Kushtha Chikitsa

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

Kushtha Chikitsa
Section/Chapter Chikitsa Sthana Chapter 7
Preceding Chapter Prameha Chikitsa
Succeeding Chapter Rajayakshma Chikitsa
Other Sections Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator Ojha S.N.,Samant A.
Reviewer Chandola H.M.
Editors Baghel M.S., Deole Y.S., Basisht G.
Year of publication 2020
Publisher Charak Samhita Research, Training and Skill Development Centre
DOI 10.47468/CSNE.2020.e01.s06.008

Abstract

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.

Keywords: Skin diseases,dermatology, discoloration, itching, saptaka dravya, kotha, Kandu, kapala, udumbara, maṇḍala, rishyajihva, puṇḍarika, sidhma, kakaṇaka, ekakushtha, charmakhya, kitibha, vipadika, alasaka, dadru, charmadala, pama, visphotaka, shataru, vicharchika, kshudrakushtha, mahakushtha, matsyashakalopamam, hasticharmavat, kinakharasparsham, lelitaka, madhvasava, shvetakaraviradya tailam, tiktekshvakvadi taila, kanakakshiritaila, tiktaṣaṭpalakam ghrita, mahatiktakam ghritam, mahakhadiram ghrita, shvitra, daruna, charunam, kilasa, psoriasis, scabies, ringworms, eczema

Introduction

Skin is the largest organ of the body constituting the integumentary system, comprising of skin, hair and nails etc. It constitutes 16% of body weight. Skin has the total surface area varying 1.2-2.2 sq.m. It is a combined product of ectoderm as well as of mesoderm. Kushtha (skin disorder or dermatosis) is a chronic disease which presents with ugly colors / complexion/ texture and altered tactile perceptions of the skin. The word kushtha is derived from kushnati vapuh meaning that which alters complexion of body by extracting.

All the types of kushtha are caused due to vitiation of tridosha with involvement of skin, blood, lymph and muscular issue. Kushtha is often translated in English as leprosy, which is not correct because of absence of Mycobacterium leprae, though the appearance of skin lesions of mahakushtha resemble leprosy. Etiological factors of kushtha are antagonistic food, toxins released from suppressed natural urges, and practices harmful to the blood and skin. It is tridoshaja disease, but because of variable proportion of one specific dosha, causes variation in features and prognosis. Variable doshic impact on skin, gives different color, complexion, pain sensitivity, texture, deformities, discharge, and tactile perception. Generalized symptoms appear only in prodromal stage.

In the context of kushtha, four aspects of skin are important. First is that it consists of six layers as described in [Cha. Sa.Sharira Sthana chapter 4], and each layer is seat of specific type of gradually progressing kushtha.

Second aspect is that it is a sensory organ too, and is seat of vata dosha. In case of kushtha vitiated vata in skin manifests as, horripilations, numbness, and loss of tactile perceptions.

Third aspect, skin is the sub-tissue or upadhatu of mamsa dhatu, texture of skin depends upon muscle texture, so the dermal deformities spread upto the mamsa dhatu or musculature and skin texture causing ugly shape of skin lesions. Lastly, affliction of deeper layers of skin deteriorates the ulcer healing ability of skin and damages the defense mechanisms against enormous pathological invasions. Thus, the kushtha stands for long time with more and more uglier shape.

This chapter is placed after Prameha Chikitsa, because one of the complications of prameha is carbuncle, which penetrates deeper into the muscles and is very similar to kushtha but the etio-pathogenesis is very different. Indulging in heavy to digest food products is responsible for increase of kleda (excess moisture) in the body. Such kleda is carried by mutra and leads to increase in quantity and frequency of mutra leading to pathogenesis of prameha. When same kleda spreads throughout the body causes shaithilyata (looseness of body tissue) and also vitiates meda dhatu. Vitiated kleda and meda are responsible for mamsa dusti which is responsible for pidika genesis and manifest as change in color, texture and sensation of tvacha (skin). This leads to various skin diseases.

Another disease named visarpa is explained later in 21st chapter of this section also has these components commonly, but due to prominence of impurity in blood that is a rapidly spreading disease whereas kushtha is slow progressing disease. Whereas visarpa advances into the visceral parts, kushtha spreads horizontally and limited to skin only.

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.

Sanskrit Text, Transliteration and English Translation

अथातः कुष्ठचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

हेतुं द्रव्यं लिङ्गं कुष्ठानामाश्रयं प्रशमनं च|
शृण्वग्निवेश! सम्यग्विशेषतः स्पर्शनघ्नानाम्||३||

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]

Etiology

विरोधीन्यन्नपानानि द्रवस्निग्धगुरूणि च|
भजतामागतां छर्दिं वेगांश्चान्यान्प्रतिघ्नताम्||४||

व्यायाममतिसन्तापमतिभुक्त्वोपसेविनाम्|
शीतोष्णलङ्घनाहारान् क्रमं मुक्त्वा निषेविणाम्||५||

घर्मश्रमभयार्तानां द्रुतं शीताम्बुसेविनाम्|
अजीर्णाध्यशिनां चैव पञ्चकर्मापचारिणाम्||६||

नवान्नदधिमत्स्यातिलवणाम्लनिषेविणाम्|
माषमूलकपिष्टान्नतिलक्षीरगुडाशिनाम्||७||

व्यवायं चाप्यजीर्णेऽन्ने निद्रां च भजतां दिवा|
विप्रान् गुरून् धर्षयतां पापं कर्म च कुर्वताम्||८||

Viruddha annapana, excessive intake of drava, snigdha and guru dravyas; restraining natural urges like vomiting etc; exercising or coming in contact of excessive heat after eating excessive quantity of food. Indulging in habits such as, taking shita quality food etc. followed by ushna quality or either fasting followed by heavy meals. Having cold water immediately after exposure to scorching sun, exertion and fear, eating uncooked or raw foods or having meals although previously taken meals have not been digested. Indulging in food and other habits which have been restricted during the phase of Panchakarma.

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]

Pathogenic factors

वातादयस्त्रयो दुष्टास्त्वग्रक्तं मांसमम्बु च|
दूषयन्ति स कुष्ठानां सप्तको द्रव्यसङ्ग्रहः||९||

अतः कुष्ठानि जायन्ते सप्त चैकादशैव च|
न चैकदोषजं किञ्चित् कुष्ठं समुपलभ्यते||१०||

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]

Premonitory signs and symptoms

स्पर्शाज्ञत्वमतिस्वेदो न वा वैवर्ण्यमुन्नतिः|
कोठानां लोमहर्षश्च कण्डूस्तोदः श्रमः क्लमः||११||

व्रणानामधिकं शूलं शीघ्रोत्पत्तिश्चिरस्थितिः|
दाहः [१] सुप्ताङ्गता चेति कुष्ठलक्षणमग्रजम्||१२||

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]

Eighteen types of skin diseases

अत ऊर्ध्वमष्टादशानां कुष्ठानां कपालोदुम्बरमण्डलर्ष्यजिह्वपुण्डरीकसिध्मकाकणकैककुष्ठचर्माख्य-किटिभविपादिकालसकदद्रुचर्मदलपामाविस्फोटकशतारुर्विचर्चिकानां लक्षणान्युपदेक्ष्यामः||१३||

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]

Seven major kushtha

1. Kapala Kushtha

कृष्णारुणकपालाभं यद्रूक्षं परुषं तनु|
कापालं तोदबहुलं तत्कुष्ठं विषमं स्मृतम्||१४||

The clinical presentation of kapala kushtha is as follows:

Color –- kr̥ṣṇa (blackish), aruṇa (reddish)

Nature – kapāla (similar to broken piece of earthen pot)

Touch – rūkṣa (dry), paruṣa (rough), tanu (thin)

Associated symptoms – severe pain

Sadhya / sadyata – Difficult to cure

2. Udumbara kushtha

दाहकण्डूरुजारागपरीतं लोमपिञ्जरम्|
उदुम्बरफलाभासं कुष्ठमौदुम्बरं विदुः||१५||

The clinical presentation of udumbara kushtha is as follows:

Color – Similar to udumbara fruit

Nature – rāgaparīta (redness), lōmapiñjara (hair on the patch become brown)

Associated symptoms – burning sensation, pruritus and pain

3.Mandala Kushtha

श्वेतं रक्तं स्थिरं स्त्यानं स्निग्धमुत्सन्नमण्डलम्|
कृच्छ्रमन्योन्यसंसक्तं कुष्ठं मण्डलमुच्यते||१६||

The clinical features of mandala kushtha are as follows:

Color – white and red

Nature – sthira (slow progress), styāna/ghana (compact), snigdha, elevated round patches

Associated symptoms – patches are matted

Sadhyasadhyata – Difficult to cure

4.Rishyajivha Kushtha

कर्कशं रक्तपर्यन्तमन्तः श्यावं सवेदनम्|
यदृष्यजिह्वासंस्थानमृष्यजिह्वं तदुच्यते||१७||

The clinical features of rishyajivha kushtha are as follows:

Color – Rakta paryanta anta śyāvaṁ (red in edges and brown inside)

Nature – karkaśa (rough), it resembles the tongue of rṣya ,a type of deer with blue testicles[ Cha.Sa. Chikitsa Sthana 7 / 17 Chakrapani]

Associated symptoms – pain

5.Pundarika Kushtha

सश्वेतं रक्तपर्यन्तं पुण्डरीकदलोपमम्|
सोत्सेधं च सदाहं च पुण्डरीकं तदुच्यते||१८||

The clinical features of pundarika kushtha are as follows:

Color – White with red edges

Nature – resembles lotus petals, elevated patches

Associated symptoms – burning sensation

6.Sidhma Kushtha

श्वेतं ताम्रं तनु च यद्रजो [१] घृष्टं विमुञ्चति|
अलाबूपुष्पवर्णं तत् सिध्मं प्रायेण चोरसि||१९||

The clinical features of sidhma kushtha are as follows:

Color – white coppery, color resembles flower of alabu (lagenaria siceraria)

Nature – thin

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

7.Kakanaka Kushtha

यत् काकणन्तिकावर्णमपाकं तीव्रवेदनम्|
त्रिदोषलिङ्गं तत् कुष्ठं काकणं नैव सिध्यति||२०||

The clinical features of Kākaṇaka kuṣṭha are as follows:

Color – resemble gunjā (abrus precatorious) i.e. red in color

Nature – does not get suppurated

Associated symptoms – Pain and incurable, all the three doshas are present

इति सप्तमहाकुष्ठानि

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

Eleven kshudra kushtha

1.Eka kuṣṭha

अस्वेदनं महावास्तु यन्मत्स्यशकलोपमम्|
तदेककुष्ठ

The clinical features of eka kushtha are as follows:

Nature – resembles scales of fish

Location – Extensive

2.Charmakhya Kushtha

चर्माख्यं बहलं हस्तिचर्मवत्||२१||

The clinical features of charmakhya are as follows:

Nature – skin is thick resembling elephant skin

3.Kitibha Kushtha

श्यावं किणखरस्पर्शं परुषं किटिभं स्मृतम्|

The clinical features of are as follows:

Color – It is blackish brown

Nature – Rough similar to scar tissue and hard to touch

Touch similar to the granulation process in wound.

4.Vaipadika Kushtha

वैपादिकं पाणिपादस्फुटनं तीव्रवेदनम्||२२||

The clinical features are as follows:

Location – Hand and legs

Nature – cracks in palms and sole

Associated symptoms – severe / excruciating pain

5.Alasaka Kuṣhtha

कण्डूमद्भिः सरागैश्च गण्डैरलसकं चितम्|

The clinical features are as follows:

Nature – Nodules

Associated symptoms – Pruritus

Color – redness

6.Dadru Kushtha

सकण्डूरागपिडकं दद्रुमण्डलमुद्गतम्||२३||

The clinical features are as follows:

Color – redness

Nature – Elevated circular patch with pidaka

Associated symptoms – Itching

7.Charmadala Kushtha

रक्तं [१] सकण्डु सस्फोटं सरुग्दलति चापि यत्|
तच्चर्मदलमाख्यातं संस्पर्शासहमुच्यते||२४||

The clinical features are as follows:

Color – Redness

Nature – pustules, cracks in skin which are crusted

Associated symptoms – Itching

8.Pāmā kuṣṭha

पामाश्वेतारुणश्यावाः कण्डूलाः पिडका भृशम्|

The clinical features are as follows:

Color – white, reddish, brownish blackish

Nature – Itching

Associated symptoms –piḍakā (erruptions)

9. Visphōṭa kuṣṭha

स्फोटाः श्वेतारुणाभासो विस्फोटाः स्युस्तनुत्वचः||२५||

The clinical features are as follows:

Color – white reddish in appearance

Nature – erruptions and pustules with thin skin

10.Śatāru kuṣṭha

रक्तं श्यावं सदाहार्ति शतारुः स्याद्बहुव्रणम्|

The clinical features are as follows:

Color – reddish, blackish

Nature – ulcerated

Associated symptoms – burning sensation and pain

11.Vicārcikā kuṣṭha

सकण्डूः पिडका श्यावा बहुस्रावा विचर्चिका||२६||

The clinical features are as follows:

Color – blackish brown

Nature – excessive exudation, eruptions

Associated symptoms – pruritus

इत्येकादश क्षुद्रकुष्ठानि

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

Dosha dominance in types of kushtha

वातेऽधिकतरे कुष्ठं कापालं मण्डलं कफे|
पित्ते त्वौदुम्बरं विद्यात् काकणं तु त्रदोषजम्||२७||

वातपित्ते श्लेष्मपित्ते वातश्लेष्मणि चाधिके|
ऋष्यजिह्वं पुण्डरीकं सिध्मकुष्ठं च जायते||२८||

चर्माख्यमेककुष्ठं च किटिमं सविपादिकम्|
कुष्ठं चालसकं ज्ञेयं प्रायो वातकफाधिकम्||२९||

पामा शतारुर्विस्फोटं दद्रुश्चर्मदलं तथा|
पित्तश्लेष्माधिकं प्रायः कफप्राया विचर्चिका||३०||

The dosha dominance in types of kushtha is as enlisted below:

Predominant Dosha Disease
Vata Kapala
Kapha Mandala, Vicharchika
Pitta Udumbara
Tridosha Kakanaka
Vata-Pitta Rishyajihva
Kapha-Pitta Pundarika
Vata-Kapha Siddhma, Carmākhya, Ekkuṣṭha, Kiṭibha, Vipādikā, Alasaka
Pitta-Kapha Pāmā, Śatāru, Visphōṭaka, Dadru, Charmadala

General guidelines for diagnosis

सर्वं त्रिदोषजं कुष्ठं दोषाणां तु बलाबलम्|
यथास्वैर्लक्षणैर्बुद्ध्वा कुष्ठानां क्रियते क्रिया||३१||

दोषस्य यस्य पश्येत् कुष्ठेषु विशेषलिङ्गमद्रिक्तम्|
तस्यैव शमं कुर्यात्ततः परं चानुबन्धस्य||३२||

Tridosha are involved in pathogenesis of all types of kushtha. Depending on dosha predominant symptoms are manifested and treatment should be decided on the basis of symptoms shown in specific kushtha. The dosha presenting important and specific symptoms should be alleviated firstly followed by the treatment of associated dosha.[31-32]

कुष्ठविशेषैर्दोषा दोषविशेषैः पुनश्च कुष्ठानि|
ज्ञायन्ते तैर्हेतुर्हेतुस्तांश्च [१] प्रकाशयति||३३||

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]

Dosha specific features of diagnosis of dosha dominance in kushtha

रौक्ष्यं शोषस्तोदः शूलं सङ्कोचनं तथाऽऽयामः|
पारुष्यं खरभावो हर्षः श्यावारुणत्वं च||३४||

कुष्ठेषु वातलिङ्गं, दाहो रागः परिस्रवः पाकः|
विस्रो गन्धः क्लेदस्तथाऽङ्गपतनं च पित्तकृतम्||३५||

श्वैत्यं शैत्यं कण्डूः स्थैर्यं चोत्सेधगौरवस्नेहाः|
कुष्ठेषु तु कफलिङ्गं जन्तुभिरभिभक्षणं क्लेदः||३६||

Symptoms due to dosha predominance include dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of vata dosha.

Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of pitta dosha.

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]

Prognosis

सर्वैर्लिङ्गैर्युक्तं मतिमान् विवर्जयेदबलम्|
तृष्णादाहपरीतं शान्ताग्निं जन्तुभिर्जग्धम्||३७||

वातकफप्रबलं यद्यदेकदोषोल्बणं न तत् कृच्छ्रम्|
कफपित्त-वातपित्तप्रबलानि तु कृच्छ्रसाध्यानि||३८||

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]

Principles of management

वातोत्तरेषु सर्पिर्वमनं श्लेष्मोत्तरेषु कुष्ठेषु|
पित्तोत्तरेषु मोक्षो रक्तस्य विरेचनं चाग्रे||३९||

In vataja kushtha, firstly administer ghritapana, whereas in kaphaja kushtha vamana procedure should be done and in pittaja kushtha, virechana along with raktamokshana should be first line of treatment.[39]

वमनविरेचनयोगाः कल्पोक्ताः कुष्ठिनां प्रयोक्तव्याः|
प्रच्छनमल्पे कुष्ठे महति च शस्तं सिराव्यधनम्||४०||

For vamana and virechana drugs mentioned in Kalpa Sthana should be used. Prachhana karma i.e. blood letting by rubbing with coarse device should be carried out if dushya dushti is less and venesection should be carried out in condition where dosha dusya dusti is strong.[40]

बहुदोषः संशोध्यः कुष्ठी बहुशोऽनुरक्षता प्राणान्|
दोषे ह्यतिमात्रहृते वायुर्हन्यादबलमाशु||४१||

Patients with excessive vitiated dosha should be given shodhana therapy repeatedly; taking care about their prana (strength). Excessive elimination of dosha may increase vata dosha which may bring about weakness and in rare condition endanger the life of patient.[41]

स्नेहस्य पानमिष्टं शुद्धे कोष्ठे प्रवाहिते रक्ते|
वायुर्हि शुद्धकोष्ठं कुष्ठिनमबलं विशति शीघ्रम्||४२||

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]

Various formulations

दोषोत्क्लिष्टे हृदये वाम्यः कुष्ठेषु चोर्ध्वभागेषु|
कुटजफलमदनमधुकैः सपटोलैर्निम्बरसयुक्तैः||४३||

शीतरसः पक्वरसो मधूनि मधुकं च वमनानि|

If dosha are utklishta and located in hridaya or kushtha is manifested in the upper part of body, then vamana should be administered with help of fruit of kuthaja, madanaphala and madhuka along with juice of patola and nimba. Sheeta rasa (cold effusion), pakva rasa(decoction), honey and madhuka should be used for vamana.[43]

कुष्ठेषु त्रिवृता दन्ती त्रिफला च विरेचने शस्ता||४४||

सौवीरकं तुषोदकमालोडनमासवाश्च सीधूनि|
शंसन्त्यधोहराणां यथाविरेकं क्रमश्चेष्टः||४५||

Trivrita, danti and triphala are to be used for virechana in kushtha. Sauviraka, tushodaka, alodhana, asava, sidhu are types of aushadi kalpana to be used in virechana. Further sansarjana karma should be followed as per order. [44-45]

दार्वीबृहतीसेव्यैः पटोलपिचुमर्दमदनकृतमालैः|
सस्नेहैरास्थाप्यः कुष्ठी सकलिङ्गयवमुस्तैः||४६||

वातोल्बणं विरिक्तं निरूढमनुवासनार्हमालक्ष्य|
फलमधुकनिम्बकुटजैः सपटोलैः साधयेत्स्नेहम्||४७||

Darvi, brihati, patola, pichumarda, madanphala, kritamala, kalinga, yava and musta should be used along with sneha for asthapana. After virechana and asthapana basti still if there is excess of vata than give anuvasana basti should be given. In such condition sneha fortified with madanaphala, madhuka, nimba, kutaja, and patola should be used. [46-47]

सैन्धवदन्तीमरिचं फणिज्झकः पिप्पली करञ्जफलम्|
नस्यं स्यात्सविडङ्गं क्रिमिकुष्ठकफप्रकोपघ्नम् [१] ||४८||

वैरेचनिकैर्धूमैः श्लोकस्थानेरितैः प्रशाम्यन्ति|
कृमयः कुष्ठकिलासाः प्रयोजितैरुत्तमाङ्गस्थाः||४९||

Saindhava, dantī, maricha, phaṇijjhaka, pippali, fruit of karanja and vidanga should be used for nasya especially in case of krimi and kapha pradhan kushtha.

Drugs mentioned in Sutra Sthana for vairechanika dhuma should be used in krimija kushtha and kilasa and also disease affecting the upper part of the body. [48-49]

स्थिरकठिनमण्डलानां स्विन्नानां प्रस्तरप्रणाडीभिः|
कूर्चैर्विघट्टितानां रक्तोत्क्लेशोऽपनेतव्यः||५०||

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]

Local treatments

आनूपवारिजानां मांसानां पोट्टलैः सुखोष्णैश्च|
स्विन्नोत्सन्नं [१] विलिखेत् कुष्ठं तीक्ष्णेन शस्त्रेण||५१||

रुधिरागमार्थमथवा शृङ्गालाबूनि [२] योजयेत् कुष्ठे|
प्रच्छितमल्पं कुष्ठं विरेचयेद्वा जलौकोभिः||५२||

ये लेपाः कुष्ठानां युज्यन्ते निर्हृतास्रदोषाणाम्|
संशोधिताशयानां सद्यः सिद्धिर्भवेत्तेषाम्||५३||

If the patches are elevated then swedana with lukewarm poultice of meat of aquatic animals should be followed by scrubbing with sharp edge surgical instrument for blood letting. For blood letting shringa (horn), alabu (gourd) may be used. Especially in alpa kushtha, prachana, virechana and/or use of jaluka should be done.

Lepa explained in kushtha become efficient if applied after raktamokshana and other shodhana procedures. [51-53]

येषु न शस्त्रं क्रमते स्पर्शेन्द्रियनाशनानि यानि स्युः|
तेषु निपात्यः क्षारो रक्तं दोषं च विस्राव्य||५४||

पाषाणकठिनपरुषे सुप्ते कुष्ठे स्थिरे पुराणे च|
पीतागदस्य कार्यो विषैः प्रदेहोऽगदैश्चानु||५५||

स्तब्धानि सुप्तसुप्तान्यस्वेदनकण्डुलानि कुष्ठानि|
कूर्चैर्दन्तीत्रिवृताकरवीरकरञ्जकुटजानाम्||५६||

जात्यर्कनिम्बजैर्वा पत्रैः शस्त्रैः समुद्रफेनैर्वा|
घृष्टानि गोमयैर्वा ततः प्रदेहैः प्रदेह्यानि||५७||

When there is loss of sensation and/or surgical interventions is prohibited, kshara should be used after rakta and dosha are eliminated.

If kushtha is hard like stone with numbness, it is stable (not spreading) and chronic in such cases antidotes should be given internally prior to the application of poison in the form of lepa followed by application of antidote.

If there is numbness around the patch of kushtha associated with complete loss of sensation along with anhidrosis, and pruritus then for scrubbing in such condition brush (kurcha) prepared from danti, trivrita, karavira, karanja, kutaja or leaves of jāti, arka, nimba or surgical instruments, samudra phena, dried cow-dung should be used followed by application of lepa. [54-57]

मारुतकफकुष्ठघ्नं कर्मोक्तं पित्तकुष्ठिनां कार्यम्|
कफपित्तरक्तहरणं तिक्तकषायैः प्रशमनं च||५८||

सर्पींषि तिक्तकानि च यच्चान्यद्रक्तपित्तनुत् [१] कर्म|
बाह्याभ्यन्तरमग्र्यं तत् कार्यं पित्तकुष्ठेषु||५९||

In pittaja kushtha line of treatment followed in vata kaphaja kushtha should be followed along with kapha, pitta and rakta should be eliminated and tikta (bitter), kashaya (astringent) drugs are to be used for pacifying the dosha. Ghee fortified with tikta (bitter) drugs and line of treatment of raktapitta should be followed internally and externally for treatment of pittaja kushtha. [58-59]

दोषाधिक्यविभागादित्येतत् कर्म कुष्ठनुत् प्रोक्तम्|
वक्ष्यामि कुष्ठशमनं प्रायस्त्वग्दोषसामान्यात्||६०||

Treatment of different kushtha categorized on basis of aggravated dosha has been explained henceforth treatment for pacifying of kushtha is being explained wherein defect in skin is general symptom. [60]

दार्वी रसाञ्जनं वा गोमूत्रेण प्रबाधते कुष्ठम्|
अभया प्रयोजिता वा मासं सव्योषगुडतैला||६१||

Dārvi or rasāñjana along with cow’s urine helps in treatment of kushtha. Similarly haritaki along with trikatu or gud and taila for period of one month is helpful. [61]

मूलं पटोलस्य तथा गवाक्ष्याः पृथक् पलांशं त्रिफलात्वचश्च [१] |
स्यात्त्रायमाणा कटुरोहिणी च भागार्धिका नागरपादयुक्ता||६२||

पलं तथैषां सह चूर्णितानां जले शृतं दोषहरं पिबेन्ना|
जीर्णे रसैर्धन्वमृगद्विजानां पुराणशाल्योदनमाददीत||६३||

कुष्ठानि शोफं ग्रहणीप्रदोषमर्शांसि कृच्छ्राणि हलीमकं च|
षड्रात्रयोगेन निहन्ति चैष हृद्बस्तिशूलं विषमज्वरं च||६४||

One pala of root of patola and gavakshi, contents of triphala (haritaki, bibhataki and amalaki) taken separately in one pala quantity each. Trayamana and katuki in quantity of 6 sanas and 4 sana of sunthi, should be taken together. One pala of this combination should be boiled in water and administered for elimination of dosha.

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]

Mustadi churna

मुस्तं व्योषं त्रिफला मञ्जिष्ठा दारु पञ्चमूल्यौ द्वे|
सप्तच्छदनिम्बत्वक् सविशालश्चित्रको मूर्वा||६५||

चूर्णं तर्पणभागैर्नवभिः संयोजितं समध्वाज्यम् [१] |
सिद्धं कुष्ठनिबर्हणमेतत् प्रायोगिकं भक्ष्यम्||६६||

श्वयथुं सपाण्डुरोगं श्वित्रं ग्रहणीप्रदोषमर्शांसि|
ब्रघ्नभगन्दरपिडकाकण्डूकोठांश्च विनिहन्ति||६७||

इति मुस्तादिचूर्ण

Musta, trikatu, triphala, manjishthā, dāruharidra, two panchamūla (brihat and laghu) saptacchada, bark of nimba, viśāla, chitraka, mūrvā are taken in equal quantity and powdered together. This powder should be mixed with nine times of saktu and should be prescribed with honey and ghrita. It is among the best treatment for kushtha which should be given everyday. The combination is also useful in shotha, pāṇḍu, śvitra, grahaṇīdoṣa, arśa, braghna, bhagandar, piḍakā, kaṇḍū, kōṭhā.

This ends the explanation of mustādichūrṇam.[65-67]

त्रिफलाफलातिविषाकटुकानिम्बकलिङ्गकवचापटोलानाम्|
मागधिकारजनीद्वयपद्मकमूर्वाविशालानाम्||६८||

भूनिम्बपलाशानां दद्याद्विपलं ततस्त्रिवृद्द्विगुणा|
तस्याश्च पुनर्ब्राह्मी तच्चूर्णं सुप्तिनुत् परमम्||६९||

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]

Benefits of lelitaka (sulphur)

लेलीतकप्रयोगो [१] रसेन जात्याः समाक्षिकः परमः|
सप्तदशकुष्ठघाती माक्षिकधातुश्च मूत्रेण||७०||

Lelitaka (sulphur) when administered with juice of jāti (āmalaki) along with honey is beneficial in 17 types of kushtha. Similarly use of makshika (copper pyrite) with cows’ urine too is very beneficial. [70]

श्रेष्ठं [२] गन्धकयोगात् सुवर्णमाक्षिकप्रयोगाद्वा|
सर्वव्याधिनिबर्हणमद्यात् कुष्ठी रसं च निगृहीतम्||७१||

वज्रशिलाजतुसहितं सहितं वा योगराजेन|
सर्वव्याधिप्रशमनमद्यात्कुष्ठी निगृह्य नित्यं च||७२||

Gandhaka (sulphur) and/or suvarṇamākṣika when used for processing of rasa (mercury) acts as the best medicine in treatment of all disease especially kushtha.

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

Madhvasava

खदिरसुरदारुसारं श्रपयित्वा तद्रसेन तोयार्थः|
क्षौद्रप्रस्थे कार्यः कार्ये ते चाष्टपलिके च||७३||

तत्राश्चूर्णानामष्टपलं प्रक्षिपेत्तथाऽमूनि|
त्रिफलैले त्वङ्मरिचं पत्रं कनकं च कर्षांशम्||७४||

मत्स्यण्डिका मधुसमा तन्मासं जातमायसे भाण्डे|
मध्वासवमाचरतः कुष्ठकिलासे शमं यातः||७५||

इति मध्वासवः

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]

Kanaka bindu arishta

खदिरकषायद्रोणं कुम्भे घृतभाविते समावाप्य|
द्रव्याणि चूर्णितानि च षट्पलिकान्यत्र देयानि||७६||

त्रिफलाव्योषविडङ्गरजनीमुस्ताटरूषकेन्द्रयवाः|
सौवर्णी च तथा त्वक् छिन्नरुहा चेति तन्मासम्||७७||

निदधीत धान्यमध्ये प्रातः प्रातः पिबेत्ततो युक्त्या|
मासेन महाकुष्ठं हन्त्येवाल्पं तु पक्षेण||७८||

अर्शःश्वासभगन्दरकासकिलासप्रमेहशोषांश्च|
ना भवति कनकवर्णः पीत्वाऽरिष्टं कनकबिन्दुम्||७९||

इति कनकबिन्द्वरिष्टम्
कुष्ठेष्वनिलकफकृतेष्वेवं पेयस्तथाऽपि पैत्तेषु|
कृतमालक्वाथश्चाप्येष विशेषात् कफकृतेषु||८०||

In ghee smeared jar one drona of decoction of khadira should be added. To these 6 palas each of powdered triphala, trikatu, viḍaṅga, haridra, musta, vāsā, indrayava, bark of sauvarni (dāruharidra), and guduchi should be added. The jar should be kept for one month inside a heap of grains. Every morning if this preparation is taken then in one month mahakuṣṭha gets cured and within 15 days ksudrakuṣṭha is cured. It is also useful arśa, śvāsa, bhagandar, kasa, kilasa, prameha and shosha. Skin achieves golden complexion after having kanakabindu. This ends explanation of kanakabindvariṣṭa. It is useful in all vataja, pittaja and kaphaja kushtha.

Especially in kaphaja kuṣṭha, kritmalaka decoction should be used in place of khadira.[76-80]

त्रिफलासवश्च गौडः सचित्रकः कुष्ठरोगविनिहन्ता|
क्रमुकदशमूलदन्तीवराङ्गमधुयोगसंयुक्तः||८१||

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

Diet in kushtha

लघूनि चान्नानि हितानि विद्यात् कुष्ठेषु शाकनि च तिक्तकानि|
भल्लातकैः सत्रिफलैः सनिम्बैर्युक्तानि चान्नानि घृतानि चैव||८२||

पुराणधान्यान्यथ जाङ्गलानि मांसानि मुद्गाश्च पटोलयुक्ताः|
शस्ता, न गुर्वम्लपयोदधीनि नानूपमत्स्या न गुडस्तिलाश्च||८३||

Easily digestible and wholesome food, green leafy vegetables bitter in taste, food and ghee prepared by fortifying with bhallataka, triphala and nimba, one year old cereals, meat of animals inhabiting from arid area, preparations of mudga and patola.

Avoid heavy to digest, sour food, milk, curd, meat of animals residing in marshy area, fish, jaggery and sesame. [82-83]

एला कुष्ठं दार्वी शतपुष्पा चित्रको विडङ्गश्च|
कुष्ठालेपनमिष्टं रसाञ्जनं चाभया चैव||८४||

Ela, kuṣṭha, dārvi, śatapuṣpā, chitraka, viḍaṅga, rasāñjana and abhaya taken together and their paste when applied has a very efficacious role in kushtha.[84]

चित्रकमेलां बिम्बीं [१] वृषकं त्रिवृदर्कनागरकम्|
चूर्णीकृतमष्टाहं भावयितव्यं पलाशस्य||८५||

क्षारेण गवां मूत्रस्रुतेन तेनास्य मण्डलान्याशु|
भिद्यन्ते विलयन्ति च लिप्तान्यर्काभितप्तानि||८६||

Chitraka, ela, bimbi, vr̥ṣaka, trivr̥tā, arka and shunthi should be powdered together and trichurate with palāśa kshara and fortify it with cows urine for eight days. Application of this paste followed by sun exposure leads to bursting and dissolution of maṇḍala. [85-86]

मांसी मरिचं लवणं रजनी तगरं सुधा गृहाद्धूमः|
मूत्रं पित्तं [२] क्षारः पालाशः कुष्ठहा लेपः||८७||

Māṁsī, maricha, lavana, haridra, tagara, sudhā and gr̥hāddhūma paste should be prepared along with cow urine, cow’s bile and palasha kshara should be applied.[87]

त्रपु सीसमयश्चूर्णं मण्डलनुत् फल्गुचित्रकौ बृहती|
गोधारसः सलवणो दारु च मूत्रं च मण्डलनुत्||८८||

Trapu (tin), sīsa (lead) and ayaś (iron) powders when applied treats maṇḍala kuṣṭha. Similarly application of phalgu, citraka, br̥hatī, gōdhārasa (meat soup of iguana) lavana, devdāru and cow’s urine is also helpful in maṇḍala. [88]

कदलीपलाशपाटलिनिचुलक्षाराम्भसा प्रसन्नेन|
मांसेषु तोयकार्यं कार्यं पिष्टे च किण्वे [३] च||८९||

तैर्मेदकः सुजातः किण्वैर्जनितं प्रलेपनं शस्तम्|
मण्डलकुष्ठविनाशनमातपसंस्थं कृमिघ्नं च||९०||

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]

Siddharthaka snana( medicinal bath)

मुस्तं मदनं त्रिफला करञ्ज आरग्वधकलिङ्गयवाः|
दार्वी ससप्तपर्णा स्नानं सिद्धार्थकं नाम||९१||

एष कषायो वमनं विरेचनं वर्णकस्तथोद्घर्षः|
त्वग्दोषकुष्ठशोफप्रबाधनः पाण्डुरोगघ्नः||९२||

Powder of musta, madanphala, triphala, karañja, āragvadha, kaliṅgaka, yava, dārvi, saptaparna are boiled in water and used for bath. This preparation is called as siddhārthaka snana.

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]

External applications

कुष्ठं करञ्जबीजान्येडगजः कुष्ठसूदनो लेपः|
प्रपुन्नाडबीजसैन्धवरसाञ्जनकपित्थलोध्राश्च||९३||

श्वेतकरवीरमूलं कुटजकरञ्जयोः फलं त्वचो दार्व्याः|
सुमनःप्रवालयुक्तो लेपः कुष्ठापहः सिद्धः||९४||

Lepa of kuṣṭha (herb), seeds of karañja and ēḍagaja is useful in kuṣṭha roga. Similarly, paste of seeds prapunnāḍa, saindhava, rasāñjana, kapittha, lōdhra, root of white variety of karavīra, fruits of kuṭaja and karañja, bark of dāruharidra along with tender leaves of jati is useful in kuṣṭha. [93-94]

लोध्रस्य धातकीनां वत्सकबीजस्य नक्तमालस्य|
कल्कश्च मालतीनां कुष्ठेषून्मर्दनालेपौ||९५||

Paste of lōdhra, dhātakī, seeds of vatsaka (kuṭaja), naktamāla and malati is to be used externally for udvartan and lepa.[95]

शैरीषी त्वक् पुष्पं कार्पास्या राजवृक्षपत्राणि|
पिष्टा च काकमाची चतुर्विधः कुष्ठनुल्लेपः||९६||

इति लेपाः

Paste of bark of shirīṣa or flowers of kārpās, leaves of rājavr̥kksha or paste of kākamācī are 4 different types of lepa useful in kuṣṭha. [96]

दार्व्या रसाञ्जनस्य च निम्बपटोलस्य खदिरसारस्य|
आरग्वधवृक्षकयोस्त्रिफलायाः सप्तपर्णस्य||९७||

इति षट् कषाययोगाः कुष्ठघ्नाः सप्तमश्च तिनिशस्य|
स्नाने पाने च हितास्तथाऽष्टमश्चाश्वमारस्य||९८||

आलेपनं प्रघर्षणमवचूर्णनमेत एव च कषायाः|
तैलघृतपाकयोगे चेष्यन्ते कुष्ठशान्त्यर्थम्||९९||

Following six decoctions viz.

  1. Dārvi, rasāñjana
  2. Nimba, paṭōla
  3. Heart wood of khadira
  4. Āragvadha and vr̥kṣaka
  5. Triphala
  6. Saptaparna

Seventh decoction is of tiniśa and decoction of āśvamāra.

All of the above decoctions should be used for bathing, drinking, in the form of lepa, for scrubbing and for dusting. The same decoctions can be used for fortifying of medicated ghee and oil.[97-99]

त्रिफला निम्बपटोलं मञ्जिष्ठा रोहिणी वचा रजनी|
एष कषायोऽभ्यस्तो निहन्ति कफपित्तजं कुष्ठम्||१००||

एतैरेव च सर्पिः सिद्धं वातोल्बणं जयति कुष्ठम्|
एष च कल्पो दिष्टः खदिरासनदारुनिम्बानाम्||१०१||

In kaphaja-pittaja kuṣṭha, triphala, nimba, paṭōla, mañjiṣṭhā, rōhiṇī, vacā, rajani should be regularly taken in the form of decoction. The same medicine, when used to fortify ghr̥ita helps in curing vataja kuṣṭha.

Khadira, asana, devadāru and nimba together when used like above has similar benefits.[100-101]

कुष्ठार्कतुत्थकट्फलमूलकबीजानि रोहिणी कटुका|
कुटजफलोत्पलमुस्तं बृहतीकरवीरकासीसम्||१०२||

एडगजनिम्बपाठा दुरालभा चित्रको विडङ्गश्च|
तिक्तालाबुकबीजं कम्पिल्लकसर्षपौ वचा दार्वी||१०३||

एतैस्तैलं सिद्धं कुष्ठघ्नं योग एष चालेपः|
उद्वर्तनं प्रघर्षणमवचूर्णनमेष एवेष्टः||१०४||

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]

Shweta-karaviradya taila

श्वेतकरवीरकरसो गोमूत्रं चित्रको विडङ्गश्च|
कुष्ठेषु तैलयोगः सिद्धोऽयं सम्मतो भिषजाम्||१०५||

इति श्वेतकरवीराद्यं तैलम्

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]

Shweta karavira palladi tailam

श्वेतकरवीरपल्लवमूलत्वग्वत्सको विडङ्गश्च|
कुष्ठार्कमूलसर्षपशिग्रुत्वग्रोहिणी कटुका||१०६||

एतैस्तैलं सिद्धं कल्कैः पादांशिकैर्गवां मूत्रम्|
दत्त्वा तैलचतुर्गुणमभ्यङ्गात् कुष्ठकण्डूघ्नम्||१०७||

इति श्वेतकरवीरपल्लवाद्यं तैलम्

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]

Tikta-ikshwakwadi tailam

तिक्तालाबुकबीजं द्वे तुत्थे रोचना हरिद्रे द्वे|
बृहतीफलमेरण्डः सविशालश्चित्रको मूर्वा||१०८||

कासीसहिङ्गुशिग्रुत्र्यूषणसुरदारुतुम्बुरुविडङ्गम्|
लाङ्गालकं कुटजत्वक् कटुकाख्या रोहिणी चैव||१०९||

सर्षपतैलं कल्कैरेतैर्मूत्रे चतुर्गुणे साध्यम्|
कण्डूकुष्ठविनाशनमभ्यङ्गान्मारुतकफहन्तृ||११०||

इति तिक्तेक्ष्वाक्वादितैलम्

Seeds of bitter variety of alābu, both varieties of tuttha (mayura and kharparika tuttha) gorōcanā, haridra, dāruharidra, fruit of br̥hatī, ēraṇḍa, viśāla, citraka, murva, kāsīsa, hiṅgu, śigru, trikatu suradāru, tumburu, viḍaṅga, lāṅgāli, bark of kuṭaja, katukarōhiṇī are pasted together and mustard oil is fortified with above medicines and cow’s urine taken in quantity four times of oil.

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

Kanakaksheeri tailam

कनकक्षीरी शैला भार्गी दन्त्याः फलानि मूलं च|
जातीप्रवालसर्षपलशुनविडङ्गं करञ्जत्वक्||१११||

सप्तच्छदार्कपल्लवमूलत्वङ्निम्बचित्रकास्फोताः|
गुञ्जैरण्डं बृहतीमूलकसुरसार्जकफलानि||११२||

कुष्ठं पाठा मुस्तं तुम्बुरुमूर्वावचाः सषड्ग्रन्थाः [१] |
एडगजकुटजशिग्रुत्र्यूषणभल्लातकक्षवकाः||११३||

हरितालमवाक्पुष्पी तुत्थं कम्पिल्लकोऽमृतासञ्ज्ञः|
सौराष्ट्री कासीसं दार्वीत्वक् सर्जिकालवणम्||११४||

कल्कैरेतैस्तैलं करवीरकमूलपल्लवकषाये|
सार्षपमथवा तैलं गोमूत्रचतुर्गुणं साध्यम्||११५||

स्थाप्यं कटुकालाबुनि तत्सिद्धं तेन मण्डलान्याशु|
भिन्द्याद्भिषगभ्यङ्गात्कृमींश्च कण्डूं च विनिहन्यात्||११६||

इति कनकक्षीरीतैलम्

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]

Sidhmahara lepa

कुष्ठं तमालपत्रं मरिचं समनःशिलं सकासीसम्|
तैलेन युक्तमुषितं सप्ताहं भाजने ताम्रे||११७||

तेनालिप्तं सिध्मं सप्ताहाह्येति [१] तिष्ठतो घर्मे|
मासान्नवं किलासं स्नानं मुक्त्वा विशुद्धतनोः||११८||

इति सिध्मे लेपः

The paste of kuṣṭha, tamālapatra, maricha, manaḥśila, kāsīsa should be mixed with oil and kept for seven days in copper vessel. Application of this oil and exposure to sun helps in curing siddhma within a week and kilāsa gets cured within a month provided the patient does not take bath but maintains cleaned body. The preparation is called as sidhma lepa.[117-118]

सर्षपकरञ्जकोषातकीनां तैलान्यथेङ्गुदीनां च|
कुष्ठेषु हितान्याहुस्तैलं यच्चापि खदिरसारस्य||११९||

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

Vipadikahara ghee and taila

जीवन्ती मञ्जिष्ठा दार्वी कम्पिल्लकः पयस्तुत्थम्|
एष घृततैलपाकः सिद्धः सिद्धे च सर्जरसः||१२०||

देयः समधूच्छिष्टो विपादिका तेन शाम्यतेऽभ्यक्ता|
चर्मैककुष्ठकिटिमं कुष्ठं शाम्यत्यलसकं च||१२१||

इति विपादिकाहरघृततैले

With jīvantī, mañjiṣṭhā, dārvi, kampillaka, payas (milk) and tuttha should be used to prepare ghee and/or fortify oil. Once sneha siddhi lakshana are seen sarjarasa and madhūcchiṣṭa should be added. Application of the oil cures, charmakuṣṭha, ekakuṣṭha, kiṭibha and alasaka type of kuṣṭha. This preparation is called as vipādikāhara ghr̥ita and taila.[120-121]

किण्वं [१] वराहरुधिरं पृथ्वीका सैन्धवं च लेपः स्यात्|
लेपो योज्यः कुस्तुम्बुरूणि कुष्ठं च मण्डलनुत्||१२२||

Application of paste of kiṇva (enzyme used for fermentation), blood of boar, pr̥thvīkā and saindhava or lepa of kustumburūṇi cures maṇḍala type of kuṣṭha.[122]

पूतीकदारुजटिलाः पक्वसुरा क्षौद्रमुद्गपर्ण्यौ च|
लेपः सकाकनासो मण्डलकुष्ठापहः सिद्धः||१२३||

Application of lepa of pūtīka, devadāru, jaṭi, pakvasurā, ksaudravalli (guduchi) mudgaparṇi and kākanāsa cures maṇḍala kuṣṭha.[123]

चित्रकशोभाञ्जनकौ गुडूच्यपामार्गदेवदारूणि|
खदिरो धवश्च लेपः श्यामा दन्ती द्रवन्ती च||१२४||

लाक्षारसाञ्जनैलाः पुनर्नवा चेति कुष्ठिनो लेपाः|
दधिमण्डयुताः सर्वे देयाः षण्मारुतकफकुष्ठघ्नाः||१२५||

  1. Citraka and śōbhāñjana
  2. Guduchi , apāmārga , devadāru
  3. Khandira
  4. Dhava
  5. Syama, dantī, dravanti
  6. lākṣā, rasāñjana , ela, punarnava

The above six combinations when mixed separately with dadhimaṇḍa and applied in the form of lepa cures kuṣṭha having predominance of vata and kapha dosha.[124-125]

एडगजकुष्ठसैन्धवसौवीरकसर्षपैः कृमिघ्नैश्च|
कृमिकुष्ठमण्डलाख्यं दद्रूकुष्ठं च शममुपैति||१२६||

Application of ēḍagaja, kuṣṭha, saindhava, sauviraka, sarṣapa and kr̥mighna (viḍaṅga) cures kr̥mi, maṇḍala and dadru kuṣṭha. [126]

एडगजः सर्जरसो मूलकबीजं च सिध्मकुष्ठानाम्|
काञ्जिकयुक्तं तु पृथङ्मतमिदमुद्वर्तनं लेपाः||१२७||

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]

Management of pitta-kapha dominant kushtha

वासा त्रिफला पाने स्नाने चोद्वर्तने प्रलेपे च|
बृहतीसेव्यपटोलाः ससारिवा रोहिणी चैव||१२८||

खदिरावघातककुभरोहीतकलोध्रकुटजधवनिम्बाः|
सप्तच्छदकरवीराः शस्यन्ते स्नानपानेषु||१२९||

Vāsā and triphalā may be used internally, for bathing, udvartana and lepa along with br̥hatī, sēvya, paṭōla, sārivā, rōhiṇī.

Similarly khadira, avaghāta (karnikākāra), kakubha, rōhītaka, lōdhra, kuṭaja, dhava, nimba, saptacchada and karavira combination is useful for external use, for bathing and internal use. [128-129]

जलवाप्यलोहकेशरपत्रप्लवचन्दनं मृणालानि|
भागोत्तराणि सिद्धं प्रलेपनं पित्तकफकुष्ठे||१३०||

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]

Management of pitta dominant kushtha

यष्ट्याह्वलोध्रपद्मकपटोलपिचुमर्दचन्दनरसाश्च|
स्नाने पाने च हिताः सुशीतलाः पित्तकुष्ठिभ्यः||१३१||

Decoction of yaṣṭyāhva, lōdhra, padmaka, paṭōla, pichumarda and chandana may be used externally for bathing and internal use. It has cooling effect and is beneficial in pittaja kuṣṭha.[131]

आलेपनं प्रियङ्गुर्हरेणुका वत्सकस्य च फलानि|
सातिविषा च ससेव्या सचन्दना रोहिणी कटुका||१३२||

Application of priyaṅgu, harēṇuka, fruits of vatsaka, ativiṣā, sēvyā, chandana and katu rōhiṇī is also useful in paittika kuṣṭha. [132]

तिक्तघृतैर्धौतघृतैरभ्यङ्गो दह्यमानकुष्ठेषु|
तैलैश्चन्दनमधुकप्रपौण्डरीकोत्पलयुतैश्च||१३३||

Massaging with tiktaghr̥ta and dhautaghr̥ta helps in reducing burning sensation in kuṣṭha. Similarly medicated oil prepared from chandana, madhuka, prapauṇḍarīka and utpala also has similar effect. [133]

क्लेदे प्रपतति चाङ्गे दाहे विस्फोटके सचर्मदले|
शीताः प्रदेहसेका व्यधो विरेको घृतं तिक्तम्||१३४||

If there is excessive secretions from skin lesion, sloughing of body parts, burning sensation, eruptions and exfoliation of skin then shitā pradēha (application of lepa with shitā dravya), sēkā, virechana and use of tikta ghr̥ita should be done.[134]

खदिरघृतं निम्बघृतं दार्वीघृतमुत्तमं पटोलघृतम्|
कुष्ठेषु रक्तपित्तप्रबलेषु भिषग्जितं सिद्धम्||१३५||

Khandiraghr̥ta, nimbaghr̥ta, dārvighr̥ta and paṭōlaghr̥ta are among the best to be used in rakta and pitta pradhana kuṣṭha.[135]

त्रिफलात्वचोऽर्धपलिकाः पटोलपत्रं च कार्षिकाः शेषाः|
कटुरोहिणी सनिम्बा यष्ट्याह्वा त्रायमाणा च||१३६||

एष कषायः साध्यो दत्त्वा द्विपलं मसूरविदलानाम्|
सलिलाढकेऽष्टभागे शेषे पूतो रसो ग्राह्यः||१३७||

ते च [१] कषायेऽष्टपले चतुष्पलं सर्पिषश्च पक्तव्यम्|
यावत्स्यादष्टपलं शेषं पेयं ततः कोष्णम्||१३८||

तद्वातपित्तकुष्ठं वीसर्पं वातशोणितं प्रबलम्|
ज्वरदाहगुल्मविद्रधिविभ्रमविस्फोटकान् हन्ति||१३९||

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 vata pitta kuṣṭha, visarpa, vātarakta, jwara, daha, gulma, vidradhi, giddiness and visphōṭaka. [136-139]

Tikta shatpala ghee

निम्बपटोलं दार्वीं दुरालभां तिक्तरोहिणीं त्रिफलाम्|
कुर्यादर्धदलांशं पर्पटकं त्रायमाणां च||१४०||

सलिलाढकसिद्धानां रसेऽष्टभागस्थिते क्षिपेत् पूते|
चन्दनकिराततिक्तकमागधिकास्त्रायमाणां च||१४१||

मुस्तं वत्सकबीजं कल्कीकृत्यार्धकार्षिकान् भागान्|
नवसर्पिषश्च षट्पलमेतत्सिद्धं [३] घृतं पेयम्||१४२||

कुष्ठज्वरगुल्मार्शोग्रहणीपाण्ड्वामयश्वयथुहारि|
पामाविसर्पपिडकाकण्डूमदगण्डनुत्सिद्धम्||१४३||

इति तिक्तषट्पलकं घृतम्

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]

Mahatiktaka ghee

सप्तच्छदं प्रतिविषां शम्पाकं तिक्तरोहिणीं पाठाम्|
मुस्तमुशीरं त्रिफलां पटोलपिचुमर्दपर्पटकम्||१४४||

धन्वयवासं चन्दनमुपकुल्यां पद्मकं हरिद्रे द्वे|
षड्ग्रन्थां सविशालां शतावरीं सारिवे चोभे||१४५||

वत्सकबीजं यासं [४] मूर्वाममृतां किराततिक्तं च|
कल्कान् कुर्यान्मतिमान्यष्ट्याह्वं त्रायमाणां च||१४६||

कल्कश्चातुर्भागो [५] जलमष्टगुणं रसोऽमृतफलानाम्|
द्विगुणो घृतात्प्रदेयस्तत्सर्पिः पाययेत्सिद्धम्||१४७||

कुष्ठानि रक्तपित्तप्रबलान्यर्शांसि रक्तवाहीनि|
वीसर्पमम्लपित्तं [६] वातासृक् पाण्डुरोगं च||१४८||

विस्फोटकान्सपामानुन्मादं कामलां ज्वरं कण्डूम्|
हृद्रोगगुल्मपिडका असृग्दरं गण्दमालां च||१४९||

हन्यादेतत् सर्पिः पीतं काले यथाबलं सद्यः|
योगशतैरप्यजितान्महाविकारान्महातिक्तम्||१५०||

इति महातिक्तकं घृतम्

Saptacchada, prativiṣā, śampāka (āragvada), tiktarōhiṇī, pāṭhā, musta, uśīra, triphala, paṭōla, picumarda, parpaṭaka, dhanvayavās, candana, upakulyā (pippali), padmaka haridra, dāruharidra, ṣaḍgrantha, viśālā, śatāvarī, both the type of sāriva (Krsna and sveta), seeds of vatsaka, yāsa, mūrvā, amr̥tā, kirātatikta, yastimadhu and trayamana are taken together and paste is prepared in quantity of one fourth of ghr̥ita. To this water should be added in quantity of 8 times of ghee along with juice of amr̥taphala (amalaki) in quantity of twice of ghr̥ita and siddha ghr̥ita should be prepared. It is beneficial in kuṣṭha, raktapitta, serious type of bleeding piles, vīsarpa, amlapitta, vātarakta, pāṇḍurōga, visphōṭakaka, pāmā, unmāda, kāmalā, jwara, kaṇḍū, hr̥drōga, gulma, piḍakā, raktapradar, gaṇdamālā. This ghee should be administered at recommended time and dose according to the strength of patient. This mahātiktakaghr̥ita is useful in above mentioned disease conditions where hundred of other preparations do not cure above diseases. [144-150]

दोषे हृतेऽपनीते रक्ते बाह्यान्तरे कृते शमने [७] |
स्नेहे च कालयुक्ते न कुष्ठमनुवर्तते [८] साध्यम्||१५१||

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]

Maha khadira ghee

खदिरस्य तुलाः पञ्च शिंशपासनयोस्तुले|
तुलार्धाः सर्व एवैते करञ्जारिष्टवेतसाः||१५२||

पर्पटः कुटजश्चैव वृषः कृमिहरस्तथा|
हरिद्रे कृतमालश्च गुडूची त्रिफला त्रिवृत्||१५३||

सप्तपर्णश्च सङ्क्षुण्णा दशद्रोणेषु वारिणः|
अष्टभागावशेषं तु कषायमवतारयेत्||१५४||

धात्रीरसं च तुल्यांशं सर्पिषश्चाढकं पचेत्|
महातिक्तककल्कैस्तु यथोक्तैः पलसम्मितैः||१५५||

निहन्ति सर्वकुष्ठानि पानाभ्यङ्गनिषेवणात्|
महाखदिरमित्येतत् परं कुष्ठविकारनुत्||१५६||

इति महाखदिरं घृतम्

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]

Treatment of maggots/micro-organisms in kushtha

प्रपतत्सु लसीकाप्रस्रुतेषु गात्रेषु जन्तुजग्धेषु|
मूत्रं निम्बविडङ्गे स्नानं पानं प्रदेहश्च||१५७||

If there is sloughing of phalanges, exudation, maggots than such kuṣṭha patient should use gomūtra, nimba and viḍaṅga in appropriated quantity for bath (dressing), internally and for lepa. [157]

वृषकुटजसप्तपर्णाः करवीरकरञ्जनिम्बखदिराश्च|
स्नाने पाने लेपे क्रिमिकुष्ठनुदः सगोमूत्राः||१५८||

Vr̥ṣa, kuṭaja, saptaparna, karavira, karañja, nimba, khadira, along with gomūtra is useful in kr̥imi and kuṣṭha in the form of lepa, internal and external use.[158]

पानाहारविधाने प्रसेचने धूपने प्रदेहे च|
कृमिनाशनं विडङ्गं विशिष्यते कुष्ठहा खदिरः||१५९||

For internal use in the form of medicine and diet along with external use in the form of prasēchana, dhupana, lepa viḍaṅga which is effective in kr̥imi and khadira which is special drug for kuṣṭha should be used.[159]

एडगजः सविडङ्गो मूलान्यारग्वधस्य कुष्ठानाम्|
उद्दालनं श्वदन्ता गोश्ववराहोष्ट्रदन्ताश्च||१६०||

Ēḍagaja, viḍaṅga, root of āragvadha and tooth of dog, cow, horse, boar and camel are useful in kuṣṭha.[160]

एडगजः सविडङ्गो द्वे च निशे राजवृक्षमूलं च|
कुष्ठोद्दालनमग्र्यं सपिप्पलीपाकलं योज्यम्||१६१||

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

Management of shwitra(vitiligo)

श्वित्राणां सविशेषं [१] योक्तव्यं सर्वतो विशुद्धानाम्|
श्वित्रे स्रंसनमग्र्यं मलपूरस इष्यते सगुडः||१६२||

तं पीत्वा सुस्निग्धो यथाबलं सूर्यपादसन्तापम्|
संसेवेत विरिक्तस्त्र्यहं पिपासुः पिबेत् पेयाम्||१६३||

In case of śvitrā, shodhana is the specific treatment especially purgation with malapūrasa along with jaggery is the best treatment for leucoderma. The patient must be firstly oleated and should take the above mentioned combination as per his bala and disease bala and later on expose to sunlight. Purgation will be started and whenever patient feels thirsty pēyā should be given for next three days. [162-163]

श्वित्रेऽङ्गे ये स्फोटा जायन्ते कण्टकेन तान्भिन्द्यात्|
स्फोटेषु विस्रुतेषु प्रातः प्रातः पिबेत् पक्षम्||१६४||

मलपूमसनं प्रियङ्गुं शतपुष्पां चाम्भसा समुत्क्वाथ्य|
पालाशं वा क्षारं यथाबलं फाणितोपेतम्||१६५||

Eruptions that occur over the hypo-pigmented patches should be punctured with thorn so that the exudation within the eruptions is removed. Later on for 15 days malapū, asana, priyaṅgu, śatapuṣpā should be boiled in water and should be administered as per strength with pālāśa kṣāra and/or with phāṇita.[164-165]

यच्चान्यत् कुष्ठघ्नं श्वित्राणां सर्वमेव तच्छस्तम्|
खदिरोदकसंयुक्तं खदिरोदकपानग्र्यं वा||१६६||

All the treatment which is kuṣṭhaghna is also useful in śvitrā especially drinks of khadira or mixed with decoctions of khadira.[166]

समनःशिलं विडङ्गं कासीसं रोचनां कनकपुष्पीम्|
श्वित्राणां प्रशमार्थं ससैन्धवं लेपनं दद्यात्||१६७||

Manaḥśila, viḍaṅga, kāsīsa, gorōcana, kanakapuṣpī (svarnakshri) and saindhava when applied externally is useful in leucoderma.[167]

कदलीक्षारयुतं वा खरास्थि दग्धं गवां रुधिरयुक्तम्|
हस्तिमदाध्युषितं वा मालत्याः कोरकक्षारम्||१६८||

नीलोत्पलं सकुष्ठं ससैन्धवं हस्तिमूत्रपिष्टं वा|
मूलकबीजावल्गुजलेपः पिष्टो गवां मूत्रे||१६९||

काकोदुम्बरिका वा सावल्गुजचित्रका गवां मूत्रे|
पिष्टा मनःशिला वा संयुक्ता बर्हिपित्तेन||१७०||

लेपः किलासहन्ता बीजान्यावल्गुजानि लाक्षा च|
गोपित्तमञ्जने द्वे पिप्पल्यः काललोहरजः||१७१||

  1. Kadalīkṣāra and bone ash of ass with blood of cow.
  2. kṣāra of flower buds of mālati mixed with hastimada (crut of elephant).
  3. Nīlōtpala, kuṣṭha (herb), saindhava mixed with elephant urine.
  4. Seed of mūlaka and bakuchi with cows’ urine.
  5. Kākōdumbar along with bakuchi, citraka and cows urine.
  6. Manaḥśilā with peacocks’ bile.
  7. Seeds of avalguja, lākṣā, cow bile, both type of añjana (rasāñjana and sauvirāñjan) pippali and powder of kalaloha.

The above 7 combination of lepa is useful in leucoderma.(168-171)

शुद्ध्या शोणितमोक्षैर्विरूक्षणैर्भक्षणैश्च सक्तूनाम्|
श्वित्रं कस्यचिदेव प्रणश्यति क्षीणपापस्य||१७२||

After shodhana therapy raktamoksana 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]

Various stages of shwitra

दारुणं चारुणं [१] श्वित्रं किलासं नामभिस्त्रिभिः|
विज्ञेयं त्रिविधं तच्च [२] त्रिदोषं प्रायशश्च तत्||१७३||

दोषे रक्ताश्रिते रक्तं ताम्रं मांससमाश्रिते|
श्वेतं मेदःश्रिते श्वित्रं गुरु तच्चोत्तरोत्तरम्||१७४||

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 mamsa dhatu and whitish in color if located in meda dhatu. The subsequent ones are more difficult to treat than earlier ones.[173-174]

Prognosis of vitiligo

यत् परस्परतोऽभिन्नं बहु यद्रक्तलोमवत्|
यच्च वर्षगणोत्पन्नं तच्छ्वित्रं नैव सिध्यति||१७५||

अरक्तलोम तनु यत् पाण्डु नातिचिरोत्थितम्|
मध्यावकाशे चोच्छूनं श्वित्रं तत्साध्यमुच्यते||१७६||

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]

Meta-physical causes of kilasa

वचांस्यतथ्यानि कृतघ्नभावो निन्दा सुराणां [१] गुरुधर्षणं च|
पापक्रिया पूर्वकृतं च कर्म हेतुः किलासस्य विरोधि चान्नम्||१७७||

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]

Summary

तत्र श्लोकाः-

हेतुर्द्रव्यं लिङ्गं विविधं ये येषु चाधिका दोषाः|
कुष्ठेषु दोषलिङ्गं समासतो दोषनिर्देशः||१७८||

साध्यमसाध्यं कृच्छ्रं कुष्ठं कुष्ठापहाश्च ये योगाः|
सिद्धाः किलासहेतुर्लिङ्गं गुरुलाघवं तथा शान्तिः||१७९||

इति सङ्ग्रहः प्रणीतो महर्षिणा कुष्ठनाशनेऽध्याये|
स्मृतिबुद्धिवर्घनार्थं शिष्याय हुताशवेशाय||१८०||

Etiology, dravya (tridosha, rasa, rakta, mamsa, ambu), various signs and symptoms, predominance of dosha in various kushtha and symptoms as per type of vitiated dosha, curable and difficult to cure types of kushtha, preparation useful in kushtha. Similarly etiology, symptoms, curable and incurable symptoms and treatment of śvitrā have been explained.

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

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.
  • These factors vitiate water component of skin, blood, muscular layer and other layers of skin and localize three dosha in the skin to cause kushtha, layer by layer.
  • Variable skin manifestations of kushtha depend upon degree of involvement of three vitiated dosha and their effect on four dhatus i.e. rasa, rakta, mamsa and lasika.
  • With involvement of first and second layer, prodromal symptoms appear. Third and fourth layer involvement results in minor kushtha. Fifth and sixth layer involvement causes mahakushtha.
  • Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color are manifestation of vata dosha. Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts are the symptoms caused by predominance of pitta dosha. 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.
  • Different degree of doshic involvement determines the color, shape, size, symptoms and discharge from the lesions. The treatment differs as per dominance of dosha.
S.No Dosha Predominant Sign Treatment Principle
1 Vata Dryness, atrophy, pricking pain / paraesthesia, pain, constriction or loss of elasticity, hardness, roughness, horripilation, blackish, brownish, slight reddish in color Ghee
2 Pitta Burning sensation, redness, exudation, suppuration, offensive smell, stickiness / moist and sloughing of body parts Virechana (therapeutic purgation), raktamokshana (bloodletting)
3 Kapha Whitish discolouration, cold in touch, pruritus, non-progressive/ slow progression of disease, elevated; heaviness and oiliness, stickiness, maggot infestation Vamana (therapeutic emesis)
  • If all symptoms appear simultaneously, then the kushtha is untreatable. Similarly, immune-compromised patients and those suffering from morbid thirst, burning sensation, loss of digestive power and lesions have maggots then the prognosis is bad. Vata kapha dominant and single dosha predominated kushtha are easily curable. Whereas kapha pitta and vata pitta dominated kushtha are kricchra sadhya i.e. curable with difficulty.
  • If the skin lesion is small, then prachchanna (bloodletting by rubbing with coarse device) should be done. If the skin lesions are large and spread all over body, siravyadha (venesection) should be done for bloodletting.
  • Frequent body purification procedures are needed in treatment of skin diseases. The treatment includes internal purification in the form of therapeutic emesis, purgation etc. and external purification in the form of local applications of lepa of purifying herbs.
  • Shwitra may be caused by meta-physical causes like sinful deeds and those in previous life.
  • Therapeutic purgation is main principle of management in shwitra (vitiligo).
  • Exposure to sunlight is one of the treatments of shwitra.

Vidhi Vimarsha (Applied Inferences )

In the context of kushtha, Ayurveda acknowledges that the human skin consists of six layers, and each layer is seat of specific type of gradually progressing kushtha:

  1. First layer udakadhara, external most layer is responsible for water metabolism. Initial pathology of minor types of kushtha starts with excessive sweating/ discoloration/itching swelling/ altered tactile sense in prodromal stage of kushtha indicative of impairment of water metabolism. This layer may be correlated with stratum corneum.
  2. Second layer is asragdhara, which contains the blood metabolites and impurities of blood trigger the pathology of kushtha and manifest as –bluish black, red, rashes/ pricking pains/ and ulceration. This layer may be correlated with stratum lucidum,
  3. The third layer of skin is the seat of sidhma and kilas kushtha.The third layer may be correlated with stratum granulosum.
  4. The fourth layer is seat of dadru and krushtha. The fourth layer may be correlated with stratum germinosum (combination of spinosum and basale layers),
  5. The fifth layer of skin is seat of makushtha and severe dermal pathologies. The fifth layer may be correlated with papillary layer.
  6. The sixth layer is the seat of most severe mahakushtha, which are incurable. The sixth layer may be compared with reticular layer.(Ch. Sharira 7/4)

Patho-physiology of kushtha

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.

2. Udumbara kushtha

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

Primary lesion manifests as red in color associated with pus, burning sensation caused mainly due to pitta and rakta. Ushna and tikshna guna is responsible for the same.

Secondary lesion includes kleda, kotha, body hair attains brownish color, excessive secretion due to sasneha, sara and drava guna of pitta and rakta.

The infectious and inflammatory phase can be explained thus:

Increased flow of inflammatory factors causes rise in temperature, redness and burning sensation. Eczema is inflammation of the skin. It is characterized by erythematous, vesicular, weeping, itchy and crusting patches. The condition is caused by dysfunctional interplay between the immune system and skin.

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

3. Mandala kushtha

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

Therefore the lesion is granulomatous in presentation. The early and indeterminate leprosy , especially lepromatous leprosy, is a skin condition consisting of pale macules. It results from failure of Th1 cell activation which is necessary to eradicate the mycobacteria. In Lepromatous Leprosy Th2 response is turned on and because of reciprocal inhibition the cell mediated response is depressed.

4. Rishyajivha kushtha

It is dominated by vata 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.

Thus inflammatory and degenerative changes dominate the condition. Pathogenesis involving infectious origin or allergic origin may be included. Diseases such as Lyme disease may be included. Expanding redness known as erythema migrans begins at the site of bite after a period of one week. There is no much itching i.e. alpa kandu but the rash is red and warm but generally painless.

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

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.

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.

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.

7.Kakanaka kushtha

It is predominated by all the three dosha. Thus symptoms of all three dosha 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.

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.

Minor kushtha

1.Eka kushtha

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

Aswēdana (Anhidrosis) may be caused by destruction of sweat glands and or integumetary system it may be due to autoimmune process or infection or anhidrosis may be due to obstruction (kapha) in the outlet or blood supply as in micro-angiopathy.

Stimulation of acetylcholine and further ionic changes caused thereafter are responsible for sweating. Lack of such impulse also causes reduced sweating. Astanga Sangrahakara has explained role of vyana vāyu in sweda which when hampered leads to anhidrosis.

Anhidrosis can occur as an isolated condition or as part of a group of symptoms associated with other diseases. Anhidrosis can also occur after skin has been injured, because sweat glands are clogged or obstructed, as an inherited defect, or as a side effect of medication.

Reduced sweating increases dryness of skin which is presented as rough, scaly or flaky skin. The word ichthyosis comes from ancient Greek where ichthys means fish. All types of ichthyosis have dry, thickened scaly or flaky skin.

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.

2. Charmakhya

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

The main symptom is skin getting thick thus disease like scleroderma, onchocerciasis, harlequin ichthyosis etc can be considered in this group.

Building up of collagen is associated with thickening of skin. Transport of fats into the space between the skin cells may be another reason for thickening of skin.

Research shows that in diabetic patient thickness of skin is observed reason being collagen bundles become large, disorganized and separated by clear spaces. Small amount of acid mucopolysachrides may be present in upper reticular dermis. Presence of active fibroblast and extensive collagen polymerization in the rough endoplasisic reticulam may be the pathogenesis for thick skin.

Calcium deposition may also be cause for tough and thick skin. Rūkṣata, kharata, guna of vata and shita guna of vata 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 vayu. 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.

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.

Granulation tissue appearance is light red or dark pink in color (śyāva), being perfused with new capillary loops or buds granular in appearance. Formation of extracellular matrix gives it hard touch and abnormal productions of skin cells (especially during wound repair) leading to overabundance of skin cells. Premature maturation of keratinocytes induced by an inflammatory cascade in the dermis also contributes for the same.

Vata, rakta, mamsa, 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.

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.

Cracked skin is often kicked off by a vicious cycle of events starting off as a minor, but leading to painful deep cracks. Plain old dry skin can lead to scaling, scaling can cause itchiness leading to scratching and scratching can cause inflammation and tears of skin that can become fissures which leads to more irritation and pain.

Healthy skin has slightly acidic pH, exposure to substances with an alkaline pH such as many commercial cleansers and hand soaps also contribute to interruptions of skin integrity. Once the skin integrity is disturbed, a homeostatic repair mechanism is stimulated that causes the rapid repair of barrier function. Continued exposure to alkaline substances will slow down repair by inhibiting normal skin acidity when there is continued exposure to unfavourable environmental factors.

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

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.

Nodular prurigo cause is unknown. It is uncertain whether scratching leads to lumps, or if the lumps appear before they are scratched. The reason for the lumps, the inflamation and the increased activity and size of nerves in the skin is under investigation but remains unknown.

Prurigo nodularis, Hyde’s diseases, picker nodules, lichen corneus obtusus, nodular lichen simplex chronicus, nodular neurodematitis circumscripta are various synonyms. The constant scratching leads to development of discrete, excoriated nodular hyperpigmented / purpuric lesion with crusted or scaly surfaces.

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 vata and kapha in causing dryness is already been discussed.

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.

Table 2. Comparison of Ksudhra kustha with its Modern resemblance:

S.No Type of Kushtha Modern Medicine equivalent
1 Eka Kushtha Ichthyosis vulgaris, psoriasis
2 Kitibha Kushtha scleroderma, onchocerciasis, harlequin ichthyosis
3 Charmakhya Kushtha psoriasis, lichen planus, lichen sclerosis
4 Vaipadika Kushtha Anhidrosis, Dermatitis, Diabetic neuropathy, Eczema, Hypothyroidism, Psoriasis, cold weather, excessive exposure to hot water, detergent chemicals and low humidity can cause skin fissure, palm and sole psoriasis
5 Alasaka Kushtha Nodular prurigo, Dermatosis neglecta
6 Dadru Kushtha Tinea corpora or ringworm of the body, Tinea faciei or Facial Ringworm, Tinea Capitis Or Blackdot Ringworm, Tinea Capitis or Scalp Ringworm, Tinea Manuum or Ringworm of the Hands, Onychomycosis, Tines Unguium or Ringworm of the nail, Impetigo, Moccasin type of Tinea Pedis
7 Charmadala Kushtha Pre ulcerative phase of Ecthyma, Interdigital type of tinea pedis (athlete’s foot)
8 Visphota Kushtha Bullous Impetigo, Vesicular type of tinea pedis (athlete’s foot), Folliculitis, Malassezia folliculitis, Eosinophilic folliculitis
9 Pama Kushtha Scabies
10 Sataru Kushtha Furuncle
11 Vicharchika Kushtha Wet eczema

Current clinical management of skin diseases

Principal treatment modalities

  1. Internal and external application of sneha (medicated ghee or oil)
  2. Shodhana (purification therapies)
  3. Raktamokshana (blood letting)

Principal drugs

  1. Gandhaka (sulphur)
  2. Nimba
  3. Bakuchi
  4. Hartal
  5. Haridra
  6. Manjishtha
  7. Khadira
  8. Sariva
  9. Patol
  10. Lodhra

Medicines:( Referred from Chikitsa Pradipa):

Type Kalpa Dose Time Anupama
Vata dominant (Kapala) Swatambhu guggulu 500-1000 mg Between Meals Ghee + Honey
Haratal Bhasma 60-120 mg After Meals Ghee + Sugar
Pitta dominant(Audumbara) Tala bhasma mixture 120-250 mg During Meals Ghee + Sugar
Karavira Twak powder 30 - 60 mg After Meals Ghee + Honey
Vata- Pitta dominant(Rishyajivha) Sarvangasundari vati 500-1000 mg Between Meals Ghee + Sugar
Katu kapittha oil 5-20 drops Before Meals Ghee + Sugar
Kapha-pittaja (pundarika) As per dosha dominance
Vata Kaphaja (Sidhma) As per dosha dominance
Tridoshaja (Kakanaka) As per dosha dominance
Vicharchika Aarogya mixture 500-1000 mg Between meals Khadirarishta
Vaipadika and Alasaka Swayambhu guggulu 250-500 mg After meals Khadirarishta
Dadru-Charmadala and Pama-Kachchu –shataru Aarogya mixture 500-1000 mg Between meals Manjishthadi kwatha
Nimba-gandhaka churna 350-750 mg Between meals Ghee + sugar
Gandhaka druti 2-5 drops Between meals Milk
Eka kushtha- charma kushtha –kitibha Gandhaka rasayana 250-500 mg After meals Ghee + sugar
Shwitra Aarogyavardhini 250-500 mg After meals Ghee + sugar
Karavira mula twak powder 30-60 mg After meals Ghee + sugar
Bakuchi seed powder 750-1500 mg After meals Khadira + Aamalaki kashaya
Sarvanga sundari vati 500 -1000 mg After meals Ghee

Related links

  1. Matrashiteeya Adhyaya Verse 29-32.
  2. Naveganadharaniya Adhyaya Verse 38.
  3. Kiyanta Shiraseeya Adhyaya Verse 65.
  4. Vidhishonitiya Adhyaya Verse 9.
  5. Atreyabhadrakapyiya Adhyaya Verse 43.
  6. Atreyabhadrakapyiya Adhyaya Verse 81 Chakrapani.
  7. Atreyabhadrakapyiya Adhyaya Verse 85 Chakrapani.
  8. Annapanavidhi Adhyaya Verse 24.
  9. Annapanavidhi Adhyaya Verse 30.
  10. Annapanavidhi Adhyaya Verse 238.
  11. Prameha Nidana Verse 3.
  12. Kushtha Nidana Verse 4 .
  13. Rogabhishagjitiya Vimana Verse 103.
  14. Rogabhishagjitiya Vimana Verse 06.
  15. Sharira Sankhya Sharira Verse 4
  16. Jwara Chikitsa Verse 285,286.
  17. Grahani Chikitsa verse 35.
  18. Vatavyadhi Chikitsa Verse 226.
  19. Phalamatra Siddhi Verse 12.

Further reading

  1. Adrienne Santos-Longhurst Type 2 Diabetes and Skin Health published Published on September 8, 2014, http://www.healthline.com/health/type-2-diabetes/skin-problems
  2. Su.Ni.5/30, Susruta Samhita Of Susruta edited by Yadavji Trikamji Acharya- Chaukhamba Orientalia, Varanasi- 6th Edition.
  3. Guerra L, Dellambra E, Brescia S, Raskovic D, Vitiligo: pathogenetic hypotheses and targets for current therapies, 2007 [PubMed]
  4. Tareke E, Rydberg P, Karlsson P, Eriksson S, Törnqvist M. Acrylamide: A cooking carcinogen? Chem Res Toxicol. 2000;13:517–22. [PubMed]
  5. Esterbauer H, Schaur RJ, Zollner H. Chemistry and biochemistry of 4-hydroxynonenal, malonaldehyde and related aldehydes. Free Radic Biol Med. 1991;11:81–128. [PubMed]
  6. Principles of Anatomy and Physiology, G.Tortora, B. Ericksons 12th Edition
  7. Type 2 Diabetes and Skin Health published by American Diabetic Association 2012
  8. Nathalie Piccardi and Patricia Manissier, Nutrition and nutritional supplementation Impact on skin health and beauty,2008 [PubMed]
  9. Wall M (March 2008). "Idiopathic intracranial hypertension (pseudotumor cerebri)". Current Neurology and Neuroscience Reports 8 (2): 87–93. doi:10.1007/s11910-008-0015-0. PMID 18460275.
  10. Tetsuya Endo, Professor at the Health Sciences University of Hokkaido, Whale, high source of Mercury Poisoning, 2000
  11. Harrison’s Principles Of Internal Medicine –Mc Graw Hill Medical Publication- 17th Edition, Volume I, 308
  12. Cutaneous Condition, The British Association of Dermatologist published by Wikipedia, 2003.
  13. Harrison’s Principles Of Internal Medicine –Mc Graw Hill Medical Publication- 17th Edition, Volume I pg. 1023.
  14. S Yadav, D De, and A J Kanwar Reverse Koebner Phenomenon In Leukocytoclastic Vasculitis Indian J Dermatol. 2011 Sep-Oct; 56(5): 598–599. doi: 10.4103/0019-5154.87169 PMCID: PMC3221237
  15. Malakar S, Dhar S. Spontaneous repigmentation of vitiligo patches distant from the autologous skin graft sites: A remote reverse Koebner's phenomenon? Dermatology. 1998;197:274. [PubMed]
  16. Loren Pickart et al; Taking Vitamin C with Sulfur Provides Your Body the Ultimate Cellular Protection! Published by skin biology forum, 2014
  17. Loren Pickart et al; The Essentials Of Copper Your Body’s Protective and Anti-Aging Metal: Published by skin biology forum, 2014.

Related Chapter

Kushtha Nidana, Skin diseases in Integrative Medicine

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