पञ्चमोऽध्यायः । अथात: कुष्ठनिदानं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ः।।१।।
Now we shall discourse on the Nidana of Kustha (cutaneous affections in general). 1
मिथ्याहाराचारस्य विशेषाद् गुरुविरुद्धासात्म्याजीर्णाहिताशिनः स्नेहपीतस्य वान्तस्य वा व्यायामग्राम्यधर्मसेविनो ग्राम्यानूपौदकमांसानि वा पयसाऽभीक्ष्णमश्नतो, यो वा मज्जत्यप्सूष्माभितप्तः सहसा छर्दि वा प्रतिहन्ति, तस्य पित्तश्लेष्माणौ प्रकुपितौ परिगृह्यानिलः प्रवृद्धस्तिर्यग्गाः सिराः सम्प्रतिपद्य समुद्भूय बाह्यं मार्गं प्रति समन्ताद् विक्षिपति । यत्र यत्र च दोषो विक्षिप्तो निःसरति तत्र तत्र मण्डलानि प्रादुर्भवन्त्ये वमुत्पन्नस्त्वचि दोषस्तत्र तत्र च परिवृद्धिं प्राप्याप्रतिक्रियमाणोऽभ्यन्तरं प्रतिपद्यते धातूनभिदूषयन् ।। २ ।।
Improper diet or conduct; especially ingestion of the improper, unwholesome, indigestible, or incongenial food; physical exercise or sexual intercourse immediately after partaking of any oleaginous substance, or after vomiting; constant use of milk in combination with the meat of any domestic, aquatic or amphibious animal; a cold water bath after an exposure to heat; and repression of any natural urging for vomiting etc. are the factors which tend to derange and aggravate the fundamental principle of Pitta and Kapha grab Vayu in a person. The grabed Vayu in combination with the agitated Pitta and Kapha enters into the vessels or ducts (Sira), which obliquely spread over the surface of the body. Thus the enraged Vayu deposits the Pitta and Kapha on the skin through the medium of their channels and spreads them over the entire surface of the body. The regions of the skin in which the aforesaid morbific diatheses are deposited become marked with circular rings or patches. The morbific diatheses (Dosas), thus lodged in the skin, continue to aggravate, and having been neglected at the outset, tend to enter into the deeper tissues and thus contaminate the fundamental principles (Dhatus) of the body. 2
तस्य पूर्वरूपाणि-त्वक्पारुष्यमकस्माद्रोमहर्षः कण्डू: स्वेदबाहुल्यमस्वेदनं वाङ्गप्रदेशानां स्वापः क्षतविसर्पणमसृजः कृष्णता चेति ।।३।।
Premonitory Symptoms: A roughness of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anaethesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premonitory stage of Kustha. 3
तत्र सप्त महाकुष्ठानि, एकादश क्षुद्रकुष्ठानि, एवमष्टादश कुष्ठानि भवन्ति । तत्र महाकुष्ठान्यरुणोदुम्बरर्ष्यजिह्वकपालकाकणकपुण्डरीकदद्रुकुष्ठानीति । क्षुद्रकुष्ठान्यपि स्थूलारुष्कं महाकुष्ठमेककुष्ठं चर्मदलं विसर्पः परिसर्पः सिध्मं विचर्चिका किटिमं पामा रकसा चेति ।। ४ ।।
सर्वाणि कुष्ठानि सवातानि सपित्तानि सश्लेष्माणि सक्रिमीणि च भवन्ति, उत्सन्नतस्तु दोषग्रहणमभिभवात् ।। ५ ।।
तत्र वातेनारुणं, पित्तेनोदुम्बरर्ष्यजिह्वकपालकाकणकानि, श्लेष्मणा पुण्डरीकं दद्रुकुष्ठञ्चेति । तेषान्तु महत्त्वं क्रियागुरुत्वमुत्तरोत्तरं धात्वनुप्रवेशाद् असाध्यत्वञ्चेति ॥ ६ ॥
Classification : [ Diseases, falling under the group of Kustha, may be divided into two broad subdivisions ], viz., Mahakusthas (major) and Ksudra (minor) Kusthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all. The Mahakusthas are classified as, Aruna, Audumbara, Rsya-Jihva, Kapala, Kakanaka, Pundarika and Dadru. The minor or Ksudra kusthas (Lichen and Dermatitis) are Sthularuska, Mahakustha, Eka-kustha, Carmadala, Visarpa, Parisarpa, Sidhma, Vicarcika, Kitima, Pama, and Rakasa. All the types of Kustha, whether major or tor involve the action of the deranged Vayu, Pitta or Kapha and are connected with the presence of parasites in those localities. The preponderance of any particular morbific diathesis (Dosa) in any case of Kustha should be looked upon as its originating cause. The type, known as Aruna Kustha, is due to the action of the preponderant Vayu, Audumbara, together with Rsya-Jihva, Kapala and Kakanaka, to a preponderance of the deranged pitta; while Pundarika and Dadru owe their origin to an excess of the deranged Kapha. These types of major or minor Kusthas are successively more extensive in their action and more incurable on account of their respectively invading a greater number of the bodily elements (Dhatus). 4-6
तत्र वातेनारुणाभानि तनूनि विसर्पीणि तोदभेदस्वापयुक्तान्यरुणानि, पित्तेन पक्वोदुम्बरफलाकृतिवर्णान्यौदुम्बराणि, ऋष्य जिह्वाप्रकाशानि खराणि ऋष्यजिह्वानि, कृष्णकपालिकाप्रकाशानि कपालकुष्ठानि, काकणान्तिकाफलसदृशान्यतीव रक्तकृष्णानि काकणकानि । तेषां चतुर्णामप्योषचोषपरिदाहधूमायनानि क्षिप्रोत्थानप्रपाकभेदित्वानि क्रिमिजन्म च सामान्यानि लिङ्गानि । ॥ ७ ॥
Mahakusthas: Aruna-kustha owes its origin to an exuberance of the deranged Vayu. It is slightly vermilion-coloured, thin and spreading in its nature. A sort of pricking, piercing pain (is experienced in the affected locality) which loses all sensibility to the touch. The type known as Audumbara is coloured and shaped like a ripe or mature Audumbara fruit and has its origin from the deranged Pitta. The type called Rsyajihva is rough and resembles the tongue of a Rsya (Deer) in shape and colour. The type known as Kapala (Macula caerulae) resembles a black (deep blue) Kharpara (baked clay). The Kakanaka type is characterised by a dark red and black colour like the seed of the Gunja berry. A sort of sucking and burning pain is experienced in the affected localitty in all the four preceding types of the disease which are the outcome of the deranged Pitta. The whole diseased surface seems as it burning with fire, and emitting hot fumes. They are speedy in their origin and rapidly suppurate and break. All these types soon become infested with parasites. These are the general features of these forms of Kusthas. 7
1. Certain authorities hold that, all types of Kustha (cutaneous affections) to be of parasitic origin. The Garuda Purana avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous affections–Kusthika-hetavontarjah slesmaja vahya-sambhavah.
पुण्डरीकपत्रप्रकाशानि पुण्डरीकाणि श्लेष्मणा; अतसीपुष्पवर्णानि ताम्राणि विसर्पीणि पिडकावन्ति च दद्रुकुष्ठानि । तयोर्द्वयोरप्युत्सन्नता परिमण्डलता कण्डूश्चिरोत्थानत्वञ्चेति सामान्यरूपाणि ।। ८॥
Pundarika : The patches resemble the petals of a (full blown ) lotus flower in colour, caused by slesma and Dadru (Ringworm) assumes the colour (faint blue) of an Atasi flower, or of copper. They are spreading in their nature and are found to be overspread with pustules. Bothe the Dadru and Pundarika types are raised, circular, and characterised by itching and take a considerable time to be fully patent. These are the general characteristics of Dadru and Pundarika. 8
क्षुद्रकुष्ठान्यत ऊर्ध्वं वक्ष्यामः
स्थूलानि सन्धिष्वतिदारुणानि स्थूलारुषि स्युः कठिनान्यरूंषि । त्वक्वोचभेदस्वपनाङ्गसादा: कुष्ठे महत्पूर्वयुते भवन्ति ।। ९ ।।
कृष्णारुणं येन भवेच्छरीरं तदेककुष्ठं प्रवदन्त्यसाध्यम् ।
स्युर्येन कण्डूव्यथनौषचोषास्तलेषु तच्चर्मदलं विसर्पवत् सर्पति सर्वतो यस्त्वग्रक्तमांसान्यभिभूय शीघ्रम् |
मूर्च्छाविदाहारतितोदपाकान् कृत्वा विसर्पः स भवेद् विकारः ।। ११ ।।
शनैः शरीरे पिडकाः सवन्त्यः सर्पन्ति यास्तं परिसर्पमाहुः । कण्ड्वन्वितं श्वेतमपायि सिध्म विद्यात् तनुप्रायश ऊर्ध्वकाये । । १२ ।।
वदन्ति ।। १० ।।
Ksudra Kusthas: We shall now describe (the features of the diseases known as ) Ksudra kusthas ( M. Text ) : The type known as Sthularuska appears about the joints. It is extremely thick at its base. This is cured with the greatest difficulty, and is strewn over with hard pustules (Arunsi). In the type known as Mahakustha the skin contracts, and with the bursting of the skin (a piercing pain is felt in the affected part), which loses all sensibility to the touch, accompanied by a general sense of lassitude in the limbs. In the Ekakustha (Ichthyosis) type the skin assumes a reddish black colour. It is incurable. In the form known as Carmadala (Hypertrophy of the skin) a burning, sucking, drawing pain is experienced in the palms of the hands and in the soles of the feet which become characterised with an itching sensation. The disease, which affects in succession the (organic principles of) skin, blood and flesh, and speedily extends all over the body, like Erysipelas, and is attended with a burning sensation (Vidaha), restlessness, suppuration and a piercing pain and loss of consciousness (epilepticfits), is called Visarpa Kustha. The form in which a number of exuding pustules gradually extend over the surface of the body is called Parisarpa Kustha. The type of the disease which is white and thin, and is characterised by itching and does not create any disturbance (in the patient), is called Sidhma (Maculae atrophicae). This form is generally found to restrict itself to the upper part of the body. 9-12
राज्योऽतिकण्ड्वर्त्तिरुजः सरूक्षा भवन्ति गात्रेषु विचर्चिकायाम् । कण्डूमती दाहरुजोपपन्ना विपादिका पादगतेयमेव ।। १३ ।।
यत् स्रावि वृत्तं घनमुग्रकण्डु तत् स्निग्धकृष्णं किटिभं (मं) वदन्ति । सास्रावकण्डूपरिदाहकाभिः पामाऽणुकाभिः पिडकाभिरूह्या ।।१४।।
स्फोटै: सदाह्रैरति सैव कच्छू: स्फिक्पाणिपादप्रभवैर्निरूप्या | कण्ड्वन्विता या पिडका शरीरे संस्रावहीना रकसोच्यते सा ।। १५ ।।
Vicharcika (Psoriasis) is characterised by excessive pain and itching and gives rise to extremely dry crack-like marks on the body [ hands and feet ]. The same form of malady attended with pain, burning and itching, and restricting itself solely to the lower extremities, is called Vipudika. The type in which the eruptions exude (a kind of slimy secretion) and which are circular, thick, excessively itching. glossy and black-coloured is called Kitima (Keloid tumours ). Small pustules or pimples characterised by an itching, burning secretion and appearing on the surface of the body are called Pama (Eczema). The preceding kinds of pimples attended with burning vesicles, are called Kacchus and are found to be chiefly confined to the legs, hands and buttocks. A sort of dry and non-exuding pimples characterised by excessive itching and appearing all over the body, is called Rakasa (dry Erythema ). 13-15
अरुः ससिध्मं रकसा महच्च यच्चैककुष्ठं कफजान्यमूनि । वायोः प्रकोपात् परिसर्पमेकं शेषाणि पित्तप्रभवाणि विद्यात् ।। १६ । ।
The forms known as Sthularuska, Sidhma, Rakasa, Mahakustha and Ekakustha should be considered as offspring of the deranged Kapha. Parisarpa-kustha alone is due to the action of the deranged Vayu, while the remaining types (of minor Kustha) owe their origin to the action of the deranged Pitta. 16
किलासमपि कुष्ठविकल्प एवं । तत् त्रिविधं – वातेन, पित्तेन, श्लेष्मणा चेति । कुष्ठकिलासयोरन्तरं त्वग्गतमेव किलासमपरिस्रावि च। तद् वातेन मण्डलमरुणं परुषं परिध्वंसि च, पित्तेन पद्मपत्रप्रतीकाशं सपरिदाहञ्च, श्लेष्मणा श्वेतं स्निग्धं बहलं कण्डूमच्च। तेषु सम्बद्धमण्डलमन्तेजातं रक्तरोम चासाध्यमग्निदग्धञ्च ।। १७ ।।
Kilasa: The disease known as Kilasa is but another form of Kustha. It may be divided into three types according to the action of the deranged Vayu, Pitta or Kapha. The difference between Kilasa and Kustha is that the former confines itself only to the Tvaka (the skin) and is marked by the absence of any secretion.¹ A case of Kilasa caused by the action of the deranged Vayu is circular, vermilion-coloured and rough to the touch. The affected part when rubbed peals off scales of morbid skin. A case of Kilasa, due to the action of the deranged Pitta, is marked by eruptions, resembling the petals of a lotus flower (in shape and colour), and are attended with an extremely burning sensation. In the type originated through the action of the deranged Kapha, the affected part (skin) assumes a glossy, white colour, unctuous becomes thick and is marked by an itching sensation. The form in which the eruptions or patches extend and become confluent, invading even the soles of the feet, the palms of the hands and the region of the anus, and in which the local hairs assume a red colour should be regarded as incurable. A case of Kilasa, which is the outcome of a burn (cicatrix) should be likewise considered as incurable. 17
कुष्ठेषु रुक्त्वक्संकोचस्वापस्वेदशोफभेदकौण्यस्वरोपघाता वातेन, पाकावदरणाङ्गुलिपतनकर्णनासाभङ्गाक्षिरागसत्त्वोत्पत्तयः पित्तेन, कण्डूवर्णभेदशफास्रावगौरवाणि श्लेष्मणा । तत्रादिबलप्रवृत्तं पौण्डरीकं काकणञ्चासाध्यम् ।। १८ ।।
A preponderance of the deranged Vayu in a case of Kustha (leprosy) is indicated by pain, contraction of the skin, local anaesthesia, a copious flow of perspiration, swelling, and piercing or cutting pain in the affected part, together with a deformity of the limbs and hoarseness. Similarly, an excess of the deranged Pitta in a case of Kustha, should be presumed from the suppuration of the affected part, from the breaking of the local skin, from the falling off of the fingers, from the sinking of the nose and ears, from the redness of the eyes and
1. A case of Kustha has its primary seat in the blood and skin(of the patient), in which it lies confined during the period of incubation, after which it attacks the skin and secretes the characteristic secretion of the deranged Dosa involved in it. from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapha, in a case of Kustha, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and Kakana which are due to the germinal defect of the patient, are incurable, inasmuch as they involve (according to Dalhana) the concerted action of the three simultaneously deranged Dosas from the very outset. 18
भवन्ति चात्र यथा वनस्पतिर्जातः प्राप्य कालप्रकर्षणम् । अन्तर्भूमिं विगाहेत मूलैर्वृष्टिविवर्धितैः ॥ १९ ॥
एवं कुष्ठं समुत्पन्नं त्वचि कालप्रकर्षतः । क्रमेण धातून व्याप्नोति नरस्याप्रतिकारिणः ।। २० ।।
Memorial Verses: As a tree, full grown in due course of time. drives its roots, which derive their nourishment from the rain water. deeper and deeper into the successive strata of the soil. so this disease (Kustha), first affecting and confining itself to the upper layers of the skin, in due course of time will invade the deeper tissues and organs etc. of the patient, if unchecked almost all the fundamental principles or elements Dhatus are attacked by its bacilli. 19-20
स्पर्शहानिः स्वेदनत्वमीषत्कण्डूश्च जायते । वैवर्ण्य रूक्षभावश्च कुष्ठे त्वचि समाश्रिते ।। २१ । ।
त्वकस्वायो रोमहर्षश्च स्वेदस्याभिप्रवर्त्तनम् । कण्डूर्विपूयकश्चैव कुष्ठे शोणितसंश्रिते ।। २२ । ।
बाहुल्यं वकाशोषश्च कार्कश्यं पिडकोद्गम: । तोदः स्फोट: स्थिरत्वञ्च कुष्ठे मांससमाश्रिते ॥ २३ ॥
दौर्गन्ध्यमुपदेहश्च पूयोऽथ पूयोऽथ क्रिमयस्तथा । गात्राणां भेदनञ्चापि कुष्ठे मेदः समाश्रिते ॥ २४ ॥
नासाभङ्गोऽक्षिरागश्च क्षतेषु च क्रिमिसम्भवः । भवेत् स्वरोपघातश्च ह्यस्थिमज्जसमाश्रिते ॥ २५ ॥
कौण्यं गतिक्षयोऽङ्गानां सम्भेदः क्षतसर्पणम् । शुक्रस्थानगते लिङ्गं प्रागुक्तानि तथैव च ।। २६ ।।
The symptoms of a case of Kustha confined only to the serous (Tvaka) fluid of the skin are the loss of the perception of touch, a scanty perspiration, itching and discoloration and roughness of the affected part. The symptoms which manifest themselves when the disease is confined to the blood are complete anaesthesia, horripilation, absence of perspiration, itching and excessive accumulation of pus in the affected parts. The symptoms of Kustha affecting only the flesh are thickness of the patches, dryness of the mouth, roughness and hardness of the patches which become covered with pustular eruptions and vesicles and associated with an excruciating pricking pain. The symptoms of (Kustha) invading the principle of fat only are a fetid smell and accumulation of pus in the affected part and a breaking of the skin, exposing deep gashing wounds which soon become infested with parasites. The body seems as if covered with a plaster. Symptoms of (Kustla) affecting only the bones and the marrow are a sinking (lit : breaking) of the nose, a redness of the eyes, loss of voice and the germination of parasites in the incidental ulcers. Symptoms of the disease restricting itself only to the principle of semen are a crippled state of the hands and distortion of the limbs, loss of the power of locomotion, spreading of ulcers and all the other symptoms similar to the preceding types of the disease. 21-26
स्त्रीपुंसयोः कुष्ठदोषाद् दुष्टशोणितशुक्रयोः।
यदपत्यं तयोर्जातं ज्ञेयं तदपि कुष्ठितम् ।। २७ ।।
A child, who is the offspring of the contaminated semen and ovum of its parents afflicted with Kustha, should be likewise regarded as a Kusthi. 27
कुष्ठमात्मवतःसाध्यं त्वग्रक्तपिशिताश्रितम् । मेदोगतं भवेद् याप्यमसाध्यमत उत्तरम् ।। २८ ।।
Prognosis: A case of Kustha appearing in a person of prudence and discretion and confined only to the serum (Tvaka), flesh and blood of his organism should be regarded as curable. A palliative treatment is the only remedy in cases where the disease is found to invade the principle of fat; whereas a case where the infection of Kustha is found to have penetrated into any of the remaining organic principles should be given up as incurable. 28
ब्रह्मस्त्रीसज्जनवध-परस्वहरणादिभिः कर्मभिः पापरोगस्य प्राहुः कुष्ठस्य सम्भवम् ।। २९ ।।
म्रियते यदि कुष्ठेन पुनर्जातेऽपि गच्छति । नातः कष्टतरो रोगो यथा कुष्ठं प्रकीर्त्तितम् ।। ३० ।।
Wise men hold that, for killing a Brahmna, or a woman or one of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. The disease reattacks a man even in his next rebirth in the event of his dying with it. Uncured Kustha (leprosy) is the most painful, and most troublesome of all diseases. 29-30
आहाराचारयोः प्रोक्तामास्थाय महतीं क्रियाम् । औषधीनां विशिष्टानां तपसश्च निषेवणात् ।
यस्तेन मुच्यते जन्तुः स पुण्यां गतिमाप्नुयात् ।। ३१ ।।
A Kusthi (leper), getting rid of this foul malady by observing the proper regimen of diet and conduct and by practising expiatory penances and by resorting to proper medicinal measures. gets an elevated status after death. 31
प्रसङ्गाद् गात्रसंस्पर्शान्निश्वासात् सहभोजनात् । सहशय्यासनाच्चापि वस्त्रमाल्यानुलेपनात् ।। ३२ ।।
कुष्ठं जवरश्च शोषश्च नेत्राभिष्यन्द एव च । औपसर्गिकरोगाश्च संक्रामन्ति नरान्नरम् ॥ ३३ ॥
Kustha (Leprosy ) is a highly contagious disease; the contagion being usually communicated through sexual intercourse with a leper (Kusthi), or by his touch or breath, or through partaking of the same bed, and eating and drinking out of the same vessel with him, or through using the wearing apparel, unguents and garlands of flowers previously used by a person afflicted with this dreadful disease. Kustha (Leprosy), fever, pulmonary consumption, ophthalmia and other Aupasargika disease (incidental to the influences of malignant planets or due to the effects of impious deeds) are communicated from one person to another. 32-33
इति सुश्रुतसंहितायां निदानस्थाने कुष्ठनिदानं नाम पञ्चमोऽध्यायः ।। १५ ।।
Thus ends the fifth Chapter of the Nidanasthana in the Susruta Samhita which treats of the Nidana of cutaneous affections (Kustha).
