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Kushtha Chikitsa (view source)

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|titlemode=append

|keywords=Skin diseases saptakō dravya, kōṭhānāṁ, Kaṇḍū, kapāla, udumbara, maṇḍala, rṣyajihva, puṇḍarīka, sidhma, kākaṇaka, ekakuṣṭha, carmākhya, kiṭima, vipādika, alasaka, dadru, carmadala, pāmā, visphōṭaka, śatāru, vicārcikā, ksudrakuṣṭha, mahakuṣṭha, matsyaśakalōpāmām, hasticarmavat, kiṇakharasparśaṁ, lēlītaka, madhvāsava, śvētakaravīrādya tailam, tiktēkṣvākvādi taila, kanakakṣīrītaila, tiktaṣaṭpalakaṁ ghr̥ta, mahātiktakaṁ ghr̥tam, mahākhadiraṁ ghr̥ta, śvitrā, dāruṇa, cāruṇaṁ, kilāsa

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|description=Chikitsa Sthana Chapter 7. Management of Kushtha (Skin ~~Disorders~~)

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|description=Chikitsa Sthana Chapter 7. Management of Kushtha (Skin Diseases)

}}

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'''<big>[[Chikitsa Sthana]] Chapter 7. Management of Kushtha (Skin ~~Disorders~~)'''</big>

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'''<big>[[Chikitsa Sthana]] Chapter 7. Management of Kushtha (Skin Diseases)'''</big>

'''<big> Abstract'''</big>

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[[Kushtha Chikitsa]] is a compendium of various skin diseases, divided into two groups i.e. major (''maha kushtha'') and ii. minor (''kshudra kushtha''). Seven types of major and eleven types of minor skin disorders or dermatosis are described here as guidelines to understand diagnosis and treatment principles of various skin disorders. Etiological factors including antagonistic food, suppression of natural urges especially vomiting, quick change in temperature, exposure to excess heat, and sudden biological changes in fluid volume and muscle mass cause ''kushtha''. Clinical features of skin disorders, their diagnosis according to dominance of ''dosha'' as well as their prognosis and treatment is described in detail. [[Panchakarma]] (five body purification procedures) are emphasized for management of skin diseases and prevention of recurrence. Local scrapping method for bloodletting in smaller lesions and venesection for large lesions, therapeutic purgation are important treatment measures in ''kushtha''. Medicinal preparations including ghee, formulations for internal administration and external application on skin lesions are described.

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'''Keywords''': Skin diseases ''~~saptakō~~ dravya, ~~kōṭhānāṁ~~, Kaṇḍū, kapāla, udumbara, maṇḍala, rṣyajihva, puṇḍarīka, sidhma, kākaṇaka, ekakuṣṭha, carmākhya, kiṭima, vipādika, alasaka, dadru, carmadala, pāmā, visphōṭaka, śatāru, vicārcikā, ksudrakuṣṭha, mahakuṣṭha, matsyaśakalōpāmām, hasticarmavat, kiṇakharasparśaṁ, lēlītaka, madhvāsava, śvētakaravīrādya tailam, tiktēkṣvākvādi taila, kanakakṣīrītaila, tiktaṣaṭpalakaṁ ghr̥ta, mahātiktakaṁ ghr̥tam, mahākhadiraṁ ghr̥ta, śvitrā, dāruṇa, cāruṇaṁ, kilāsa

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'''Keywords''': Skin diseases ''saptaka dravya, koṭhānāṁ, Kaṇḍū, kapāla, udumbara, maṇḍala, rṣyajihva, puṇḍarīka, sidhma, kākaṇaka, ekakuṣṭha, carmākhya, kiṭima, vipādika, alasaka, dadru, carmadala, pāmā, visphōṭaka, śatāru, vicārcikā, ksudrakuṣṭha, mahakuṣṭha, matsyaśakalōpāmām, hasticarmavat, kiṇakharasparśaṁ, lēlītaka, madhvāsava, śvētakaravīrādya tailam, tiktēkṣvākvādi taila, kanakakṣīrītaila, tiktaṣaṭpalakaṁ ghr̥ta, mahātiktakaṁ ghr̥tam, mahākhadiraṁ ghr̥ta, śvitrā, dāruṇa, cāruṇaṁ, kilāsa

''

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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.

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

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==Sanskrit Text, Transliteration and English Translation==

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</div></div>

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

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Now we shall expound the chapter "Kushtha Chikitsa'' (Management of skin diseases). Thus said Lord Atreya.

Etiology, factors essential for genesis of disease, symptoms and signs, premonitory features, pathogenesis along with treatment is being mentioned. Listen Agnivesha! The specialty of this disease is that there is loss of integrity of seat of ''sparshanendriya'' i.e. ''tvacha''. [1-3]

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==== Etiology ====

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=== Etiology ===

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Consuming new grains, curds, fish, excessive salty and sour food items. Black grams, radish, 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 etiological and risk factors of ''kushtha''. [4-8]

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==== Pathogenic factors ====

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=== Pathogenic factors ===

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The vitiated three ''doshas''- ''vata, pitta, kapha'' along with impaired ''tvak, rakta, mamsa'' and ''ambu'' together constitute seven essential entities which play role in pathogenesis of ''kushtha''. ''Kushtha'' can be classified into seven ''mahakushtha'' (major skin disorders) and eleven ''kshudrakushtha'' (eleven minor skin disorders). Single ''dosha'' cannot cause ''kushtha'' on its own i.e. ''kushtha'' is not an ''nanatmaja'' (disease caused by single specific ''dosha'') disease. [9-10]

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

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=== Premonitory signs and symptoms ===

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Decreased touch sensation, excessive sweating or absence of sweating (which may be localized or generalized), change in color (discoloration), 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]

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

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=== Eighteen types of skin diseases ===

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Henceforth 18 types of ''kushtha'' 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 ''vicārchikā''.[13]

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==== Seven major kushtha ====

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=== Seven major kushtha ===

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===== 1. ''Kapala Kushtha'' =====

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==== 1. ''Kapala Kushtha'' ====

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'''Sadhya / sadyata''' – Difficult to cure

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===== 2.''Udumbara kushtha'' =====

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==== 2.''Udumbara kushtha'' ====

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'''Associated symptoms''' – burning sensation, pruritus and pain

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===== 3.''Mandala Kushtha'' =====

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==== 3.''Mandala Kushtha'' ====

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'''Sadhyasadhyata''' – Difficult to cure

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===== 4.''Rishyajivha Kushtha'' =====

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==== 4.''Rishyajivha Kushtha'' ====

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'''Associated symptoms''' – pain

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===== 5.''Pundarika Kushtha'' =====

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==== 5.''Pundarika Kushtha'' ====

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'''Associated symptoms''' – burning sensation

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===== 6.''Sidhma Kushtha''=====

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==== 6.''Sidhma Kushtha''====

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'''Associated symptom''' – particles resembling dust are observed, it is located mostly on chest [due to dominance of ''kapha'' on ''ura pradesh'' Ca.Ci.7/19 Chakrapani].

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===== 7.''Kakanaka Kushtha'' =====

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==== 7.''Kakanaka Kushtha'' ====

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This ends the explanation of seven ''mahakushtha''.[14-20]

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==== Eleven ''kshudra kushtha'' ====

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=== Eleven ''kshudra kushtha'' ===

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===== 1.''Eka kuṣṭha'' =====

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==== 1.''Eka kuṣṭha'' ====

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'''Location''' – Extensive

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===== 2.''Charmakhya Kushtha''=====

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==== 2.''Charmakhya Kushtha''====

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'''Nature''' – skin is thick resembling elephant skin

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===== 3.''Kitibha Kushtha'' =====

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==== 3.''Kitibha Kushtha'' ====

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Touch similar to the granulation process in wound.

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===== 4.''Vaipadika Kushtha'' =====

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==== 4.''Vaipadika Kushtha'' ====

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'''Associated symptoms''' – severe / excruciating pain

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===== 5.''Alasaka Kuṣhtha'' =====

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==== 5.''Alasaka Kuṣhtha'' ====

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'''Color''' – redness

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===== 6.''Dadru Kushtha'' =====

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==== 6.''Dadru Kushtha'' ====

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'''Associated symptoms''' – Itching

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===== 7.''Charmadala Kushtha'' =====

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==== 7.''Charmadala Kushtha'' ====

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'''Associated symptoms''' – Itching

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===== 8.''Pāmā kuṣṭha'' =====

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==== 8.''Pāmā kuṣṭha'' ====

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'''Associated symptoms''' –''piḍakā'' (erruptions)

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===== 9. ''Visphōṭa kuṣṭha'' =====

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==== 9. ''Visphōṭa kuṣṭha'' ====

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'''Nature''' – erruptions and pustules with thin skin

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===== 10.''Śatāru kuṣṭha'' =====

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==== 10.''Śatāru kuṣṭha'' ====

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'''Associated symptoms''' – burning sensation and pain

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===== 11.''Vicārcikā kuṣṭha'' =====

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==== 11.''Vicārcikā kuṣṭha'' ====

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This ends the explanation of 11 ''ksudrakuṣṭha''.[21-26]

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==== ''Dosha'' dominance in types of ''kushtha'' ====

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=== ''Dosha'' dominance in types of ''kushtha'' ===

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|}

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==== General guidelines for diagnosis ====

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=== General guidelines for diagnosis ===

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Specific ''kushtha'' determine the predominance of specific ''dosha'' and vice versa is also true i.e. predominance of ''dosha'' determines the specific type of ''kushtha''. Similarly specific symptoms determine the causative factors vice versa causative factors determine the specific symptoms.[33]

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==== ''Dosha'' specific features of diagnosis of ''dosha'' dominance in ''kushtha'' ====

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=== ''Dosha'' specific features of diagnosis of ''dosha'' dominance in ''kushtha'' ===

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''Kapha dosha'' is responsible for symptoms like whitish discoloration, cold in touch, pruritus, non-progressive / slow progression of disease, elevated; heaviness and oiliness are presented along with maggot’s formation and stickiness like symptoms.[34-36]

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==== Prognosis ====

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=== Prognosis ===

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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 ''vata kapha'' predominated ''kushtha'' and single ''dosha'' predominated ''kushtha'' are not so difficult to treat. Whereas ''kapha pitta'' and ''vata pitta'' dominated ''kushtha'' are ''krichchra sadhya'' i.e. curable, but with efforts. [37-38]

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==== Principles of management ====

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=== Principles of management ===

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After ''shodhana'' and letting of blood, ''sneha'' should be administered since after ''shodhana'', ''vata dosha'' enters the ''shuddha koshtha'' of patient and is cause for immediate ''bala kshaya''.[42]

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==== Various formulations ====

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=== Various formulations ===

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If the patches are stable and hard, then give fomentation by ''prastara sweda'' or ''nadi sweda'' method and later on with the help of ''kurcha'' (a surgical instrument) scrub the patches so that there is increased flow of ''rakta'' in that specific area along with blood letting.[50]

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==== Local treatments ====

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=== Local treatments ===

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After the combination has been digested by ''jatharagni'' of patient, soup of animal and birds residing in arid land along with old ''shali'' type of rice should be given. The preparation when administered for 6 days cures ''kushtha, shotha, grahani, arsha, mutrakricha, halimaka,'' chest pain and pain in bladder region along with ''vishama jwara''. [62-64]

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==== ''Mustadi churna'' ====

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=== ''Mustadi churna'' ===

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''Triphala, ativiṣā, kaṭuki, nimba, kaliṅgaka, vachā, paṭōla, pippali, haridra, dāruharidra, padmaka, mūrvā, viśālā, bhūnimba'' and palāśa, all are taken in two ''pala'' quantity each (i.e. total 34 ''pala''), double the total quantity of above ''churna'' (68 ''pala'') ''trivrita'' is taken and double of ''trivrita'' (136 ''pala'') ''brahmi churna'' should be taken. It is a best combination for numbness.[68-69]

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==== Benefits of ''lelitaka'' (sulphur) ====

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=== Benefits of ''lelitaka'' (sulphur) ===

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Similarly ''kushtha'' patient should regularly consume ''parada'' (mercury) with ''vajra shilajatu'' or ''yogaraja'' which helps in curing of all diseases. [71-72]

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==== ''Madhvasava'' ====

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=== ''Madhvasava'' ===

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Decoction should be prepared from 8 ''pala'' each of water extract of ''khadira'' and ''devadāru'' to this one ''prastha'' of honey should be added. To this powder (''bhasma / mandura'') of iron in 8 ''pala'' quantity should be added along with ''triphala, ela, tvak, maricha, patra'' and ''kanaka'' (''nagkeshara'') in one ''karsa'' quantity. ''Matsyaṇḍikā'' (sugar) should be added in quantity equal to honey (one ''prastha''). This preparation should be kept in an iron jar for one month. This is called as ''madhvāsava'' and it is administered in ''kushtha'' and ''kilāsa''.[73-75]

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==== ''Kanaka bindu arishta'' ====

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=== ''Kanaka bindu arishta'' ===

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''Triphalāsava'' prepared from jaggery along with ''chitraka, kramuka, daśamūla, dantī, varā'' (''triphala'') and honey helps in treating various ''kushtha''.[81]

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==== Diet in ''kushtha'' ====

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=== Diet in ''kushtha'' ===

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From ''kshara'' of ''kadalī, palāśa, pātalā'' and ''nichula kshara jala'' (alkaline water) should be prepared which should be well filtered. The same should be added to meat of animals for cleaning of meat, for making paste and for fermentation process. A self fermented (''medaka'') alcoholic formulation should be prepared. After well fermented ''medaka'' prepared the ''kinva'' (fermented paste of drug) should be removed and applied as paste. It is useful in ''maṇḍala kuṣṭha'' and other ''kr̥imi'' infestations.[89-90]

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==== ''Siddharthaka snana''( medicinal bath) ====

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=== ''Siddharthaka snana''( medicinal bath) ===

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Decoction of above combination is useful for ''vamana'' and ''virechana'' procedures. It helps in promotion of color and complexion. It is also useful in ''tvagdōṣa, kuṣṭha, śōpha'' and ''panduroga''.[91-92]

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==== External applications ====

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=== External applications ===

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''Kuṣṭha, arka, tuttha, katphala,'' seeds of ''mūlaka, katukarōhiṇī,'' fruits of ''kuṭaja, utpala, musta, br̥hatī, karavīra, kāsīsa, ēḍagaja, nimba, pāṭhā, durālabhā, citraka, viḍaṅga,'' seeds of ''alābū'' which is bitter in taste, ''kampillaka, sarṣapa, vacā'' and ''dārvī'' when used for preparation of medicated oil helps in reducing ''kuṣṭha''. The same contents may be used for ''lepa, udvartana'', scrubbing and dusting. [102-104]

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==== ''Shweta-karaviradya taila'' ====

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=== ''Shweta-karaviradya taila'' ===

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Physicians recommend that, medicated oil prepared with the help of juice of white variety of ''karavīra,'' cows’ urine, ''chitraka'' and ''viḍaṅga'' cures all type of ''kuṣṭha''. This ends the explanation of ''śvēta karavīrādya taila''.[105]

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==== ''Shweta karavira palladi tailam'' ====

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=== ''Shweta karavira palladi tailam'' ===

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Paste of tender leaves of ''śvēta karavīra,'' root and bark of ''vatsaka, viḍaṅga, kuṣṭha,'' root of ''arka, sarṣapa,'' bark of ''śigru, rōhiṇī,'' 1/4th quantity of oil and cows urine in quantity four times that of oil and then ''taila siddhi'' is done then it helps in treating ''kuṣṭha'' and itching. The preparation is known as ''śvēta karavīrapallavādya tailam''.[106-107]

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==== ''Tikta-ikshwakwadi tailam'' ====

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=== ''Tikta-ikshwakwadi tailam'' ===

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Application of ''tikta ekṣvākvādi tailam'' is useful in itching, ''kuṣṭha'' and ''vāta kapha'' dominated diseases. [108-110]

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==== ''Kanakaksheeri tailam'' ====

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=== ''Kanakaksheeri tailam'' ===

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''Kanakakṣīrī'' (''Kankuṣṭha''), ''śailā'' (''manashila''), ''bhārangi,'' fruits, root and tender leaves of ''dantī, sarṣapa, laśuna, viḍaṅga,'' bark of ''karañja'', ''saptacchadā,'' tender leaves, root and bark of ''arka, nimba, chitraka, āsphōtāḥ, guñja, eraṇḍa,'' root of ''br̥hatī,'' seeds of ''surasā'' and fruits of ''arjaka kuṣṭha, pāṭhā, musta, tumburu, vacā, murva, ṣaḍgranthā, ēḍagaja, kuṭaja, śigru, trikatu, bhallataka, kṣavaka, haritāla, avākpuṣpī'' (''apāmārga''), ''tuttha, kampillaka, amr̥tāsañjña'' (''kharparika tuttha''), ''saurāṣṭrī, kāsīsa,'' bark of ''dārvi, sarjikālavaṇa''. All the above medicines should be pasted and oil should be added (either sesame or mustard oil) along with decoction of root and tender leaves of ''karavira'' and four times of oil, cows urine should be added and the same should be stored in container of ''kaṭukālābu''. It immediately cures ''maṇḍala kuṣṭha'' by ''bhedana'' of ''mandala'' also cures ''kr̥imi'' and itching. This preparation is known as ''kanakakṣīrī taila'' .[111-116]

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==== ''Sidhmahara lepa'' ====

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=== ''Sidhmahara lepa'' ===

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Oil extracted from ''sarṣapa, karañja, kōṣātakī,'' and ''ingudi'' when fortified with heartwood of ''khadira'' is useful in ''kuṣṭha''.[119]

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==== ''Vipadikahara ghee'' and ''taila'' ====

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=== ''Vipadikahara ghee'' and ''taila'' ===

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Application of ''ēḍagaja'' or ''sarjarasa'' or seeds of ''mūlaka'' prepared by adding ''kāñji'' should be used as ''udvartana'' or in the form of ''lepa'' it cures ''sidhma''.[127]

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==== Management of ''pitta-kapha'' dominant ''kushtha'' ====

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=== Management of ''pitta-kapha'' dominant ''kushtha'' ===

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Application of water (one part), ''vāpya'' (''kuṣṭha'' herb) (2 part), ''lōha'' (''agaru'') (3 part) ''kēśara'' (4 part), ''patra'' (5 part), ''plava'' or ''kaivartamusta'' (6 part), ''chāndana, mr̥ṇāla'' (8 part) is useful in ''pitta-kapha'' type of ''kuṣṭha''.[130]

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==== Management of ''pitta'' dominant ''kushtha'' ====

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=== Management of ''pitta'' dominant ''kushtha'' ===

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''Triphala'' fruit pulp in quantity of ½ ''pala'' each, ''paṭōla patra'' ½ ''pala'' quantity, one ''karsa'' each of ''katurōhiṇī, nimba, yaṣṭyāhva'' and ''trāyamāṇa'' and two ''pala'' of dehusked seeds of ''masūra'' which should be boiled in one ''āḍhaka'' of water and reduced to 1/8th. The decoction should be filtered and to this eight ''pala'' of decoction, four ''pala'' of ghee should be added and cooked till 8 ''palas'' remain and this medicated ghee should be administered lukewarm. It is useful in ''vāta pitta kuṣṭha, visarpa, vātarakta, jwara, daha, gulma, vidradhi,'' giddiness and ''visphōṭaka''. [136-139]

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==== ''Tikta shatpala'' ghee ====

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=== ''Tikta shatpala'' ghee ===

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''Nimba, paṭōla, dārvi, duralabha, tiktarōhiṇī, triphala, parpaṭaka'' and ''trāyamāṇa'' are taken in half ''pala'' quantity and boiled with water in quantity of one ''āḍhaka'' and reduced to 1/8th. The decoction should be filtered and to it paste of ''chandana, kirātatiktaka, pippali, trāyamāṇa, musta,'' seeds of ''vatsaka'' in quantity of half ''karsa'' should be added along with 6 ''palas'' of ''ghr̥ita'' and ''sneha siddhi'' should be carried out. This ''tiktaṣaṭpala ghr̥ita'' is useful in ''kuṣṭha, jwara, gulma, arśa, grahani, pāṇḍu, śvayathu, pāmā, visarpa, piḍakā, kaṇḍū, mada'' and ''galagaṇḍa''. [140-143]

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==== ''Mahatiktaka'' ghee ====

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=== ''Mahatiktaka'' ghee ===

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After ''shodhana'' of ''dosha'', blood letting, external and internal ''shamana'' therapies and administration of ghee at appropriate time helps in curing skin diseases and also prevents recurrence. [151]

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==== ''Maha khadira'' ghee ====

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=== ''Maha khadira'' ghee ===

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Five ''tulā'' of ''khadira,'' one ''tulā'' each of ''śiṁśapa'' and ''āsana,'' half ''tulā'' each of ''karañja, ariṣṭa, vētasa, parpata, kuṭaja, vrsa, kr̥mi hara (viḍaṅga), haridra, kr̥tamāla, guḍūcī, triphala, trivr̥t, saptaparṇa'' should be cut into small parts and boiled in 10 ''drōṇa'' of water and reduced to 1/8th . To this add one ''ādhaka'' each of ''ghrit'' and juice of ''āmalaki'' along with one ''pala'' of ''mahātiktaka kalka'' content. ''Sneha siddhi'' should be done; this ''mahākhadira ghr̥ita'' when used internally and for application cures all type of ''kuṣṭha''.[152-156]

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==== Treatment of maggots/micro-organisms in ''kushtha'' ====

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=== Treatment of maggots/micro-organisms in ''kushtha'' ===

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''Ēḍagaja, viḍaṅga, haridra, dāruharidra,'' root of ''rājavr̥kṣa, pippali, pākala'' (''kuṣṭha'' herb) are useful in ''kuṣṭha''.[161]

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==== Management of ''shwitra''(vitiligo) ====

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=== Management of ''shwitra''(vitiligo) ===

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After ''shodhana'' therapy ''raktamōkṣana'' and also intake of ununctuous food like ''saktū'' (roasted corn flour) leucoderma is cured only in few who are free from effects of sinful deeds. [172]

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==== Various stages of ''shwitra'' ====

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=== Various stages of ''shwitra'' ===

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''Dāruṇa, chāruṇa,'' and ''kilāsa'' are the various synonyms for ''śvitrā''. It is of 3 types and generally all the ''tridosha'' are involved. If the ''dosha'' responsible for ''śvitrā'' are seated in the ''rakta dhatu'' then the color of hypo-pigmentation is red. It is copper-colored if ''dosha'' are seated in ''māṁsa dhatu'' and whitish in color if located in ''meda dhatu''. The subsequent ones are more difficult to treat than earlier ones.[173-174]

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==== Prognosis of vitiligo ====

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=== Prognosis of vitiligo ===

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If the patches are conjoined together and are more in number, if the body hair above the patches are red in color and if the disease is more than one year old. Such ''śvitrā'' never gets cured. If body hair over the patches is not red if skin is thin and pale in color. The disease, if is not old, space between patches is elevated then such ''śvitrā'' is ''sādhya'' (curable). [175-176]

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==== Meta-physical causes of ''kilasa'' ====

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=== Meta-physical causes of ''kilasa'' ===

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Untruthfulness, ungratefulness, no respect for the gods, disrespect for the peers (guru), sinful acts, and misdeeds of past life and intake of mutually contradictory food are the causes for ''śvitrā''.[177]

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==== Summary ====

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=== Summary ===

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The above detailed description has been given by Lord Punarvasu with a view of sharpening the memory and intellect of disciple Agnivesha.

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=== Tattva Vimarsha (Fundamental Principles) ===

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== Tattva Vimarsha (Fundamental Principles) ==

*Important etiological factors for skin diseases include: Diet and beverages with antagonistic properties, excess intake of liquid, unctuous, heavy to digest food, suppression of natural urges specially that of emesis, excess exercise, exposure to excess heat, excessive eating, quick change in environmental temperature, inappropriate follow up of purification procedures, eating new grains, curd, fish, sesame, excessive salty and sour food, black gram, radish, milk, sugar products, following daytime sleep, and bad thoughts and deeds towards venerable people.

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#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)

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==== Patho-physiology of ''kushtha'' ====

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=== Patho-physiology of ''kushtha'' ===

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===== 1. ''Kapāla kushtha'' =====

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==== 1. ''Kapāla kushtha'' ====

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 (''nistoda'') 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''.

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===== 2. ''Udumbara kushtha'' =====

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==== 2. ''Udumbara kushtha'' ====

It is ''pitta'' dominated ''kushtha''. Hyper-pigmentation, increased vaso-congestion, burning, pain and pus formation are the symptoms and signs.

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Dyshidrosis, discoid eczema, venous eczema, dermatitis herpetiformis, autoeczematization, eczema overlaid by viral infections can be understood under ''udumbara kushtha''.

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===== 3. ''Mandala kushtha'' =====

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==== 3. ''Mandala kushtha'' ====

It is predominated by ''kapha dosha''. The ''sthira, snigdha guna'' brings about ''sthirata'' and ''snigdhata'' to the ''kushtha''.

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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.

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===== 4. ''Rishyajivha kushtha'' =====

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==== 4. ''Rishyajivha kushtha'' ====

It is dominated by ''vāta'' and ''pitta dosha''. ''Vata dosha'' brings roughness, pain whereas pitta is responsible for the discoloration, burning sensation whereas both the ''dosha'' are responsible for ''ashugati'' and ''samuthana''.

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Classically the innermost portion remain darker red and becomes indurated (is thicker and firmer).

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===== 5. ''Pundarika kushtha'' =====

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==== 5. ''Pundarika kushtha'' ====

It is dominated by ''pitta'' and ''kapha''. ''Pitta'' is responsible for redness, burning sensation, ''pāka'' (..), pus formation whereas ''kapha'' is responsible for whitish nature, itching and ''kr̥mi''.

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Primary lesion manifest as ''rakta rāji sirā santata utsedavanti'' i.e. vessel are inflamed and are palpable. Systemic vasculitis may affect the skin and vascular damage may be the main feature in several skin diseases. The histological features that are common are:- Vessel wall damage , red cell extravasation, and invasion of inflammatory cells into vessel walls.

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===== 6. ''Sidhma kushtha'' =====

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==== 6. ''Sidhma kushtha'' ====

It is dominated by ''vata kapha dosha'', fine powder falls after scratching and resembles color similar to flower of ''alābū''. The specialty of disease is that it is mainly seen in ''urabhāga'' i.e. trunk. ''Tinea versicolar'' is a condition characterized by a skin eruption on the trunk and proximal extremity. The symptoms of this condition include; fine scaling of the skin producing a very superficial ash like scale. Pale (''sveta''), dark tan (''arun''), pink in color (''shukla rakta avabhasani'') with a reddish undertone (''tamra'') that can darken when the patient is overheated, such as in a hot shower or during/ after exercise, tanning typically makes the affected areas contrast more starkly with the surrounding skin leading to sharp borders. In people with dark skin tones, pigmentary changes such as hypo-pigmentation (loss of color) are common while in those with lighter skin color hyper-pigmentattion (increase in skin color) is more common. The yeast is thought to feed on skin oils (lipids) as well as dead skin cells.

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===== 7.''Kakanaka kushtha'' =====

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==== 7.''Kakanaka kushtha'' ====

It is predominated by all the three ''dosha''. Thus symptoms of all three dōṣha are observed. The presentation is similar to ''gunja'' i.e bright red with black spot. In [[Nidana Sthana]], it has been explained to be of different colors and it is ''asadhya''.

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Squamous cell carcinoma or squamous cell cancer or epidermoid carcinoma or squamous cell epithelioma is a cancer of a kind of epithelial cell, the squamous cell. These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of the skin cancer. However, squamous cells also occur in the lining of the digestive tract, lungs and other areas of body and squamous cell carcinoma occurs as a form of cancer in diverse tissue such as lips, mouth, esophagus, urinary bladder, prostrate, lung, vagina and cervix. Despite sharing the name squamous cell carcinoma there may be tremendous differences in presenting symptoms, natural history, prognosis and response to treatment. It arises from the uncontrolled multiplication of cells of epithelium, or cells showing particular cytological or tissue architectural characteristic of squamous cell differentiation, such as the presence of keratin, tonofilament bundles or dermosomes structures involved in cell to cell adhesion. This non melanoma skin cancer may appear as a firm red nodule, a scaly growth that bleeds or develops a crust or a sore that does not heal.

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===== Minor ''kushtha'' =====

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==== Minor ''kushtha'' ====

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====== 1.''Eka kushtha'' ======

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==== 1.''Eka kushtha'' ====

It is a skin disease caused due to ''vāta kapha'' predominance. As discussed previously ''vata dosha'' is responsible for the degenerative or destructive changes whereas ''kapha'' is responsible for obstructive changes.

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''Ichthyosis vulgaris'' is a skin condition that causes dry, dead skin cells to accumulate in patches on the surface of skin. It is also known as “fish scale disease” because the dead skin accumulates in a similar pattern to a fish scale.

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====== 2. ''Charmakhya'' ======

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==== 2. ''Charmakhya'' ====

Skin is similar to elephant (pachyderms) and thick is nature ''pachys'' means thick and ''derma'' means skin.

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Calcium deposition may also be cause for tough and thick skin. ''Rūkṣata, kharata, guna'' of ''vāta'' and ''shita guna'' of ''vāta'' and ''kapha'' along with increase of ''guruta, manda'' and ''sthira guna'' of ''kapha'' contribute to thickening of skin. ''Khara'' is also property of ''asthi dhatu'' which is generated by interplay between ''prithvi, agni'' and ''vāyu''. Here calcium is representative of ''prithvi mahabhuta''. So ''prithvi mahabhuta bhuyista āhara'' or increased ''parthivagni'' can lead to increased absorption of calcium from gastrointestinal tract.

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====== 3. ''Kitibha kushtha'' ======

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==== 3. ''Kitibha kushtha'' ====

Skin diseases in which process of tissue granulation takes place is ''Kitibha kushtha''. When this process takes abnormally ''Kitibha kushtha'' is formed. It may take place in psoriasis, lichen planus, lichen sclerosis.

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''Vāta, rakta, māṁsa, kapha''- all take part in healing of wound but whenever abnormality at the level of these factors takes place granulation process is hampered which gives the ''kiṇakharasparśa''.

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====== 4. ''Vaipadika kushtha'' ======

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==== 4. ''Vaipadika kushtha'' ====

Skin fissure is a cutaneous condition in which there is a linear like cleavage of skin, sometimes defined as extending into the dermis. Skin dryness is the cause.

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Anhidrosis, Dermatitis, Diabetic neuropathy, Eczema, Hypothyroidism, Psoriasis, cold weather, excessive exposure to hot water, detergent chemicals and low humidity can cause cracked skin.

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====== 5.''Alasaka kushtha'' ======

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==== 5.''Alasaka kushtha'' ====

''Ganda'' here means nodular growth. Chronic and repetitive scratching, picking or rubbing may result in permanent changes to the skin, including nodular lichenification (''ganda''), hyperkeratosis, hyperpigmentation (''rāga'') and skin thickening.

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The wart like plaque may be observed in dermatosis neglecta; an skin condition in which accumulation of sebum, keratin, sweat, dirt and debris lead to localized patch of skin. Dryness is the main cause for the above pathogenesis and role of vāta and kapha in causing dryness is already been discussed.

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~~'''''~~Vichārchikā''~~:'''~~

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==== 6.Vichārchikā''====

It is caused by ''kapha'' dominated condition. ''Kapha'' by its ''snigdha, guru, mridu'' and ''sheeta guna'' when increased above normal condition it leads to obstructive changes at the integumentary system. Reduced blood supply causes blackish brown discoloration. Further obstructive changes reduce the local immunity and give a chance for dermatophytes to penetrate the skin barrier. It results in eruptions and thereby causing excessive exudation. Secondary infection and reduced blood supply is cause for pruritus. It can be compared with wet eczema.

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|}

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Current clinical management of skin diseases:

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===Current clinical management of skin diseases===

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Principal treatment modalities:

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====Principal treatment modalities====

#Internal and external application of sneha (medicated ghee or oil)

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#Raktamokshana (blood letting)

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Principal drugs:

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====Principal drugs====

#Gandhaka (sulphur)

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