Introduction

The term Kushta is derived from Sanskrit root ‘Kush’ meaning that which comes from inner part or affects inner part of body. The word Kushta means disease in which there will be Dushti (vitiation) of Twacha (skin) associated with Vaivarnyam (discol-ouration).^[1] In Ayurvedic classics, Kushta is class-ified under Ashta Mahagada & is Rakta Pradoshaja Vikara.^[2] It is considered as an umbrella term, where it includes most of Twak Gata Vikaras^[3] (cutaneous manifestations). According to Acharya Sushruta, Kushta originates from complex interplay of dietary, behavioural, & metabolic factors. Nidanas (causes) are Mitya Ahara Achara (improper diet & lifestyle) especially Guru (heavy), Virudha (non-congenial), Asatmya Ahara (incompatible), intake of food without digestion of previous meal, indulging in Vyayama (exercise) or Vyavaya (sexual intercourse) after Snehapana (oleation therapy) or Vamana (emetic therapy), intake of Payasa (sweet porridge) with Gramya (desert) or Anupa Desha Mamsa (aquatic region meat), and/ or suppression of Chardi (emesis). These trigger Vata vitiation, which in turn aggravates Pitta and Kapha. The Doshas infiltrate Siras leading to Twak, causing Twak disorders with Mandalakara (circular) lesions.^[4] Dhatugata Kushta is progressive disorder where vitiated Doshas penetrate superficial layers of skin, affecting deeper Dhatu. Acharya Sushruta categorizes its clinical presentation based on specific Dhatu involved. When Rasa Dhatu is vitiated, Lakshanas are Sparsha-hina (loss of touch sensation), Kandu (itching), Vaivarnya (discolouration) & Rukshata (dryness).^[5] Gradually as vitiated Doshas enters next Dhatus, different symptoms are manifested. Lakshanas of other Dhatus are mentioned in tabular column [Table 1].

Table 1: Lakshanas of Dhatugata Kushta

Result

Itching sensation reduced within 7 days of treat-ment. There was reduction in size of papules & no new papule formation noted during treatment dura-tion [Figure 1]. Gradual reduction in blackish discol-ouration was noted after 1st sitting of Jalokava-charnam, [Figure 2]. After 2 sitting 50% reduction was noted [Figure 3]. When pat. came for follow up after month, discolouration was reduced aro. 90% with no new lesion anywhere in body [Figure 4].

Figure 1: During the 1st week of treatment

Figure 2: After 1st sitting of Jalaukavacharnam

Figure 3: After 2nd sitting of Jalaukavacharnam

If the Doshas are present in deeper Dhatus, then Siravyadha is advised. On this basis Jalaukava-charnam was selected.^[14] Jalaukavacharnam helps in expelling the doshas collected at the local region, removes obstruction, and improves blood circulation thereby helps in reducing the symptoms of Vaivarnya.^[15]

Conclusion

In this case, Kapha-Pitta Hara Chikitsa was adopted with consideration of Rasa-Rakta Dhatu Dushti. Internal medication was targeted to reduce the Kapha Dosha, improve the quality of Rakta Dhatu, and to detoxify the body. External treatment helped in removing the accumulated doshas collected at the local site.

As the patient was Sukumara, Vamana and Virechana was not advised. The adopted treatment has proved beneficial in arresting the progression of the condition, with complete remission of the signs and symptoms. It can be considered as an alternative management for Kushta Chikitsa for those patients who cannot undergo the classical Vamana and Virechana procedure.

The added advantage for this case was that it was not a long-standing condition and the Dhatu vitiated was at the level of Rakta Dhatu, which is said be Saadya by Acharya Sushrutha.

References