E-ISSN:2456-3110

Review Article

Kustha

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

An overview of Kustha and its management approaches in Ayurvedic texts

Kuldeep.1*, Verma S.2, Awasthi S.3, Vikas.4
DOI: http://dx.doi.org/10.21760/jaims.8.6.15

1* Kuldeep, Assistant Professor, Department of Samhita and Siddhanta, Awasthi Ayurvedic Medical College and Hospital, Nalagarh, Himachal Pradesh, India.

2 Sheetal Verma, Final Year Post Graduate Scholar, Department of Panchkarma, RGGPG Ayu. College & Hospital, Paprola, Himachal Pradesh, India.

3 Sakshi Awasthi, Assistant Professor, Department of Samhita and Siddhanta, Awasthi Ayurvedic Medical College and Hospital, Nalagarh, Himachal Pradesh, India.

4 Vikas, Assistant Professor, Department of Panchkarma, Khlasa Ayurvedic Medical College & Hospital, Nangal Kalan, Punjab, India.

Our skin serves as a barrier to ward off numerous outside intrusions. The body's skin is the only organ that is easily visible to the eyes. The largest organ and one that is most vulnerable to illness and damage is the skin. Skin is an indicator of normal physiology and expresses emotions due to its visibility. It connects the internal and exterior environments and houses the complexion that preserves personality and beauty. In the society, it helps people develop their own identities. A homeostatic imbalance in the body may be the cause of changes in skin colour. Skin health is influenced by a variety of interconnected elements, including diet, hygiene, circulation, age, immunity, genetics, psychological state, and medication. Skin is referred to as 'Twacha' or 'Charma' in Ayurveda. Twacha is derived from the Sanskrit term Dhatu - Twach Samvarne, which means body covering. The broad categories of Kushtha have been used to discuss all skin conditions in Ayurveda. The seat of Sparshajnanendriya, one of the Vata Jnanendriyas, is Twacha, and it is the largest of the five Jnanendriyas.

Keywords: Kushtha, Kitibha Kushtha, Psoriasis

Corresponding Author How to Cite this Article To Browse
Kuldeep, Assistant Professor, Department of Samhita and Siddhanta, Awasthi Ayurvedic Medical College and Hospital, Nalagarh, Himachal Pradesh, India.
Email: 		Kuldeep, Sheetal Verma, Sakshi Awasthi, Vikas, An overview of Kustha and its management approaches in Ayurvedic texts. J Ayu Int Med Sci. 2023;8(6):93-96.
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https://jaims.in/jaims/article/view/2541

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-26 2023-04-28 2023-05-05 2023-05-12 2023-05-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by Kuldeep, Sheetal Verma, Sakshi Awasthi, Vikasand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Maha Kushtha and Kshudra Kushtha are the two forms of Kushtha that are covered in the classical Ayurvedic literature. Maha Kushtha is divided into seven categories, whereas Kshudra Kushtha is divided into eleven. Kapala, Udumbhara, Mandala, Rushyajihwa, Pundarika, Sidhma, and Kakanaka make up the Maha Kushtha. Kshudra Kushtha consists of Eka Kushtha, Charmakhya, Kitibha, Vipaadika, Alasaka, Dadru, Charmadala, Paama, Visphota, Shataru, and Vicharchika. Shyava Krushna Varna, Parushata, Kharasparsha, Kandu, Ghanatwam, and Srava are some of the Lakshanas of Kitibha Kushtha.

Psoriasis and Kitibha Kushtha share many of the same defining features, according to modern science. Skin and joints are both impacted by the illness psoriasis. On the skin, it frequently results in reddish scaly patches. Psoriasis is a condition that alters a person's typical skin texture and aesthetic appeal, which leads to social stigma and may lower one's self-esteem. One of the most fascinating and puzzling skin disorders is psoriasis. It is a papulosquamous skin condition characterised by erythemato-squamous lesions that are clearly defined. Psoriasis' precise cause is still unknown, but genetics are thought to play a role. It is renowned for its remission and exacerbation cycles. Climate, streptococcal infection, etc. can cause psoriasis to flare up. One of the main triggering elements in the disease's exacerbation is stressed out psychologically. The disease itself may make a patient depressed in response, which could make his condition worse. A specific patient's course and prognosis are unpredictable. It's referred to as a Punarbhavakara Vyadhi in Ayurvedic literature. Psoriasis rarely poses a threat to life. Psoriasis currently has no viable treatments available. PUVA and corticosteroids are the main treatments for psoriasis in contemporary medicine. Serious side effects of these treatments include liver and kidney failure, bone marrow depletion, etc.

Twacha Sharira: Acharya Sushruta revealed how Twacha forms in a growing foetus. According to him, Twacha grows after ovum fertilisation just like cream does on the top of boiled milk. Acharya Vagbhata adopted a similar strategy. One of the Matruja Bhava is Twacha. Twacha development in the foetus will be finished, according

to Vaghbhata, in the sixth month. The creation of Twacha as a result of Paka of Rakta Dhatu by its Dhatwagni in the foetus was described by Vaghbhata. It forms Paka, and then dries off to become Twacha.

1. Avabhasini 1/18th Adhisthana of Varana-Chaya Prasadaka, Adhishtana of Sidma and Padmakantaka
2. Lohita 1/16 Adhishtana of Tilakalaka, Vyanga and Nyaccha
3. Shweta 1/12 Adhishtana of Charmadala, Ajakallika and Mashaka
4. Tamra 1/8 Adhishtana of Kilasa Kushthadi
5. Vedini 1/5 Adhishtana of Kushtha, Visarpa
6. Rohini 1 Vreehi Pramana Adhishtana of Granti, Apache, Arbuda, Sleepada and Galaganda
7. Mamsadara Vreehi Dwaya Adhishtana of Bhagandara, Vidradi and Arsha

Twacha's connection to Dosha-Dushya[1]

Vata : Adhishtana of Vata is Sparshanendriya and Adhishtana of Samana Vayu comprises Swedavaha Srotas, which is present in Twacha.

Pitta : Bhrajaka-Pitta type of skin contains Pitta Dosha.

Kapha : Although there isn't any concrete proof that the Kapha Dosha is the skin's Adhishtana, its influence can be seen in the skin's Mardavata (softness) and Snighdhata (oiliness).

Rasa : The texture of a person's skin can indicate the quality of their Sara Purusha (basic constitution). If the skin is Shaitya (cool) and Rukshta (dry), it suggests a deficiency (Kshaya) of Rasa (body fluids), while if it is soft and moist, it indicates an excess (Vrudhi) of Rasa.

Rakta : The function of Rakta Dhatu (blood tissue) is described as Sparsa Jnana (sense of touch) and Varna Prasadana (providing colour). Skin is the Adhistana (site) of skin diseases caused by Rakta Dushti (blood-related disorders) such as Kushtha, Neelika, and Visarpa, which suggests a relationship between skin and Rakta Dhatu.

Mamsa : The Prasada Bhaga (nutritive part) of Mamsa Dhatu (muscle tissue) forms the six layers of the skin.

Sweda : The function of Sweda (sweat) is to maintain the moisture of the body and the softness of the skin. Imbalances in Sweda Lakshanas (sweat-related symptoms) can also be manifested in the skin.



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Kushtha: Amarakosha claims that the word Kushtha's derivation is derived from the root "Kush," which denotes that it originates from the inner part. The meaning can be deduced from the look of the impacted Twacha, which is caused by the body's Rakta, Lasika, Ambu, and Tridoshas becoming vitiated.

Shabdakalpadruma defines Kushtha as something which produces contempt and disdain.

The Kushtha Roga, according to Acharya Vagbhata, is what leads to Vaivarnya and Dushti in the Twacha.

Shabdhakalpadruma claims that the meaning of the word "Kitibha" is "Kesa Keeta."

According to Monier Williams, the English translation of the word kitibha means "louse" (a parasitic insect that infects human skin and hair and spreads several diseases).

Nidana: There is no explanation of specific Nidana[2] for Kitibha Kushtha in the Ayurvedic classics. The Samanya Kushtha Roga Nidana, which is the general Nidana for the Kushtha Roga, should be taken into consideration. Studying Nidana aids in both therapy planning and revalidation for the current study. Nidana falls into the following categories:

Aharaj Nidan: Following improper diet and lifestyle habits (Mithyahara Vihara).

1. Consuming excessive amounts of sweet, sour, and oily foods such as honey, yogurt, and oily substances.

2. Consuming excessive amounts of sweet, sour, salty, and oily foods, as well as sesame seeds.

3. Eating spicy and dry foods such as chili and dried fish, along with milk.

4. Consuming milk after consuming sour foods.

5. Consuming sugarcane juice.

6. Overeating

Viharaj Nidan

1. Daytime sleep (Diwaswapna).

2. Sexual intercourse (Maithuna).

3. Physical exercise (Vyayama).

4. Sexual activity after improper diet (Ahitasana) consumption.

5. Suppressing the urge to vomit (Chardi Vegadharana).

6. Drinking cold water after experiencing fear, fatigue, or heat exhaustion (Bhaya, Shrama, Santapa).

Lakshana

The word "Lakshana" is used to describe a Roga's distinguishing characteristics. Lakshana has the synonyms Rupa and Linga. On the fifth stage of the Kriyakala, also known as the Vyakta stage, a Roga's Lakshana[3] will appear. There are several Ayurvedic manuscripts that contain the Lakshanas of Kitibha Kushtha, including the following:

  • Shyav Varna: The dark complexion (Shyava Varna) is due to the presence of Vata Dosha.
  • Kharatvam: Roughness (Khartwam) and dryness (Parusham) of the skin indicate the involvement of Vata Dosha. The roughness can also result in a harsh touch (Karkasha Sparsha).
  • Krishna Varna: The bluish-black colour (Krishna Varna) is due to the presence of Vata Dosha, which turns the reddish colour (Aruna Varna) of the skin into a darker shade.
  • Snigdha: The term Snigdha is contradictory in the context of skin conditions, as it can refer to both oily and moist properties. In the case of excessive Kleda Guna (moistness), the skin may appear oily or moist. In Kitibha (a skin condition), the predominance of Kapha Dosha can cause the skin to appear moist.
  • Srava: Discharge (Srava) from a wound or lesion is due to Pitta Dosha.
  • Ugra Kandu: Ugrakandu (severe itching) is due to Kapha Dosha.
  • Vridhi: Vridhi (increase in size) of a lesion can occur due to various reasons, including Dosha imbalance, infection, or growth.
  • Guru/Dhrudam/Ghana refers to the thickness of the wound site (Vrana Sthana). The phrase "Prashanthani Cha Puna Punarutpadhyante / Vartate Cha Samutpnnam" means that the disease tends to recur even after complete disappearance.



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Acharya Charaka has listed the symptoms of Kitibha Kushtha, which include Shyava Varna, Kharasparsha, and Parushata. Other prominent Ayurvedic texts such as Sushruta, Madhavanidana, Vagbhata, Yogaratnakara, and Kasyapa have also described Kitibha Kushtha using the same set of symptoms as mentioned by Charaka.

Samprapti: Samprapti is the term for the chain of events starting with the vitiation of the Doshas as a result of a particular Nidana and ending with the full-fledged manifestation of the illness following the Dosha-Dushya Sammurchana. The understanding of Samprapti aids the doctor in comprehending the distinctive characteristics of a sickness, such as the involvement of a certain Dosha or Agni[4] etc. If the Chikitsa planning is not in accordance with the Samprapti Ghataks, it is said to be in vain. Samprapti of Kitibha Kushtha is being derived here based on Kushtha Roga because no detailed Samprapti of Kitibha Kushtha is mentioned in literature.

Tridoshajanya Vyadhi is Kushtha. This Roga is thought to require the involvement of multiple Doshas in order to materialise. The Amshamshakalpana of Dosha serves as the foundation for categorising Kushtha. Tridoshas, Twak, Rakta, Mamsa, and Ambu are the Kushtha Sapta Dravyas.

Acharya Charaka asserts that Nidana Sevana results in Prakopa of Tridosha, which then causes the vitiated Doshas to get Ashraya in Twak, Rakta, Mamsa, and Ambu, creating the Shaithalyatha in these Dhatus, which results in the manifestation of Kushtha Roga. He has also been told that the Vatadi Doshas get Prakopa and perform Dushana of Twak, Rakta, Mamsa, and Ambu, resulting in seven or eleven different forms of Maha and Kshudra Kushtha, respectively, in Chikitsasthana.

Sadhyasadhyata: The Kushtha Sadhyasadhyata is mentioned in Ayurvedic texts; however, the Kitibha Sadhyasadhyata is not explained individually. The status of the Roga's Sadhya and Asadhyata was discussed by Acharyas before they explained Chikitsa, which provides doctors with a thorough guide for treatment.

Sadhya Kushtha: Sadhya Kushtha - Eka Dosholbana Vata-Kapha Pradhanata, which has only affected Twak, Rakta, and Mamsa, has the chance to fully get back in this state,

Krichrasadhya Kushtha: If the patient has either Kapha Pitta Mishrita, Vata Pitta, or just one Pitta Dosha, there is a slim chance that they will be cured during this Avastha.

Yapya Kushtha: The Rogi will be free from the Roga's sufferings if the Doshas are in Medo Dhatu, he performs the right Bheshaja, and he abides by Pathya. Vyadhi is likely to relapse after he quits the Aushadhis and begins to follow the Apathya.

Asadhya Kushtha: If the following characteristics are present, such as Sarva Lingayukta, Abala, Trushna, Daha, Santhagni, the existence of Jantu, Doshas that have attained Asthi, Majja, and Shukra Dhatus.

Updrava: Upadravas might happen before the disease has fully shown or while the sickness is still active. The following are the Kushtha Upadravas:

These are just a few examples of the various names of health conditions such as Prasravana, Angabheda, Patana Anyangavayavanam, Trushna, Jwara, Atisara, Daha, Dourbalya, Arochaka, and Avipaka.

Pathya - Apathya: When something is harmful to the Srotas but pleasing to the Manas, it is known as Pathya. Combining Pathya Sevana with medication can accelerate the healing process of the disease and minimize discomfort.

Pathya : The recommended dietary regimen includes light food (Laghu Anna), bitter greens (Tikta Shaka), split chickpeas (Bhallataka), a mixture of three fruits (Triphala), rice mixed with neem leaves (Nimbayukta Anna), ghee (Ghrita), ancient grains (Purana Dhanya), meat from wild animals (Jangala Mamsa), mung beans (Mudga), and pointed gourd (Patola). For drinking (Pana), bathing (Snana), and sprinkling (Parisheka), consumption of Khadira Kashaya is suggested.

Apathya : Acharya Sushruta suggests avoiding Mamsa (meat), Vasa (fat), Dugdha (milk), Dadhi (curd), Taila (oil), Kulatha (horse gram), Masha (black gram), Nishpava (green gram), Ikshu (sugarcane), Amla (sour fruits), Virudha Ahara (incompatible food), Adhyasana (overeating), Ajeerna (indigestion), Vidahi (burning sensation), and Abhishyandi (mucus-forming foods). On the other hand, according to Acharya Charaka, Guru (heavy food), Amla (sour fruits), Payas (rice pudding), Dadhi (curd),


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Anupamamsa (unwholesome meat), Matsya (fish), Guda (jaggery), and Tila (sesame) should be avoided (considered Apathya).

Chikitsa: Skin disorders take a long time to develop, are frequently incurable, and call for patience to take treatment for a longer period. Without the vitiation of Tridoshas, Kushtha Roga is not possible.

Nidana Parivarjana should be the primary line of treatment because the sickness manifests itself from the Nidana. By limiting the vitiation of Doshas, it halts the further advancement of illnesses.

Samshodhana is the name of the therapy that tries to eliminate the morbid elements that are to blame.

Acharya Sharangadhara asserts that Dosha Bahulyata is the cause of Kushtha Roga. Shamana Aushadhi finds it extremely challenging to address these Tiryagami Doshas.

According to Acharya Vagbhata, the Kushtha Rogi receives Snehapanam in the Purvarupa Avastha.

According to Acharya Charaka, Virechana should be given initially, followed by Niruha Basti and Madhuphaladi Sidha Taila for Vata Dosha Pradhana Kushtha. Since Kushtha is a Tridoshajanya Vyadhi, it is best to treat the predominant Doshas before moving on to the anubhandha Doshas. Regular Panchakarma process advice reveals the degree of Dosha participation in the Kushtha Roga. Bahudoshaavastha mentions Shodhana Karmas. In Charaka Chikitsasthana, Vamana Karma is recommended for Kaphapradhana and Doshotklesa Kushtha.[5] Raktamokshana, Virechana, and Vamana are performed every six months, one month, and every fifteen days, respectively, for this reason. The use of Shaman is in the treatment of Kushtha. It is advised to use Shamana Chikitsa to calm the remaining Doshas after finishing the Shodhana Karma. Shamana treatment is recommended in circumstances where people in the modern world do not have enough time in their hectic schedules for Shodhana therapy. Tikta and Kashaya Dravyas' Shamana therapy has been detailed by Charaka.

When used after Samshodhana, Shamana Aushadhi is more effective. External therapy plays a vital role in treating Kushtharoga because the affected areas, Sthanasamasraya, and Vyaktasthana, are located in the Twacha (skin).

The traditional literature frequently refers to Lepa Yoga, highlighting the significance of external medical care in treating the condition.

Discussion

Modern medical descriptions of dermatological problems sometimes draw comparisons to Kushtha Roga. Kushtha Roga, including psoriasis, is considered a persistent and challenging illness to treat due to its complex pathophysiology, which is influenced by various factors such as dietary, behavioral, environmental, genetic, and immunologic factors. Psoriasis is an inflammatory condition that leads to excessive proliferation of keratinocytes in the epidermis and an increased rate of cell turnover.
Up to 30% of individuals with this condition may experience joint involvement, and it commonly affects the skin in areas such as the elbows, knees, scalp, lumbosacral region, intergluteal clefts, and glans penis. Immunological changes brought on by Kapha disruption favour the emergence of psoriasis. Keratinocyte hyperproliferation develops in the epidermis as a result of Pitta disruption. Vitiated Vata is the cause of an increase in the epidermal cell turnover rate. Therefore, psychological stress resulting from any factor has a negative impact on Mana, which in turn causes the onset or exacerbation of an underlying skin condition. Psoriasis and psychological stress have a substantial correlation, according to several research on the condition.

Conclusion

One of the first diseases that mankind is aware of is Kushtha. It is said to as one of the most chronic diseases in the Ayurvedic medical system. A vast variety of dermatological problems were described by Ayurveda, including their classification, etiopathogenesis, clinical manifestation, prevention, and therapy. The seat of the Saparshanendriya (organ responsible for touch sensation), the skin is an important organ of communication with the outside world and has an enduring bond with Mana. Therefore, any kind of psychosocial stress can contribute to the development or worsening of dermatological disorders, whether directly or indirectly. The emergence of a wide variety of dermatological illnesses today is primarily caused by stress and weakened immunity.


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The Ayurvedic pharmacological and non-pharmacological treatments for dermatological problems are effective immuno-modulators and stress-reducers. Therefore, when implemented properly, these measures are both economical and offer management in a natural manner without any negative effects.

References

1. Charak Samhita" with Hindi Vidyotini Commentary by Pt. Kashinath Shastri and Dr. Gorakhnath Chaturvedi, Part 1, has been reprinted by Chaukhamba Bharti Academy in Varanasi in 2002.

2. Sushrut Samhita. Dr. Shastri Ambikadutt, published in Varanasi in 2002 by Chaukhamba Sanskrit Sansthan, specifically focuses on the Nidansasthana section.

3. Vaidya Yadunandana Upadhyaya edited the "Astanga Hrdayam Nidansthana" by Vagbhata, which includes the 'Vidyotini' Hindi Commentary by Kaviraja Atrideva Gupta. This edition was published by Chaukhamba Sanskrit Sansthan in Varanasi in 2005.

4. Chaukhamba Visvabharti in Varanasi reprinted the "Bhel Samhita" Nidan sthana text in 2008. This edition includes an English translation, commentary, and critical notes by Dr. K.H. Krishnaurthy, which were edited by Prof. PriyaVrat Sharma.

5. Parameswarappa's Ayurvediya Vikriti Vigyan & Roga Vigyan. Volume II, 1st edition, was written by Byadgi P.S. and published by Chaukhambha Sanskrit Sansthan in Varanasi in 2009. The book focuses on Kushtha.


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