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→5.Alasaka Kuṣṭha
Fig 13a alasaka resembeling with prurigo nodularis
Fig 13a alasaka resembeling with prurigo nodularis
Dadru kuṣṭha
===== 6.Dadru kuṣṭha =====
सकण्डूरागपिडकं दद्रुमण्डलमुद्गतम्||२३||
सकण्डूरागपिडकं दद्रुमण्डलमुद्गतम्||२३||
sakaṇḍūrāgapiḍakaṁ dadrumaṇḍalamudgatam||23||
sakaṇḍūrāgapiḍakaṁ dadrumaṇḍalamudgatam||23||
Fig 14a dadruresembeling with ringworm
Fig 14a dadruresembeling with ringworm
Charmadala Kuṣṭha
===== 7.Charmadala Kuṣṭha =====
रक्तं [१] सकण्डु सस्फोटं सरुग्दलति चापि यत्|
रक्तं [१] सकण्डु सस्फोटं सरुग्दलति चापि यत्|
तच्चर्मदलमाख्यातं संस्पर्शासहमुच्यते||२४||
तच्चर्मदलमाख्यातं संस्पर्शासहमुच्यते||२४||
Fig. 15. Charmadala resembeling with atheletics foot
Fig. 15. Charmadala resembeling with atheletics foot
Pāmā kuṣṭha
===== 8.Pāmā kuṣṭha =====
पामाश्वेतारुणश्यावाः कण्डूलाः पिडका भृशम्|
पामाश्वेतारुणश्यावाः कण्डूलाः पिडका भृशम्|
pāmāśvētāruṇaśyāvāḥ kaṇḍūlāḥ piḍakā bhr̥śam|
pāmāśvētāruṇaśyāvāḥ kaṇḍūlāḥ piḍakā bhr̥śam|
The clinical features are as follows:
The clinical features are as follows:
Colour – white, reddish, brownish blackish
Colour – white, reddish, brownish blackish
Nature – Itching
Associated symptoms –piḍakā (erruptions)
Associated symptoms –piḍakā (erruptions)
Fig. 16. Pāmā resembeling with scabies
Fig. 16. Pāmā resembeling with scabies
Visphōṭa kuṣṭha
===== 9. Visphōṭa kuṣṭha =====
स्फोटाः श्वेतारुणाभासो विस्फोटाः स्युस्तनुत्वचः||२५||
sphōṭāḥ śvētāruṇābhāsō visphōṭāḥ syustanutvacāḥ||25||
sphōṭāḥ śvētāruṇābhāsō visphōṭāḥ syustanutvacāḥ||25||
sphoTAH shvetAruNAbhAso visphoTAH syustanutvacaH||25||
sphoTAH shvetAruNAbhAso visphoTAH syustanutvacaH||25||
Fig17 Visphōṭa resembeling with herpetic folliculitis
Fig17 Visphōṭa resembeling with herpetic folliculitis
Śatāru kuṣṭha
===== 10.Śatāru kuṣṭha =====
रक्तं श्यावं सदाहार्ति शतारुः स्याद्बहुव्रणम्|
रक्तं श्यावं सदाहार्ति शतारुः स्याद्बहुव्रणम्|
raktaṁ śyāvaṁ sadāhārti śatāruḥ syādbahuvraṇam|
raktaṁ śyāvaṁ sadāhārti śatāruḥ syādbahuvraṇam|
Fig. 18a Śatāru resembeling with furuncle
Fig. 18a Śatāru resembeling with furuncle
Vicārcikā kuṣṭha
===== 11.Vicārcikā kuṣṭha =====
सकण्डूः पिडका श्यावा बहुस्रावा विचर्चिका||२६||
सकण्डूः पिडका श्यावा बहुस्रावा विचर्चिका||२६||
sakaṇḍūḥ piḍakā śyāvā bahusrāvā vicārcikā||26||
sakaṇḍūḥ piḍakā śyāvā bahusrāvā vicārcikā||26||
Fig. 19 Vicārcikā resembeling with wet eczema
Fig. 19 Vicārcikā resembeling with wet eczema
इत्येकादश क्षुद्रकुष्ठानि
इत्येकादश क्षुद्रकुष्ठानि
ityēkādaśa kṣudrakuṣṭhāni
ityēkādaśa kṣudrakuṣṭhāni
ityekAdasha kShudrakuShThAni
ityekAdasha kShudrakuShThAni
This ends the explanation of 11 ksudrakuṣṭha.(21-26)
This ends the explanation of 11 ksudrakuṣṭha.(21-26)
Dosha dominance in types of kushtha:
==== Dosha dominance in types of kushtha ====
वातेऽधिकतरे कुष्ठं कापालं मण्डलं कफे|
वातेऽधिकतरे कुष्ठं कापालं मण्डलं कफे|
पित्ते त्वौदुम्बरं विद्यात् काकणं तु त्रदोषजम्||२७||
पित्ते त्वौदुम्बरं विद्यात् काकणं तु त्रदोषजम्||२७||
Pitta kapha Pāmā, Śatāru, Visphōṭaka, Dadru, Charmadala
Pitta kapha Pāmā, Śatāru, Visphōṭaka, Dadru, Charmadala
Kapha Vichārchikā
Kapha Vichārchikā
General guidelines for diagnosis:
==== General guidelines for diagnosis ====
सर्वं त्रिदोषजं कुष्ठं दोषाणां तु बलाबलम्|
सर्वं त्रिदोषजं कुष्ठं दोषाणां तु बलाबलम्|
यथास्वैर्लक्षणैर्बुद्ध्वा कुष्ठानां क्रियते क्रिया||३१||
यथास्वैर्लक्षणैर्बुद्ध्वा कुष्ठानां क्रियते क्रिया||३१||
दोषस्य यस्य पश्येत् कुष्ठेषु विशेषलिङ्गमद्रिक्तम्|
दोषस्य यस्य पश्येत् कुष्ठेषु विशेषलिङ्गमद्रिक्तम्|
तस्यैव शमं कुर्यात्ततः परं चानुबन्धस्य||३२||
तस्यैव शमं कुर्यात्ततः परं चानुबन्धस्य||३२||
sarvaṁ tridōṣajaṁ kuṣṭhaṁ dōṣāṇāṁ tu balābalam|
sarvaṁ tridōṣajaṁ kuṣṭhaṁ dōṣāṇāṁ tu balābalam|
yathāsvairlakṣaṇairbuddhvā kuṣṭhānāṁ kriyatē kriyā||31||
yathāsvairlakṣaṇairbuddhvā kuṣṭhānāṁ kriyatē kriyā||31||
Tridōsha are involved in pathogenesis of all types of kuṣṭha. Depending on dōsha predominancy symptoms are manifested and treatment should be decided on the basis of symptoms shown in specific kuṣṭha. The dōsha presenting important and specific symptoms should be alleviated firstly followed by the treatment of associated dōsha.(31-32)
Tridōsha are involved in pathogenesis of all types of kuṣṭha. Depending on dōsha predominancy symptoms are manifested and treatment should be decided on the basis of symptoms shown in specific kuṣṭha. The dōsha presenting important and specific symptoms should be alleviated firstly followed by the treatment of associated dōsha.(31-32)
कुष्ठविशेषैर्दोषा दोषविशेषैः पुनश्च कुष्ठानि|
कुष्ठविशेषैर्दोषा दोषविशेषैः पुनश्च कुष्ठानि|
ज्ञायन्ते तैर्हेतुर्हेतुस्तांश्च [१] प्रकाशयति||३३||
ज्ञायन्ते तैर्हेतुर्हेतुस्तांश्च [१] प्रकाशयति||३३||
j~jAyante tairheturhetustAMshca [1] prakAshayati||33||
j~jAyante tairheturhetustAMshca [1] prakAshayati||33||
Specific kuṣṭha determine the predominancy of specific dōsha and viceversa is also true i.e. predominancy of dōsha determines the specific type of kuṣṭha. Similarly specific symptoms determine the causative factors vice versa causative factors determine the specific symptoms.(33)
Specific kuṣṭha determine the predominancy of specific dōsha and viceversa is also true i.e. predominancy of dōsha determines the specific type of kuṣṭha. Similarly specific symptoms determine the causative factors vice versa causative factors determine the specific symptoms.(33)
Dosha specific features of diagnosis of dosha dominance in kushtha:
==== Dosha specific features of diagnosis of dosha dominance in kushtha ====
रौक्ष्यं शोषस्तोदः शूलं सङ्कोचनं तथाऽऽयामः|
रौक्ष्यं शोषस्तोदः शूलं सङ्कोचनं तथाऽऽयामः|
पारुष्यं खरभावो हर्षः श्यावारुणत्वं च||३४||
पारुष्यं खरभावो हर्षः श्यावारुणत्वं च||३४||
Symptoms due to doṣha predominancy - Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in colour are manifestation of vata dosha.
Symptoms due to doṣha predominancy - Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in colour are manifestation of vata dosha.
Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominancy of pitta dosha.
Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominancy of pitta dosha.
Kapha dosha is responsible for symptoms like whitish discolouration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented alongwith maggot’s formation and stickiness like symptoms.(34-36)
Kapha dosha is responsible for symptoms like whitish discolouration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented alongwith maggot’s formation and stickiness like symptoms.(34-36)
Prognosis:
==== Prognosis ====
सर्वैर्लिङ्गैर्युक्तं मतिमान् विवर्जयेदबलम्|
सर्वैर्लिङ्गैर्युक्तं मतिमान् विवर्जयेदबलम्|
तृष्णादाहपरीतं शान्ताग्निं जन्तुभिर्जग्धम्||३७||
तृष्णादाहपरीतं शान्ताग्निं जन्तुभिर्जग्धम्||३७||
kaphapitta-vAtapittaprabalAni tu kRucchrasAdhyAni||38||
kaphapitta-vAtapittaprabalAni tu kRucchrasAdhyAni||38||
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 vāta kapha predominated kuṣṭha and single dosha predominated kuṣṭha are not so difficult to treat. Whereas kapha pitta and vāta pitta dominated kuṣṭha are kr̥cchra sadhya i.e. curable, but with efforts. (37-38)
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 vāta kapha predominated kuṣṭha and single dosha predominated kuṣṭha are not so difficult to treat. Whereas kapha pitta and vāta pitta dominated kuṣṭha are kr̥cchra sadhya i.e. curable, but with efforts. (37-38)
Principles of management:
==== Principles of management ====
वातोत्तरेषु सर्पिर्वमनं श्लेष्मोत्तरेषु कुष्ठेषु|
वातोत्तरेषु सर्पिर्वमनं श्लेष्मोत्तरेषु कुष्ठेषु|
पित्तोत्तरेषु मोक्षो रक्तस्य विरेचनं चाग्रे||३९||
पित्तोत्तरेषु मोक्षो रक्तस्य विरेचनं चाग्रे||३९||
pittottareShu mokSho raktasya virecanaM cAgre||39||
pittottareShu mokSho raktasya virecanaM cAgre||39||
In vātaja kuṣṭha, firstly administer ghr̥itapana, whereas in kaphaja kuṣṭha vamana procedure should be done and in pittaja kuṣṭha, virechana alongwith raktamokshana should be first line of treatment.(39)
In vātaja kuṣṭha, firstly administer ghr̥itapana, whereas in kaphaja kuṣṭha vamana procedure should be done and in pittaja kuṣṭha, virechana alongwith raktamokshana should be first line of treatment.(39)
वमनविरेचनयोगाः कल्पोक्ताः कुष्ठिनां प्रयोक्तव्याः|
वमनविरेचनयोगाः कल्पोक्ताः कुष्ठिनां प्रयोक्तव्याः|
प्रच्छनमल्पे कुष्ठे महति च शस्तं सिराव्यधनम्||४०||
प्रच्छनमल्पे कुष्ठे महति च शस्तं सिराव्यधनम्||४०||
doShe hyatimAtrahRute vAyurhanyAdabalamAshu||41||
doShe hyatimAtrahRute vAyurhanyAdabalamAshu||41||
Patients with excessive vitiated dosha should be given shodhan therapy repeatedly; taking care about their prana (strength). Excessive alimination of dosha may increase vāta dosha which may bring about weakness and in rare condition endanger the life of patient.(41)
Patients with excessive vitiated dosha should be given shodhan therapy repeatedly; taking care about their prana (strength). Excessive alimination of dosha may increase vāta dosha which may bring about weakness and in rare condition endanger the life of patient.(41)
स्नेहस्य पानमिष्टं शुद्धे कोष्ठे प्रवाहिते रक्ते|
स्नेहस्य पानमिष्टं शुद्धे कोष्ठे प्रवाहिते रक्ते|
वायुर्हि शुद्धकोष्ठं कुष्ठिनमबलं विशति शीघ्रम्||४२||
वायुर्हि शुद्धकोष्ठं कुष्ठिनमबलं विशति शीघ्रम्||४२||
vAyurhi shuddhakoShThaM kuShThinamabalaM vishati shIghram||42||
vAyurhi shuddhakoShThaM kuShThinamabalaM vishati shIghram||42||
After shodhana and letting of blood, sneha should be administered since after shodhan, vāta dosha enters the shudha kosṭha of patient and is cause for immediate bala kshaya.(42)
After shodhana and letting of blood, sneha should be administered since after shodhan, vāta dosha enters the shudha kosṭha of patient and is cause for immediate bala kshaya.(42)
Various formulations:
==== Various formulations ====
दोषोत्क्लिष्टे हृदये वाम्यः कुष्ठेषु चोर्ध्वभागेषु|
दोषोत्क्लिष्टे हृदये वाम्यः कुष्ठेषु चोर्ध्वभागेषु|
कुटजफलमदनमधुकैः सपटोलैर्निम्बरसयुक्तैः||४३||
कुटजफलमदनमधुकैः सपटोलैर्निम्बरसयुक्तैः||४३||