The Nidanam of cutaneous affections (Kshthas) ||164||

1-2Dhanvantari said: -The principles of the deranged Vayu, Pittam and Kapham, aggravated through the agency of injudicious diet and conduct, or through the dynamics of sinful acts. of Karma, are sent coursing through the vessels of the body, which thereby vitiating the blood, fat, flesh, and skin of the locality, are kept incarcerated in the surface of the skin, bringing about a discolouring of the skin.
3These diseases are called Kushtham (cutaneous affections). Neglected at the outset, these Kushtham spread all over the body, gradually invading the fundamental principles of the organism, whether external or internal.
4The affected parts become contracted, and are characterized by the absence, or discharge, of a clammy perspiration. Later on, parasites are found to germinate in those localities, which gradually attack the skin, hairs, and vessels of the part. In the type known as Maya (external) Kushtham, the body, of the patient appears as if it has been dusted with ashes.
5-6The disease (Kushtham) admits of being divided into seven kinds according to the several, duplicate, or concerted actions of the morbific principles of the deranged Vayu, Pittam, and Kaphah, such as the Vataja, Pittaja, Khapaja, Vata-Pittaja, Vata-Slemaja, Pitta-Slemaja and Sannipatika types. In each type of Kushtham the deranged Vayu, Pittam and Kapham are found to act in unison, though the action of any of them may predominate therein.
7-9The type of Kushtham, which is due to the action of the deranged Vayu, is called Kapala; that which is due to the deranged Pittam is called Audumabara; artd that which has its origin in the deranged Kapham is called Mandala. Besides these the types known as Vicarcika and Rishyajihva originate through the action of th deranged Vayu and Pittam, the types known as Carmakushtha (Prurigo), Kitima (Keloid tumour), Alasa and Vipadika owe their origin to the deranged Vayu and Sleshma, while the types known as Dadru (Ringworm), Sataru Pundarica, Vishphota, Pama Sidhma (Leuco-derma) and Carmadala Impertigo) are brought about through the action of the deranged Pittam andKapham.
10Of all these types of Kushtham Dadru and Kakana Kushtham should be regarded as most common (Prathama). The seven types such as the Pundarika etc., are called Maha Kustham (Leprosy).
11The affected patches in this disease become soft and rough. Perspiration may be entirely absent, or a kind of clammy perspiration may be felt in these localities.
12-13An itching, burning sensation in the skin, attended with complete anesthesia and con-traction of the spots, marks the premonitory stage of this disease, and the patient suffer from vanishings of sight. A large number of ulcers of patches are found to appear at a time in this disease, which become permanent (refuse to be healed), and an aching pain is constantly experienced in their inside. The patches, just after their appearance, are felt rough to the touch, and the deranged Vayu, Pittam and Kapha in these spots are extremely aggravated even at a slight exciting cause. Thinness or poverty of blood, and horripilation are the premonitory symptoms of all types of Kushtham- The forehead of the patient, during this stage, becomes blackish, or reddish, then dry and rough.
14The disease which extensive patches covered over with hairs, and attended with an excruciating pain, are found to appear in certain parts of the body, is called Kapala Kushtam, which should be considered as one of the most dreadful types of leprosy.
15In the type known as Audumbara, the ulcerated patches assume the colour of a ripe Audumbara (ficus Indica). They become rounded in size, attended, with pain and burning, and exude a copious discharge.
16They appear in detached patches and never burst, although parasites are found to germinate in their midst. The ulcerated patches, in this disease, become thick, firm (non-shifting) and glossy, and are found to exude a red and white discharge.
17In the type known as Mandala Kushtam (Erythema) the pitches are found to be raised, confluent, soft and yellowish marked by an itching sensation and the germination of parasites in their inside.
18The type of Kushtam in which crops of black, itching, excluding pustules are found to appear on the skin is called Vicarcika. These patches become of a tawny brown colour, and are felt a little raised and rough to the touch.
19The type in which lepirous patches, resembling the tongue of a (Rishya) deep in colour and shape, are found to appear on the skin of the body, is called Rishyajihva, marked by the germination of large number of parasites in their inside. The type in which the skin of the patient becomes dry and rough like that of an elephant is called Carmakhyam.
20The type in which the patches becomes hard and shining like the scales of a fish, dry, itching, flame coloured, cannot bear the least touch, and is marked by the absence of perspiration, is called Kipma (keloid tumour).
21In the Sidhma-type, the ulcers become rough in their inside and glossy on the surface. A kind of dust-like efflorescence is obtained by rubbing these patches which are found to be extremely thin and transparent and are felt flower-like soft to the touch, marked by the absence of perspiration.
22The form of Kushtam in which the patches are marked with red marks, being thin at their upper ends, and characterized by an extremely itching sensation, and which appear usually at the hands and legs are called Vipadika.
23An excruciating pain and an in tolerable itching sensation mark the several types of Kushtham which become studded with red pustules and spread like the roots of Durva grass, tinged with a colour like that of an Atasi flower.
24-25In the type known as Dadru (Ring worm), the patches are found to be a little elevated distributed in ring-like grooves and are attended with an itching sensation. In the type due to the concerted action of the deranged Vayu, Pittam and Kapham, the patches are found to be thick at the base, marked by bleeding and a burning sensation in the incidental ulcers, which break out in large numbers. Grey, or red coloured, circular patches, attended with pain and burning appear on the skin of the patient in this type of Leprosy.
26The type in which raised, reddish, patches, like dried leaves, studded over with white or red-coloured vesicles, appear on the skin, is called Pundarikam.
27In the type known as Nina the patches are marked by a pain and itching sensation, and assume a reddish or dusky hue, covered over with dry, erysipelatous eruptions, and usually appear about the elbow, hands, and the lumbar region.
28An excruciating pain and an intolerable burning sensation mark the types known as Kakana, Carmadala etc.
29The colour of the patches in the Kakana type is at first red which changes into black, resembl-ing the washings of Triphala. The patches in all types of leprosy may subsequently assume a black hue through the agency of their respective exciting factors.
30The exciting factor in each case should be ascertained with regard to the colour of the leprous patches and the symptoms, specifically developed therein.
31-33A case of Kustam originated through the action of any particular morbific principle should be abandoned as incurable, as soon as its complication with the other two of the morbific principles of (Vayu, Pittam and Kapham). would be detected. A cases of Kushtham m which the virus is found to invade the organic principles of bone, or semen, should be considered as extremely hard to cure. With the help of suitable medicines, the disease may be suppressed, for the time being, in cases where the virus affects the fat only, while a redical cure may be expected in those in which only the fish and bones are affected. Cases of Kushtam, originated through the action of the deranged Vayu and Kapham, should be regarded as incurable, like those which ate confined only to the skin, and do not secrete any discharge or cast any sediment. Discolouring and dryness of the skin are all that characterize a case of Kushtam confined only to the skin, while perspiration, heat, and swelling at and of the palms of hands and soles of feet, appearance of bulbous ulcers about the joints, and an extreme pain are the symptoms which become manifest in cases in which the virus attacks the blood. The adipose tissues of the body seem as if being crushed and suffer a marked deterioration through the virulence of the deranged Vayu, Pittam, and Kapham, in this disease.
34The voice becomes sunk and hollow, the eye sight is impaired and bones, fat and marrow are destroyed with the progress of this dreadful scourge.
35The parasites destroy the organic principle of semen in the patient, disqualifying him to discharge his conjugal duties. All the abovesaid forms of Kushtam with their respective specific symptoms may attack even the lower animals.
36The disease known as Svitram (Leuco-derma) as well as the dreadful Kilasa originate from the same cause as Kul?tnam. Both these forms of disease are non-bleeding and involve the concerted action of the three morbific principles of the deranged Vayu, Pittam, and Kapham.
37-38In the Vataja type of Svitra the patches become dry and vermil-coloured, while in the Pittaja type they are found to be copper-coloured like lotus leaves. A burning sensation is present in these patches, and the virus attacks the hairs of the affected parts, causing their entire destruction (them to fall off) in this type. In the Kaphaja type of Svitra the patches become thick and white, attended with an itching sensation. The virus gradually and successively attack is the organic principles of blood, flesh, and fat in both these diseases, which become more and more difficult to cure as it invades these successive principles. Both Svitra and Kilasa (Psoriasis) originate from the same cause, and the patches in similar types of both of them are found to assume the same colour.
39Cases of recent origin in which the patches are not confluent, and the local hairs have not become white, and which are not the results of burns or scalds, may be expected to be cured, the rest should be given up as incurable.
40Cases of Kilasa even of recent origin, in which the spots (patches) are found to appear on the lips, or on the palms of hand, or on the soles of feet, or about the anus, should be specially given up as incurable.
41All diseases, and cutaneous affections in special, are contagious; and are contaminated from one person to another through the use of the same bed, seat, unguent, apparels etc., with a diseased person.