Diagnosis and Treatment of leprosy (Kushta) in Astangahrdaya samhita of Vagbhata

 Diagnosis and Treatment of leprosy (Kushta) in Astangahrdaya samhita of  Vagbhata 

We shall now expound the chapter, Kustha-svitra-krimi nidanam-diagnosis of leprosy, leucoderma and worms (parasites); thus said Atreya and other great sages. \

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.  

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. 

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 out side of kustha (different from leprosy). 4-6a

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)

Kustha is of seven kinds; by each dosa separately, by combination of any two and by all of them together. Though all kinds are caused by the combination of all three dosas their 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) 

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)

Kapala kustha: 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. 

Udumbara kustha: 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. 

Mandala kustha: 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. 

Vicharchika: 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. 

Charmakhya Kustha: Skin resembling that of the elephant and rough to touch is Carmakhya kustha. Eka kustha In Eka kustha the leison is very wide (covers a large area) non-sweating and resembles the skin of the fish. Kitibha Kustha Kitibha kustha has dry skin; rough, and hard, creating sound on scratching, itching, hard and black. Sidhama Kustha 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 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. 

Dadru kustha: 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. 

Sataru kustha: 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. 

Pundarika kustha: 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: Visphota kustha has thin skin patches covered with blackish red blebs. Pama kustha 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: 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: 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 kustha and of many colours. 26-30. 

 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.) 

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