9,091
edits
Changes
→Vidhi Vimarsha
#The sixth layer is the seat of most severe ''mahakushtha'', which are incurable. The sixth layer may be compared with reticular layer.(Ch. Sharira 7/4)
#The sixth layer is the seat of most severe ''mahakushtha'', which are incurable. The sixth layer may be compared with reticular layer.(Ch. Sharira 7/4)
Patho-physiology of kushtha:
==== Patho-physiology of ''kushtha'' ====
1. Kapāla kuṣṭha:
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 inturn kapha), proliferation of keratinocytes. Primary lesion manifest in the form of dry, rough and blackish brownish colour. 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 (nistōda) 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 kuṣṭha.
===== 1. ''Kapāla kushtha'' =====
2. Udumbara kuṣṭha:
It is pitta dominated kuṣṭha. Hyperpigmentation, increased vasocongestion, burning, pain and pus formation are the symptoms and signs.
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 (nistōda) 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''.
Primary lesion manifests as red in colour associated with pus, burning sensation caused mainly due to pitta and rakta. Usna and tiksna guna is responsible for the same.
Secondary lesion includes kleda, kotha, body hair attains brownish colour, excessive secretion due to sasneha, sara and drava guna of pitta and rakta.
===== 2. ''Udumbara kushtha'' =====
Dyshidrosis, discoid eczema, venous eczema, dermatitis herpetiformis, autoeczematization, eczema overlaid by viral infections can be understood under udumbara kuṣṭha.
It is ''pitta'' dominated ''kushtha''. Hyper-pigmentation, increased vaso-congestion, burning, pain and pus formation are the symptoms and signs.
3. Mandala kuṣṭha:
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.
4. Rushyajivha kushtha:
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:
Increased flow of inflammatory factors causes rise in temperature, redness and burning sensation. Eczema is inflammation of the skin. It is characterized by erythematous, vesicular, weeping, itchy and crusting patches. The condition is caused by dysfunctional interplay between the immune system and skin.
Dyshidrosis, discoid eczema, venous eczema, dermatitis herpetiformis, autoeczematization, eczema overlaid by viral infections can be understood under ''udumbara kushtha''.
===== 3. ''Mandala 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.
===== 4. ''Rishyajivha kushtha'' =====
It is dominated by vāta and pitta dōṣha. Vāta dōṣha brings roughness, pain whereas pitta is responsible for the discolouration, burning sensation whereas both the dōṣha are responsible for ashugati and samuthan.
It is dominated by vāta and pitta dōṣha. Vāta dōṣha brings roughness, pain whereas pitta is responsible for the discolouration, burning sensation whereas both the dōṣha are responsible for ashugati and samuthan.
Thus inflammatory and degenerative changes dominate the condition. Pathogenesis involving infective 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. Classically the innermost portion remain darker red and becomes indurated (is thicker and firmer).
Thus inflammatory and degenerative changes dominate the condition. Pathogenesis involving infective 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. Classically the innermost portion remain darker red and becomes indurated (is thicker and firmer).