अथातो कुष्ठश्वित्रकृमिनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ।
We shall now expound the chapter, Kustha-svitra-krimi nidanam-diagnosis of leprosy, leucoderma and worms (parasites); thus said Atreya and other great sages.
Kustha nidana – causes of leprosy
मिथ्याहारविहारेण विशेषेण विरोधिना । साधुनिन्दावधान्यस्वहरणाद्यैश्च सेवितैः ॥ १ ॥
पाप्मभिः कर्मभिः सद्यः प्राक्तनैर्वरिता मलाः । सिरा: प्रपद्य तिर्यग्गास्त्वग्लसीकासृगाभिषम् ॥ २ ।।
दूषयन्ति श्लथीकृत्य निश्चरन्तस्ततो बहिः । त्वचः कुर्वन्ति वैवर्ण्यं दुष्टाः कुष्ठमुशन्ति तत् ॥ ३ ॥
The malas (dosas) getting aggravated by unsuitable foods and activities, especially by foods which are incompatable, by sinful acts of the present life such as scolding/defaming or killing the pius ( ascetics, elders, preceptors etc.), robbing the properties of others etc. or sinful acts of the previous lives; invade the channels present everywhere inside, vitiate the skin, lasika (lymph), blood and muscles make them flabby ( loose, weak ) and fall out, discolouration of the skin; this disease is called Kustha. 1-3. cause Notes : Though the term ‘Kustha’ is generally applied to leprosy, it also includes some other diseases of the skin as will be evident from the details further on.
कालेनोपेक्षितं यस्मात्सर्वं कुष्णाति तद्वपुः । प्रपद्य धातून्व्याप्यान्तः सर्वान् सक्लेद्य चावहेत् ॥ ४ ॥
सस्वेदक्लेदसङ्कोथान् कृमीन् सूक्ष्मान् सुदारुणान् । लोमत्वक्स्त्रायुधमनीतरुणास्थीनि यैः क्रमात् ॥ ५ ॥
भक्षयेच्छित्रमस्माच्च कुष्ठबाह्यमुदाहृतम् ।
Allowed the lapse of time, it makes the entire body look ugly by spreading to all the tissues, causing too much of moistness inside them, leading to flow of sweat and exudations, putrefaction, formation of minute (invisible) worms (bacilli, bacteria, virus etc.) which are very troublesome; these worms, eat away the hairs, skin, tendons, arteries, veins and cartillages one after the ther.
Because of this, svitra (leucoderma) is described as out4-6a. side of kustha ( different from leprosy).
Notes : Though svitra (leucoderma ) also causes discolouration of the skin and ugliness, it does not involve other tissues nor produce exudation, putrefaction, appearance of bacteria, mutilation of the part affected etc. Hence it is a different disease altogether, non-contegeous and non-mutilating.
Kusthabheda – types of skin diseases
कुष्ठानि सप्तधा दोषैः पृथमिश्रैः समागतैः ॥ ६ ॥
सर्वष्वपि त्रिदोषेषु व्यपदेशोऽधिकत्वतः । वातेन कुष्ठं कापालं, पित्तादौदुम्बरं, कफात् ॥ ७ ॥
मण्डलाख्यं विचर्ची च, ऋक्षाख्यं वातपित्तजम् । चर्मैककुष्ठकिटिभसिध्मालसविपादिकाः ॥८॥
वातश्लेष्मोद्भवाः, श्लेष्मपित्ताद्दद्रुशतारुषी । पुण्डरीकं सविस्फोटं पामा चर्मदलं तथा ॥ ९ ॥
सर्वै स्यात्काकणं पूर्वं त्रिकं दद्रु सकाकणम् । पुण्डरीकर्क्षजिह्वे च महाकुष्ठानि सप्त तु॥ १०॥
Kustha is of seven kinds; by each dosa seperately, by combination of any two and by all of them together. Though all kinds are caused by the combination of all three dosastheir classification as above is on the basis of predominance, From (the predominance of ) vata arises kapala; from pitta, arises audumbara; from kapha arise mandala and vicarci; from vatapitta arises rsyajihva; from vataslesma (kapha) arise carma, ekakustha, kitibha, sidhma, alasa, and vipadika; from slesma (kapha) pitta arise dadru, sataru, pundarika, visphota, pama and carmadala; from all dosas together arises kakana.
Of these, the first three (kapala, udumbara, mandala), dadru, kakana, pundarika and rsyajihva-these seven mahakusthas. 6b-10.
Purvarupa – premonitary symptoms
अतिश्लक्ष्णखरस्पर्शखादस्वेदविवर्णताः दाहः कण्डूस्त्वचि स्वापस्तोदः कोठोन्नतिः श्रमः ॥ ११ ॥
व्रणानामधिकं शूलं शीघ्रोत्पत्तिश्चिरस्थितिः । रूढानामपि रूक्षत्वं निमित्तेऽल्पेऽपि कोपनम् ॥ १२ ॥
रोमहर्षोऽसृजः कार्यं कुष्ठलक्षणमग्रजम्।
The skin is very smooth, hard to touch, with or without sweating, discolouration, burning sensation, itching, loss of tactile sensation (anaesthesia), pricking pain; elevated raised patches of skin, exertion, severe pain in the wounds which arise quickly and stay long, roughness even in those wounds which have healed, the unds get exacerbated (flare up) even with trivial causes, occurance of horripilations, black colour of the blood are the premonitory symptoms of kustha.
Rupa – clinical features
कृष्णारुणकपालाभं रूक्षं सुप्तं खरं तनु ॥ १३ ॥ विस्तृतासमपर्यन्तं हृषितैर्लोमभिश्चितम् । तोदाढ्यमल्पकण्डूकं कापालं
Skin patches which are blackish red, resembling potsherds, dry, anaesthetic, rough, thin, wide, of uneven edges, studded with more hairs, having horripilations, with severe puncturing pain, less of itching, and spreading quickly are the features of Kapala kustha. 13b-14.
पक्क्रोदुम्बरताम्रत्वग्रोम बहलं बहलक्लेदरक्तं गौरसिराचितम् । दाहरुजाधिकम् ॥ १५ ॥
विद्यादुदुम्बरम् । आशूत्थानावदरणकृमि शीघ्रसर्पि च ॥ १४॥
Skin patches resembling ripe fruit of udumbara, (dusky red) with coppery-red skin and hairs studded with white coloured veins, thick, exuding large quantity of moisture and blood, with severe burning sensation and pain, quick in manifestation, putrefaction and appearance of worms (bacteria, bacilli) indicate Udumbara kustha. 15-16a.
स्थिरं स्त्यानं गुरु स्निग्धं श्वेतरक्तमनाशुगम् ॥ १६ ॥ अन्योन्यसक्तमुत्सन्नं बहुकण्डूत्रतिक्रिमि ।
श्लक्ष्णपीताभपर्यन्तं मण्डलं परिमण्डलम् ॥ १७ ॥
Skin patches static, hard, heavy, unctuous, whitish-red, not developing quickly, joined with one another, raised, with more of itching, exudation and worms (bacteria/bacilli); edges smooth, yellowish and cirular-are the features of Mandala kustha.
सकण्डूपिटिका श्यावा लसीकाढ्या विचर्चिका |
Vicharchika has eruptions which are itching, black and fullof lymph.
परुषं तनु रक्तान्तमन्तः श्यावं समुन्नतम् ॥ १८ ॥
सतोददाहरुक्क्लेदं कर्कशैः पिटिकैश्चितम् । ऋष्यजिह्वाकृति प्रोक्तमृष्यजिह्वं बहुक्रिमि ॥ १९ ॥
Skin patches are rough, thin, with red coloured edges and black in the centre, greatly raised, with pricking pain, burning sensation, constant pain and exudation, studded with rough (hard) eruptions, resembling the tongue of the black deer and having more of worms ( bacilli ) are the features of Rsyajihva kustha. 18b-19.
हस्तिचर्मखरस्पर्शं चर्म एकाख्यं महाश्रयम् । अस्वेदं मत्स्यशकलसन्निभम् किटिभं पुनः ॥ २० ॥
रूक्षं किणखरस्पर्शं कण्डूमत्परुषासितम् । सिध्मं रूक्षं बहिः स्निग्धमन्तर्घृष्टं रजः किरेत् ॥ २१ ॥
श्लक्ष्णस्पर्शं तनु श्वेतताम्रं दौग्धिकपुष्पवत् । प्रायेण चोर्ध्वकाये स्यात् गण्डैः कण्डूयुतैश्चितम् ॥ २२ ॥
रक्तैरलसकम् पाणिपाददार्यो विपादिकाः । तीव्रार्यो मन्दकण्ड्वश्च सरागपिटिकाचिताः ॥ २३ ॥
Skin resembling that of the elephant and rough to touch is Carmakhya kustha.
In Eka kustha the leison is very wide (covers a large area) non-sweating and resembles the skin of the fish.
Kitibha kustha has dry skin; rough, and hard, creating sound on scratching, itching, hard and black.
In Sidhama the patches ( skin ) is dry outside and moist inside, gives out small scales when scratched, smooth to touch, thin, whitish coppery coloured resembling flower of dugdhika (alabu) plant, usually common in the upper parts of the body.
Alasaka kustha is studded with small tumors; with itching and red in colour. Vipadika kustha causes cracks/fissures in the hands and feet, has severe pain and mild itching, studded with red coloured eruptions. 20-23.
दीर्घप्रताना दूर्वावदतसीकुसुमच्छविः ।
उत्सन्नमण्डला दद्रूः कण्डूमत्यनुषङ्गिणी ॥ २४ ॥
Skin patches long and wide like the blade of durva grass, has the colour similar to that of the flower of atasi, raised, round patch with itching persisting for a long time are the features of Dadru kustha. 24.
स्थूलमूलं सदाहार्ति रक्तश्यावं बहुव्रणम् ।
प्रायशः पर्वजन्म च ॥ २५ ॥
Sataru kustha has multiple ulcers, which are deep seated, having burning sensation and pain, reddish-black in colour, with more of exudate and worms, commonly occuring on joints. 25.
रक्तान्मन्तरा पाण्डु कण्डूदाहरुजान्वितम्। सोत्सेधमाचितं रक्तैः पद्मपत्रमिवांशुभिः ॥ २६ ॥
विभेदि घनभूरिलसीकासृक्प्रायमाशु च। पुण्डरीकम् तनुत्वग्भिश्चितं स्फोटैः सितारुणैः ॥ २७ ॥
विस्फोटम् पिटिका: पामा कण्डूक्लेदरुजाधिकाः । सूक्ष्मा: श्यावारुणा बह्व्यः प्रायः स्फ्क्यिाणिकूर्परे ॥ २८ ॥
सस्फोटमस्पर्शसहं कण्डूषातोददाहवत् । रक्तं दलच्चर्मदलम् काकणं तीव्रदाहरुक् ॥ २९ ॥
पूर्वं रक्तं च कृष्णं च काकणन्तीफलोपमम् । कुष्ठलिङ्गैर्युतं सर्वैर्नैकवर्णं ततो भवेत् ॥ ३० ॥
Skin patches with red edges and white inside, with itching, burning sensation and pain, raised, covered with reddish dust resembling the lotus petal, exudes thick and copious lymph and blood and splitting quickly are the features of Pundarika kustha.
Visphota kustha has thin skin patches covered with blackish red blebs.
Pama kustha has eruptions which have severe itching, more exudate and pain, small in size, blackish red and large in number commonly on the buttocks, hands and elbows.
Charmadala kustha has blebs which do not allow touching, severe itching, heat, pricking, and burning sensation, red in colour and the skin is cracked.
Kakana kustha has severe burning sensation and pain, red and black at the time of onset, resembling the seeds of kakananti (gunja) then gradually attaining all the features of 26-30. kustha and of many colours.
दोषभेदीयविहितैरादिशेल्लिङ्गकर्मभिः । कुष्ठेषु दोषोल्वणताम्
In kustha, the recognition of the aggravation of the dosas, the symptoms and furnctions arising then on, are the same as have been described in dosabhediya (chapter 12 of sutrasthana.)
Sadhyasadhyata – prognosis of skin diseases
सर्वदोषोल्वणं त्यजेत् ॥ ३१ ॥
रिष्टोक्तं यच्च यच्चास्थिमज्जशुक्रसमाश्रयम् । याप्यं मेदोगतम् कृच्छ्रं पित्तद्वन्द्वात्रमांसगम् ॥ ३२ ॥
अकृच्छ्रं कफवाताढ्यं त्वक्स्थमेकमलं च यत् ।
Kustha which has been caused by the aggravation of all the dosas, which has been described in rista chapter ( 5 of sarirasthana) and that which has localised in the bone, marrow and semen should be refused treatment; that localised in the fat tissue is controllable and persists long, that caused by pitta combination (with any other dosa) and localised in blood and kapha and vata and localised in the skin only and that caused by any one mala ( dosa ) is not difficult to cure.
तत्र त्वचि स्थिते कुष्ठे तोदवैवर्ण्यरूक्षताः ॥ ३३ ॥
स्वेदस्वापश्वयथवः शोणिते, पिशिते पुनः । पाणिपादाश्रिताः स्फोटा: क्लेदः सन्धिषु चाधिकम् ॥ ३४ ॥
कौण्यं गतिक्षयोऽङ्गानां दलनं स्याच्च मेदसि ।
नासाभङ्गोऽस्थिमज्जस्थे नेत्ररागः स्वरक्षयः ॥ ३५ ॥
क्षते च कृमयः, शुक्रे स्वदारापत्यबाधनम् । यथापूर्वं च सर्वाणि स्युर्लिङ्गान्यसृगादिषु ॥ ३६ ॥ इति कुष्ठनिदानम् ।
Kustha localised in the skin produces pricking pain, discolouration and dryness; localised in the blood it causes (more of) sweating, loss of sensation and swelling; localised in the muscles it gives rise to blebs in the hands and feet, profuse exudation, appears specially on the joints; localised in fat tissue, it causes shortening on the arm (by multilation), inability to walk and splitting of the body parts; localised in the bones and morrow, it produces mutilation of the nose, redness of the eyes, loss of voice and appearance of worms in the wounds; localised in the semen (reproductive tissue) it spreads to the wife and children. They ( wife and children ) will develop all the symptoms (of kustha) described so far caused by vitiated blood etc. ( other dhatus / tissues ) . 33b – 36.
Thus ends the diagnosis of kustha.
अथ श्वित्रनिदानम् ।
Diagnosis of leucoderma – Svitra
कुष्ठैकसम्भवं श्वित्रं किलासं दारुणं च तत् । निर्दिष्टमपरित्रावि त्रिधातूद्भवसंश्रयम् ॥ ३७ ॥
Svitra (leucoderma ) also known as kilasa and daruna, is pointed to be similar to kustha (in causing ugliness), is non exudative and arising from (the aggravation of) the three dhatus (dosas) and three dhatus (rakta, mamsa and medas).
वाताद्र्क्षारुणं, पित्तात्ताम्रं कमलपत्रवत् । सदाहं रोमविध्वंसि, कफाच्छ्वेतं घनं गुरू ॥ ३८ ॥
सकण्डु, च क्रमाद्रक्तमांसमेदःसु चादिशेत् । वर्णेनैवेद्गुभयं कृच्छ्रं तच्चोत्तरोत्तरम् ॥ ३९ ॥
From (the predominance of) vata, it (the skin) is dry and aruna (light red); from pitta it is of tamra (coppery colour) resembling a lotus petal, has burning sensation and destruction of hair of the body; from kapha, the skin is sveta (white, thick, heavy and has itching; these (three kinds) are localised in the rakta (blood), mamsa (muscle) and medas (fat) respectively and also in respect of their colour, each succeeding kind more difficult to cure ( than its preceding).
Notes: The above statement is explained by Arunadatta as follows;
vataja svitra is aruna (light red) in colour, localised in the rakta dhatu (blood) and krichra ( difficult to cure ) ;
pittaja svitra is tamra (copper-like or lotus petal like) in colour, localised in mamsadhatu (muscle) and krichratara (more difficult to cure );
kaphaja svitra is sveta (white ) localised in medas dhatu (fat) and krichratama ( most difficult to cure).
अशुक्लरोमाबहलमसंसृष्टं मिथो नवम्। अनग्निदग्धजं साध्यं, श्वित्रं, वर्ज्यमतोऽन्यथा ॥ ४० ॥ जातमप्यचिरन्तनम् । गुह्यपाणितलौष्ठेषु
Svitra (leucoderma ) having black hairs, patches not thick, not joined together, of recent onset and that not caused by burning by fire are curable; whereas others (of opposite qualities) are rejectable; so also that arising on the genitals, and palms, soles and lips, even though not long-standing. 40-41a.
स्पर्शैकाहारशय्यादिसेवनात् प्रायशो गदाः ॥ ४१ ॥ सर्वे सञ्चारिणो, नेत्रत्वग्विकारा विशेषतः । इति श्वित्रनिदानम् ।
Generally diseases spread (from person to person) by contact (physical, sexual etc.) common food (more than one person using the same food being consumed by a patient, use of same vessels, utensils etc.), bed etc. (clothes, garlands and any other article used by the patient); especially so the diseases of the eyes and skin. 41b-42a.
Thus ends the diagnosis of Svitra ( leoucoderma).
अथ कृमिनिदानम् ।
Krimi nidana – diagnosis of parasites
Krimi bheda – types of parasites
कृमयस्तु द्विधा प्रोक्ता बाह्याभ्यन्तरभेदतः ॥ ४२ ॥
बहिर्मलकफासृग्विड्जन्मभेदाच्चतुर्विधाः नामतो विंशतिविधाः ।
Krimi, (worms, parasites) are of two kinds viz bahya (external) and abhyantara (internal) and of four kinds on the basis of their origin (substance from which they develop) viz the external wastes (sweat), kapha, asrk (blood) and vit (faeces) and twenty kinds (species) by their names. 42b-43a.
Rahya – external parasites
तिलप्रमाणसंस्थानवर्णाः केशाम्बराश्रयाः । बहुपादाश्च सूक्ष्माश्च यूका लिक्षाश्च नामतः ॥ ४४ ॥
द्विधा ते कोठपिटिकाकण्डूगण्डान् प्रकुर्वते ।
The external arise from uncleanliness, resemble tila (seed of sesame) in size, shape, and colour, dwell in the hairs and clothes, have many legs and are small in size; are of two kinds, yuka and liksa by name; they produce rashes, eruptions, itching and small tumors. 43b-45a.
Notes: Yuka and liksa are the two kinds of louse, the head louse and body louse, both found in persons who are unclean. Head louse is black resides at the root of the hairs of the head. Body louse is white resides in the hairs of the axilla and pubis and take shelter inside the folds of clothes. Both spread from person to person by direct migration or indirect migration through combs, dress etc. or by their eggs being carried by air or hairs.
Abhyantara Krimi – internal parasites
कुष्ठैकहेतवोऽन्तर्जाः श्लेष्मजास्तेषु चाधिकम् ॥ ४५ ॥
मधुरान्नगुडक्षीरदधिसक्तुनवौदनैः शकृजा बहुविड्धान्यपर्णशाकोलकादिभिः ॥ ४६ ॥
Those born inside, have the same cause as those of kustha (leprosy and other skin diseases); in addition, ingestion of sweet foods, molasses, milk curds (yoghart, curdled milk), flour of grains and freshly harvested grains are special for slesmaja (kaphaja) krimi (worms born from kapha); those grains and leafy vegetables which produce more faeces and those pulses which are in green state are special for sakrijja (worms born from faeces). 45b-46.
कफादामाशये जाता वृद्धाः सर्पन्ति सर्वतः । पृथुब्रध्वनिभाः केचित् केचिद्गण्डूपदोपमाः ॥ ४७ ॥
रूढधान्याङ्कुराकारास्तनुदीर्घास्तथाऽणवः । श्वेतास्ताम्रावभासाश्च नामतः सप्तधा तु ते ॥ ४८ ॥
अन्त्रादा उदरावेष्टा हृदयादा महाकुहाः । कुरवो दर्भकुसुमाः सुगन्धास्ते च कुर्वते ॥ ४९ ॥
हल्लासमास्यस्त्रवणमविपाकमरोचकम् मूर्च्छाच्छर्दिज्वरानाहकार्श्यक्षवथुपीनसान् । ॥५०॥
Those arising from kapha, reside in the amasaya (stomach and small intestine), when increased in number they move everywhere (inside the alimentary tract) some have big buttocks, some resemble earthworm, some others are like the sprouts of germinating grains; are thin, long or minute, white or coppery in colour; they are seven species by name, viz antrada, udaravesta, hrdayada, mahakuha, kuarva, darbhakusuma and sugandha; they give rise to nausea, more of salivation, indigestion, loss of taste / appetite, fainting vomitting, fever, flatulence, (or distention of the abdomen) emaciation, more of sneezing and nasal catarrh. 47-50.
रक्तवाहिसिरोत्थाना रक्तजा जन्तवोऽणवः । अपादा वृत्तताम्राश्च सौक्ष्म्यात्केचिददर्शनाः ॥ ५१ ॥
केशादा लोमविध्वंसा लोमद्वीपा उदुम्बराः । षट् ते कुष्ठैककर्माणः सहसौरसमातरः ॥ ५२ ॥
Those arising from blood reside in the blood vessels, are minute, devoid of legs, round, copper coloured, some are invisible being very minute; are of six species by namekesada, roma vidhvamsa, lomadvipa udumbara, aurasa and matara; these give rise to the same symptoms as those of kustha (leprosy and other skin diseases). 51-52. 10 A.H.II
पक्काशये पुरीषोत्था जायन्तेऽधोविसर्पिणः । वृद्धाः सन्तो भवेयुश्च ते तदाऽस्योद्गारनिःश्वासा यदाऽऽमाशयोन्मुखाः ॥ ५३॥
विङ्गन्धानुविधायिनः | श्यावपीतसितासिताः ॥ ५४ ॥
पृथुवृत्ततनुस्थूलाः ते पञ्च नाम्ना कृमयः ककेरुकमकेरुकाः । सौसुरादा: सुलूनाख्या लेलिहा जनयन्ति च ॥ ५५ ॥
विड्भेदशूलविष्टम्भकार्यपारुष्यपाण्डुताः रोमहर्षाग्निसदनगुदकण्डूर्विनिर्गमात् । ॥५६॥
Those arising from faeces reside in the pakvasaya (large intestine), usually moving downwards; when increased in number they travel up towards the amasaya (stomach and small intestine), then produce smell of faeces in the mouth, belchings and expiration; they are thick, round, thin (thread like) or thick, blue, yellow, white or black in colour; of five kinds (species) by name-viz kakeruka, makeruka, sausurada, suluna and leliha; they give rise to diarrhoea, abdominal pain, stasis of food undigested for long periods, emaciation, roughness of the skin, anaemia horripilations, weakness of digestion and itching in the rectum (anus) by coming out of it. 53-56.
Notes Mention of sweet foods, etc. as the cause is to stress that such foods cause weakness of digestive activity which in turn helps the growth of para sites insides the alimentary oanal. Kaphaja and purisaja krimi are intestinal parasites such as round worms (ascaris lumbricoides) hookworms (ankylostoma duodenale) thread worms ( oxyuris vermicularis), tape worm (tenia solium, tenia saginata), many kinds of amaeba (entaemaoba hystalatica etc., flagellae etc.) the eggs (ova) or parts of the body of these parasites gain entry into the human body through infected water, articles of food (leaves, vegetables, meat etc.) when these are consumed without proper cleaning and cooking. In persons who have strong digestive power, the ova etc. are destroyed by the hydrochloric acid in the stomach but in those who have poor digestive power, the acid being weak and insufficient the ova etc. escape into the intestines, hatch there and make their living, giving rise to many troubles to the person. Some of the names of these parasites are based on their physical features and function while some others are traditional names, different from one text to the other. It has not been possible to identify all of them with the common parasites affecting the Indian population in the present day.
Raktaja krimi are the various parasites (of malaria, filaria) bacilli (leprosy), virus etc. found in the blood, organs such as liver and spleen. These come into the human body through the bites of musquitoes, fleas, bed bug etc. All the parasites described above are called vaikarika krimi pathogenic worms.
There is mention of another kind of worms also, known as sahaja krimi-worms born along with the person-which are avaikarika-non pathogenic-present in the alimentary canal which help in the maintainance of health.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने कुष्ठश्वित्रकृमिनिदानं नाम चतुर्दशोऽध्यायः ॥ १४ ॥
There ends the chapter Kustha-svitra-krimi nidana-the fourteenth in of Astangahrdaya samhita composed by Srimad Vagbhata, son of Sri Vaidyapati Simhagupta.