Critical analysis of Maha kushta and kshudra kushta wsr to modern and its management.pdf

Mahakushta and Kshudra Kushta are classifications of skin diseases in Ayurveda, with Mahakushta representing severe conditions and Kshudra Kushta encompassing milder forms. A critical analysis reveals that Mahakushta includes eight types, often correlating with serious modern skin diseases like leprosy and psoriasis, while Kshudra Kushta has eleven types, resembling conditions such as eczema and dermatitis. This comparison highlights the relevance of Ayurvedic classifications in understanding skin disorders today, suggesting potential integration of Ayurvedic treatments . The Ayurvedic classification of skin diseases provides valuable insights that can supplement modern dermatology. Integrating selective ayurvedic therapies may enhance treatment of stubborn skin conditions.

1. CRITICAL ANALYSIS OF
MAHAKUSTA AND
KSUDRA KUSHTA WITH
RESPECT TO MODERN
AND ITS
MANAGEMENT
Presented by Shanmugaloga S
PgScholar
Deptof Shalya tantra
GamcBangalore

2. ABSTRACT
Skin is the largest sense organ of our body which has the power to
perceive all the senses like pain , pressure ,touch , temperature,
etc.Also it provides protection to the body from external factors
We all know that Healthy skin is the reflection of healthy body
where in affection of the former will not only have an impact on
the somatic makeup but also on the psychological and social aspect
of an individual
KUSHTA is one among the ASHTA MAHAGADA
SANTARPANAJANYA VYADHI which primarily AFFECTS
SKIN
Kushta is brief term for all the conditions affecting skin from acne to necrotizing
fatal skin disorders.

3. MORPHOLOGICAL DESCRIPTION OF SKIN LESION
Macules:
*Usually flat non palpable lesions, <10mm in diameter.
*represent change in colour
* not raised or depressed
Papules:
*Elevated lesions, <10mm in diameter
*can be felt or palpated

4. Plaques :
*plaques are palpable lesions, >10mm
*elevated or depressed
*may be flat topped or rounded
*lesions of psoriasis form plaques
Vesicles:
*fluid filled Blisters <10mm in diameter
*Charaterestics of herpes infection

5. Bullae:
*clear fluid filled blisters >10mm
*may be caused by burns, bites,
allergic contact dermatitis
Pustules:
*pustules are vesicles that contain pus
*common in bacterial infections
Crusts(scabs) :
*Consist of dried serum, blood, pus

6. Urticaria (Wheals Or hives) :
*Elevated lesions caused by Localized Edema
*pruritic And red
*Due to hypersensitivity to drugs, stings, Autoimmunity
Less commonly due to sunlight, temperature and pressure
Scale:
* Accumulation of epithelium
*In disorders like psoriasis, Seborrheic dermatitis
Scars:
* Area of fibrosis that replace normal skin after injury
* some become thickenes and raised eg: keloid

7. Petechiae:
* Red/purple dots that represent bleeding from
leaking capillaries
Purpura:
* Petechiae that have collected together and
become bigger
Ulcers:
* results from loss of epidermis and dermis

8. Diagnostic tests:
* diagnostic tests are indicates when cause of skin disease or lesion is not
obvious from history and physical examination. These include
*Patch testing
*Biopsy
*scraping – helps to diagnose fungal infection and scabies
*examination by woodlight – helps to diagnose and define the
extent of lesions
*Diascopy – used to determine whether Erethyma in skin lesion
is due to blood Within superficial vessles Or due to hemorrhage

9. Management of skin diseases:
*Treatment of established skin disease is directed towards Promoting healing
And preventing secondary infection and further damage
*Common treatment methods for Skin conditions include
*Antihistamine
*medicated cream and ointment
*Antibiotics
*vitamins or steroid injections
*laser therapy

10. *blisters should be Carefully lanced with sterile needle. Release of blister fluid
results in small scars
* wound should be carefully cleansed with soap and water
* infected lesions should be dressed with betadine
*avoid using Adhesive plaster, as removal of it may damage the skin
*patients with severely infected lesions require course of systemic antibiotics
such as cloxacillin.

11. Skin gets affected mostly in all the disease conditions for eg in jwara ,
rakta pitta , prameha etc because it covers the entire body and keeping
it healthy is of utmost importance
For eg in jwara bahirparimarjana kriya is recommended to remove the
twakgata dosa( labhate sukham angani bala varnam vardhate)
If a kushta rogi dies and if born again it appears in his next birth that’s
why it is said as kastatara vyadhi
We know that Agni is the certain cause for all the diseases so it goes
with kushta also as the qualities of skin gets affected if agni is
impaired ….. in functions of agni it is stated by charakacharya that
varna (complexion), prabha (radiance) and tejas (lustre)are all
depends upon the agni

12. NIDANA
AHARAJA VIHARAJA MANASIKA KARANA ANYA KARANA
Ati drava snigdha guru dravya
sevanam
Ati vyayama , santapa , Lobha moha krodha matsyaPanchakarma vyapat
Nava anna , dadhi , matsya ati
lavanam amla sevana
Gharma srama bhaya
artanam dhrutam shitambu
sevinam
Any stress Disrespecting gurus, elderly
persons
Pishta anna, masha mulaka tila kshira
guda
Chardi vegadharana Indulging in sinful activities
Ajirna adhyasanam Diva swapnam Poorva janma papam
krtam
Viruddha aharaa
Vidahi anna
Abishyandi ahara

13. SAMPRAPTI : SAPTAKO DRAVYA SANGRAHA :- 7 COMPONENTS
INVOLVED IN PATHOGENESIS OF KUSHTA ROGA
TRIDOSHAS – VATA , PITTA , KAPHA
DUSYAS – TWAK RAKTA MAMSA AMBU

ASRASRAYI BHAVAM
PITTAM (BHRAJAKA, RANJAKA)- RAKTAM
KAPHAM(AVALAMBHAKA , TARPAKA)- RASA(TWAK) MAMSA
VATA (UDANA , SAMANA)

14. TYPES
MAHA KUSHTA 7 KSUDRA KUSTA 11
KAPALA-kapalabham (vata pradhanya) Eka kustam Pama
UDUMBARA-udumbara phalaba(pittam) Charmakyam Visphota
MANDALA-mandalabham(circular) kapham Kitibha Shataru
RISYAJIHWA-risyajihwa samsthanam (vp) Vaipadikam Vicharchika
PUNDARIKA-pundarika dalopamam(kp) Alasakam
SIDHMA- alabu puspa varna(vk) Dadru
KAKANAKA-kakananthika varna (gunja bija sa varnam)
tridosajam
Charmadala

15. MAHA KUSHTA
KAPALA KUSHTA Compared with PSORIASIS

17. UDUMBARA COMPARED MANDALA WITH
WITH SCLERODERMA FURUNCLES

18. RSYAJIHWA WITH PUNDARIKA WITH
LICHEN PLANUS URTICARIA

19. SIDHMA WITH KAKANAKA WITH
PITYRIASIS VERSICOLOR SQUAMOUS CELL CARCINOMA

20. KSUDRA KUSTAM 11
1)EKA KUSHTAM – MATSYA SAKALOPAMAM – AS OF FISHY SCALES
COMPARED WITH ICHTHYOSIS VULGARIS –INHERITED CONDITION IN WHICH DEAD SKIN
CELL ACCUMULATE IN THICK , DRY SCALES ON SURFACE OF SKIN (PLAQUE FORMATION)

21. 2) CHARMAKYAM – HASTI CHARAMVAT – AS OF ELEPHANT SKIN COMPARED WITH
A)SCLERODERMA(CREST SYNDROME)
CALCINOSIS
RAYNAUD’S PHENOMENA
ESOPHAGEAL DYSFUNCTION
SCLERODACTYLY( THICKENING AND TIGHTENING ON FINGERS)
TELANGIECTASIS(RED MARKS ON SKIN SURFACE D/T CAPILLARY DILATATION
B) XERODERMA- DRY SKIN

22. 3)KITIBHA KINA KHARA SPARSHA, PARUSHA
COMPARED WITH
A)GUTTATE PSORIASIS – LOOKS LIKE RED RAIN DROP ON SKIN -AUTO IMMUNE DISORDER
TRIGGERED BY URTI; STREP INFECTION, STRESS, TONSILITIS,ENVIRONMENTAL FACTORS,ETC

(A) (B)
B)ACTINIC KERATOSIS- SOLAR KERATOSIS BECAUSE ROUGH SCALY BROWN PATCHES DEVELOPS
ON EXPOSURE TO SUN

23. 4)VAIPADIKA KUSHTA- PANI PADA SPHUTANAM
COMPARED WITH PALMAR PLANTAR PSORIASIS- AN AUTO IMMUNE CONDITION
AFFECTING BOTH HANDS AND FEET OR ALONE

24. 5)ALASAKAM – SA RAGA GANDAIHI(NODULAR GROWTH)
COMPARED WITH TENIA INFECTION CAUSED BY RINGWORM , FUNGUS
CAUSES RING LIKE PATCHES

25. 6)DADRU- MANDALA (CIRCULAR PATCHES) WITH ELEVATIONS
COMPARED WITH A)PURIGO NODULARIS – HARD ITCHY LUMP OR NODULES
PRURITIS IS INTENSE WORSENED BY HEAT, SWEATING,IRRITATION FROM CLOTHING …. BUT
SCRATCHING LEADS TO PAIN AND FORMATION OF SECONDARY SKIN LESIONS
COMMONEST SITE- LEGS/ ARMS
ASSOCIATED WITH ATOPIC DERMATITIS, LYMPHOMA, HIV, SEVERE ANEMIA, KIDNEY DISEASE
B) LICHEN PLANUS – CHRONIC INFLAMMATORY AUTO IMMUNE DISEASE WHICH FORMS SMALL
HARD ROUND LESIONS AFFECTING SKIN, NAILS, HAIR AND MUCOUS MEMBRANE

(A ) (B)

26. 7)CHARMADALA – CHARMADALAMAKYATHAM SPARSHASAHAM-
COMPARED WITH HSV HERPES SIMPLEX VIRUS 1 (ORAL HERPES)
HERPES SIMPLEX VIRUS 2 ( GENITAL HERPES)
FORMS BLISTERS ,REDNESS, PAIN, ITCHING, ENLARGED LYMPH NODES WITH
TENDERNESS

27. 8) PAMA – PIDAKA( SWETA, ARUNA, SYAVA WITH KANDU)
COMPARED WITH SCABIES- DERMATOLOGICAL
CONDITION CAUSED BY SARCOPTES SCABIEI(8 LEGGED
MICROSCOPIC MITE) – CONTAGIOUS-ITCHY PATCHES OR RASHES
VARY FROM SILVERY GREY TO BROWN

28. 9) VISPHOTA – SPHOTA ( SWETA ARUNA ….. TANU TWACHA)
COMPARED WITH A)PEMPHIGUS – AUTO IMMUNE DISEASE
CAUSES PAINFUL BLISTERS ON SKIN , MUCOUS MEMBRANES OF
MOUTH,GENITALS
B) CHICKEN POX – HIGHLY CONTAGIOUS VIRAL INFECTION
WHICH CAUSES ITCHY BLISTER LIKE RASH ON SKIN

29. 10) SHATARU – BAHU VRANAM ( RAKTA DAHA ARTI)
COMPARED WITH PYODERMA GANGRENOSUM- AUTO
INFLAMMATORY DISORDER WHICH SPREADS RAPIDLY WITH
PAINFUL ULCERS
ASSOCIATED WITH IBS ,RA, HEPATITIS , LEUKEMIA,ETC

30. 12) VICHARCHIKA – SYAVA SRAVA PIDAKA
COMPARED WITH ECZEMA- PATCHES OF SKIN BECOMES
INFLAMMED, RED, ITCHY,CRACKED AND ROUGH

31. DOSHAJA LAKSHANAS

32. CHIKITSA SUTRAM

33. WHILE PLANNING FOR CHIKITSA, IT
IS CONCERNED WITH PREDOMINANCE OF DOSHAS THOUGH
IT IS BRIEF WITH 11 TYPES . INITIALLY KUSHTA IS CONFINED
TO SKIN AND GRADUALLY INVADES OTHER DHATUS(KRAMAN
DHATUN VYAPNOTI) ,IF NOT TREATED EARLY AND PROPERLY.
SO CHIKITSA MUST BE STARTED AFTER PROPER PLANNING.
Vata and kapha – not difficult to
treat
eka kushta, carmakhya ,
kitibha , vipadika , Alasaka
Kapha – not difficult to treat
Vicharchika
Pitta and kapha – difficult to be
treated
dadru , carmadala , pama ,
visphota , sataru

34. CHIKITSA MODALITY
Dosha pradhanya chikitsa
SHODANA chikitsa
Order of doing shodanam
method of doing shodana – start with ama pachana, dipana, snehapana,
abhyanga, swedana, vamana, 1day rest ,samsarjana kramam,
sadyosnehanam,virechana, samsarjana kramam, nasyam,vairechanika dhuma,
raktamokshanam and vasti if needed
Frequency of doing shodana
Bahya upakramas- snana, udwartana, lepam ,malahara, upanaha
Dhatu gata kushta chikitsa

35. Goal – dhatu samyata – which can be achieved by dosha shamana
More importantly to keep in mind before starting chikitsa Is nidana parivarjana because chikitsa will work
only after that
Doshas are either eliminated or pacified after ascertaining the bala of rogi and avastha of rogam
For SHODANA or SHAMANA do start with SNEHA PRAYOGAM
For shodanam
Snehanam with maha tiktaka grtam, vajraka grta, maha vajraka grta,tuvaraka tailam, bhallataka tailam
Vatapittam go with grta
Vata kapha go with tailam
Swedanam done one day prior to vamana
Or 3 days in virechanam
Mrudu-exposure to sun or hot water bath
Vamana with kutaja, madanaphala, madhuka, nimba mixed with patola kwatham
Virechanam with trivrit , danti, triphala, manibadra gudam ,avipattikara choornam
Depending upon the intensity of shodanam do samsarjana kramam for 3 to 7 days
In excessive vata dosha after virechana plan anuvasana or asthapana vasti
Nasya with saindhava , danti, maricha, phanijakka, karanja ( for kusta due to kapha and krimi)
Vairechanika Duma is advised after nasya

36. Rakta mokshana is one of the main line of treatment as kusta is rakta pradoshaja vyadhi
In kushta of bigger size or spreaded all over the body or deep seated – sira vyadhanam done
In minor kusta or twaksthita dosha – prachanam, jalouka avacaranam done
After shodanam for the purpose of rasayana certain drugs are administered
For eg bhallataka shilajatu tuvaraka gugguku khadira asana agaru bakuchi markava rasayanam
For external - gandhaka preparation
Siddhartaka snana churna – musta madana Karanja aragwadha triphala indrayava darvi saptaparna
Vamana every 15 days
Virechana every 30 days
Rakta Mokshan twice a year (in Small quantity)
Nasyam every 3
rd
day
As kushta has impact on psychological aspect or arise due to manasika karana – manasika chikitsa should be
done.
Satvavajaya chikitsa
Daivavyapashraya chikitsa
Achara rasayana.

37. SHAMANA OUSHADIS
GHRTA
Guggulu tiktaka grta
Mahatiktaka grta
Kalyanaka grta
Shatadhouta grta
Tiktaka grta
Aragwadadhi pancatiktaka grta
KASAYAM
Guduchyadhi ks
Patolamooladhi ks
Manjishtadhi ks
Punarnavadi ks
Nimbadhi ks
Shonitamrutam ks
Tiktaka ks
Patola katurohinyadhi ks
Aragwadadhi ks
CHURNAM
Avipattikara churnam
Rajanyadhi ch
Nimbadhi ch
Vara ch
Sudarasana ch
LEPAM
Sindhooradhi lepam
Avalguja beejadhi lepam
Rasotthamadhi lepam
Rasa karpura

38. TAILAM
Guggulu marichyadhi tailam
Vajraka tailam
Maha vajraka tailam
Durvadhi tailam
Maha marichadhi tailam
Somaraji tailam
Jivantyadhi yamakam
Eladhi tailam
Dinesha eladhi tailam
Dinesha valyadhi Tailam
Gandhaka tailam
Markava tailam
Chemabarutyadhi kera tailam
Malathyadhi tailam
Durdurapatradhi keratailam
Karappan tailam
Kumkuma tailam
RASA OUSHADIS
Talakeswara ras
Rasamanikhya
Rasa sindhooram
Vyadhi harana Ras
GUGGULU
Amruta guggulu
Kaisora guggulu

39. ARISTA and ASAVAM
Khadiraristam
Aragwadharistam
Sarivadyaristam
Nimbamrutasavam
Chitrakasavam
Chandanasavam
LEHYAM
Manibhadra gudam
Amruta bhallataka
Haridra Khanda
Madhusnuhi rasayanam
Markava rasayana
Gandhaka rasayanam
GULIKA
Arogyavardhini vati
Dushivishari gulika
Krimighna vati
Krimi shodhani vati
Vilwadi gulika

40. Pathyam:
Light cereals (laghu anna) and bitter vegetables(tikta shaka)
Edibles and grta mixed with bhallataka,triphala,nimba should be used.
Purana dhanya, jangala mamsa, mudga and patola are recommended.
Apathyam:
Guru amla payas dhadhi anupa mamsa matsya gudam tilam are
contraindicated
Avoid vidahi ,viruddha , abishyandi ,nava anna, pishta anna( bakery
items)
Oily items, refrigerated foods, tinned foods, pickles, Fermented foods.