kusta chikitsa.pptx

A comparitive study on vatarakta chikitsam wsr to Bruhattrayee

1. Title of this seminar A Comparative study on Chikitsa -Sutra of Kushta Vyadhi of Bruhatrayee Presenter Dr.Bharath V, Final year pg scholor , Dept of Ayurveda Samhitha and siddhanta , GAMC Mysuru Under the guidance of Dr Shreevatsa Prof and HOD Dept of Ayurveda Samhitha and siddhanta , GAMC Mysuru 2

2. Contents of this presentation Introduction Reference ( शास्त्र सन्दर्भ ) Understanding the Vyadhi सामान्य चिकित्सा सूत्र from बृहत्रयी Discussion on - सामान्य चिकित्सा सूत्र from बृहत्रयी Special points about the disease Kushta Conclusion Note: as this presentation is oriented towards comparative Chikitsa sootra from Bruhatrayee , Chikitsa components are highlighted, other components like Samprapti , individual types of Kushta , individual formulations in detail are not elaborately discussed. However related information is stated wherever necessary. No contemporary correlations comparisons are carried out 3

3. Introduction Chikitsa -sutra is a guideline that provides an idea to physician based on which one can plan the treatment. Considering the word meaning; ‘ Chikitsa ’ is ‘treatment’, and ‘sutra’ is the ‘formula’. Chikitsa is defined as याभिः क्रियाभिर्जायन्ते शरीरे धातवः समाः | सा चिकित्सा विकाराणां कर्म तद्भिषजां स्मृतम् || ३४ || ( Cha.Su.16/34) The procedure from which the components of ‘ Shareera ’ ( Dosha , Dhatu, Mala and so on) attains normalcy, is known as ‘ Chikitsa ’ for that disease and that is the duty of ‘ Bhishak ’ . 4

4. Synonyms of the term Chikitsa used in Charaka samhitha are as follows ( Cha chi 1/1/3-4) चिकित्सितं व्याधिहरं पथ्यं साधनमौषधम् | प्रायश्चित्तं प्रशमनं प्रकृतिस्थापनं हितम् || ३ || विद्याद्भेषजनामानि , ...| ४ | As it can be seen among all Bruhatrayee , every disease passes through a pathway known as ‘ Samprapti ’ to exhibit itself. Disintegrating this pathway i.e., ‘ Samprapti Vighatana ’ itself is prime consideration in Chikitsa . Whole of the formulations mentioned for that disease would be firmly adhere to this basic principle 5

5. The later part would be recovering the damage caused by manifested disease, to attain normalcy of Dhatus . In general, this is the normal protocol in treating every disease seen in Bruhatrayee . In most of the diseases initially Shodhana therapy is advised as first line of treatment based on predominance of Doshas . In some diseases Karmukata (roughly, special actions) such as Vaatanulomana , Marga-avarana-harana , Agni- deepana , even surgical procedures like Chedana-Bhedana parasurgical procedures like Kshara -karma, Agni-karma also comes under the category of Chikitsa Sutra. Secondary part treatment focus on the damage control and avoiding the re-occurrence of the diseases. 6

6. Characteristics of Shuddha-Chikitsa (Cha Ni 8/23) प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत् | नासौ विशुद्धः , शुद्धस्तु शमयेद्यो न कोपयेत् || २३ || Any treatment is said as Shuddha-Chikitsa when, it is capable of curing the disease for which it is administered for and not leading to any complications. In this presentation comparative Chikitsa sutra of Kushtavyadhi from Bruhatrayee are dealt. 7

7. Reference ( शास्त्र सन्दर्भ ) चरक संहिता चिकित्सास्थान -7 th chapter सुश्रुत संहिता चिकित्सास्थान -9 th and 10 th chapters अष्टाङ्ग हृदय चिकित्सास्थान -19 th chapter 8

8. Understanding the Vyadhi As seen previously ‘ Samprapti Vighatana ’ itself is prime consideration in Chikitsa , here with the quick look about Samanya-Samprapti-Ghataka of Kushta . सम्प्राप्ति घटक Note - सम्प्राप्ति घटक of each type of Kushta varies, the information given is in broad sense and combination of all three Samhitha s , it changes from one type to another type of Kushta . In general 9

9. दोष - त्रिदोष दूष्य - त्वक् मांस रक्त लसीका ( सप्तकोद्रव्य सङ्ग्रह ) / सप्तधातु as per अचार्य सुश्रुत अधिष्ठान - त्वक् मांस रक्त लसीका and other धातु s स्रोतस् - रसवहा रक्तवहा मांसवहा उदकवहा अन्नवहा स्वेदवहा ( सुश्रुताचर्य - धातुगत कुष्ठ so all Dhatuvaha srotas mentioned by him can be considered) स्रोतोदुष्टि - सङ्ग विमार्गगमन अग्नि - जाठराग्नि धात्वाग्नि उद्भवस्थान - आमाशय / पक्वाशय 10

10. सञ्चारस्थान - सर्वशरीर व्यक्तस्थान - त्वक् (and other धातु ) रोगमार्ग - बाह्य / आभ्यन्तर व्याधि स्वभाव - चिरकारि and दारुण साध्यासाध्यता - कृच्छ्रसाध्य Apart from these कृमि सम्प्राप्ति , श्वित्र सम्प्राप्ति , सन्तर्पणोक्त व्याधि सम्प्राप्ति are also similar to Kushta sampraapti These points play an important role in deciding the treatment. 11

11. साध्यासाध्यता Before entering into Chikitsa -Sutra, it is important to consider the साध्यासाध्यता of the disease. साध्यानामपि ह्युपेक्ष्यमाणानां त्वङ्मांसशोणितलसीकाकोथक्लेदसंस्वेदजाः क्रिमयोऽभिमूर्च्छन्ति ; ते भक्षयन्तस्त्वगादीन् दोषाः पुनर्दूषयन्त इमानुपद्रवान् पृथक् पृथगुत्पादयन्ति If the Sadhya-Kushta are neglected then they will lead to formation of the Krimi of various types, they will spread by consuming the twagadi avayavas , again causing the vitiation of Doshas . Final stage of the disease would reach to following conditions, प्रस्रवणमङ्गभेदः पतनान्यङ्गावयवानां तृष्णाज्वरातीसारदाहदौर्बल्यारोचकाविपाकाश्च , तथाविधमसाध्यं विद्यादिति || ११ || It could reach so severe that the patient may lose his body parts as such. In that condition the disease becomes incurable. 12

12. सर्वैर्लिङ्गैर्युक्तं मतिमान् विवर्जयेदबलम् | तृष्णादाहपरीतं शान्ताग्निं जन्तुभिर्जग्धम् || ३७ || वातकफप्रबलं यद्यदेकदोषोल्बणं न तत् कृच्छ्रम् | कफपित्त-वातपित्तप्रबलानि तु कृच्छ्रसाध्यानि || ३८ || If the Kushta is manifested with all the Tridoshaja lakshanas in a weak person, if the person is affected with Trushna , Daaha , if his Agni is lost, if he is affected by the Krumi then the disease becomes Asadhya . Kapha -pitta and Vata -pitta dominant Kushta are Kruchhrasadhya in nature. The Kushta of Vata-kapha dominant and localised to particular part of the body is easily curable. 13

13. Another important factor to consider in case of Kushta disease is, all types of Kushta are Tridoshaja , as it mentioned as, , न चैकदोषजं किञ्चित् कुष्ठं समुपलभ्यते || १० || Further it is said as, सर्वं त्रिदोषजं कुष्ठं दोषाणां तु बलाबलम् | यथास्वैर्लक्षणैर्बुद्ध्वा कुष्ठानां क्रियते क्रिया || ३१ || 14

14. All Kushta are Tridoshaja in nature, by considering the predominance of dosha it is categorised under specific Doshas . By looking into the dominance of Doshas one has to plan for the treatment. दोषस्य यस्य पश्येत् कुष्ठेषु विशेषलिङ्गमद्रिक्तम् | तस्यैव शमं कुर्यात्ततः परं चानुबन्धस्य || ३२ || By countering the predominant Dosha Lakshana through treatment, one has to go for Anubandha lakshana treatment. 15

15. सामान्य चिकित्सा सूत्र चरक संहिता चिकित्सा स्थान 7/39-40   वातोत्तरेषु सर्पिर्वमनं श्लेष्मोत्तरेषु कुष्ठेषु | पित्तोत्तरेषु मोक्षो रक्तस्य विरेचनं चाग्रे || ३९ || In Vaatadosha predominance conditions, Sarpi prayoga In Shleshmadosha predominance conditions, Vamana karma In Pittadosha predominance conditions, Raktamokshana and Virechana karma. 16

16. अग्रे इति सर्पिरादिषु योज्यं ; तेन वातोत्तरादिषु सर्पिरादि प्रथमं कर्तव्यं , तदनु वक्ष्यमाणा चिकित्सा कार्येत्यर्थः |- Acharya Chakrapani opines that, the word अग्रे has to be joined with all the treatment procedures mentioned in the Sootra later the next treatments. Preferable line of treatment based on Doshas could be as follows, In Vaatadosha predominant Kushta - महातिक्तक घृत , तिक्तषट्फलकं घृतं , महाखदिरं घृतं (all these are mentioned in same chapter) and other similar Ghrutas processed with the drugs of कुष्ठघ्न दशेमानि महाकषाय can be used. 17

17. Though in the main चिकित्सा - सूत्र there is no mentioning of बस्तिकर्म , बस्तिप्रयोग is mentioned as a चिकित्सा in वातप्रधान कुष्ठ in same chapter. दार्वीबृहतीसेव्यैः पटोलपिचुमर्दमदनकृतमालैः | सस्नेहैरास्थाप्यः कुष्ठी सकलिङ्गयवमुस्तैः || ४६ || Nirooha basti with drugs like दारुहरिद्रा बृहती पटोल पिचुमर्द मदनफल कृतमाला इन्द्रयव नागरमुस्ता After निरूहबस्ति if the patient is अनुवासनयोग्य , then physician can plan for अनुवासन बस्ति with मदनफल , मधुक , निम्ब , कुटजफल पटोलसाधित तैल . 18

18. In Shleshmadosha predominance Kushta - conditions and also in the conditions of उत्क्लिष्ट दोष in हृदय ( उरोभाग ) and in ऊर्ध्वभाग शरीर , Vamana karma is first line of treatment by using कुटजफल , मदनफल , मधुक , पटोलरस , निम्बरस , मधु , शीतरस - शीतकषाय , दोषोत्क्लिष्टे हृदये वाम्यः कुष्ठेषु चोर्ध्वभागेषु | कुटजफलमदनमधुकैः सपटोलैर्निम्बरसयुक्तैः || ४३ || शीतरसः पक्वरसो मधूनि मधुकं च वमनानि | वमनविरेचनयोगाः कल्पोक्ताः कुष्ठिनां प्रयोक्तव्याः |- अनागतावेक्षण तन्त्रयुक्ति is used to understand this sloka. Utilization of Vamana- Virechana yogas , mentioned in Kalpasthana . वमनयोग mentioned specifically for कुष्ठफलशृति in कल्पस्थान are इक्ष्वाकुकल्प , जीमूतकल्प , कृतवेधनकल्प 19

19. In Pittadosha predominance Kushta conditions, Raktamokshana and Virechana karma प्रच्छनमल्पे कुष्ठे महति च शस्तं सिराव्यधनम् || ४० || Administering प्रच्छन्न कर्म in case of अल्प कुष्ठ ( अल्पदोषलक्षण ) , सिराव्यधन in case of महति कुष्ठ . ( बहुदोषलक्षण ) The drugs mentioned for विरेचन कर्म , in the same chapter are त्रिवृत् दन्ती त्रिफला कुष्ठेषु त्रिवृता दन्ती त्रिफला च विरेचने शस्ता || ४४ || The विरेचन योग s mentioned for Kushta in कल्पस्थान are, त्रिवृत् योग - कल्याणक गुड , सुधा कल्प , सप्तला शङ्खिनि कल्प 20

20. Further specific consumables are mentioned instead of regular Samsarjana krama as, सौवीरकं तुषोदकमालोडनमासवाश्च सीधूनि | शंसन्त्यधोहराणां यथाविरेकं क्रमश्चेष्टः || ४५ || The mode of administering the Shodhana karma is specified in the same context like, बहुदोषः संशोध्यः कुष्ठी बहुशोऽनुरक्षता प्राणान् | दोषे ह्यतिमात्रहृते वायुर्हन्यादबलमाशु || ४१ || In case of बहुदोषावस्था ; स्तोक - स्तोक दोष हरण through multiple संशोधन , by protecting the प्राण . If Doshas are removed excessively then, the aggravated Vaatadosha will take off the life immediately. 21

21. स्नेहपान indication after शोधनकर्म   स्नेहस्य पानमिष्टं शुद्धे कोष्ठे प्रवाहिते रक्ते | वायुर्हि शुद्धकोष्ठं कुष्ठिनमबलं विशति शीघ्रम् || ४२ || After Koshta-shuddi by Shodhana -karma and after Rakta-mokshana one has to go for Snehapana administration. Because for a weak person affected with Kushta ; after Shodhana karma there is a tendency of Vaatadosha to get lodged in Koshta . 22

22. रक्तमोक्षण कर्म specified for treating Kushta स्थिरकठिनमण्डलानां स्विन्नानां प्रस्तरप्रणाडीभिः | कूर्चैर्विघट्टितानां रक्तोत्क्लेशोऽपनेतव्यः || ५० || आनूपवारिजानां मांसानां पोट्टलैः सुखोष्णैश्च | स्विन्नोत्सन्नं विलिखेत् कुष्ठं तीक्ष्णेन शस्त्रेण || ५१ || रुधिरागमार्थमथवा शृङ्गालाबूनि योजयेत् कुष्ठे | प्रच्छितमल्पं कुष्ठं विरेचयेद्वा जलौकोभिः || ५२ || the indication for specific रक्तमोक्षण कर्म are seen here, along with the Poorvakarma and associated procedures with them. Thus, in a gist, that particular place has to be made Mrudu with Swedana karma , should be made loose / lax with surgical instruments later it should be subjected for रक्तमोक्षण कर्म . Notable point here is all 4 types of रक्तमोक्षण कर्म mentioned in SushrutaSamhita are seen here. 23

23. ये लेपाः कुष्ठानां युज्यन्ते निर्हृतास्रदोषाणाम् | संशोधिताशयानां सद्यः सिद्धिर्भवेत्तेषाम् || ५३ || After रक्तमोक्षण कर्म , कुष्ठघ्नलेप प्रयोग is done to get faster results. Some of the special treatment principles mentioned in Kushta Vyadhi शस्त्रकर्म , क्षारप्रयोग , अगद प्रयोग , घर्षण प्रदेह प्रयोग येषु न शस्त्रं क्रमते स्पर्शेन्द्रियनाशनानि यानि स्युः | तेषु निपात्यः क्षारो रक्तं दोषं च विस्राव्य || ५४ || In conditions where शस्त्रकर्म cannot be possible and स्पर्शज्ञान is lost there क्षारप्रयोग is indicated, after रक्तमोक्षण 24

24. पाषाणकठिनपरुषे सुप्ते कुष्ठे स्थिरे पुराणे च | पीतागदस्य कार्यो विषैः प्रदेहोऽगदैश्चानु || ५५ || In stony hard conditions of Kushta , which has lost its sensations, which is immobile and chronic in nature one has to go for a special treatment. Initially patient is given with Agada - Aushadha , later Visha is applied over the place as pradeha , after its removal again Agada- Aushadha is applied over that area. 25

25. स्तब्धानि सुप्तसुप्तान्यस्वेदनकण्डुलानि कुष्ठानि | कूर्चैर्दन्तीत्रिवृताकरवीरकरञ्जकुटजानाम् || ५६ || जात्यर्कनिम्बजैर्वा पत्रैः शस्त्रैः समुद्रफेनैर्वा | घृष्टानि गोमयैर्वा ततः प्रदेहैः प्रदेह्यानि || ५७ || One more special mode of applying the Pradeha has been mentioned here as, initially doing the घर्षण (methodical rubbing) with the mentioned drugs, then applying the Pradeha with Kushtaghna Dravya . 26

26. Due importance has been given to Rasadravyas in this chapter, लेलीतकप्रयोगो रसेन जात्याः समाक्षिकः परमः | सप्तदशकुष्ठघाती माक्षिकधातुश्च मूत्रेण || ७० || श्रेष्ठं गन्धकयोगात् सुवर्णमाक्षिकप्रयोगाद्वा | सर्वव्याधिनिबर्हणमद्यात् कुष्ठी रसं च निगृहीतम् || ७१ || वज्रशिलाजतुसहितं सहितं वा योगराजेन | सर्वव्याधिप्रशमनमद्यात्कुष्ठी निगृह्य नित्यं च || ७२ || Drugs like are noticed here गन्धक , स्वर्णमाक्षिक , रस ( पारद ) , वज्रशिलाजतु , माक्षिक 27

27. Non re-occurrence of Sadhya-Kushta दोषे हृतेऽपनीते रक्ते बाह्यान्तरे कृते शमने | स्नेहे च कालयुक्ते न कुष्ठमनुवर्तते साध्यम् || १५१ || This is an important Sootra found in this chapter highlighting the अपुनर्भव - चिकित्सा . For the sake of convenience, it will be shown in flowchart. दोषहरण through संशोधन ,  रक्तमोक्षण ,  अभ्यन्तर - बाह्यशमन ,  स्नेह - प्रयोग  साध्यकुष्ठ will become अपुनर्भवत्व 28

28. In the same Adhikarana of Kushta chikitsa , at the end of the chapter, Kilaasa nidana are mentioned. Notable point here is except Viruddhaahara , all others are related with Papakarma . Due to similarity in the Nidanas and the Chikitsa this might have placed in this context. वचांस्यतथ्यानि कृतघ्नभावो निन्दा सुराणां गुरुधर्षणं च | पापक्रिया पूर्वकृतं च कर्म हेतुः किलासस्य विरोधि चान्नम् || १७७ || 29

29. चिकित्सा सूत्र from सुश्रुतसंहिता ९. कुष्ठचिकित्सितम् साध्यासाध्यता as per सुश्रुतसंहिता before चिकित्सा कुष्ठमात्मवतः साध्यं त्वग्रक्तपिशिताश्रितम् | मेदोगतं भवेद्याप्यमसाध्यमत उत्तरम् || २९ || Kushata reached till मांसधातुगत and the person is जितेन्द्रिय - साध्य , मेदोधातुगत - याप्य , rest of the Dhatu s- असाध्य In Sushruta samhitha the chapter begins with Vishesha nidaana which contributes for the kushta vyadhi , as निदान परिवर्जन is the first treatment. (This method is seen in Charaka samhitha too). 30

30. Immediately contra indication i.e., अपथ्य is seen तत्र त्वग्दोषी मांसवसादुग्धदधितैलकुलत्थमाषनिष्पावेक्षुपिष्टविकाराम्लविरुद्धाध्यशनाजीर्णविदाह्यभिष्यन्दीनि दिवास्वप्नं व्यवायं च परिहरेत् || ४ || After this पथ्य has been mentioned ततः शालिषष्टिकयवगोधूमकोरदूषश्यामाकोद्दालकादीननवान् भुञ्जीत मुद्गाढक्योरन्यतरस्य यूषेण सूपेन वा निम्बपत्रारुष्करव्यामिश्रेण , मण्डूकपर्ण्यवल्गुजाटरूषकरूपिकापुष्पैः सर्पिःसिद्धैः सर्षपतैलसिद्धैर्वा , तिक्तवर्गेण वाऽभिहितेन ; मांससात्म्याय वा जाङ्गलमांसममेदस्कं वितरेत् ; तैलं वज्रकमभ्यङ्गार्थे ; आरग्वधादिकषायमुत्सादनार्थे ; पानपरिषेकावगाहादिषु च खदिरकषायम् ; इत्येष आहाराचारविभागः || ५ || 31

31. As seen in Kushta samprapti from Sushruta samhitha , he has classified Kushtha based on the Dhatugataavasthaa , and chikitsa also explained based on same pattern. तत्र पूर्वरूपेषूभयतः संशोधनमासेवेत | Initially both Vamana and Virechana should be administered (that is Oordhva and Adhah Shodhana ) Later in same sloka , Dhatugata-Kushta Chikitsa sutra has been narrated as 32

32. अवस्था चिकित्सा तत्र त्वक्सम्प्राप्ते शोधन आलेपनानि शोणितप्राप्ते संशोधन आलेपन कषायपान शोणितावसेचनानि मांसप्राप्ते शोधन आलेपन कषायपान शोणितावसेचन अरिष्ट - मन्थप्राशाः चतुर्थकर्मगुणप्राप्तं याप्यमात्मवतः संविधानवतश्च तत्र संशोधनाच्छोणितावसेचनाच्चोर्ध्वं भल्लात शिलाजतु धातु माक्षीक गुग्गुल् अगुरु तुवरक खदिरा असना अयस्कृतिविधानम आसेवेत पञ्चमं नैवोपक्रमेत् Rest others असाध्य 33

33. Planning for the Chikitsa should be like, initially Ghrutayogas and tailayogas are mentioned for the shodhanakarma (for snehapaana ) Dosha predominance Ingredients of Sneha वात प्रधान   मेषशृङ्गीश्वदंष्ट्राशार्ङ्गेष्टागुडूचीद्विपञ्चमूलीसिद्धं तैलं घृतं वा वातकुष्ठिनां पानाभ्यङ्गयोर्विदध्यात् पित्त प्रधान   धवाश्वकर्णककुभपलाशपिचुमर्दपर्पटकमधुकरोध्रसमङ्गासिद्धं सर्पिः पित्तकुष्ठिनां श्लेष्मा प्रधान   प्रियालशालारग्वधनिम्बसप्तपर्णचित्रकमरिचवचाकुष्ठसिद्धं श्लेष्मकुष्ठिनां भल्लातकाभयाविडङ्गसिद्धं वा सर्व कुष्ठ   सर्वेषां तुवरकतैलं भल्लातकतैलं वेति || ७ || 34

34. In further slokas महातिक्तक सर्पि , तिक्तक सर्पि 2,3,4, or 5 सिराव्यधन (places) , 7 types of लेपकल्प and various kinds of क्षारकल्प are explained. Here also mentioning of रसौषधि द्रव्य are seen. Point of discussion वायसीफल्गुतिक्तानां शतं दत्त्वा पृथक् पृथक् || २९ || द्वे लोहरजसः प्रस्थे त्रिफलात्र्याढकं तथा | त्रिद्रोणेऽपां पचेद्यावद्भागौ द्वावसनादपि || ३० || शिष्टौ च विपचेद्भूय एतैः श्लक्ष्णप्रपेषितैः | कल्कैरिन्द्रयवव्योषत्वग्दारुचतुरङ्गुलैः || ३१ || 35

35. Cont … पारावतपदीदन्तीबाकुचीकेशराह्वयैः | कण्टकार्या च तत्पक्वं घृतं कुष्ठिषु योजयेत् || ३२ || दोषधात्वाश्रितं पानादभ्यङ्गात्त्वग्गतं तथा | अप्यसाध्यं नृणां कुष्ठं नाम्ना नीलं नियच्छति || ३३ || In the Phalashruti , Neelam ghruta is said to cure even Asadhya-Kushta . If it can cure then how the disease become Asadhya ? If the Kushta is Asadhya then how it can be curable by any medicine? 36

36. Protocol to administer Shodhana karma in case of Kushta , it’s a special contribution from Sushrutaacharya , and the same is followed by Acharya Vagbhata too. पक्षात् पक्षाच्छर्दनान्यभ्युपेयान्मासान्मासात् स्रंसनं चापि देयम् | स्राव्यं रक्तं वत्सरे हि द्विरल्पं नस्यं दद्याच्च त्रिरात्रात्त्रिरात्रात् || ४३ || शोधन Time gap duration वमन   15 days स्रंसन / विरेचन   30 days रक्त मोक्षण 6 months नस्य 3 days 37

37. Complete elimination of Doshas are stressed by Acharya Sushruta , because if any small residual of Doshas are left behind in Kushta patient then it will spread again all over the body, even it may progress to incurable conditions. Hence one should take care of complete elimination of Doshas and also procedure of conduction of Shodhana karma, i.e., Samyak karma should be taken care of दुर्वान्तो वा दुर्विरिक्तोऽपि वा स्यात् कुष्ठी दोषैरुद्धतैर्व्याप्तदेहः | निःसन्दिग्धं यात्यसाध्यत्वमाशु तस्मात् कृत्स्नान्निर्हरेत्तस्य दोषान् || ४२ | 38

38. At the end of all the Yogas importance of Khadiraprayoga has been told दिदृक्षुरन्तं कुष्ठस्य खदिरं कुष्ठपीडितः | सर्वथैव प्रयुञ्जीत स्नानपानाशनादिषु || ७० || यथा हन्ति प्रवृद्धत्वात् कुष्ठमातुरमोजसा | तथा हन्त्युपयुक्तस्तु खदिरः कुष्ठमोजसा || ७१ || The one who wants to see the end of Kushtavyadhi then he must try to admister Khadira from all the possible ways. As Pravruddha Kushta destroys the Ojas of the patient similarly Khadira destroys the power of Kushta vyadhi . 39

39. Point to be noted here in Sushruta Samhita is Kushta chikitsa is explained in two chapters. कुष्ठचिकित्सितम् , महा - कुष्ठचिकित्सितम् this will be dealt in discussion part. In महा कुष्ठचिकित्सितम् along with Kushta Chikitsa other सन्तर्पण जन्य विकार s like, प्रमेह , दारुण सर्वाङ्गशोफ , मेदुर , कफामय and औषधयोग for all these together can be seen. Most of these yogas seems to be Vyadhi specific रसायन औषधयोग . 40

40. चिकित्सा सूत्र from अष्टाङ्ग हृदय ( १९. कुष्ठचिकित्सिताध्यायः ) The chapter of कुष्ठचिकित्सिताध्यायः in अष्टाङ्ग हृदय begins from Snehapaana , and Dosha -specific Snehas are being mentioned Dosha predominance Ingredients of Sneha वात प्रधान   तत्र वातोत्तरे तैलं घृतं वा साधितं हितम् || १ || दशमूलामृतैरण्डशार्ङ्गेष्टामेषशृङ्गिभिः | पित्त प्रधान   पटोलनिम्बकटुकादार्वीपाठादुरालभाः || २ || पर्पटं त्रायमाणां च पलांशं पाचयेदपाम् | द्व्याढकेऽष्टांशशेषेण तेन कर्षोन्मितैस्तथा || ३ || त्रायन्तीमुस्तभूनिम्बकलिङ्गकणचन्दनैः | सर्पिषो द्वादशपलं पचेत्तत्तिक्तकं जयेत् || ४ || पित्तकुष्ठपरीसर्पपिटिकादाहतृड्भ्रमान् | कण्डुपाण्ड्वामयान् गण्डान् दुष्टनाडीव्रणापचीः || ५ || विस्फोटविद्रधीगुल्मशोफोन्मादमदानपि | हृद्रोगतिमिरव्यङ्गग्रहणीश्वित्रकामलाः || ६ || भगन्दरमपस्मारमुदरं प्रदरं गरम् | अर्शोऽस्रपित्तमन्यांश्च सुकृच्छ्रान् पित्तजान् गदान् || ७ || 41

41. Dosha predominance Ingredients of Sneha श्लेष्मा प्रधान   कफोत्तरे घृतं सिद्धं निम्बसप्ताह्रचित्रकैः || ११ || कुष्ठोषणवचाशालप्रियालचतुरङ्गुलैः | सर्व कुष्ठ   सर्वेषु चारुष्करजं तौवरं सार्षपं पिबेत् || १२ || स्नेहं घृतं वा कृमिजित्पथ्याभल्लातकैः शृतम् | This pattern is similar to that of Sushruta samhitha . 42

42. आरग्वधस्य मूलेन शतकृत्वः शृतं घृतम् || १३ || पिबेन् कुष्ठं जयत्याशु भजन् सखदिरं जलम् | …… स्निग्धस्य शोधनं योज्यं विसर्पे यदुदाहृतम् | अतीतावेक्षण तन्त्रयुक्ति is seen here as previous chapter is विसर्पचिकित्सितम् ( treatment said in previous chapter is रसेन युक्तं त्रायन्त्या द्राक्षायास्त्रैफलेन वा | विरेचनं त्रिवृच्चूर्णं पयसा सर्पिषाऽथवा || ३ || योज्यं , कोष्ठगते दोषे विशेषेण विशोधनम् |) 43

43. स्नेहपान in between शोधनकर्म is told as a special treatment स्नेहैराप्याययेच्चैनं कुष्ठघ्नैरन्तराऽन्तरा || १६ || मुक्तरक्तविरिक्तस्य रिक्तकोष्ठस्य कुष्ठिनः | प्रभञ्जनस्तथा ह्यस्य न स्याद्देहप्रभञ्जनः || १७ || Further वज्रक , महावज्रक , दन्तीघृत are told by Acharya Vagbhata . Interestingly mentioning of Pathya and Apathya , is seen in between the formulations is seen. It’s a point for todays discussion. 44

44. Later the rasayana formulations similar to that of महाकुष्ठचिकित्सितम् सुश्रुत संहिता are seen. And also, diseases specific Rasayana are noted रसायनप्रयोगेण तुवरास्थीनि शीलयेत् | भल्लातकं बाकुचिकां वह्निमूलं शिलाह्वयम् || ५३ || Different Lepa yogas have been mentioned according to the conditions (ex, त्वक् गत कुष्ठ ). These should be administered after eliminating the Doshas through Shodhana procedures. 45

45. Apart from Shodhana other treatment procedures are seen in this chapter, such as स्वेदन , उल्लेखन using शस्त्र , क्षारपातन , विषप्रयोग , प्रदेह followed after घर्षण all these procedures and indications are similar to that of चरक संहिता . Most of the formulations mentioned in बृहत्रयी in कुष्ठचिकित्सा अधिकरण are not pointing towards any specific names of Kushta , but here such specificity can be noticed in some yogas for example, मुस्तामृतासङ्गकटङ्कटेरी - कासीसकम्पिल्लककुष्ठरोध्राः | गन्धोपलः सर्जरसो विडङ्गं मनःशिलाले करवीरकत्वक् || ६७ || तैलाक्तगात्रस्य कृतानि चूर्णा - न्येतानि दद्यादवचूर्णनार्थम् | दद्रूः सकण्डूः किटिभानि पामा विचर्चिका चेति तथा न सन्ति || ६८ || Usage of रसौषधि द्रव्य is also noted in बाह्य आभ्यन्तर प्रयोग in this chapter. 46

46. As seen in सुश्रुत संहिता and in चरक संहिता , usually for any disease चिकित्सा सूत्र is mentioned at the beginning and औषधकल्प are mentioned afterwards, but in अष्टाङ्ग हृदय , चिकित्सा सूत्र is mentioned at the end of the chapter वातोत्तरेषु सर्पिर्वमनं श्लेष्मोत्तरेषु कुष्ठेषु | पित्तोत्तरेषु मोक्षो रक्तस्य विरेचनं चाग्रे || ९२ || This is similar to that of Charaka samhitha 47

47. ये लेपाः कुष्ठानां युज्यन्ते निर्हृतास्रदोषाणाम् | संशोधिताशयानां सद्यः सिद्धिर्भवति तेषाम् || ९३ || दोषे हृतेऽपनीते रक्ते बाह्यान्तरे कृते शमने | स्नेहे च कालयुक्ते न कुष्ठमतिवर्तते साध्यम् || ९४ || Special protocol mentioned by Acharya Vagbhata , after administering the Shodhana -karma ( Vamana & Virechana ), Raktamokshana and giving Shamanoushadhi one should opt for Snehana karma (by considering the time factor). By doing so all Sadhya Kushta can be treated. 48

48. बहुदोषः संशोध्यः कुष्ठी बहुशोऽनुरक्षता प्राणान् | दोषे ह्यतिमात्रहृते वायुर्हन्यादबलमाशु || ९५ || This is similar to that of Charaka samhitha . In case if excess removal of Doshas are done then the aggravated Vaatadosha will do Balahaani immediately. 49

49. पक्षात्पक्षाच्छर्दनान्यभ्युपेयान्मासान्मासाच्छोधनान्यप्यधस्तात् | शुद्धिर्मूर्घ्नि स्यात्त्रिरात्रात्त्रिरात्रात् षष्ठे षष्ठे मास्यसृड्मोक्षणं च || ९६ || यो दुर्वान्तो दुर्विरिक्तोऽथवा स्यात् कुष्ठी दोषैरुद्धतैर्व्याप्यतेऽसौ | निःसन्देहं यात्यसाध्यत्वमेवं तस्मात् कृत्स्नान्निर्हरेदस्य दोषान् || ९७ || This is similar to that of Sushruta samhitha . 50

50. Importance given to सद्वृत्त and दैवव्यपाश्रय चिकित्सा is mentioned at the end of the chapter as व्रतदमयमसेवा त्यागशीलाभियोगो द्विजसुरगुरुपूजा सर्वसत्त्वेषु मैत्री | शिवशिवसुतताराभास्कराराधनानि प्रकटितमलपापं कुष्ठमुन्मूलयन्ति || ९८ || Interesting point noted here is the फलश्रुति for most of formulations is सर्वकुष्ठ , and specifications is highlighted wherever necessary. 51

51. Discussion चरक संहिता Understanding the disease through a simile (Cha.Ni.5/14-15) यथा ह्यल्पेन यत्नेन छिद्यते तरुणस्तरुः | स एवातिप्रवृद्धस्तु छिद्यतेऽतिप्रयत्नतः || १४ || एवमेव विकारोऽपि तरुणः साध्यते सुखम् | विवृद्धः साध्यते कृच्छ्रादसाध्यो वाऽपि जायते || १५ || By applying अधिकरण and हेत्वर्थ तन्त्रयुक्ति , one can interpret the mechanism behind व्याधिसंप्राप्ति and चिकित्सा विधान . As the plant gets stronger by deepening its roots, this disease also gets stronger by entering deeper. Early stage requires lesser efforts to cure, whereas if its left untreated then more efforts needed to treat. 52

52. The same simile is used by Acharya Sushruta too, in Nidaansthana as, यथा वनस्पतिर्जातः प्राप्य कालप्रकर्षणम् | अन्तर्भूमिं विगाहेत मूलैर्वृष्टिविवर्धितैः || २० || एवं कुष्ठं समुत्पन्नं त्वचि कालप्रकर्षतः | क्रमेण धातून् व्याप्नोति नरस्याप्रतिकारिणः || २१ || 53

53. Firstly, one can notice that, though Shodhana is the prime line of treatment mentioned by all Bruhatrayee , Basti-karma is not mentioned by any of the three in Chikitsa -sutra, for Vatadosha predominance Kushta . Rather it is said as बृंहण बस्तिकर्म is contraindicated विशोधनीय व्याधि condition, for example कुष्ठ प्रमेह . (Cha.Si.1/36) न बृंहणीयान् विदधीत बस्तीन् विशोधनीयेषु गदेषु वैद्यः | कुष्ठप्रमेहादिषु मेदुरेषु नरेषु ये चापि विशोधनीयाः || ३६ || 54

54. But this doesn’t direct towards the absolute contra indication of Bastikarma in Kushtavyadhi , Acharya Charaka provides a freedom to Vaidya to administer Basti karma, based on his Yukti , (Cha.Si.2/27) only if it follows the criteria of Shuddha Chikitsa अवस्थां प्राप्य निर्दिष्टं कुष्ठिनां बस्तिकर्म च || २७ || Ubhaya bhaga (i.e., Oordhva and Adho ) shodhana is mentioned by all the Bruhatrayee . Apart from this Acharya Charaka also accepted Raktamokshana , which he doesn’t categorised under Shodhana (Panchakarma). The probable justification would be considering Rakta as a Dooshya among Sapta-Dooshya and it could be corrected by Rakta sravana . 55

55. Acharya Charaka has given more importance to Doshas in categorisation and treatment of Kushta सर्वं त्रिदोषजं कुष्ठं दोषाणां तु बलाबलम् | यथास्वैर्लक्षणैर्बुद्ध्वा कुष्ठानां क्रियते क्रिया || ३१ || दोषस्य यस्य पश्येत् कुष्ठेषु विशेषलिङ्गमद्रिक्तम् | तस्यैव शमं कुर्यात्ततः परं चानुबन्धस्य || ३२ || कुष्ठविशेषैर्दोषा दोषविशेषैः पुनश्च कुष्ठानि | (Cha.chi.7/33) 56

56. सुश्रुतसंहिता Different approach towards treatment can be seen in the views of Acharya Charaka and Acharya Sushruta , which is based on the Samprapti framed by individual texts. Acharya Sushruta given importance to Dhatus, both in explaining Lakshana and Chikitsa . He also specified the time duration of administering Shodhana -karma . 57

57. Specialty is, Acharya Sushruta mentioned treatment of Kushta in two chapters, कुष्ठचिकित्सितम् and महाकुष्ठचिकित्सितम् . Achrya Dalhana opines as … तस्माद्धात्वनुप्रविष्टानि सप्त कुष्ठानि महान्तीत्यतो महतां धात्वनुप्रविष्टानां कुष्ठानां चिकित्सितमिति व्याख्या ज्यायसीति ; गयी तु महतां सप्तानां काकणकवर्जितानामित्याह || १-२ || Any Kushta if not treated in the early stage then it enters into उत्तरोत्तर धातु similar to the tree strengthens its roots by getting deeper and accordingly the treatment varies. It can be interpreted as, in this chapter the chronic stage of Kushtachikitsa is explained. 58

58. आचर्य गयादास opines in Nidaanasthaana that तत्र सप्त महाकुष्ठानीत्यादि | महत्त्वमेषामुत्तरोत्तरधात्वनुप्रवेशात् | धात्वन्तरप्रवेशोऽप्येषां बहुबहुलदोषारम्भात् | अत एव क्रिया महती महाकुष्ठे , क्षुद्रे पुनरल्पा | Based on the efforts required to treat also, Kushta is categorised as Maha and Alpa Only Mahakushta and other सन्तर्पण जन्य विकार s like, प्रमेह , दारुण सर्वाङ्गशोफ , मेदुर , कफामय are dealt in this chapter as there is क्रियाविषेश , that is अपतर्पण and रसायन 59

59. By looking into the contents, initially mentioning of पथ्य , later मन्थः , आसव , सुरा , अवलेह , चूर्णक्रिया , अयस्कृति , रसायनयोग , खदिरप्रयोग विधान , एकमूलिका प्रयोग विधान are seen in the chapter of महाकुष्ठचिकित्सितम् . All these are to be followed after Shodhana -procedures and are having व्याधिप्रत्यनीक रसायन effect. Single drug therapy ( एकमूलिकाप्रयोग ) for longer period can also be seen as अमृतवल्लीस्वरसं क्वाथं वा प्रातः प्रातरुपसेवेत , तत्सिद्धं वा सर्पिः , अपराह्णे ससर्पिष्कमोदनमामलकयूषेण भुञ्जीत ; एवं मासमुपयुज्य सर्वकुष्ठैर्विमुच्यत इति || १४ || 60

60. अष्टाङ्ग हृदय While mentioning about Kushta-chikitsitam Acharya Vagbhata initially mentions about the Shamanoushadhi (in the form of प्रलेप , चूर्ण आसव अरिष्ट कषाय and so on ) Chikitsa -sutra is mentioned at the end of the chapter. While narrating the samprapti three diseases are dealt in together ( निदानस्थान १४ . कुष्ठश्वित्रकृमिनिदानाध्यायः ) but while mentioning the Chikitsa its dealt independently ( चिकित्सास्थान १९ . कुष्ठचिकित्सिताध्यायः ), which directs towards though Kushtavyadhi has similar samprapti with other diseases, its unique in its treatment. That is apart from सम्प्राप्ति विघटन to highlight the चिकित्सा - विशेष this might have placed under separate अधिकरण . 61

61. In अष्टाङ्ग हृदय , चिकित्सा सूत्र is mentioned at the end of the chapter. This approach might have followed due to, blending the views of both चरक संहिता and सुश्रुत संहिता . Acharya Vagbhata , accepted both the views, and documented without much changes in Chikitsa -sutra . In this chapter 92-95 th slokas are exactly that of Charaka Samhita, and 96-97 th slokas are from Sushruta Samhitha . यथानिदान - तथा चिकित्सा is seen at the end of the chapter, सद्वृत्त , पुण्यकर्म , दैवव्यपाश्रय चिकित्सा are given due importance as a part of treatment. 62

62. Never forget medicines in KushtaVyadhi After textual and practical analysis some of the important drugs are mentioned here which are popularly known as drugs of choice, they are खदिर , तुवरक , भल्लातक , मञ्जिष्ठा , काकोदुम्बर , निम्ब , हरिद्रा , आरग्वध , बाकुची रसौषधि - गन्धक , कासीस , हरताल , पारदभस्म योग - गन्धक रसायन , खदिरादि वटि , आरोग्यवर्धिनि वटि , महामञ्जिष्ठादि कषाय , तुवरक तैल , मरिचादि तैल , सिद्धार्थक चूर्ण , अवल्गुजादि लेप , हरिद्राखण्ड Many more additions can be done to this list based on the Yukti of Vaidya 63

63. Special points about कुष्ठ व्याधि It falls in all the three categories of दोषज कर्मज दोषकर्मज व्याधि , accordingly the treatment varies. Special importance has been given to पाप कर्म and पूर्वजन्मकृत कर्म (in both manifestation of the disease and in treatment) by all Bruhatrayee . म्रियते यदि कुष्ठेन पुनर्जातेऽपि गच्छति | नातः कष्टतरो रोगो यथा कुष्ठं प्रकीर्तितम् || ३१ || आहाराचारयोः प्रोक्तामास्थाय महतीं क्रियाम् | औषधीनां विशिष्टानां तपसश्च निषेवणात् | यस्तेन मुच्यते जन्तुः स पुण्यां गतिमाप्नुयात् || ३२ || (Su.ni.5) 64

64. This vyadhi follows a person even from one birth to another birth, until the karmakshaya occurs. आहाराचारयोरिति अनेन युक्तिव्यपाश्रयं चिकित्सितमुक्तम् | तपसश्च निषेवणादित्यनेन दैवव्यपाश्रयमुक्तम् | पुण्यां गतिमाप्नुयात् क्षीणपापत्वात् || ३१ - ३२ || In the Nidaana sthana of Sushruta samhitha itself Acharya Chakrapaani gives a hint for further treatment based on the sampraapti . कुष्ठं दीर्घरोगाणां , - in the context of Agrya prakarana . 65

65. Conclusion After analysing the Chikitsa -sutra from Bruhatrayee , Similarities Dissimilarities All three texts mentioned Shodhana as the prime line of treatment, except Basti karma.   सन्तर्पणजन्य व्याधि , दोष कर्म , कृमि- श्वित्र in same Adikarana all these concepts are accepted in together Acharya Charaka’s Chikitsa sutra is more oriented towards Doshas , Whereas Acharya Sushruta focuses on Dhatugata avastha of Kushta in treatment. 66

66. Similarities Dissimilarities Through Shodhana procedures अल्पाल्प दोष निर्हरण by multiple administration of procedures are accepted. Procedures for Karmakshaya are highlighted by all. Such as स्वेदन , उल्लेखन using शस्त्र , क्षारपातन , विषप्रयोग , प्रदेह followed after घर्षण are accepted. Acharya Vaghbhata mentioned samprapti in combined adhikarana कुष्ठश्वित्रकृमिनिदानाध्यायः and chikitsa in separate adhikarana कुष्ठचिकित्सिताध्यायः Acharya Vaghbhata accepted both the views from चरक संहिता and सुश्रुत संहिता Style of narration differs as it can be seen in the placement of Chikitsa -sutra, Pathyaapathya , Shodhana-shamana formulations and explanation of Sadvrutta . 67

67. Samprapti Vighatana of Kushta-Vyadhi is a main protocol of Chikitsa , among which Daiva Vyapashraya Chikitsa is evidently seen in combating Papakarma . Though its not mentioned in main Chikitsa -sutra , all three accepted this point in Samprapti . Thus, based on the Chikitsa -sutras discussed here one can plan for the treatment of Kushtavyadhi by keeping the criteria of Shuddha Chikitsa in centre. 68

68. Points of discussion दोषधात्वाश्रितं पानादभ्यङ्गात्त्वग्गतं तथा | अप्यसाध्यं नृणां कुष्ठं नाम्ना नीलं नियच्छति || ३३ || In the Phalashruti , Neelam ghruta is said to cure even Asadhya-Kushta . If it can cure then how the disease become Asadhya ? If the Kushta is Asadhya then how it can be curable by any medicine? Interestingly mentioning of Pathya and Apathya , is seen in between the formulations is seen. Neither at the beginning nor at the end. 69

69. Discussion and suggestions 70

70. Thank you 71