Rishyajivha'')

+

| ''[[Vata]]- [[Pitta]]'' dominant(''Rishyajivha'')

| ''Sarvangasundari vati''

| 500-1000 mg

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|-

| ''Kapha-pittaja'' (''pundarika'')

−

| As per ''dosha'' dominance

+

| As per ''[[dosha]]'' dominance

|

|-

−

| ''Vata ~~Kaphaja~~'' (''Sidhma'')

+

| ''[[Vata]] [[Kapha]]ja'' (''Sidhma'')

−

| As per ''dosha'' dominance

+

| As per ''[[dosha]]'' dominance

|

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|-

| ''Tridoshaja'' (''Kakanaka'')

−

| As per ''dosha'' dominance

+

| As per ''[[dosha]]'' dominance

|

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=== Related Chapter ===

−

* [[Kushtha Nidana]]

+

[[Kushtha Nidana]], [[Skin diseases in Integrative Medicine]]

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