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Kushtha Nidana (view source)

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{{#seo:

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|title=Kushtha Nidana

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|titlemode=append

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|keywords=Kushtha, Mandal, Kapala, Kakanak, Audambar, Rishyajihva, Pundareeka, Sidhma, causes of skin diseases, discoloration of skin

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|description=Nidana Sthana Chapter 5. Diagnosis and etiopathogenesis of Skin diseases

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}}

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<big>'''Nidana Sthana Chapter 5. Diagnosis and etiopathogenesis of Skin diseases '''</big>

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</div>

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

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अथातः कुष्ठनिदानं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaḥ kuṣṭhanidānaṁ vyākhyāsyāmaḥ||1||

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iti ha smAhabhagavAnAtreyaH||2||

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</div></div>

Now I shall expound the chapter on diagnosis of ''kushtha'' (dermatosis).

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==== Pathogenic factors in ''kushtha'' ====

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सप्त द्रव्याणि कुष्ठानां प्रकृतिर्विकृतिमापन्नानि भवन्ति|

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एतत् सप्तानां सप्तधातुकमेवङ्गतमाजननं कुष्ठानाम्, अतःप्रभवाण्यभिनिर्वर्तमानानि केवलं

शरीरमुपतपन्ति||३||

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sapta dravyāṇi kuṣṭhānāṁ prakr̥tirvikr̥timāpannāni [1] bhavanti|

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

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</div></div>

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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]

</div>

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

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न च किञ्चिदस्ति कुष्ठमेकदोषप्रकोपनिमित्तम्, अस्ति तु खलु समानप्रकृतीनामपि कुष्ठानां दोषांशांशविकल्पानुबन्धस्थानविभागेन वेदनावर्णसंस्थानप्रभावनामचिकित्सितविशेषः|

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दोषा हि विकल्पनैर्विकल्प्यमाना विकल्पयन्ति विकारान्, अन्यत्रासाध्यभावात्|

तेषां विकल्पविकारसङ्ख्यानेऽतिप्रसङ्गमभिसमीक्ष्य सप्तविधमेव कुष्ठविशेषमुपदेक्ष्यामः||४||

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na ca kiñcidasti kuṣṭhamēkadōṣaprakōpanimittam, asti tu khalu samānaprakr̥tīnāmapi kuṣṭhānāṁdōṣāṁśāṁśavikalpānubandhasthānavibhāgēna vēdanāvarṇasaṁsthānaprabhāvanāmacikitsitaviśēṣaḥ|

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na caki~jcidastikuShThamekadoShaprakopanimittam, astitukhalusamAnaprakRutInAmapi

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

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</div></div>

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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]

</div>

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

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इह वातादिषु त्रिषु प्रकुपितेषु त्वगादींश्चतुरः प्रदूषयत्सु वातेऽधिकतरे कपालकुष्ठमभिनिर्वर्तते, पित्ते त्वौदुम्बरं, श्लेष्मणि मण्डलकुष्ठं, वातपित्तयोरृष्यजिह्वं, पित्तश्लेष्मणोः पुण्डरीकं, श्लेष्ममारुतयोःसिध्मकुष्ठं, सर्वदोषाभिवृद्धौ काकणकमभिनिर्वर्तते; एवमेष सप्तविधः कुष्ठविशेषो भवति|

स चैष भूयस्तरतमतः प्रकृतौ विकल्प्यमानायां भूयसीं विकारविकल्पसङ्ख्यामापद्यते||५||

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iha vātādiṣu triṣu prakupitēṣu tvagādīṁścaturaḥ pradūṣayatsu vātē'dhikatarēkapālakuṣṭhamabhinirvartatē, pittē tvaudumbaraṁ, ślēṣmaṇi maṇḍalakuṣṭhaṁ, vātapittayōṟuṣyajihvaṁ,pittaślēṣmaṇōḥ puṇḍarīkaṁ, ślēṣmamārutayōḥ sidhmakuṣṭhaṁ, sarvadōṣābhivr̥ddhaukākaṇakamabhinirvartatē; ēvamēṣa saptavidhaḥ kuṣṭhaviśēṣō bhavati|

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

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</div></div>

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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:

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==== Common etiological factors of ''kushtha'' ====

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तत्रेदं सर्वकुष्ठनिदानं समासेनोपदेक्ष्यामः- शीतोष्णव्यत्यासमनानुपूर्व्योपसेवमानस्य तथा सन्तर्पणापतर्पणाभ्यवहार्यव्यत्यासं, मधुफाणितमत्स्यलकुचमूलककाकमाचीः सततमतिमात्रमजीर्णे च समश्नतः,चिलिचिमं च पयसा, हायनकयवकचीनकोद्दालककोरदूषप्रायाणि चान्नानि क्षीरदधितक्रकोलकुलत्थमाषातसीकुसुम्भस्नेहवन्ति, एतैरेवातिमात्रं सुहितस्य च व्यवायव्यायामसन्तापानत्युपसेवमानस्य,भयश्रमसन्तापोपहतस्य च सहसा शीतोदकमवतरतः, विदग्धं चाहारजातमनुल्लिख्य विदाहीन्यभ्यवहरतः, छर्दिं च प्रतिघ्नतः, स्नेहांश्चातिचरतः, त्रयो दोषाः युगपत् प्रकोपमापद्यन्ते; त्वगादयश्चत्वारःशैथिल्यमापद्यन्ते; तेषु शिथिलेषु दोषाः प्रकुपिताः स्थानमधिगम्य सन्तिष्ठमानास्तानेव त्वगादीन् दूषयन्तः कुष्ठान्यभिनिर्वर्तयन्ति||६||

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tatrēdaṁ sarvakuṣṭhanidānaṁ samāsēnōpadēkṣyāmaḥ- śītōṣṇavyatyāsamanānupūrvyōpasēvamānasyatathā santarpaṇāpatarpaṇābhyavahāryavyatyāsaṁ, madhuphāṇitamatsyalakucamūlakakākamācīḥsatatamatimātramajīrṇē ca samaśnataḥ, cilicimaṁ ca payasā,hāyanakayavakacīnakōddālakakōradūṣaprāyāṇi cānnānikṣīradadhitakrakōlakulatthamāṣātasīkusumbhasnēhavanti, ētairēvātimātraṁ suhitasya cavyavāyavyāyāmasantāpānatyupasēvamānasya, bhayaśramasantāpōpahatasya ca sahasāśītōdakamavatarataḥ, vidagdhaṁ cāhārajātamanullikhya vidāhīnyabhyavaharataḥ, chardiṁ capratighnataḥ, snēhāṁścāticarataḥ, trayō dōṣāḥ yugapat prakōpamāpadyantē; tvagādayaścatvāraḥśaithilyamāpadyantē; tēṣu śithilēṣu dōṣāḥ prakupitāḥ sthānamadhigamya santiṣṭhamānāstānēva tvagādīndūṣayantaḥ kuṣṭhānyabhinirvartayanti||6||

tatredaMsarvakuShThanidAnaMsamAsenopadekShyAmaH- shItoShNavyatyAsamanAnupUrvyopasevamAnasyatathA santarpaNApatarpaNAbhyavahAryavyatyAsaM,madhuphANitamatsyalakucamUlakakAkamAcIH satatamatimAtramajIrNecasamashnataH, cilicimaMcapayasA, hAyanakayavakacInakoddAlakakoradUShaprAyANicAnnAnikShIradadhitakrakolakulatthamAShAtasIkusumbhasnehavanti, etairevAtimAtraMsuhitasyacavyavAyavyAyAmasantApAnatyupasevamAnasya, bhayashramasantApopahatasyacasahasAshItodakamavatarataH, vidagdhaMcAhArajAtamanullikhyavidAhInyabhyavaharataH, chardiMcapratighnataH, snehAMshcAticarataH, trayodoShAHyugapatprakopamApadyante; tvagAdayashcatvAraHshaithilyamApadyante; teShushithileShudoShAHprakupitAHsthAnamadhigamyasantiShThamAnAstAnevatvagAdIndUShayantaHkuShThanyabhinirvartayanti||6||

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</div></div>

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

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</div>

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

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तेषामिमानि पूर्वरूपाणि भवन्ति; तद्यथा- अस्वेदनमतिस्वेदनं पारुष्यमतिश्लक्ष्णता वैवर्ण्यं कण्डूर्निस्तोदः सुप्तता परिदाहः परिहर्षो लोमहर्षः खरत्वमूष्मायणं गौरवं श्वयथुर्वीसर्पागमनमभीक्ष्णं च कायेकायच्छिद्रेषूपदेहः पक्वदग्धदष्टभग्नक्षतोपस्खलितेष्वतिमात्रं वेदना स्वल्पानामपि च व्रणानां दुष्टिरसंरोहणं चेति||७||

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

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

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</div></div>

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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]

</div>

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

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ततोऽनन्तरं कुष्ठान्यभिनिर्वर्तन्ते, तेषामिदं वेदनावर्णसंस्थानप्रभावनामविशेषविज्ञानं भवति; तद्यथा- रूक्षारुणपरुषाणि विषमविसृतानि खरपर्यन्तानि तनून्युद्वृत्तबहिस्तनूनि सुप्तवत्सुप्तानि हृषितलोमाचितानि निस्तोदबहुलान्यल्पकण्डूदाहपूयलसीकान्याशुगतिसमुत्थानान्याशुभेदीनि जन्तुमन्ति कृष्णारुणकपालवर्णानि च कपालकुष्ठानीति विद्यात्(१);

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tatō'nantaraṁ kuṣṭhānyabhinirvartantē, tēṣāmidaṁ vēdanāvarṇasaṁsthānaprabhāvanāmaviśēṣavijñānaṁbhavati; tadyathā- rūkṣāruṇaparuṣāṇi viṣamavisr̥tāni kharaparyantāni tanūnyudvr̥ttabahistanūni [1]suptavatsuptāni [2] hr̥ṣitalōmācitāninistōdabahulānyalpakaṇḍūdāhapūyalasīkānyāśugatisamutthānānyāśubhēdīni jantumantikr̥ṣṇāruṇakapālavarṇāni ca kapālakuṣṭhānīti vidyāt(1);

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tato~anantaraMkuShThanyabhinirvartante, teShAmidaMvedanAvarNasaMsthAnaprabhAvanAmavisheShavij~jAnaM

bhavati; tadyathA- rUkShAruNaparuShANiviShamavisRutAnikharaparyantAnitanUnyudvRuttabahistanUnisuptavatsuptAnihRuShitalomAcitAni nistodabahulAnyalpakaNDUdAhapUyalasIkAnyAshugatisamutthAnAnyAshubhedIni jantumantikRuShNAruNakapAlavarNAnicakapAlakuShThanItividyAt(1);

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</div></div>

Thereafter (above pathogenesis), ''kushtha'' is manifested. The specific diagnosis (of types) for nomenclature is based upon sensation, discoloration, site of lesion, effect of lesion.

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</div>

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

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ताम्राणि ताम्रखररोमराजीभिरवनद्धानिबहलानि बहुबहलपूयरक्तलसीकानि कण्डूक्लेदकोथदाहपाकवन्त्याशुगतिसमुत्थानभेदीनि ससन्तापक्रिमीणि पक्वोदुम्बरफलवर्णान्यौदुम्बरकुष्ठानीति विद्यात् (२);

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tāmrāṇi tāmrakhararōmarājībhiravanaddhānibahalāni bahubahalapūyaraktalasīkāni kaṇḍūklēdakōthadāhapākavantyāśugatisamutthānabhēdīnisasantāpakrimīṇi pakvōdumbaraphalavarṇānyaudumbarakuṣṭhānīti vidyāt(2);

tAmrANitAmrakhararomarAjIbhiravanaddhAnibahalAnibahubahalapUyaraktalasIkAnikaNDUkledakothadAhapAkavantyAshugatisamutthAnabhedInisasantApaKrimi<br>NipakvodumbaraphalavarNAnyaudumbarakuShThanItividyAt(2);

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</div></div>

''Audumbara kushtha'' has the following features:

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</div>

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

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स्निग्धानि गुरूण्युत्सेधवन्तिश्लक्ष्णस्थिरपीतपर्यन्तानि शुक्लरक्तावभासानि शुक्लरोमराजीसन्तानानि बहुबहलशुक्लपिच्छिलस्रावीणि बहुक्लेदकण्डूक्रिमीणि सक्तगतिसमुत्थानभेदीनि परिमण्डलानि मण्डलकुष्ठानिविद्यात्(३);

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

snigdhAnigurUNyutsedhavantishlakShNasthirapItaparyantAnishuklaraktAvabhAsAnishuklaromarAjIsantAnAnibahubahalashuklapicchilasrAvINibahukledakaNDUKrimiNisak<br>tagatisamutthAnabhedIniparimaNDalAnimaNDalakuShThanividyAt(3);

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</div></div>

''Mandala kushtha'' has following features:

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</div>

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

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परुषाण्यरुणवर्णानि बहिरन्तःश्यावानि नीलपीतताम्रावभासान्याशुगतिसमुत्थानान्यल्पकण्डूक्लेदक्रिमीणि दाहभेदनिस्तोद(पाक)बहुलानि शूकोपहतोपमवेदनान्युत्सन्नमध्यानि तनुपर्यन्तानिकर्कशपिडकाचितानि दीर्घपरिमण्डलान्यृष्यजिह्वाकृतीनि ऋष्यजिह्वानीति विद्यात् (४);

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

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

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</div></div>

''Rishyajivha kushtha'' has following features:

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</div>

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

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शुक्लरक्तावभासानि रक्तपर्यन्तानि रक्तराजीसिरासन्ततान्युत्सेधवन्ति बहुबहलरक्तपूयलसीकानिकण्डूक्रिमिदाहपाकवन्त्याशुगतिसमुत्थानभेदीनि पुण्डरीकपलाशसङ्काशानि पुण्डरीकाणीति विद्यात् (५);

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śuklaraktāvabhāsāni raktaparyantāniraktarājīsirāsantatānyutsēdhavanti bahubahalaraktapūyalasīkānikaṇḍūkrimidāhapākavantyāśugatisamutthānabhēdīni puṇḍarīkapalāśasaṅkāśāni puṇḍarīkāṇīti vidyāt (5);

shuklaraktAvabhAsAniraktaparyantAniraktarAjIsirAsantatAnyutsedhavantibahubahalaraktapUyalasIkAnikaNDUKrimidAhapAkavantyAshugatisamutthAnabhedInipuNDarIkap<br>alAshasa~gkAshAnipuNDarIkANItividyAt(5);

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</div></div>

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''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);

</div>

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

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परुषारुणानि विशीर्णबहिस्तनून्यन्तःस्निग्धानि शुक्लरक्तावभासानिबहून्यल्पवेदनान्यल्पकण्डूदाहपूयलसीकानि लघुसमुत्थानान्यल्पभेदक्रिमीण्यलाबुपुष्पसङ्काशानि सिध्मकुष्ठानीति विद्यात् (६);

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

paruShAruNAnivishIrNabahistanUnyantaHsnigdhAnishuklaraktAvabhAsAnibahUnyalpavedanAnyalpakaNDUdAhapUyalasIkAnilaghusamutthAnAnyalpabhedaKrimiNyalAbup<br>uShpasa~gkAshAnisidhmakuShThanItividyAt (6);

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</div></div>

''Sidhma kushtha'' has following features:

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</div>

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

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काकणन्तिकावर्णान्यादौ पश्चात्तु सर्वकुष्ठलिङ्गसमन्वितानि पापीयसा सर्वकुष्ठलिङ्गसम्भवेनानेकवर्णानि काकणानीति विद्यात्| तान्यसाध्यानि, साध्यानि पुनरितराणि||८||

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kākaṇantikāvarṇānyādau paścāttu sarvakuṣṭhaliṅgasamanvitāni pāpīyasā [6]sarvakuṣṭhaliṅgasambhavēnānēkavarṇāni kākaṇānīti vidyāt|

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kAkaNantikAvarNAnyAdaupashcAttusarvakuShThali~ggasamanvitAnipApIyasA [6] sarvakuShThali~ggasambhavenAnekavarNAnikAkaNAnItividyAt| tAnyasAdhyAni, sAdhyAnipunaritarANi||8||

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</div></div>

''Kakanaka kushtha'' has following features:

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==== Prognosis ====

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तत्र यदसाध्यं तदसाध्यतां नातिवर्तते, साध्यं पुनः किञ्चित् साध्यतामतिवर्तते कदाचिदपचारात्| साध्यानि हि षट् काकणकवर्ज्यान्यचिकित्स्यमानान्यपचारतो वा दोषैरभिष्यन्दमानान्यसाध्यतामुपयान्ति||९||

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tatra yadasādhyaṁ tadasādhyatāṁ nātivartatē, sādhyaṁ punaḥ kiñcit sādhyatāmativartatēkadācidapacārāt|

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

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</div></div>

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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]

</div>

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

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साध्यानामपि ह्युपेक्ष्यमाणानां त्वङ्मांसशोणितलसीकाकोथक्लेदसंस्वेदजाः क्रिमयोऽभिमूर्च्छन्ति; ते भक्षयन्तस्त्वगादीन् दोषाः पुनर्दूषयन्त इमानुपद्रवान् पृथक् पृथगुत्पादयन्ति- तत्र वातः श्यावारुणवर्णंपरुषतामपि च रौक्ष्यशूलशोषतोदवेपथुहर्षसङ्कोचायासस्तम्भसुप्तिभेदभङ्गान्, पित्तं दाहस्वेदक्लेदकोथस्रावपाकरागान्, श्लेष्मा त्वस्य श्वैत्यशैत्यकण्डूस्थैर्यगौरवोत्सेधोपस्नेहोपलेपान्, क्रिमयस्तु त्वगादींश्चतुरःसिराः स्नायूश्चास्थीन्यपि च तरुणान्याददते ||१०||

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sādhyānāmapi hyupēkṣyamāṇānāṁ tvaṅmāṁsaśōṇitalasīkākōthaklēdasaṁsvēdajāḥkrimayō'bhimūrcchanti; tē bhakṣayantastvagādīn dōṣāḥ [1] punardūṣayanta imānupadravān pr̥thakpr̥thagutpādayanti- tatra vātaḥ śyāvāruṇavarṇaṁ paruṣatāmapi caraukṣyaśūlaśōṣatōdavēpathuharṣasaṅkōcāyāsastambhasuptibhēdabhaṅgān, pittaṁdāhasvēdaklēdakōthasrāvapākarāgān, ślēṣmā tvasyaśvaityaśaityakaṇḍūsthairyagauravōtsēdhōpasnēhōpalēpān, krimayastu tvagādīṁścaturaḥ sirāḥsnāyūścāsthīnyapi ca taruṇānyādadatē [2] ||10||

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

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</div></div>

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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:

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*''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]

</div>

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

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asyāṁ caivāvasthāyāmupadravāḥ kuṣṭhinaṁ spr̥śanti; tadyathā- prasravaṇamaṅgabhēdaḥpatanānyaṅgāvayavānāṁ tr̥ṣṇājvarātīsāradāhadaurbalyārōcakāvipākāśca, tathāvidhamasādhyaṁvidyāditi||11||

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

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</div></div>

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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]

</div>

==== Summary ====

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भवन्ति चात्र-

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सङ्ख्या द्रव्याणि दोषाश्च हेतवः पूर्वलक्षणम्|

रूपाण्युपद्रवाश्चोक्ताः कुष्ठानां कौष्ठिके पृथक्||१६||

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bhavanti cātra- sādhyō'yamiti yaḥ pūrvaṁ narō rōgamupēkṣatē|

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tatrashlokaH-

sa~gkhyAdravyANidoShAshcahetavaHpUrvalakShaNam| rUpANyupadravAshcoktAHkuShThanAMkauShThikepRuthak||16||

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</div></div>

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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.

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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]

</div>

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

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ityagniveshakRutetantrecarakapratisaMskRutenidAnasthAnekuShThanidAnaMnAmapa~jcamo~adhyAyaH||5||

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</div></div>

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

Agnivesha

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