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All the kushtha are curable except mahakushtha named “kakanak”, because it does not have any systemic involvements. At the end of the chapter, three types of skin disorders caused by hypo pigmentations are mentioned as “shwitra” with their treatments.

All the kushtha are curable except mahakushtha named “kakanak”, because it does not have any systemic involvements. At the end of the chapter, three types of skin disorders caused by hypo pigmentations are mentioned as “shwitra” with their treatments.

   

   

अथातः कुष्ठचिकित्सितं व्याख्यास्यामः||१||  

अथातः कुष्ठचिकित्सितं व्याख्यास्यामः||१||  

Now we shall expound the chapter on management of kuṣṭha (obstinate skin diseases) .Thus said Lord Atreya.

Now we shall expound the chapter on management of kuṣṭha (obstinate skin diseases) .Thus said Lord Atreya.

Aetiology, factors essential for genesis of disease, symptoms and signs, premonitory features, pathogenesis along with treatment is being mentioned. Listen Agnivesha! The speciality of this disease is that there is loss of integrity of seat of sparśanendriya i.e. tvacha. (1-3)

Aetiology, factors essential for genesis of disease, symptoms and signs, premonitory features, pathogenesis along with treatment is being mentioned. Listen Agnivesha! The speciality of this disease is that there is loss of integrity of seat of sparśanendriya i.e. tvacha. (1-3)

Etiology:

 

==== Etiology ====

 

विरोधीन्यन्नपानानि द्रवस्निग्धगुरूणि च|  

विरोधीन्यन्नपानानि द्रवस्निग्धगुरूणि च|  

भजतामागतां छर्दिं वेगांश्चान्यान्प्रतिघ्नताम्||४||  

भजतामागतां छर्दिं वेगांश्चान्यान्प्रतिघ्नताम्||४||  

viprAn gurUn dharShayatAM pApaM karma ca kurvatAm||8||

viprAn gurUn dharShayatAM pApaM karma ca kurvatAm||8||

Virudha annapāna, excessive intake of drava, snigdha and guru dravyas; restraining natural urges like vomiting etc; exercising or coming in contact of excessive heat after eating excessive quantity of food. Indulging in habits such as, taking shita quality food etc. followed by ushṇa quality or either fasting followed by heavy meals. Having cold water immediately after exposure to scorching sun, exertion and fear, eating uncooked or raw foods or having meals although previously taken meals have not been digested. Indulging in food and other habits which have been restricted during the phase of panchakarma. Consuming new grains, curds, fish, excessive salty and sour food items. Black grams, raddish, food prepared from flour paste, sesame, milk and jaggery products. Indulging in sexual activity even if the food is not well digested (sexual intercourse immediately after taking food), sleeping during day time, insulting peers like brahmin / guru and other respected personal and doing sinful acts are the aetiological and risk factors of kuṣṭha. [4-8]

Virudha annapāna, excessive intake of drava, snigdha and guru dravyas; restraining natural urges like vomiting etc; exercising or coming in contact of excessive heat after eating excessive quantity of food. Indulging in habits such as, taking shita quality food etc. followed by ushṇa quality or either fasting followed by heavy meals. Having cold water immediately after exposure to scorching sun, exertion and fear, eating uncooked or raw foods or having meals although previously taken meals have not been digested. Indulging in food and other habits which have been restricted during the phase of panchakarma. Consuming new grains, curds, fish, excessive salty and sour food items. Black grams, raddish, food prepared from flour paste, sesame, milk and jaggery products. Indulging in sexual activity even if the food is not well digested (sexual intercourse immediately after taking food), sleeping during day time, insulting peers like brahmin / guru and other respected personal and doing sinful acts are the aetiological and risk factors of kuṣṭha. [4-8]

Pathogenic factors:

 

==== Pathogenic factors ====

 

वातादयस्त्रयो दुष्टास्त्वग्रक्तं मांसमम्बु च|  

वातादयस्त्रयो दुष्टास्त्वग्रक्तं मांसमम्बु च|  

दूषयन्ति स कुष्ठानां सप्तको द्रव्यसङ्ग्रहः||९||  

दूषयन्ति स कुष्ठानां सप्तको द्रव्यसङ्ग्रहः||९||  

na caikadoShajaM ki~jcit kuShThaM samupalabhyate||10||

na caikadoShajaM ki~jcit kuShThaM samupalabhyate||10||

The vitiated three dosha; vāta, pitta, kapha alongwith impaired tvak, rakta, māṁsa and ambu together constitute seven essential entities which play role in pathogenesis of kuṣṭha. Kuṣṭha can be classified into seven mahakuṣṭha (major skin disorders) and eleven kshudrakuṣṭha (eleven minor skin disorders). Single dōsha cannot cause kuṣṭha on its own i.e. kuṣṭha is not an nānātmaja (disease caused by single specific dosha) disease. [9-10]

The vitiated three dosha; vāta, pitta, kapha alongwith impaired tvak, rakta, māṁsa and ambu together constitute seven essential entities which play role in pathogenesis of kuṣṭha. Kuṣṭha can be classified into seven mahakuṣṭha (major skin disorders) and eleven kshudrakuṣṭha (eleven minor skin disorders). Single dōsha cannot cause kuṣṭha on its own i.e. kuṣṭha is not an nānātmaja (disease caused by single specific dosha) disease. [9-10]

Premonitory signs and symptoms

 

==== Premonitory signs and symptoms ====

 

स्पर्शाज्ञत्वमतिस्वेदो न वा वैवर्ण्यमुन्नतिः|  

स्पर्शाज्ञत्वमतिस्वेदो न वा वैवर्ण्यमुन्नतिः|  

कोठानां लोमहर्षश्च कण्डूस्तोदः श्रमः क्लमः||११||  

कोठानां लोमहर्षश्च कण्डूस्तोदः श्रमः क्लमः||११||  

Decreased touch sensation, excessive sweating or absence of sweating (which may be localized or generalized), change in colour (discolouration), papules on skin, horripilation, pruritus, pricking pain, physical exhaustion, mental fatigue, severe pain in ulcerated area, sudden appearance and chronic the ulcers, burning sensation, numbness are the premonitory symptoms of skin disease.[11-12]

Decreased touch sensation, excessive sweating or absence of sweating (which may be localized or generalized), change in colour (discolouration), papules on skin, horripilation, pruritus, pricking pain, physical exhaustion, mental fatigue, severe pain in ulcerated area, sudden appearance and chronic the ulcers, burning sensation, numbness are the premonitory symptoms of skin disease.[11-12]

Eighteen types of skin diseases:

==== Eighteen types of skin diseases ====

 

अत ऊर्ध्वमष्टादशानां कुष्ठानां कपालोदुम्बरमण्डलर्ष्यजिह्वपुण्डरीकसिध्मकाकणकैककुष्ठचर्माख्य-किटिभविपादिकालसकदद्रुचर्मदलपामाविस्फोटकशतारुर्विचर्चिकानां लक्षणान्युपदेक्ष्यामः||१३||  

अत ऊर्ध्वमष्टादशानां कुष्ठानां कपालोदुम्बरमण्डलर्ष्यजिह्वपुण्डरीकसिध्मकाकणकैककुष्ठचर्माख्य-किटिभविपादिकालसकदद्रुचर्मदलपामाविस्फोटकशतारुर्विचर्चिकानां लक्षणान्युपदेक्ष्यामः||१३||  

ata ūrdhvamaṣṭādaśānāṁ kuṣṭhānāṁkapālōdumbaramaṇḍalarṣyajihvapuṇḍarīkasidhmakākaṇakaikakuṣṭhacarmākhya-kiṭibhavipādikālasakadadrucarmadalapāmāvisphōṭakaśatārurvicārcikānāṁ lakṣaṇānyupadēkṣyāmaḥ||13||  

ata ūrdhvamaṣṭādaśānāṁ kuṣṭhānāṁkapālōdumbaramaṇḍalarṣyajihvapuṇḍarīkasidhmakākaṇakaikakuṣṭhacarmākhya-kiṭibhavipādikālasakadadrucarmadalapāmāvisphōṭakaśatārurvicārcikānāṁ lakṣaṇānyupadēkṣyāmaḥ||13||  

Henceforth 18 types of kuṣṭha alongwith their signs and symptoms are described viz kapāla, udumbara, maṇḍala, rṣyajihva, puṇḍarīka, sidhma, kākaṇaka, ekkuṣṭha, carmākhya, Kiṭibha, vipādikā, alasaka, dadru, charmadala, pāmā, visphōṭaka, śatāru  and vicārcikā.[13]

Henceforth 18 types of kuṣṭha alongwith their signs and symptoms are described viz kapāla, udumbara, maṇḍala, rṣyajihva, puṇḍarīka, sidhma, kākaṇaka, ekkuṣṭha, carmākhya, Kiṭibha, vipādikā, alasaka, dadru, charmadala, pāmā, visphōṭaka, śatāru  and vicārcikā.[13]

Seven major kushtha:

 

1. Kapāla Kuṣṭha:

==== Seven major kushtha ====

 

===== 1. Kapāla Kuṣṭha =====

 

कृष्णारुणकपालाभं यद्रूक्षं परुषं तनु|  

कृष्णारुणकपालाभं यद्रूक्षं परुषं तनु|  

कापालं तोदबहुलं तत्कुष्ठं विषमं स्मृतम्||१४||  

कापालं तोदबहुलं तत्कुष्ठं विषमं स्मृतम्||१४||  

The clinical presentation fo Kapāla Kuṣṭha is as follows:  

The clinical presentation fo Kapāla Kuṣṭha is as follows:  

Colour –- kr̥ṣṇa (blackish), aruṇa (reddish)

Colour –- kr̥ṣṇa (blackish), aruṇa (reddish)

Nature – Kapāla (similar to broken piece of earthen pot)

Nature – Kapāla (similar to broken piece of earthen pot)

Touch – Rūkṣa (dry), paruṣa (rough), tanu (thin)

Touch – Rūkṣa (dry), paruṣa (rough), tanu (thin)

Associated symptoms – severe pain

Associated symptoms – severe pain

Sadhya / sadyata – Difficult to cure

Sadhya / sadyata – Difficult to cure

    

    

Fig.1: Kapāla resembling with actinic keratosis non hypertrohic  

Fig.1: Kapāla resembling with actinic keratosis non hypertrohic  

   

   

Fig. 1a: Kapāla resembling with tuberculoid leprosy  

Fig. 1a: Kapāla resembling with tuberculoid leprosy  

Udumbara kuṣṭha:

 

===== 2.Udumbara kuṣṭha =====

 

दाहकण्डूरुजारागपरीतं लोमपिञ्जरम्|  

दाहकण्डूरुजारागपरीतं लोमपिञ्जरम्|  

उदुम्बरफलाभासं कुष्ठमौदुम्बरं विदुः||१५||  

उदुम्बरफलाभासं कुष्ठमौदुम्बरं विदुः||१५||  

   

   

Fig. 2c udumbara resembling with dyshidrosis  

Fig. 2c udumbara resembling with dyshidrosis  

Maṇḍala Kuṣṭha:

 

===== 3.Maṇḍala Kuṣṭha =====

 

श्वेतं रक्तं स्थिरं स्त्यानं स्निग्धमुत्सन्नमण्डलम्|  

श्वेतं रक्तं स्थिरं स्त्यानं स्निग्धमुत्सन्नमण्डलम्|  

कृच्छ्रमन्योन्यसंसक्तं कुष्ठं मण्डलमुच्यते||१६||  

कृच्छ्रमन्योन्यसंसक्तं कुष्ठं मण्डलमुच्यते||१६||  

Fig.3 Maṇḍala resembling with lepromatous leprosy  

Fig.3 Maṇḍala resembling with lepromatous leprosy  

   

   

Fig. 3a Maṇḍala resembling with lepromatous leprosy  

Fig. 3a Maṇḍala resembling with lepromatous leprosy

R̥ṣyajihvā kuṣṭha:

R̥ṣyajihvā kuṣṭha:

कर्कशं रक्तपर्यन्तमन्तः श्यावं सवेदनम्|  

कर्कशं रक्तपर्यन्तमन्तः श्यावं सवेदनम्|