The fifth chapter of Nidanasthana of Sushruta Samhita is known as as Kustha Nidanam Adhyaya. This chapter offers with Pores and skin Illnesses.
अथातः कुष्ठनिदानं व्याख्यास्यामः ।।१ ।।
यथोवाच भगवान् धन्वन्तरिः ।।२ ।।
We are going to now expound Kustha Nidāna – prognosis of Leprosy (and another ailments of the pores and skin); as revealed by the venerable Dhañvañtari .
Nidāna – Samprāpti: Causes and Pathogenesis
मिथ्याहाराचारस्य विशेषाद्गुरुविरुद्धासात्म्याजीर्णाहिताशिनः स्नेहपीतस्य वान्तस्य वा व्यायामग्राम्यधर्मसेविनो ग्राम्यानूपौदकमांसानि वा पयसाऽभीक्ष्णमश्नतो यो वा मज्जत्यप्सूष्माभितप्तः सहसा छर्दिं वा प्रतिहन्ति, तस्य पित्तश्लेष्माणौ प्रकुपितौ परिगृह्यानिलः प्रवृद्धस्तिर्यग्गाः सिराः सम्प्रपद्य समुद्धूय बाह्यं मार्गं प्रति समन्ताद्विक्षिपति, यत्र यत्र च दोषो विक्षिप्तो निश्चरति तत्र तत्र मण्डलानि प्रादुर्भवन्ति, एवं समुत्पन्नस्त्वचि दोषस्तत्र तत्र च परिवृद्धिं प्राप्याप्रतिक्रियमाणोऽभ्यन्तरं प्रतिपद्यते धातूनभिदूषयन् ||३||
Causative components of Kustha – Under talked about are the causative components of kustha –
- indulgence in unhealthy / improper meals and actions, particularly meals that are heavy (laborious for digestion), incompatible, unaccustomed, raw and unhealthy;
- individuals who’ve consumed fat for oleation remedy,
- individuals who’ve vomited simply then,
- individuals who indulge extra in bodily actions and copulation,
- individuals who devour meat of animals of home and of marshy areas together with milk continuously,
- he who immerses himself in water instantly after getting fatigued by publicity to warmth, or
- he who suppresses the bouts of vomiting all of a sudden
Pathogenesis of Kustha –
Pitta and kapha develop into aggravated by the above talked about causative components. Later, vata will get related to pitta and kapha and turns into aggravated. These doshas transfer by way of the veins (blood vessels) spreading side-wards. Vata conveys pitta and kapha to the outside i.e. in direction of the pores and skin, everywhere in the physique.
In whichever space (area) of the physique these (doshas) get deposited, mandalas (patches) develop on the pores and skin. The areas whereby these patches are fashioned on the pores and skin, the doshas develop into elevated (and exhibit their signs). If not handled (successfully on this stage), the doshas get deep inside, and vitiate the dhatus (tissues).
Purvarūpa: Premonitory signs
तस्य पूर्वरूपाणि – त्वक्पारुष्यमकस्माद्रोमहर्षः कण्डूः स्वेदबाहुल्यमस्वेदनं वाऽङ्ग प्रदेशानां स्वापः क्षतविसर्पणमसृजः कृष्णता चेति ।।४ ।।
Its premonitory signs are –
- roughness of the pores and skin,
- horripilation with none trigger,
- itching,
- both profuse perspiration or absence of perspiration,
- lack of sensation within the pores and skin / sure areas of the physique,
- spreading of wound to different areas and
- black coloration of the blood
Kustha bheda: Sorts of kustha
तत्र सप्त महाकुष्ठानि, एकादश क्षुद्रकुष्ठानि, एवमष्टादश कुष्ठानि भवन्ति |
तत्र महाकुष्ठान्यरुणोदुम्बरर्ष्य(र्क्ष)जिह्वकपालकाकणकपुण्डरीकदद्रुकुष्ठानीति |
क्षुद्रकुष्ठान्यपि स्थूलारुष्कं महाकुष्ठमेककुष्ठं चर्मदलं विसर्पः परिसर्पः सिध्मं विचर्चिका किटिभं (मं) पामा रकसा चेति ||५||
Mahā kustha are seven in quantity. Kshudra Kustha are eleven in quantity. Altogether, the Kusthas are eighteen sorts.
Mahakusthas are –
- Aruna,
- Udumbara,
- Rsyajihva,
- Kapāla,
- Kākanaka,
- Pundarika and
- Dadru
Ksudrakusthas are – - Sthularuska,
- Mahākustha,
- Ekakustha,
- Carmadala,
- Visarpa,
- Parisarpa,
- Sidhma,
- Vicarcikā,
- Kitibha,
- Pāmā and
- Rakasā
Dosha involvement in all Kusthas
सर्वाणि कुष्ठानि सवातानि सपित्तानि सश्लेष्माणि सक्रिमीणि च भवन्ति , उत्सन्न तस्तु दोषग्रहणमभिभवात् ।।६ ।।
Vata, pitta, kapha and krimi are concerned in all varieties of kustha. They need to be acknowledged on the time of their predominance in kustha.
Mahā kustha
Dosha involvement
तत्र वातेनारुणं , पित्तेनोदुम्बरय॑जिह्वकपालकाकणकानि , श्लेष्मणा पुण्डरीकं दद्रुकुष्ठं चेति । तेषां महत्त्वं क्रियागुरुत्वमुत्तरोत्तरं धात्वनुप्रवेशादसाध्यत्वं चेति ।।७ ।।
Aruņa Kustha is born from Vata. Subsequently, Vata and its signs are predominant in Aruna kind of Kustha.
Under talked about varieties of Kustha are born from Pitta and therefore pitta is predominant in these kusthas –
- Udumbara,
- Rsyajihva,
- Kapāla and
- Kākaņaka
The Kusthas born from Kapha are Pundarika and Dadru. Kapha is due to this fact predominant in these two varieties of Kustha.
Because of the entry (invasion) of those kusthas into the tissues their deep-rootedness, functionality to afflict (and produce nice modifications) and incurability will successively improve (with invasion of each tissue).
Laksanas: Indicators and signs
तत्र, वातेनारुणाभानि तनूनि विसर्पीणि तोदभेदस्वापयुक्तान्यरुणानि |
पित्तेन पक्वोदुम्बरफलाकृतिवर्णान्यौदुम्बराणि, ऋष्य(क्ष)जिह्वाप्रकाशानि खराणि ऋष्य(क्ष)जिह्वानि, कृष्णकपालिकाप्रकाशानि कपालकुष्ठानि, काकणन्तिकाफलसदृशान्यतीव रक्तकृष्णानि काकणकानि ; तेषां चतुर्णामप्योषचोषपरिदाहधूमायनानि क्षिप्रोत्थानप्रपाकभेदित्वानि क्रिमिजन्म च सामान्यानि लिङ्गानि |
श्लेष्मणा पुण्डरीकपत्रप्रकाशानि पौण्डरीकाणि, अतसीपुष्पवर्णानि ताम्राणि वा विसर्पीणि पिडकावन्ति च दद्रुकुष्ठानि; तयोर्द्वयोरप्युत्सन्नता परिमण्डलता कण्डूश्चिरोत्थानत्वं चेति सामान्यानि रूपाणि ||८||
- Aruna kustha –
Causative Dosha – Vata
Patches are
- gentle purple in colour
- skinny
- spreading
- related to pricking and slicing pains
- related to lack of sensation
- Audumbara kustha –
Causative Dosha – Pitta
Form and Shade – much like the ripe fruit of Udumbara - Rsyajihva kustha –
Causative Dosha – Pitta
Patches – resemble the tongue of Rsya – kind of deer in look, are tough / course. - Kapala kustha –
Causative Dosha – Pitta
Patches – resemble items of Kapala – black mud pot. - Kakanantika kustha –
Causative Dosha – Pitta
Patches – resemble the fruit of Kakanantika (Gunja – Abrus precatorius).
Shade – vivid purple and black.
Under talked about are the signs of the above mentioned 4 varieties of Kusthas brought on by predominant aggravation of pitta (from Audumbara Kustha to Kakanantika Kustha),
- localized burning sensation,
- sucking ache
- burning sensation everywhere in the physique,
- feeling as if sizzling fumes are popping out (of the lesions)
- fast in onset
- fast in ripening,
- fast in progress,
- fast in look of krimi – worms
- Pundarika kustha –
Causative Dosha – Kapha
Patches – resemble petals of Pundarika (lotus flower) - Dadru kustha —
Patches – resemble flowers of Atasi in colour. They’re coppery or purple in colour. The lesions / patches unfold out and would have eruptions.
Basic options of Pundarika and Dadru Kustha –
- form of patches – elevated and round
- itching
- sluggish onset of signs
Ksudra Kustha
क्षुद्रकुष्ठान्यत ऊर्ध्वं वक्ष्यामः
स्थूलानि सन्धिष्वतिदारुणानि स्थूलारुषि स्युः कठिनान्यरूंषि ।।
त्वक्कोचभेदस्वपनाङ्गसादाः कुष्ठे महत्पूर्वयुते भवन्ति ।।९ ।।
कृष्णारुणं येन भवेच्छरीरं तदेककुष्ठं प्रवदन्ति कुष्ठम् ।।
स्युर्येन कण्डूव्यथनौषचोषास्तलेषु तच्चर्मदलं वदन्ति ।।१० ।।
विसर्पवत् सर्पति सर्वतो यस्त्वग्रक्तमांसान्यभिभूय शीघ्रम् ।।
मूर्छाविदाहारतितोदपाकान् कृत्वा विसर्पः स भवेद्विकारः ।।११ ।।
शनैः शरीरे पिडकाः स्रवन्त्यः सर्पन्ति यास्तं परिसर्पमाहुः ।।
कण्ड्वन्वितं श्वेतमपायि सिध्य विद्यात्तनु प्रायश ऊर्ध्वकाये ।१२ ।।
राज्योऽतिकण्ड्वर्तिरुजः सरूक्षा भवन्ति गात्रेषु विचर्चिकायाम् ।।
कण्डूमती दाहरुजोपपन्ना विपादिका पादगतेयमेव ।।१३ ।।
यत् स्रावि वृत्तं घनमुग्रकण्डु तत् स्निग्धकृष्णं किटिभं वदन्ति ।।
सास्त्रावकण्डूपरिदाहकाभिः पामाऽणुकाभिः पिडकाभिरूह्या ।।१४ ।।
स्फोटैः xÉSÉWæûUÌiÉ सैव कच्छू : स्फिक्रपाणिपादप्रभवनिरूप्या ।।
कण्ड्वन्विता या पिडका शरीरे संस्रावहीना रकसोच्यते सा ।।१५ ।।
Now we are going to describe Ksudra Kusthas – Minor leprosy
Sthülāruși
- Website of manifestation – close to or on the massive joints
- Ulcers – are fashioned, that are thick, immovable and dreadful
Mahat kuştha
- Pores and skin manifestations – constriction and splitting of pores and skin, lack of sensation of the pores and skin
- Weak spot of the physique
Eka kuştha
- The physique turns into blackish purple in colour on this situation
- Carmadala kuştha—
Under talked about signs will be discovered within the palms and soles –
- Itching
- Ache
- Burning sensation
- Sucking ache
Visarpa kuştha
Nature and similarity with Visarpa – this circumstances spreads everywhere in the physique similar to Visarpa does (herpes, erysipelas). It spreads by invading the pores and skin, blood and muscle tissue in a short time. It’s accompanied with the beneath talked about signs –
- Fainting
- Burning sensation inside the physique
- Restlessness
- Pricking ache
- Manufacturing of ulcers
Parīsarpa kustha
Eruptions having the beneath talked about properties seem everywhere in the physique slowly,
- Have exudations / discharges
- Spreading in nature
Sidhma kustha
This situation presents with patches of pores and skin with beneath talked about options –
- Itching
- White in colour
- Skinny
- Often seen in higher elements of the physique
- Not troublesome
Vicarcikā kuştha
In the sort of Kustha, strains or furrows seem everywhere in the physique which presents with –
Vipadika Kustha
On this, strains or furrows are fashioned within the ft solely, which presents with –
- Itching
- Burning sensation
- Ache
Kitibha kustha
In the sort of Kshudra Kustha – the pores and skin patch has –
- Exudation
- Spherical
- Thick
- Has extreme itching
- Unctuous
- Black in colour
Pāmā kustha
This kind of Kustha manifests as eruptions which has the beneath talked about signs throughout –
- Exudation
- Itching
- Burning sensation
Kachchu is a variant of Pama. Kachchu is a situation presenting with vesicles (blebs) which have burning sensation. They seem on the buttock, palms and ft.
Rakasa kustha
This situation presents with eruptions everywhere in the physique. There may be itching however no exudation.
Dosha involvement in Ksudra Kustha
अरु : ससिध्यं रकसा महच्च यच्चैककुष्ठं कफजान्यमूनि ।।
वायोः प्रकोपात् परिसर्पमेकं शेषाणि पित्तप्रभवाणि विद्यात् ।।१६ ।।
Among the many Kshudra Kusthas,
Under talked about are Kapha Predominant Kusthas –
- Sthūlāru,
- Sidhma,
- Rakasa,
- Mahat Kustha and
- Eka
Under talked about are Vata Predominant Kusthas – - Parisarpa
The Kusthas apart from these talked about in Kapha and Vata predominant Kshudra Kusthas are the Pitta predominant Kusthas.
In keeping with Acharya Dalhana, Visarpa has fast spreading nature whereas Visarpa Kustha spreads slowly. That is the distinction between these two circumstances.
Kilasa: Leucoderma
किलासमपि कुष्ठविकल्प एव ; तत्रिविधं – वातेन , पित्तेन , श्लेष्मणा चेति । कुष्ठ किलासयोरन्तरं – त्वग्गतमेव किलासमपरिस्रावि च । तद्वातेन मण्डलमरुणं परुषं परिध्वंसि च , पित्तेन पद्मपत्रप्रतीकाशं सपरिदाहं च , श्लेष्मणा श्वेतं स्निग्धं बहलं कण्डूमच्च । तेषु संबद्ध मण्डलमन्तेजातं रक्तरोमचासाध्यमग्निदग्धं च ।।१७ ।।
Kilasa (leukoderma, vitiligo) can be a kind of Kustha. It’s of three sorts. They’re produced by Vata, Pitta and Kapha individually.
Kilasa is confined solely to the pores and skin and doesn’t have exudations. That is the distinction of Kilasa from Kustha.
Signs of Kilasa produced by Vata –
The patches are –
- Mild purple in colour
- Tough
- Destroys the pores and skin
Signs of Kilasa produced by Pitta –
The patches – - Resembles lotus petals in colour i.e. gentle purple in colour
- Related to burning sensation
Signs of Kilasa produced by Kapha –
The patches – - Are white in colour
- Unctuous
- Thick and
- Are related to itching
Kilasa having the beneath talked about options are incurable – - The patches are fused collectively,
- The patches are localized on the ends of the physique i.e. palms, ft, lips and genital organs,
- Has purple coloured hairs
- Brought on by hearth burns
Doșa lakṣana in Kustha
कुष्ठेषु तु त्वक्संकोचस्वापस्वेदशोफभेदकौण्यस्वरोपघाता वातेन , पाकावदरणाङ्गुलिप तनकर्णनासाभङ्गाक्षिरागसत्त्वोत्पत्तय : पित्तेन , कण्डूवर्णभेदशोफास्रावगौरवाणि श्लेष्मणा ।।१८ ।।
Signs resulting from Vata – In Kuştha, the beneath talked about signs are resulting from vata –
- constriction of the pores and skin,
- lack of sensation,
- sweating,
- swelling,
- splitting (cracking),
- distortion of the arms (lack of fingers) and
- problems (hoarseness of loss) of voice
Signs resulting from Pitta – In Kustha, the beneath talked about signs are resulting from pitta – - ripening (ulceration and suppuration),
- cracking,
- lack of fingers and toes,
- distortion of the ears and nostril,
- purple colour of the eyes and look of worms (micro organism and so forth)
Signs resulting from Kapha – In Kustha, the beneath talked about signs are resulting from kapha – - itching,
- change of colour,
- swelling,
- exudation and
- feeling of heaviness
Sādhyāsādhyata: Prognosis
तत्रादिबलप्रवृत्तं पौण्डरीकं काकणं चासाध्यम् ।।१९ ।।
Pundarika and kakana varieties of Kustha are incurable. They’re Adibala Pravritta circumstances i.e. they’re brought on by defect of shukra and sonita and are congenital.
Anology of unfold manifestation and unfold of kustha
भवन्ति चात्र
यथा वनस्पतिर्जातः प्राप्य कालप्रकर्षणम् ।।
अन्तर्भूमिं विगाहेत मूलैर्वृष्टिविवधितैः ।।२० ।।
एवं कुष्ठं समुत्पन्नं त्वचि कालप्रकर्षतः ।।
क्रमेण धातून व्याप्नोति नरस्याप्रतिकारिणः ।।२१ ।।
Some verses right here
When a seed is put within the floor and is nourished by water, its roots come out and it (plant) comes out from the bottom sooner or later of time i.e. at correct time, to develop into a tree.
Equally, Kustha too firstly arises within the pores and skin. Later, sooner or later of time, it invades the opposite tissues additionally, particularly so, in individuals in whom it has not been handled correctly and in correct time.
Dhātugata kuștha lakṣaṇa: Signs in tissues
स्पर्शहानिः स्वेदनत्वमीषत्कण्डूश्च जायते ।।
वैवयं रूक्षभावश्च कुष्ठे त्वचि समाश्रिते ।।२२ ।।
त्वक्स्वापो रोमहर्षश्च स्वेदस्याभिप्रवर्तनम्||
कण्डूर्विपूयकश्चैव कुष्ठे शोणितसंश्रिते ।।२३ ।।
बाहुल्यं वक्त्रशोषश्च कार्कश्यं पिडकोद्गमः ।।
तोदः स्फोटः स्थिरत्वं च कुष्ठे मांससमाश्रिते ।।२४ ।। be
दौर्गन्ध्यमुपदेहश्च पूयोऽथ क्रिमयस्तथा ।।
गात्राणां भेदनं चापि कुष्ठे मेदःसमाश्रिते ।।२५ ।।
नासाभङ्गोऽक्षिरागश्च क्षते च क्रिमिसंभवः ।।
भवेत् स्वरोपघातश्च ह्यस्थिमज्जसमाश्रिते ।।२६ ।।
कौण्यं गतिक्षयोऽङ्गानां संभेदः क्षतसर्पणम् ।।
शुक्रस्थानगते लिङ्गं प्रागुक्तानि तथैव च ।।२७ ।।
स्त्रीपुंसयो : कुष्ठदोषाढुष्टशोणितशुक्रयोः ।।
यदपत्यं तयोर्जातं ज्ञेयं तदपि कुष्ठितम् ।।२८ ।।
Twakgata Kustha – Under talked about are the signs of kustha invading the pores and skin (rasa dhatu) –
- lack of sensation of contact,
- sweating,
- slight itching,
- discoloration and
- dryness
Raktagata Kustha – The signs of kustha invading the blood are –
- lack of sensation,
- horripitations,
- sweating,
- itching,
- formation of pus (dangerous odor)
Mamsagata Kustha – The signs of kustha invading the muscle tissue are –
- thickness of the pores and skin,
- dryness of the mouth,
- roughness of the pores and skin,
- look of eruptions,
- pricking and bursting ache and
- stability
Medogata Kustha – The signs of kustha invading the fats tissue are –
- dangerous odor and
- coating of physique in extra / formation of wastes in extra
- pus formation,
- look of worms (micro organism and so forth),
- mutilation of physique elements
Asthi-Majjagata Kustha – The signs of kustha invading the bone and bone marrow tissue are –
- distortion (loss) of the nostril,
- purple colour of the eyes,
- improvement of worms within the wounds,
- problems (loss) of voice
Sukragata Kustha – The signs of kustha invading the semen tissue are –
- distortion of the arm,
- lack of ability to stroll,
- splitting of the physique elements,
- spreading of the injuries and
- signs described up to now
When the doshas producing kustha are current within the sperm and ovum (of fogeys), the kids born to such dad and mom would additionally undergo from Kustha.
Prognosis of Kustha
कुष्ठमात्मवतः साध्यं त्वग्रक्तपिशिताश्रितम् ।।
मेदोगतं भवेद्याप्यमसाध्यमत उत्तरम् ।।२९ ।।
Kuştha has a good prognosis and is curable in
- individuals who’re self-controlled
- when it’s seated in pores and skin, blood and muscle tissues
Kustha persists for very long time with out getting cured when it invades and will get seated in fats tissue. It’s manageable however can’t be solely cured.
Then again, when the kustha invades and will get seated within the succeeding tissues i.e. bones, bone marrow and semen, it turns into incurable.
Different causes of Kustha
ब्रह्मस्त्रीसज्जनवधपरस्वहरणादिभिः ।।
कर्मभिः पापरोगस्य प्राहुः कुष्ठस्य संभवम् ।।३० ।।
Under talked about are the causes of kustha born of sin –
- killing Brahmana, girls and pious individuals
- robbing different’s wealth
- acts of sin
Causes for Kustha being probably the most troublesome illness
म्रियते यदि कुष्ठेन पुनर्जातेऽपि गच्छति ।।
नातः कष्टतरो रोगो यथा कुष्ठं प्रकीर्तितम् ।।३१ ।।
आहाराचारयोः प्रोक्तामास्थाय महतीं क्रियाम् ।।
औषधीनां विशिष्टानां तपसश्च निषेवणात् ।।
यस्तेन मुच्यते जन्तुः स पुण्यां गतिमाप्नुयात् ।।३२ ।।
If the individual dies of kustha and is reborn, kustha nonetheless follows him and troubles him within the subsequent life too. Subsequently it’s mentioned that no different illness is as troublesome as Kustha. Solely the one that strictly adheres to the advocated meals and actions, places nice efforts to endure therapies and use of particular medicinens and in addition resorts to penances, would attain a blissful life.
Roga sankramana: Spreading of ailments
प्रसङ्गाद्गात्रसंस्पर्शान्निश्वासात् सहभोजनात् ।।
सहशय्यासनाच्चापि वस्त्रमाल्यानुलेपनात् ।।३३ ।।
कुष्ठं ज्वरश्च शोषश्च नेत्राभिष्यन्द एव च ।।
औपसर्गिकरोगाश्च संक्रामन्ति नरान्नरम् ।।३४ ।।
Illnesses like kustha (pores and skin ailments, leprosy), jvara (fever), sosa (consumption), netrabhisyanda (conjunctivitis) and aupasargika rogas (contagious ailments) unfold from one individual to the opposite because of the beneath talked about causes –
- touching the physique of the affected person regularly
- inhaling the air expired by the affected person
- eating in the identical place with the affected person or sharing the plates, meals and utensils
- sleeping with the affected person
- sitting along with the affected person
- sporting the costume, garlands and unguents utilized by the affected person
इति श्रीसुश्रुतसंहितायां निदानस्थाने कुष्ठनिदानं नाम पञ्चमोऽध्यायः ।।५ ।।
Thus ends the Fifth chapter by title Kustha nidanam – in Nidānā sthāna of Suśruta saṁhita.