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=== Abstract ===

=== Abstract ===

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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 [[Charak 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 ===

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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 Charak 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]].  

Some scholars like William Monier and others have translated the word ''kushtha'' as leprosy which is incorrect, because skin manifestations of advanced ''kushtha'' resemble leprosy, but there is absence of Mycobacterium leprea. In advanced stages of ''kushtha'', secondary infection with bacteria occurs (''jantudagdha'' or eaten by microorganism). Skin disorders are innumerable, and accordingly a broad pathogenesis and management has been described. Among the two broad groups, ''Mahakushtha'' (major dermatosis) has seven types which include the conditions where all the seven pathological components are involved. The disease progresses beyond the skin and may lead to destruction of limbs. Whereas ''kshudra-kushtha'' (minor dermatosis) has eleven types which includes the conditions where some of the seven pathological components are involved, have few symptoms, disease runs a chronic course and is usually curable. ''Kushtha'' is described in such a fashion that it may explain any of the dermatological conditions of present era. Their pathological features can be ascertained and treatment protocol can be established.

Some scholars like William Monier and others have translated the word ''kushtha'' as leprosy which is incorrect, because skin manifestations of advanced ''kushtha'' resemble leprosy, but there is absence of Mycobacterium leprea. In advanced stages of ''kushtha'', secondary infection with bacteria occurs (''jantudagdha'' or eaten by microorganism). Skin disorders are innumerable, and accordingly a broad pathogenesis and management has been described. Among the two broad groups, ''Mahakushtha'' (major dermatosis) has seven types which include the conditions where all the seven pathological components are involved. The disease progresses beyond the skin and may lead to destruction of limbs. Whereas ''kshudra-kushtha'' (minor dermatosis) has eleven types which includes the conditions where some of the seven pathological components are involved, have few symptoms, disease runs a chronic course and is usually curable. ''Kushtha'' is described in such a fashion that it may explain any of the dermatological conditions of present era. Their pathological features can be ascertained and treatment protocol can be established.

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 Charak 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).

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

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

ityagniveshakRutetantrecarakapratisaMskRutenidAnasthAnekuShThanidAnaMnAmapa~jcamo~adhyAyaH||5||

ityagniveshakRutetantrecarakapratisaMskRutenidAnasthAnekuShThanidAnaMnAmapa~jcamo~adhyAyaH||5||

Thus ends the fifth chapter on [[Kushtha Nidana]] in [[Nidana Sthana]] in the treatise composed by Agnivesha and as redacted by Charaka.

Thus ends the fifth chapter on [[Kushtha Nidana]] in [[Nidana Sthana]] in the treatise composed by Agnivesha and as redacted by Charak.

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

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

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

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

Charaka and Sushruta both have enumerated the layers of skin and the thickness of layers and diseases occurring in these layers have also been narrated. Their possible modern equivalence as given by some scholars in Ayurvedic texts is as follows:

Charak and Sushruta both have enumerated the layers of skin and the thickness of layers and diseases occurring in these layers have also been narrated. Their possible modern equivalence as given by some scholars in Ayurvedic texts is as follows:

{| class="wikitable"

{| class="wikitable"

Prognostic criteria for curability or incurability has been given much importance. Text cautions that incurable will not leave its nature, however curable conditions can become incurable due improper treatment. With the availability of newer treatments and better diagnostic tools many syndromes which, were listed as incurable have become palliable. The management of leprosy is one example of change in the approach to management with the help of antibiotics, but, with limitations. The outcome of treatment can be significantly changed if the current antibiotic treatment is supplemented with Ayurvedic management.  

Prognostic criteria for curability or incurability has been given much importance. Text cautions that incurable will not leave its nature, however curable conditions can become incurable due improper treatment. With the availability of newer treatments and better diagnostic tools many syndromes which, were listed as incurable have become palliable. The management of leprosy is one example of change in the approach to management with the help of antibiotics, but, with limitations. The outcome of treatment can be significantly changed if the current antibiotic treatment is supplemented with Ayurvedic management.  

After the fifth stage of the therapeutic intervention i.e. rupa (proper manifestation) if the disease is not managed properly or the intervention is ineffective the disease progresses further and produces symptoms of upadrava (complications). These symptoms and signs have again been classified on the basis of tri-dosha. As the rasa(twak), rakta, mamsa and lasika ( lymphatic tissue) are involved in the manifestation of kushtha, its progression to the deeper tissues like meda, asthi, majja and shukra will lead to complications. This includes permanent disfiguration of organs, loss of phalanges and infection of wounds by maggots causing severe damage to the tissues like bones. (shloka (10-16)

After the fifth stage of the therapeutic intervention i.e. rupa (proper manifestation) if the disease is not managed properly or the intervention is ineffective the disease progresses further and produces symptoms of upadrava (complications). These symptoms and signs have again been classified on the basis of tri-dosha. As the rasa(twak), rakta, mamsa and lasika ( lymphatic tissue) are involved in the manifestation of kushtha, its progression to the deeper tissues like meda, asthi, majja and shukra will lead to complications. This includes permanent disfiguration of organs, loss of phalanges and infection of wounds by maggots causing severe damage to the tissues like bones. (shloka (10-16)

If the symptomatology described by Charaka and Dhatugata symptoms of Sushruta are compared, it is evident that the symptoms described for rasa dhatu represent poorvarupa. Rakta and mamsagata symptoms are listed as rupa of kushtha. The symptoms listed as medagata are the disfigurement of the organs, falling of limbs and flaring of skin lesions. The symptoms listed as asthigata kushtha are saddle nose, kerato- conjunctivitis, growth of maggots in lesions and loss of speech. This list of dhatugata kushtha described by Sushruta covers almost all the complications of leprosy. Thus taking into the consideration of Dhatugata stage of the disease further insight in the management of the disease as Sushruta has advised to increase the intensity of the treatment taking into the consideration of the dhatu involved.

If the symptomatology described by Charak and Dhatugata symptoms of Sushruta are compared, it is evident that the symptoms described for rasa dhatu represent poorvarupa. Rakta and mamsagata symptoms are listed as rupa of kushtha. The symptoms listed as medagata are the disfigurement of the organs, falling of limbs and flaring of skin lesions. The symptoms listed as asthigata kushtha are saddle nose, kerato- conjunctivitis, growth of maggots in lesions and loss of speech. This list of dhatugata kushtha described by Sushruta covers almost all the complications of leprosy. Thus taking into the consideration of Dhatugata stage of the disease further insight in the management of the disease as Sushruta has advised to increase the intensity of the treatment taking into the consideration of the dhatu involved.

Sushruta in Ni 7/21-26 has explained the symptomatology on the basis of dhatugata stage of the dosha. Rasa, lasika, rakta and mamsa are dushya, in this disease hence complications arise when the dosha proceed to the deeper dhatu, meda and majja.

Sushruta in Ni 7/21-26 has explained the symptomatology on the basis of dhatugata stage of the dosha. Rasa, lasika, rakta and mamsa are dushya, in this disease hence complications arise when the dosha proceed to the deeper dhatu, meda and majja.

Samswedaja Krimi (Maggot/micro-organisms infestation with sweating) is a complication is to be kept in mind for treatment purpose.

Samswedaja Krimi (Maggot/micro-organisms infestation with sweating) is a complication is to be kept in mind for treatment purpose.