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=== Abstract ===

=== Abstract ===

The fifth chapter of [[Nidana Sthana]] of [[Charaka Samhita]] deals with diagnosis of generalized skin disease called ''Kushtha''. The disease has variable skin manifestations depending upon degree of involvement of three vitiated ''dosha'' and their effect on four vitiated factors i.e. ''rasa, rakta, mamsa'' and ''lasika'' (lymphatic system). On the basis of clinical manifestations and severity, ''kushtha'' is classified into seven major types, eleven minor types or innumerable types due to the permutation and combination of dosha, their predominance, involvement of particular quality of a ''dhatu'' and accretion of ''dosha'' at different sites. The etiopathology, prodromal symptoms (''poorvarupa''), symptomatology of seven major types of ''kushtha''(''maha-kushtha''), their ''dosha'' predominance, prognosis, complications and significance of early treatment are described in this chapter.

The fifth chapter of [[Nidana Sthana]] of [[Charaka Samhita]] deals with diagnosis of generalized skin disease called ''Kushtha''. The disease has variable skin manifestations depending upon degree of involvement of three vitiated ''dosha'' and their effect on four vitiated factors i.e. ''rasa, rakta, mamsa'' and ''lasika'' (lymphatic system). On the basis of clinical manifestations and severity, ''kushtha'' is classified into seven major types, eleven minor types or innumerable types due to the permutation and combination of dosha, their predominance, involvement of particular quality of a ''dhatu'' and accretion of ''dosha'' at different sites. The etiopathology, prodromal symptoms (''poorvarupa''), symptomatology of seven major types of ''kushtha''(''maha-kushtha''), their ''dosha'' predominance, prognosis, complications and significance of early treatment are described in this chapter.

'''Keywords''': ''Kushtha, Mandal, Kapala, Kakanak, Audambar, Rishyajihva, Pundareeka, Sidhma

'''Keywords''': ''Kushtha, Mandal, Kapala, Kakanak, Audambar, Rishyajihva, Pundareeka, Sidhma

''

''

 

=== Introduction ===

=== Introduction ===

 

The term ''kushtha'' literally means disfigurement of skin. Thus all the dermatological manifestations have been clubbed under the term ''kushtha''. For which Charaka has devoted two full chapters, the fifth chapter in [[Nidana Sthana]] dealing with the etiopathogenesis and the seventh chapter in the [[Chikitsa Sthana]] deals with etiopathogenesis and treatment. Dermatological diseases have been classified into four groups, which include seven types of ''kushtha'' (dermatosis), seven types of ''visarpa'' (a form of acute dermatitis like erysipelas), seven types of ''pidaka'' (papular presentations) and three types of ''kilasa'' (vitiligo) ([[Sutra Sthana]] 19/3). However, looking to the clinical importance, acuteness and progression, one full chapter has been devoted to ''visarpa'', one of the major dermatological conditions (Cha.Chi. 21).Some other clinical presentations like Urticaria (''udarda, kotha''), ''nilika'' (bluish discoloration of the skin), ''tilalklaka'' (mole), ''piplu''(port wine mark on skin), ''vyanga'' etc. have also been explained briefly at other places. Detailed description and classification of ''pidaka'' (papules) is given in the seventeenth chapter of [[Sutra Sthana]].  

The term ''kushtha'' literally means disfigurement of skin. Thus all the dermatological manifestations have been clubbed under the term ''kushtha''. For which Charaka has devoted two full chapters, the fifth chapter in [[Nidana Sthana]] dealing with the etiopathogenesis and the seventh chapter in the [[Chikitsa Sthana]] deals with etiopathogenesis and treatment. Dermatological diseases have been classified into four groups, which include seven types of ''kushtha'' (dermatosis), seven types of ''visarpa'' (a form of acute dermatitis like erysipelas), seven types of ''pidaka'' (papular presentations) and three types of ''kilasa'' (vitiligo) ([[Sutra Sthana]] 19/3). However, looking to the clinical importance, acuteness and progression, one full chapter has been devoted to ''visarpa'', one of the major dermatological conditions (Cha.Chi. 21).Some other clinical presentations like Urticaria (''udarda, kotha''), ''nilika'' (bluish discoloration of the skin), ''tilalklaka'' (mole), ''piplu''(port wine mark on skin), ''vyanga'' etc. have also been explained briefly at other places. Detailed description and classification of ''pidaka'' (papules) is given in the seventeenth chapter of [[Sutra Sthana]].  

The concept of micro-organism and parasitology was established by Charaka and he had the knowledge that micro-organisms are responsible for the causation of dermatological manifestations (Cha. VI. 7/11). Their treatment is to be followed like the treatment of ''kushtha''. In the symptomatology of ''kushtha'' presence of ''krimi'' is described as one of the symptoms, which denotes visible worms usually maggots (''samsvedaja krimi'')(Cha. Ni. 5).

The concept of micro-organism and parasitology was established by Charaka and he had the knowledge that micro-organisms are responsible for the causation of dermatological manifestations (Cha. VI. 7/11). Their treatment is to be followed like the treatment of ''kushtha''. In the symptomatology of ''kushtha'' presence of ''krimi'' is described as one of the symptoms, which denotes visible worms usually maggots (''samsvedaja krimi'')(Cha. Ni. 5).

 

===Sanskrit Text, Transliteration and English Translation===

===Sanskrit Text, Transliteration and English Translation===

saptadravyANikuShThanAMprakRutirvikRutimApannAnibhavanti| tadyathA- trayodoShAvAtapittashleShmANaHprakopaNavikRutAH, dUShyAshcasharIradhAtavastva~gmAMsashoNitalasIkAshcaturdhAdoShopaghAtavikRutAiti| etatsaptadhAtukameva~ggatamAjananaMkuShThanAm, ataHprabhavANyabhinirvartamAnAnikevalaMsharIramupatapanti||3||

saptadravyANikuShThanAMprakRutirvikRutimApannAnibhavanti| tadyathA- trayodoShAvAtapittashleShmANaHprakopaNavikRutAH, dUShyAshcasharIradhAtavastva~gmAMsashoNitalasIkAshcaturdhAdoShopaghAtavikRutAiti| etatsaptadhAtukameva~ggatamAjananaMkuShThanAm, ataHprabhavANyabhinirvartamAnAnikevalaMsharIramupatapanti||3||

 

The pathology of skin diseases origin from the deranged physiology of seven factors connected to skin. They are ''vata, pitta'' and ''kapha'' ''doshas'' in aggravated state and ''dhatus'', namely, ''tvak'' (the word ''tvak'' represents skin. Since the skin is organ in which ''rasa dhatu'' is present, ''tvak'' word is used instead of ''rasa dhatu'' ), ''mamsa, shonita'' and ''lasika'' that get deranged due to aggravated ''dosha''. So seven type of ''kushtha'' are manifested by these seven morbid factors. Thus preliminary and manifested ''kushtha'' gradually afflicts the whole body. [3]

The pathology of skin diseases origin from the deranged physiology of seven factors connected to skin. They are ''vata, pitta'' and ''kapha'' ''doshas'' in aggravated state and ''dhatus'', namely, ''tvak'' (the word ''tvak'' represents skin. Since the skin is organ in which ''rasa dhatu'' is present, ''tvak'' word is used instead of ''rasa dhatu'' ), ''mamsa, shonita'' and ''lasika'' that get deranged due to aggravated ''dosha''. So seven type of ''kushtha'' are manifested by these seven morbid factors. Thus preliminary and manifested ''kushtha'' gradually afflicts the whole body. [3]

 

==== Possible types of ''kushtha'' ====

==== Possible types of ''kushtha'' ====

na caki~jcidastikuShThamekadoShaprakopanimittam, astitukhalusamAnaprakRutInAmapi

na caki~jcidastikuShThamekadoShaprakopanimittam, astitukhalusamAnaprakRutInAmapi

kuShThanAMdoShAMshAMshavikalpAnubandhasthAnavibhAgenavedanAvarNasaMsthAnaprabhAvanAmacikitsitavisheShaH| sasaptavidho~aShTAdashavidho~aparisa~gkhyeyavidhovAbhavati| doShA hi vikalpanairvikalpyamAnAvikalpayantivikArAn, anyatrAsAdhyabhAvAt| teShAMvikalpavikArasa~gkhyAne~atiprasa~ggamabhisamIkShyasaptavidhamevakuShThavisheShamupadekShyAmaH||4||  

kuShThanAMdoShAMshAMshavikalpAnubandhasthAnavibhAgenavedanAvarNasaMsthAnaprabhAvanAmacikitsitavisheShaH| sasaptavidho~aShTAdashavidho~aparisa~gkhyeyavidhovAbhavati| doShA hi vikalpanairvikalpyamAnAvikalpayantivikArAn, anyatrAsAdhyabhAvAt| teShAMvikalpavikArasa~gkhyAne~atiprasa~ggamabhisamIkShyasaptavidhamevakuShThavisheShamupadekShyAmaH||4||  

 

Variation in single ''dosha'' cannot cause ''kushtha''. Even in ''kushtha'' with similar presentations, the clinical features in terms of sensation in skin, colour, site of skin lesion, other symptoms, and treatment may vary depending on the variation in vitiation of (qualities of) ''dosha''. Therefore there are seven or eighteen or innumerable types of ''kushtha''. The variations in qualities of vitiated ''dosha'' lead to further differentiation in types of diseases, except in incurable conditions. As there might be innumerable types of ''kushtha'' leading to expansion of text, only seven types of ''kushtha'' are described here. [4]

Variation in single ''dosha'' cannot cause ''kushtha''. Even in ''kushtha'' with similar presentations, the clinical features in terms of sensation in skin, colour, site of skin lesion, other symptoms, and treatment may vary depending on the variation in vitiation of (qualities of) ''dosha''. Therefore there are seven or eighteen or innumerable types of ''kushtha''. The variations in qualities of vitiated ''dosha'' lead to further differentiation in types of diseases, except in incurable conditions. As there might be innumerable types of ''kushtha'' leading to expansion of text, only seven types of ''kushtha'' are described here. [4]

 

==== Seven types of ''kushtha'' ====

==== Seven types of ''kushtha'' ====

   

   

ihavAtAdiShutriShuprakupiteShutvagAdIMshcaturaHpradUShayatsuvAte~adhikatarekapAlakuShThamabhinirvartate, pittetvaudumbaraM, shleShmaNimaNDalakuShThaM, vAtapittayorRuShyajihvaM, pittashleShmaNoHpuNDarIkaM, shleShmamArutayoHsidhmakuShThaM, sarvadoShAbhivRuddhaukAkaNakamabhinirvartate; evameShasaptavidhaHkuShThavisheShobhavati| sacaiShabhUyastaratamataHprakRutauvikalpyamAnAyAMbhUyasIMvikAravikalpasa~gkhyAmApadyate||5||  

ihavAtAdiShutriShuprakupiteShutvagAdIMshcaturaHpradUShayatsuvAte~adhikatarekapAlakuShThamabhinirvartate, pittetvaudumbaraM, shleShmaNimaNDalakuShThaM, vAtapittayorRuShyajihvaM, pittashleShmaNoHpuNDarIkaM, shleShmamArutayoHsidhmakuShThaM, sarvadoShAbhivRuddhaukAkaNakamabhinirvartate; evameShasaptavidhaHkuShThavisheShobhavati| sacaiShabhUyastaratamataHprakRutauvikalpyamAnAyAMbhUyasIMvikAravikalpasa~gkhyAmApadyate||5||  

 

When ''vata'' and other ''doshas'' are aggravated and affect four vitiated ''dhatus'' such as ''twak'', and there is dominance of ''vata'' ''dosha'', then the disease is known as ''kapala kushtha''. Similarly ''dosha'' dominance with other six diseases are explained in the table below:

When ''vata'' and other ''doshas'' are aggravated and affect four vitiated ''dhatus'' such as ''twak'', and there is dominance of ''vata'' ''dosha'', then the disease is known as ''kapala kushtha''. Similarly ''dosha'' dominance with other six diseases are explained in the table below:

 

Table 1: The major skin diseases and its dosha dominance.

Table 1: The major skin diseases and its dosha dominance.

The common etiological factors for all types of ''kushtha'' are briefly described below:  

The common etiological factors for all types of ''kushtha'' are briefly described below:  

 

*Continuous exposure to sudden interchange use of cold and hot without following gradual change rule (exposure to sudden change in temperature),  

*Continuous exposure to sudden interchange use of cold and hot without following gradual change rule (exposure to sudden change in temperature),  

*Sudden interchange/ alternate consumption of nourishing and depleting diets (change is diet qualities);

*Sudden interchange/ alternate consumption of nourishing and depleting diets (change is diet qualities);

Above causative factors lead to simultaneous aggravation of all the ''tridosha'', weakness in the skin etc. four ''dushyas''. Aggravated ''doshas'' lodge themselves in these weakened factors and after localization, further vitiate them and manifest ''kushtha''. [6]

Above causative factors lead to simultaneous aggravation of all the ''tridosha'', weakness in the skin etc. four ''dushyas''. Aggravated ''doshas'' lodge themselves in these weakened factors and after localization, further vitiate them and manifest ''kushtha''. [6]

 

==== Premonitory signs of ''kushtha'' ====

==== Premonitory signs of ''kushtha'' ====

tēṣāmimāni pūrvarūpāṇi bhavanti; tadyathā- asvēdanamatisvēdanaṁ pāruṣyamatiślakṣṇatā vaivarṇyaṁkaṇḍūrnistōdaḥ suptatā paridāhaḥ pariharṣō lōmaharṣaḥ kharatvamūṣmāyaṇaṁ gauravaṁśvayathurvīsarpāgamanamabhīkṣṇaṁ ca kāyē kāyacchidrēṣūpadēhaḥpakvadagdhadaṣṭabhagnakṣatōpaskhalitēṣvatimātraṁ vēdanā svalpānāmapi ca vraṇānāṁduṣṭirasaṁrōhaṇaṁ cēti||7||

tēṣāmimāni pūrvarūpāṇi bhavanti; tadyathā- asvēdanamatisvēdanaṁ pāruṣyamatiślakṣṇatā vaivarṇyaṁkaṇḍūrnistōdaḥ suptatā paridāhaḥ pariharṣō lōmaharṣaḥ kharatvamūṣmāyaṇaṁ gauravaṁśvayathurvīsarpāgamanamabhīkṣṇaṁ ca kāyē kāyacchidrēṣūpadēhaḥpakvadagdhadaṣṭabhagnakṣatōpaskhalitēṣvatimātraṁ vēdanā svalpānāmapi ca vraṇānāṁduṣṭirasaṁrōhaṇaṁ cēti||7||

teShAmimAnipUrvarUpANibhavanti; tadyathA- asvedanamatisvedanaMpAruShyamatishlakShNatAvaivarNyaMkaNDUrnistodaHsuptatAparidAhaHpariharSholomaharShaHkharatvamUShmAyaNaMgauravaMshvayathurvIsarpAgamanamabhIkShNaMcakAyekAyacchidreShUpadehaHpakvadagdhadaShTabhagnakShatopaskhaliteShvatimAtraMvedanAsvalpAnAmapicavraNAnAMduShTirasaMrohaNaMceti||7||  

teShAmimAnipUrvarUpANibhavanti; tadyathA- asvedanamatisvedanaMpAruShyamatishlakShNatAvaivarNyaMkaNDUrnistodaHsuptatAparidAhaHpariharSholomaharShaHkharatvamUShmAyaNaMgauravaMshvay<br>athurvIsarpAgamanamabhIkShNaMcakAyekAyacchidreShUpadehaHpakvadagdhadaShTabhagnakShatopaskhaliteShvatimAtraMvedanAsvalpAnAmapicavraNAnAMduShT<br>irasaMrohaNaMceti||7||  

 

The clinical manifestations of skin diseases are preceded by or associated with loss or excessive sweating (at the site of localization of vitiates ''doshas''), excess rough or excess smooth skin, discoloration, itching, pricking sensation, numbness, severe burning sensation, tingling sensation, goose bumps, xerosis on palpation, hot flashes, heaviness, swelling, if there is tenderness it indicates the possibility of suppurated, burnt, bitten, broken, injured and dislocated parts and even smaller ulcers become chronic, non healing.[7]

The clinical manifestations of skin diseases are preceded by or associated with loss or excessive sweating (at the site of localization of vitiates ''doshas''), excess rough or excess smooth skin, discoloration, itching, pricking sensation, numbness, severe burning sensation, tingling sensation, goose bumps, xerosis on palpation, hot flashes, heaviness, swelling, if there is tenderness it indicates the possibility of suppurated, burnt, bitten, broken, injured and dislocated parts and even smaller ulcers become chronic, non healing.[7]

 

==== Specific features of ''kapala kushtha'' ====

==== Specific features of ''kapala kushtha'' ====

   

   

''Kapala kushtha'' has the following specific manifestations:

''Kapala kushtha'' has the following specific manifestations:

 

Dry, crimson red in color, coarse, unevenly spread, having rough edges, thin and slightly elevated periphery, severe numbness, covered with bristling hair, afflicted with extreme piercing pain, having mild itching, burning sensation, less serous and pus discharge, having acute manifestation and quick progression, are infested with maggots  and appear like a black or blackish red piece of broken earthen pot.(1)

Dry, crimson red in color, coarse, unevenly spread, having rough edges, thin and slightly elevated periphery, severe numbness, covered with bristling hair, afflicted with extreme piercing pain, having mild itching, burning sensation, less serous and pus discharge, having acute manifestation and quick progression, are infested with maggots  and appear like a black or blackish red piece of broken earthen pot.(1)

 

==== ''Audumbara kushtha'' ====

==== ''Audumbara kushtha'' ====

tāmrāṇi tāmrakhararōmarājībhiravanaddhānibahalāni bahubahalapūyaraktalasīkāni kaṇḍūklēdakōthadāhapākavantyāśugatisamutthānabhēdīnisasantāpakrimīṇi pakvōdumbaraphalavarṇānyaudumbarakuṣṭhānīti vidyāt(2);

tāmrāṇi tāmrakhararōmarājībhiravanaddhānibahalāni bahubahalapūyaraktalasīkāni kaṇḍūklēdakōthadāhapākavantyāśugatisamutthānabhēdīnisasantāpakrimīṇi pakvōdumbaraphalavarṇānyaudumbarakuṣṭhānīti vidyāt(2);

tAmrANitAmrakhararomarAjIbhiravanaddhAnibahalAnibahubahalapUyaraktalasIkAnikaNDUkledakothadAhapAkavantyAshugatisamutthAnabhedInisasantApaKrimiNipakvodumbaraphalavarNAnyaudumbarakuShThanItividyAt(2);

tAmrANitAmrakhararomarAjIbhiravanaddhAnibahalAnibahubahalapUyaraktalasIkAnikaNDUkledakothadAhapAkavantyAshugatisamutthAnabhedInisasantApaKrimi<br>NipakvodumbaraphalavarNAnyaudumbarakuShThanItividyAt(2);

''Audumbara kushtha'' has the following features:

''Audumbara kushtha'' has the following features:

 

The color of affected part of skin is coppery, covered with coppery-rough (thick) hair, have plenty of thick discharge of pus, blood and lymph accompanied with itching, moistened, sloughing, burning sensation and suppuration, having acute manifestation and quick progression, associated with rise in temperature and infested with maggots, appear like the ripe fruit of ''Udumbara'' (Ficus racemosa Linn) in color.(2)

The color of affected part of skin is coppery, covered with coppery-rough (thick) hair, have plenty of thick discharge of pus, blood and lymph accompanied with itching, moistened, sloughing, burning sensation and suppuration, having acute manifestation and quick progression, associated with rise in temperature and infested with maggots, appear like the ripe fruit of ''Udumbara'' (Ficus racemosa Linn) in color.(2)

 

==== ''Mandala kushtha'' ====

==== ''Mandala kushtha'' ====

snigdhānigurūṇyutsēdhavanti ślakṣṇasthirapītaparyantāni [3] śuklaraktāvabhāsāni śuklarōmarājīsantānānibahubahalaśuklapicchilasrāvīṇi [4] bahuklēdakaṇḍūkrimīṇi saktagatisamutthānabhēdīni parimaṇḍalānimaṇḍalakuṣṭhāni vidyāt(3);

snigdhānigurūṇyutsēdhavanti ślakṣṇasthirapītaparyantāni [3] śuklaraktāvabhāsāni śuklarōmarājīsantānānibahubahalaśuklapicchilasrāvīṇi [4] bahuklēdakaṇḍūkrimīṇi saktagatisamutthānabhēdīni parimaṇḍalānimaṇḍalakuṣṭhāni vidyāt(3);

snigdhAnigurUNyutsedhavantishlakShNasthirapItaparyantAnishuklaraktAvabhAsAnishuklaromarAjIsantAnAnibahubahalashuklapicchilasrAvINibahukledakaNDUKrimiNisaktagatisamutthAnabhedIniparimaNDalAnimaNDalakuShThanividyAt(3);

snigdhAnigurUNyutsedhavantishlakShNasthirapItaparyantAnishuklaraktAvabhAsAnishuklaromarAjIsantAnAnibahubahalashuklapicchilasrAvINibahukledakaNDUKrimiNisak<br>tagatisamutthAnabhedIniparimaNDalAnimaNDalakuShThanividyAt(3);

''Mandala kushtha'' has following features:

''Mandala kushtha'' has following features:

 

Skin is unctuous, heavy, elevated with smooth, fixed and yellowish margins, white and reddish in appearance, filled with white hairlines associated with copious, thick, white  and slimy discharge, excessive oozing and itching,  infested with numerous maggots, lesions are slow to spread & progression, round in shape.(3)

Skin is unctuous, heavy, elevated with smooth, fixed and yellowish margins, white and reddish in appearance, filled with white hairlines associated with copious, thick, white  and slimy discharge, excessive oozing and itching,  infested with numerous maggots, lesions are slow to spread & progression, round in shape.(3)

 

==== ''Rishyajihva kushtha'' ====

==== ''Rishyajihva kushtha'' ====

paruṣāṇyaruṇavarṇāni bahirantaḥśyāvāninīlapītatāmrāvabhāsānyāśugatisamutthānānyalpakaṇḍūklēdakrimīṇi dāhabhēdanistōda(pāka)bahulāniśūkōpahatōpamavēdanānyutsannamadhyāni tanuparyantāni karkaśapiḍakācitānidīrghaparimaṇḍalānyr̥ṣyajihvākr̥tīni r̥ṣyajihvānīti vidyāt (4);

paruṣāṇyaruṇavarṇāni bahirantaḥśyāvāninīlapītatāmrāvabhāsānyāśugatisamutthānānyalpakaṇḍūklēdakrimīṇi dāhabhēdanistōda(pāka)bahulāniśūkōpahatōpamavēdanānyutsannamadhyāni tanuparyantāni karkaśapiḍakācitānidīrghaparimaṇḍalānyr̥ṣyajihvākr̥tīni r̥ṣyajihvānīti vidyāt (4);

paruShANyaruNavarNAnibahirantaHshyAvAninIlapItatAmrAvabhAsAnyAshugatisamutthAnAnyalpakaNDUkledaKrimiNidAhabhedanistoda(pAka)bahulAnishUkopahatopamavedanAnyutsannamadhyAnitanuparyantAnikarkashapiDakAcitAnidIrghaparimaNDalAnyRuShyajihvAkRutIniRuShyajihvAnItividyAt(4);

paruShANyaruNavarNAnibahirantaHshyAvAninIlapItatAmrAvabhAsAnyAshugatisamutthAnAnyalpakaNDUkledaKrimiNidAhabhedanistoda(pAka)bahulAnishUkopahatopam<br>avedanAnyutsannamadhyAnitanuparyantAnikarkashapiDakAcitAnidIrghaparimaNDalAnyRuShyajihvAkRutIniRuShyajihvAnItividyAt(4);

''Rishyajivha kushtha'' has following features:

''Rishyajivha kushtha'' has following features:

 

In this skin is rough, downy red, blackish in the center as well as in the periphery, have the appearance of shades of blue, yellow and coppery tinge associated with acute onset and spreading, with less itching, oozing and maggot infestation, having excessive burning sensation, ulceration, piercing pain (suppuration) as if pierced with bristles, with elevated center and thin margins; surrounded with rough papules and  having large circumference  and shape like that of the antelope (''rishyajihva'') tongue. (4);

In this skin is rough, downy red, blackish in the center as well as in the periphery, have the appearance of shades of blue, yellow and coppery tinge associated with acute onset and spreading, with less itching, oozing and maggot infestation, having excessive burning sensation, ulceration, piercing pain (suppuration) as if pierced with bristles, with elevated center and thin margins; surrounded with rough papules and  having large circumference  and shape like that of the antelope (''rishyajihva'') tongue. (4);

 

==== ''Pundarika kushtha'' ====

==== ''Pundarika kushtha'' ====

śuklaraktāvabhāsāni raktaparyantāniraktarājīsirāsantatānyutsēdhavanti bahubahalaraktapūyalasīkānikaṇḍūkrimidāhapākavantyāśugatisamutthānabhēdīni puṇḍarīkapalāśasaṅkāśāni puṇḍarīkāṇīti vidyāt (5);

śuklaraktāvabhāsāni raktaparyantāniraktarājīsirāsantatānyutsēdhavanti bahubahalaraktapūyalasīkānikaṇḍūkrimidāhapākavantyāśugatisamutthānabhēdīni puṇḍarīkapalāśasaṅkāśāni puṇḍarīkāṇīti vidyāt (5);

shuklaraktAvabhAsAniraktaparyantAniraktarAjIsirAsantatAnyutsedhavantibahubahalaraktapUyalasIkAnikaNDUKrimidAhapAkavantyAshugatisamutthAnabhedInipuNDarIkapalAshasa~gkAshAnipuNDarIkANItividyAt(5);  

shuklaraktAvabhAsAniraktaparyantAniraktarAjIsirAsantatAnyutsedhavantibahubahalaraktapUyalasIkAnikaNDUKrimidAhapAkavantyAshugatisamutthAnabhedInipuNDarIkap<br>alAshasa~gkAshAnipuNDarIkANItividyAt(5);  

 

''Pundarika kushtha'' has following features: In this type, the skin is white with reddish shade, with red margins covered with red lines and blood vessels, elevated, with copious thick blood, pus and serous discharge, associated with itching, maggots infestation, burning sensation and suppuration, and having acute manifestation and quick progression, appears like the petals of lotus(or Butea monospemum flower). (5);

''Pundarika kushtha'' has following features: In this type, the skin is white with reddish shade, with red margins covered with red lines and blood vessels, elevated, with copious thick blood, pus and serous discharge, associated with itching, maggots infestation, burning sensation and suppuration, and having acute manifestation and quick progression, appears like the petals of lotus(or Butea monospemum flower). (5);

 

==== ''Sidhma kushtha'' ====

==== ''Sidhma kushtha'' ====

paruṣāruṇāni [5] viśīrṇabahistanūnyantaḥsnigdhāni śuklaraktāvabhāsānibahūnyalpavēdanānyalpakaṇḍūdāhapūyalasīkānilaghusamutthānānyalpabhēdakrimīṇyalābupuṣpasaṅkāśāni sidhmakuṣṭhānīti vidyāt (6);

paruṣāruṇāni [5] viśīrṇabahistanūnyantaḥsnigdhāni śuklaraktāvabhāsānibahūnyalpavēdanānyalpakaṇḍūdāhapūyalasīkānilaghusamutthānānyalpabhēdakrimīṇyalābupuṣpasaṅkāśāni sidhmakuṣṭhānīti vidyāt (6);

paruShAruNAnivishIrNabahistanUnyantaHsnigdhAnishuklaraktAvabhAsAnibahUnyalpavedanAnyalpakaNDUdAhapUyalasIkAnilaghusamutthAnAnyalpabhedaKrimiNyalAbupuShpasa~gkAshAnisidhmakuShThanItividyAt (6);

paruShAruNAnivishIrNabahistanUnyantaHsnigdhAnishuklaraktAvabhAsAnibahUnyalpavedanAnyalpakaNDUdAhapUyalasIkAnilaghusamutthAnAnyalpabhedaKrimiNyalAbup<br>uShpasa~gkAshAnisidhmakuShThanItividyAt (6);

''Sidhma kushtha'' has following features:

''Sidhma kushtha'' has following features:

 

In this type, skin is rough and downy red in color, with external margins fissured and thin, unctuous at the center, having white and red shades, numerous lesions, associated with mild pain, itching, burning sensation, purulent and serous discharge, having mild initiation and progression, and less maggots infestation, appear like flower of ''alabu'' (Lagenaria siceraria Standi (bottle gourd)) – are to be known as ''sidhma kushtha''(6);

In this type, skin is rough and downy red in color, with external margins fissured and thin, unctuous at the center, having white and red shades, numerous lesions, associated with mild pain, itching, burning sensation, purulent and serous discharge, having mild initiation and progression, and less maggots infestation, appear like flower of ''alabu'' (Lagenaria siceraria Standi (bottle gourd)) – are to be known as ''sidhma kushtha''(6);

 

==== ''Kakanaka kushtha'' ====

==== ''Kakanaka kushtha'' ====

tatrayadasAdhyaMtadasAdhyatAMnAtivartate, sAdhyaMpunaHki~jcitsAdhyatAmativartatekadAcidapacArAt| sAdhyAni hi ShaTkAkaNakavarjyAnyacikitsyamAnAnyapacAratovAdoShairabhiShyandamAnAnyasAdhyatAmupayAnti||9||  

tatrayadasAdhyaMtadasAdhyatAMnAtivartate, sAdhyaMpunaHki~jcitsAdhyatAmativartatekadAcidapacArAt| sAdhyAni hi ShaTkAkaNakavarjyAnyacikitsyamAnAnyapacAratovAdoShairabhiShyandamAnAnyasAdhyatAmupayAnti||9||  

 

The incurable disease never give up its incurability (never become curable). The curable disease may sometimes become incurable due to misconduct (not following the diet and lifestyle regulations properly). The six (types of) ''kushtha'' are curable except ''kakanaka''. However if not treated properly, they may become incurable due to lack of timely management, improper management and constantly excess aggravation of ''doshas''. [9]

The incurable disease never give up its incurability (never become curable). The curable disease may sometimes become incurable due to misconduct (not following the diet and lifestyle regulations properly). The six (types of) ''kushtha'' are curable except ''kakanaka''. However if not treated properly, they may become incurable due to lack of timely management, improper management and constantly excess aggravation of ''doshas''. [9]

 

==== Complications of ''kushtha'' ====

==== Complications of ''kushtha'' ====

sAdhyAnAmapihyupekShyamANAnAMtva~gmAMsashoNitalasIkAkothakledasaMsvedajAHkrimayo~abhimUrcchanti; tebhakShayantastvagAdIndoShAHpunardUShayantaimAnupadravAnpRuthakpRuthagutpAdayanti- tatravAtaHshyAvAruNavarNaMparuShatAmapica raukShyashUlashoShatodavepathuharShasa~gkocAyAsastambhasuptibhedabha~ggAn, pittaMdAhasvedakledakothasrAvapAkarAgAn, shleShmAtvasyashvaityashaityakaNDUsthairyagauravotsedhopasnehopalepAn, krimayastutvagAdIMshcaturaHsirAHsnAyUshcAsthInyapicataruNAnyAdadate ||10||  

sAdhyAnAmapihyupekShyamANAnAMtva~gmAMsashoNitalasIkAkothakledasaMsvedajAHkrimayo~abhimUrcchanti; tebhakShayantastvagAdIndoShAHpunardUShayantaimAnupadravAnpRuthakpRuthagutpAdayanti- tatravAtaHshyAvAruNavarNaMparuShatAmapica raukShyashUlashoShatodavepathuharShasa~gkocAyAsastambhasuptibhedabha~ggAn, pittaMdAhasvedakledakothasrAvapAkarAgAn, shleShmAtvasyashvaityashaityakaNDUsthairyagauravotsedhopasnehopalepAn, krimayastutvagAdIMshcaturaHsirAHsnAyUshcAsthInyapicataruNAnyAdadate ||10||  

 

If the curable diseases are neglected (not treated), then they are also afflicted with putrefaction of skin, muscle tissue, blood, lymph and ''swedaja krimi'' (maggots or micro-organisms). The ''krimi'' get nourishment from the decayed skin etc. and further vitiate ''doshas'' leading to variety of complications corresponding to individual ''doshas'' as follows:  

If the curable diseases are neglected (not treated), then they are also afflicted with putrefaction of skin, muscle tissue, blood, lymph and ''swedaja krimi'' (maggots or micro-organisms). The ''krimi'' get nourishment from the decayed skin etc. and further vitiate ''doshas'' leading to variety of complications corresponding to individual ''doshas'' as follows:  

   

   

*''Pitta'' causes burning sensation, sweating, moistening, putrefaction, discharge, suppuration and redness;  

*''Pitta'' causes burning sensation, sweating, moistening, putrefaction, discharge, suppuration and redness;  

*''Kapha'' causes whiteness, coldness, itching, immobility, heaviness, protuberance, unctuousness and coating, maggots eat up the skin etc. (skin, flesh, blood, lymph) vessels, ligaments  and cartilages. [10]

*''Kapha'' causes whiteness, coldness, itching, immobility, heaviness, protuberance, unctuousness and coating, maggots eat up the skin etc. (skin, flesh, blood, lymph) vessels, ligaments  and cartilages. [10]

 

अस्यां चैवावस्थायामुपद्रवाः कुष्ठिनं स्पृशन्ति; तद्यथा- प्रस्रवणमङ्गभेदः पतनान्यङ्गावयवानां तृष्णाज्वरातीसारदाहदौर्बल्यारोचकाविपाकाश्च, तथाविधमसाध्यं विद्यादिति||११||  

अस्यां चैवावस्थायामुपद्रवाः कुष्ठिनं स्पृशन्ति; तद्यथा- प्रस्रवणमङ्गभेदः पतनान्यङ्गावयवानां तृष्णाज्वरातीसारदाहदौर्बल्यारोचकाविपाकाश्च, तथाविधमसाध्यं विद्यादिति||११||  

asyAMcaivAvasthAyAmupadravAHkuShThinaMspRushanti; tadyathA- prasravaNama~ggabhedaHpatanAnya~ggAvayavAnAMtRuShNAjvarAtIsAradAhadaurbalyArocakAvipAkAshca, tathAvidhamasAdhyaMvidyAditi||11||  

asyAMcaivAvasthAyAmupadravAHkuShThinaMspRushanti; tadyathA- prasravaNama~ggabhedaHpatanAnya~ggAvayavAnAMtRuShNAjvarAtIsAradAhadaurbalyArocakAvipAkAshca, tathAvidhamasAdhyaMvidyAditi||11||  

 

During this stage, a patient of ''kushtha'' afflicts with complications such as- excessive discharge, ulceration of body parts, sequestration of body  parts (necrosis of phallenges), thirst, fever, diarrhea, burning sensation, debility, anorexia, indigestion. Such types of ''kushtha'' should be known as incurable. [11]

During this stage, a patient of ''kushtha'' afflicts with complications such as- excessive discharge, ulceration of body parts, sequestration of body  parts (necrosis of phallenges), thirst, fever, diarrhea, burning sensation, debility, anorexia, indigestion. Such types of ''kushtha'' should be known as incurable. [11]

 

==== Summary ====

==== Summary ====

tatrashlokaH-  

tatrashlokaH-  

sa~gkhyAdravyANidoShAshcahetavaHpUrvalakShaNam| rUpANyupadravAshcoktAHkuShThanAMkauShThikepRuthak||16||

sa~gkhyAdravyANidoShAshcahetavaHpUrvalakShaNam| rUpANyupadravAshcoktAHkuShThanAMkauShThikepRuthak||16||

 

The individual, who neglects the disease in early stage by assuming it as curable,( does not take treatment at early stage) can be regarded as dead after a lapse of time(due to complications). The individual who took treatment properly prior to full manifestation of disease or in its early stage attains happiness for long time. Just as a tender plant is easy to cut down with a little effort, but the same require great effort when fully grown.

The individual, who neglects the disease in early stage by assuming it as curable,( does not take treatment at early stage) can be regarded as dead after a lapse of time(due to complications). The individual who took treatment properly prior to full manifestation of disease or in its early stage attains happiness for long time. Just as a tender plant is easy to cut down with a little effort, but the same require great effort when fully grown.

Likewise, a disease is easily curable in the early stage; it becomes incurable or difficulty to cure as it reaches the advanced stage.[12-15]

Likewise, a disease is easily curable in the early stage; it becomes incurable or difficulty to cure as it reaches the advanced stage.[12-15]

 

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने कुष्ठनिदानं नाम पञ्चमोऽध्यायः||५||  

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते निदानस्थाने कुष्ठनिदानं नाम पञ्चमोऽध्यायः||५||  

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

 

*''Kushtha'' is the result of combined and simultaneous involvement of all the three ''dosha'' and subsequently vitiation of the four body constituents i.e. ''rasa'' (''twak'', or skin), ''mamsa''(muscle tissue), ''rakta''(blood), and ''lasika''(lymph).

*''Kushtha'' is the result of combined and simultaneous involvement of all the three ''dosha'' and subsequently vitiation of the four body constituents i.e. ''rasa'' (''twak'', or skin), ''mamsa''(muscle tissue), ''rakta''(blood), and ''lasika''(lymph).

*There can be infinite clinical presentations of ''kushtha'' (skin diseases) depending upon severity of combination of abovementioned vitiating factors.

*There can be infinite clinical presentations of ''kushtha'' (skin diseases) depending upon severity of combination of abovementioned vitiating factors.

The ''mahakushtha'' has been classified under seven types as per their ''dosha'' predominance accordingly symptomatology of these has been described. All the body physiology and pathology is designated to a particular ''dosha'' thus the diseases are basically diagnosed on the basis of three ''dosha'' and their combinations. The color, texture, secretions, margins, and types of pain associated with these lesions, as wsell as their progression have been classified on the basis of three ''dosha''.

The ''mahakushtha'' has been classified under seven types as per their ''dosha'' predominance accordingly symptomatology of these has been described. All the body physiology and pathology is designated to a particular ''dosha'' thus the diseases are basically diagnosed on the basis of three ''dosha'' and their combinations. The color, texture, secretions, margins, and types of pain associated with these lesions, as wsell as their progression have been classified on the basis of three ''dosha''.

 

===== Layers of skin =====

===== Layers of skin =====

|}

|}

 

Thus on the basis of symptomatology of it can be inferred that maha-kushtha is a group of skin diseases that includes Leprosy. However, there is ample scope to include, diagnose and treat any other syndromes available today or occurring in future on the basis of this description of kushtha.(shloka 8 -1 to 6)

Thus on the basis of symptomatology of it can be inferred that maha-kushtha is a group of skin diseases that includes Leprosy. However, there is ample scope to include, diagnose and treat any other syndromes available today or occurring in future on the basis of this description of kushtha.(shloka 8 -1 to 6)

Prognosis of kushtha:  

Prognosis of kushtha:  

Eswar Reddy M - Effect of Pancha KarmaChikitsa and GandhakaRasayana in the management of leprosy. 1988 Kayachikitsa Mysore

Eswar Reddy M - Effect of Pancha KarmaChikitsa and GandhakaRasayana in the management of leprosy. 1988 Kayachikitsa Mysore

Bora Dilip - To study Vedini-Tvacha in Sushrutaw.s.r.  to leprosy. ShareeraRachana – Ashtanga Ayurved Mahavi-dyalaya, Pune

Bora Dilip - To study Vedini-Tvacha in Sushrutaw.s.r.  to leprosy. ShareeraRachana – Ashtanga Ayurved Mahavi-dyalaya, Pune