अथातः कुष्ठश्वित्रकृमिनिदानं नामाध्यायं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the chapter known as Kustha-Svitra-Krimi nidanam diagnosis of Leprosy, Leucoderma and Worms (parasites); thus said Atreya and other great sages. (1)
Kustha nidana samprapti – causes and pathogenesis of Psoriasis
मिथ्याहारविहारेण विशेषेण विरोधिना | साधुनिन्दावधान्यस्वहरणाद्यैश्च सेवितैः ॥ २ ॥
पाप्मभिः कर्मभिः सद्यः प्राक्तनैवेरिता मलाः । सिराः प्रपद्यतिर्यग्गास्त्वग्लसीकासृगामिषम् ॥३॥
दूषयन्तः श्रूथीकृत्य निश्चरन्तस्ततो बहिः । त्वचः कुर्वन्ति वैवर्ण्य दुष्टाः कुष्ठमुशन्ति तत् ॥४॥
कालेनोपेक्षितं यस्मात् सर्वं कुष्णाति तद्वपुः ।
Indulgence in unsuitable foods and activities, especially the incompatable (foods), abusing the ascetics (and such other good persons), committing murder, usurping the properties of others and such other sinful acts pertaining to the present life and effects of actions of past lives all together cause aggravation (increase) of malas (doshas). They (doshas) invading the tiryakgata siras (veins and other vessels, channels etc. present in the tissues) vitiates the tvak (skin), lasika ( lymph) asrk (blood), and amisa (muscles); making them loose (weak), then spread outwards, cause discolouration of the skin after a long time of negligence and produce Kustha. It is called so, because it makes the entire body ugly (by mutilation) (2-5a)
Notes: Though the term ‘kustha’ is generally translated as leprosy’ it also includes many other diseases of the skin.
प्रपद्य धातूनव्याप्यान्तः सर्वान्संक्लेद्यचावहेत् ॥५॥
सस्वेदक्लेदसंकोथान् कृमीन् सूक्ष्मान् सुदारुणान् । लोमत्वक्स्नायुधमनीतरुणास्थीनि यैः क्रमात् ॥६॥
The disease (kustha) getting deep inside, invades all the dhatus, creates more moisture in them; combining with sweat, moisture and putrefaction give rise to the growth of minute krimis (worms, bacteria, bacilli, virus etc.) which are very harmful. They eat away the hairs, skin, tendons, arteries, and tender bones (cartilages) in that order, gradually. (5b-6)
भक्षयेत् वित्रमस्माच्च कुष्ठबाह्यमुदाहृतम् । कुष्ठानि सप्तधा दोषैः पृथमिश्रैः समागतैः ॥७॥ सर्वेष्वपि त्रिदोषेषु व्यपदेशोऽधिकत्वतः ।
Even Svitra (leucoderma) is called so for the same reason making the body ugly known as Bahyakustha ( external leprosy).
Kustha is of seven kinds; one from each dosha seperately, one each from combination of any two doshas and from the combination of all the three together; in all kinds all the three doshas are the causes but they are classified on the basis of the predominant dosha. (7)
वातेन कुष्ठं कापालं पित्तादौदुम्बरं कफात् ॥ ८ ॥
मण्डलाख्यं विचर्ची चऋष्याख्यं वातपित्तजम् । चर्मैककुष्ठकिटिभसिध्मालसविपादिकाः ॥९॥
वातश्लेष्मोद्भवाः श्लेष्मपित्ताद्दद्रुशतारुषी । पुण्डरीकं सविस्फोटं पामा चर्मदलं तथा ॥१०॥
सर्वैः स्यात् काकणं पूर्वं त्रिकं दद्रु सकाकणम् । पुण्डरीकर्ष्यजिह्वे चमहाकुष्ठानि सप्त तु ॥ ११ ॥
Kapala kustha is produced by vata, audumbara from pitta, mandala and vicarci from kapha; rsya (jihva) from vatapitta; carma, ekakustha, kitibha, sidhma, alasa and vipadika are from vataslesma, dadru, sataru, pundarika, visphota, pama, carmadala are from slesmapitta; kakana is from all the doshas together; the first three (kapala, audumbar, mandala) along with dadru, kakana, pundarika and rsyajihva are the seven Mahakustha (the remaining eleven are Ksudra kustha ) . ( 8 – 11 )
Purvarupa – premonitory symptoms of Psoriasis
अतिश्लक्ष्णखरस्पर्शस्वेदास्वे दविवर्णताः । दाहः कण्डूस्त्वचि स्वापस्तोदः कोठोन्नतिः श्रमः ॥ १२ ॥
व्रणानामधिकं शूलं शीघ्नोत्पत्तिश्चिरस्थितिः । रूढानामपि रूक्षत्वं निमित्तेऽल्पेऽति कोथनम् ॥ १३ ॥
रोमहर्षोऽसृजः कार्यं कुष्ठलक्षणमग्रजम् ।
The skin becoming very smooth or very rough, presence or absence of sweating, discolouration, burning sensation, itching, loss of sensation of touch, pricking pain, patches raised, fatigue, severe pain in the wound, quick formation and long continuance of wounds, roughness of the site even after its healing, putrefaction of the ulcer from even a minor cause, horripilations and black colour of the blood – these are the prodromal symptoms of kustha. (12-13)
Lakshana – clinical features of Psoriasis
कृष्णारुणकपालाभं रूक्षं सुप्तं खरं तनु ॥१४॥
विस्तृतासमपर्यन्तं हृषितैर्लोमभिश्चितम् । तोदाढ्यमल्पकण्डूकं कापालं शीघ्रसर्पि च ॥१५॥
Blackish-redcolour of the patch on the skin resembling a potsherd, dry, senselessness, rough, thin, wide, irregular edges, covered with hairs standing on their ends, severe pricking pain, mild itching and quick spreading are the features of Kapalakustha. (14-15) पक्कोदुम्बरताम्रत्वग्रोमगौरसिराचितम् । बहलं बहुलक्लेदं रक्तं दाहरुजाकरम् ॥ १६ ॥
आशूत्थानावदरणकृमि विद्यादुदुम्बरम् ॥१७॥
The skin and hairs (on the patch) resembling a ripe fruit of udumbara, coppery in colour, covered with white coloured veins, thick, with copious exudation, red, causing burning sensation and pain, quick in onset, purtrefaction and growth of krimis (bacteria) are the features of Audumbara kustha. (16-17)
स्थिरं स्त्यानं गुरु स्निग्धं श्वेतरक्तमनाशुगम् । अन्योन्यासक्तमुत्सन्नं बहुकण्डूस्रुतिक्रिमि ॥१८॥
श्लक्ष्णपीताभपर्यन्तं मण्डलं परिमण्डलम् । सकण्डूपिटका श्यावा लसीकाढ्या विचर्चिका ॥१९॥
Skin patch immovable, hard, heavy, oily, whitish-red, slow in developing, patches fused with one another, elevated, having severe itching, exudation and too much of worms (bacteria), patches being smooth, yellowish edges, circular in shape studded with painful eruptions which are bluish and full of lymph-are the features of Vicarcika. (18-19)
परुषं तनुरक्तान्तमन्तःश्यावं समुन्नतम् । सतोददाहरुक्क्लेदं कर्कशै: पिटकैश्चितम् ॥ २० ॥
ऋष्यजिह्वाकृति प्रोक्तमृष्यंजिह्वं बहुक्रिमि | हस्तिचर्मखरस्पर्शं चर्मकाख्यं महाश्रयम् ॥२१॥
अस्वेदं मत्स्यशकलसन्निभं किटिभं पुनः । रूक्षं किणखरस्पर्शं कण्डूमत् परुषासितम् ॥२२॥
सिध्म रूक्षं बहिः स्निग्धमन्तर्घृष्टं रजः किरेत् । श्लक्ष्णस्पर्शं तनुश्वेतताम्रं दौग्धिकपुष्पवत् ॥ २३ ॥
प्रायेण चोर्ध्वकाये स्याद्गण्डैः कण्डूयुतैश्चितम् । रक्तैरलसकं पाणिपाददार्यो विपादिकाः ॥ २४॥
तीव्रार्त्यो मन्दकण्ड्वश्च सरागपिटकाचिताः । दीर्घप्रताना दूर्वावदतसीकुसुमच्छविः ॥२५॥
उत्सन्नमण्डला दद्रुः कण्डूमत्यनुषङ्गिणी | स्थूलमूलं सदाहार्ति रक्तश्यावं बहुव्रणम् ॥ २६ ॥
शतारु: क्लेदजन्त्वाढ्यं प्रायशः पर्वजन्म च । रक्तान्तमन्तरापाण्डुकण्डुदाहरुजान्वितम् ॥२७॥
सोत्सेधमाचितं रक्तैः पद्मपत्रमिवांशुभिः । घनभूरिलसीकासृक्प्रायमाशु विभेदि च ॥ २८ ॥
पुण्डरीकम् तनुत्वग्भिश्चितं स्फोटैः सितारुणैः । विस्फोटं पिटकाः पामाकण्डूक्लेदरुजाधिकाः ॥२९॥
सूक्ष्मा: श्यावारुणा बहव्यः प्रायः स्फिक्याणिकूर्परे । सस्फोटमस्पर्शसहं कण्डूषातोददाहवत् ॥ ३० ॥
रक्तं दलच्चर्मदलं काकणं तीव्रदाहरुक् । पूर्वं रक्तं च कृष्णं च काकणन्तीफलोपमम् ॥३१॥
Patches are rough, thin, edges red, blue in the interior, elevated, having pricking pain, burning sensation, constant pain and exudation, studded with hard eruptions, resembling the tongue of rsya (black buck) and with too much of worms (bacteria) are the features of Rsyajihva kustha.
Skin like that of the elephant, rough to touch and covering a large area – are the features of Carmakhya kustha.
Skin, not sweating, resembles the scales of the fish, dry, producing sound (while scratching) rough, itching, course and black – are the features of Kitibha.
In Sidhma, the skin is dry externally and greasy internally, fine scales fall out when scratched, studded with small tumors which are smooth to touch, thin, white or coppery, resembling the flower of dugdhika plant, leison commonly found in the upper parts of the body and having itching.
Alasaka has tumors of red colour; Vipadika has fissures and cracks of the hands and feet, severe pain and studded with red eruptions having mild itching.
Dadru has raised patches, elongated and spread out like durva grass, with colour resembling the flower of atasi with itching and persisting for a long time.
Sataru has multiple ulcers of hard base, having burning sensation and pain, redish blue in colour with too much of exudation and worms (bacteria) usually found on joints of bones.
Pundarika has raised patches which have red edges and white centre itching, burning sensation, pain, covered with dust of red colour resembling lotus petal, hard, containing lot of lymph and blood and breaking up quickly.
Visphota, has the skin which is thin, studded with vesicles of white-red colour,
Pama has pustules with severe itching, exudation and pain, small bluish-red, large in number and commonly found on the buttocks, hands and elbows. Carmadala has blebs which donot tolerate touch are having itching, sucking or pricking pain, burning sensation, red and bursting.
Kakana has severe burning sensation, and pain, has red and black colour resembling the seed of kakananti, at the time of commencement and later developing all the features of kustha and having different colours. (20-31)
Sadhyasadhyata – prognosis of Psoriasis
कुष्ठलिङ्गैर्युतं सर्वैर्नैकवर्णं ततो भवेत् । दोषभेदीयविहितैरादिशेल्लिङ्गकर्मभिः ॥३२॥
कुष्ठेषु दोषोल्बणतां सर्वदोषोल्बणं त्यजेत् । रिष्टोक्तं यच्च यच्चास्थिमज्जशुक्रसमाश्रयम् ॥३३॥
याप्यं मेदोगतं कृच्छ्रं पित्तद्वन्द्वात्रमांसगम् । अकृच्छ्रं कफवाताढ्यं त्वक्स्थमेकमलं च यत् ॥३४॥
The predominance of the doshas in kustha is to be determined in accordance with the symptoms and functions described in dosha-bhediya 20 of sutrasthana); that which has the predominance of all the doshas should be rejected, so also those having fatal signs of kustha (described in chapter 11 of sharira sthana), and that residing (invading) in the bones, marrow, and semen. Those residing in fat tissue is controllable but persist for long periods, those which are caused by combination of pitta with any other dosha, that residing in blood and muscle tissues are difficult to cure; that arising from kaphavata predominance and those residing in the skin and produced by any one dosha is not difficult ( easy ) to cure. (32-34)
तत्र त्वचि स्थिते कुष्ठे तोदवैवर्ण्यरूक्षताः । स्वेदस्वापश्वयथवः शोणिते पिशिते पुनः ॥ ३५ ॥
पाणिपादाश्रिताः स्फोटाः क्लेदः सन्धिषु चाधिकम् । कौण्यं गतिक्षयोऽङ्गानां दलनं स्याच्च मेदसि ॥३६॥
नासाभङ्गोऽस्थिमज्जस्थे नेत्ररागः स्वरक्षयः । क्षते च कृमयः शुक्रे स्वदारापत्यबाधनम् ॥३७॥
If kustha resides in tvak ( skin, vis a vis rasa ), the symptoms are pricking pain, discolouration and dryness; if residing in sonita (blood), there is (more of) perspiration, loss of sensation of touch, and swelling; if in the muscular tissue, there is vesicles manifesting in the hands and feet and large quantity of fluid in the joints; if in medas (adipose tissue) there will be bending (curvature) of the arm, loss of movement (inability to move) cracking or splitting of the body parts; if in asthi–majja (bone and marrow) there occurs breaking of the nose (multilation of the tip of the nose), red colour of the eyes, loss of voice, and development of worms (bacteria) in the ulcers; and if in sukra (semen) there will be trouble ( transmission of the disease) to the wife and children. ( 35-37)
यथापूर्वं च सर्वाणि स्युर्लिङ्गान्यसृगादिषु ॥ ३८ ॥
All the symptoms will be found in all the kinds, commencing with that of the blood etc succesively (in kustha residing in blood the symptoms of its previous condition, i,e, of the skin – will also be present; in kustha residing in muscle, the symptoms of those of the skin and blood will also be found; in kustha residing in fat the symptoms of those of the skin, blood and muscles will also be present and so on. (38)
Svitra – Leucoderma
कुष्ठैकसम्भवं श्वित्रं किलासं चारुणं च तत् । निर्दिष्टमपरित्रावि त्रिधातूद्भवसंश्रयम् ॥ ३९ ॥
Svitra, Kilasa or Aruna is also described as similar to kustha (in respect of causes, doshas, dusyas, etc); it is non-exudative, produced by three dhatus (vata, pitta and kapha combined together) and residing in three dhatus (tvak or rasa, rakta and mamsa). (39)
वाताद्र्क्षारुणं पित्तात्तानं कमलपत्रवत् । सदाहं रोमविध्वंसि कपाच्छ्वेतं घनं गुरु ॥४०॥ सकण्डु श्च क्रमाद्रक्तमांसमेदस्सु चादिशेत् । वर्णेनैवेदृगुभयं कृच्छ्रं तच्चोत्तरोत्तरम् ॥४१॥
That (svitra) due to vata is non-glistening, mild and red in colour; that due to pitta is coppery-red like the lotus petal, having burning sensation and loss of hairs; that due to kapha is white in colour, thick, heavy, and has itching; the above three are residing in rakta, (blood) mamsa (muscle) and medas (fat) respectively; so also in respect of colours with the combinations of both is more and more difficult to cure successively. (40-41 )
अशुक्लरोमाबहुलमसंसृष्टं मिथो नवम्। अनग्निदग्धजं साध्यं श्वित्रं वर्ज्यमतोऽन्यथा ॥ ४२ ॥ गुह्यपाणितलौष्ठेषु जातमप्यचिरन्तनम् ।
That (svitra) which has black hairs ( on the skin), not occupying wide areas, not coalesed (patches joining together) of recent onset, and that not due to burns by fire – are curable; all others should be rejected and also that which is born (seen) on genitals, palms and lips even though of recent origin (to be rejected). ( 42 )
स्पर्शैकाहारशय्यादिसेवनात् प्रायशो गदाः ॥४३॥ सर्वे सञ्चारिणो नेत्रत्वग्विकारा विशेषतः ।
Generally diseases spread from person to person by touch (physical contact), eating together (in a common plate), sleeping together on common bed and such other activities, especially so, diseases of the eyes and skin. (43)
Krimi roga – parasitic disorders
कृमयस्तु द्विधा प्रोक्ता बाह्याभ्यन्तरभेदतः ॥४४॥
बहिर्मलकफासृग्विड्जन्मभेदाच्चतुर्विधाः । नामतो विंशतिविधा बाह्यास्तत्रामृजोद्भवाः ॥ ४५ ॥
तिलप्रमाणसंस्थानवर्णाः केशाम्बराश्रयाः । बहुपादाश्च सूक्ष्माश्च यूका लिक्षाश्च नामतः ॥४६॥
द्विधा ते कोठपिटकाकण्डूगण्डान् प्रकुर्वते ।
Krimis (parasites) are spoken of as two kinds viz Bahya (external) and Abhyantara (internal); these are of four kinds – as arising from external dirt, kapha, asrk (blood) and vit (faeces) and twenty kinds by name.
Of these, the external ones are born because of uncle anliness; these resemble (the seed of) tila (sesamum) in size, shape and colour, reside in the hairs and cloth, have many legs, are small in size; these are of two kinds-yuka and liksa by name. They produce kotha (rashes) pidaka ( papulas) kandu (itching), and ganda ( enlargement of lymph glands, tumors etc). (44-46)
कुष्ठैकहेतवोऽन्तर्जाः श्लेष्मजास्तेषु चाधिकम् ॥४७॥
मधुरान्नगुडक्षीरदधिसक्तुनवोदनैः । शकृज्जा बहुविड्धान्यपर्णशाकौकुलादिभिः ॥४८॥ ॥
The internal ones are born from the same causes as those of kustha; among these, those born from kapha are produced by excess indulgence in sweet foods, jaggery (treacle) milk, curds, cornflour and freshly harvested grains. Those born from faeces are produced by indulgence in foods which produce more faeces, leafy vegetables, dishes prepared from gains stored in granaries, which are uncooked grains etc. (47-48)
कफादामाशये जाता वृद्धाः सर्पन्ति सर्वतः । पृथुब्रध्धनिभाः केचित् केचित् गण्डूपदोपमाः ॥४९॥
रूढधान्याङ्कराकारास्तनुदीर्घास्तथाणवः । श्वेतास्ताम्रावभासाश्च नामतः सप्तधा तु ते ॥५०॥
अन्त्रादा उदरावेष्टा हृदयादा महारुहाः । चुरवो दर्भकुसुमाः सुगन्धास्ते तु कुर्वते ॥५१॥
हृल्लासमास्यस्त्रवणमविपाकमरोचकम् । मूर्छाच्छर्दिज्वरानाहकार्यक्षवथुपीनसान् ॥५२॥
Those born of kapha, grow in the amasaya (stomach and small intestine) and move to all other places when they grow in number; some of them are thick and resemble a leather strap, some others resemble earthworms, some are like sprouts of germinating grains, some others are thin, long and minute, white, or coppery in colour, they are of seven kinds by name viz, Antrada, Udaravesta, Hridayada, Maharuha, Curava, Darbhakusuma and Sugandha. They produce nausea, more of salivation, indigestion, loss of appetite (or of taste), fainting, vomiting, fever, distention of abdomen, emaciation, more of sneezing and nasal catarrah. (49-52)
रक्तवाहिसिरास्थाना रक्तजाजन्तवोऽणवः । अपादा वृत्तताम्राश्च सौक्ष्म्यात् केचिददर्शनाः ॥५३॥
केशादा लोमविध्वंसा लोमद्वीपा उदुम्बराः । षट् ते कुष्ठैककर्माणः सहसौरसमातरः ॥५४॥
Those born from rakta (blood) reside in the veins carrying blood, are atomic (minute) without legs, round, copper coloured, some are invisible being very minute; they are six in kind and named as Kesada, Lomavidhamsa, Lomadvipa, Udumbara, Aurasa and Matara; they produce kustha ( leprosy and other skin diseases). (53-54)
पक्काशये पुरीषोत्था जायन्तेऽधोविसर्पिणः । वृद्धास्ते स्युर्भवेयुश्च ते यदामाशयोन्मुखाः ॥५५॥
तदास्योद्गारनिश्वासा विड्गन्धानुविधायिनः । पृथुवृत्ततनुस्थूलाः श्यावपीतसितासिताः॥५६॥
ते पञ्च नाम्ना कृमय: ककेरुकमकेरुकाः । सौसुरादाः सलूनाख्या: लेलिहा जनयन्ति च ॥५७॥
विड्भेदशूलविष्टम्भकार्यपारुष्यपाण्डुताः । रोमहर्षाग्निसदनगुदकण्डूर्विनिर्गमात् ॥५८ ॥
Those born of purisa ( faeces) grow in the pakvasaya (large intestine) generally moving downwards, but when they grow in number they even more upwards to the amasaya (stomach) producing smell of faeces in the mouth, in the belching and in the expired air, they are big, round, thin or thick, blue, yellow, black and white in colour, they are of five kinds of Kakeruka, Makeruka, Sausurada, Saluna and Leliha; they produce loose motions, colic, stasis of food without digestion, emaciation, roughness, yellowishwhite colour of the body, horripilations, weak digestion, itching in the anus by their coming out. through it. (55-58)
॥ इति चतुर्दशोऽध्यायः ॥ Thus ends the Fourteenth chapter.
