AN UPDATE TO KUSHTA W.S.R.

TO SKIN DISEASE: A LITERARY

REVIEW

*Dr. Sangeetha, **Dr. Pundareekaksha rao

* Final year BAMS, Ayurveda College, Coimbatore, Tamilnadu, India – 641402

**Assistant Professor, Ayurveda College, Coimbatore, Tamilnadu, India – 641402

ABSTRACT:

The emergence of cosmetic and anti-ageing treatments has changed the face of the skin care
industry. According to Ayurveda, a disease that tears or pulls out and destroy the beauty of the
body is called Kushta. Ayurveda has discussed certain skin diseases under the name of Kushta.
Kushta can be correlated with psoriasis or other skin diseases and it represents a type of
Adhyatmika pain of the shareera. It is a broad term used for certain skin diseases which is having
some peculiar features like discolouration, scaly lesions, itching, burning sensation, etc. The
prevalence of skin disease in India is 10-12% of the total population with Eczema and Psoriasis
being the major contributors. The population affected across India from skin disease is estimated
at nearly 15.1 crore in 2013 which increases to about 18.8 crore people by 2015 at a CAGR
(Compound Annual Growth Rate). The severity of growing skin diseases in India is further
emphasized by the fact that the WHO has included it under the most common non-
communicable diseases in India. Gone are the days when skin care was limited to the treatment
of common skin diseases. The classical treatment protocol can be followed in kushta patients
who include nidanaparivarjana, sodhana, rasayana, pathya, etc. The shodana aims at removing
accumulated toxins from the shareera followed by rasayana which helps to reduce symptoms
and provide better quality of life in kushta patients.

Key Words: Kusta, Psoriasis, Adhyatmika, Sodhana, Rasayana

INTRODUCTION:

Skin is an outermost cover of the body which plays a chief role in maintaining barrier between
internal and external environment. In addition, the healthy skin is the primary requirement for the
beauty as well as having an attractive personality, which are the basic instincts of the human
being. Any weakness in the skin becomes a great handicap for a person in the society, because it
has a visible pathology. Ayurveda has discussed the skin diseases under the name of kushta and
in other words it can be listed as Ayurveda Dermatology. It is not a correlation with skin diseases
mentioned in allopathic medicine but can cover up all dermatological manifestations under
eighteen subtypes of kushta1. According to Ayurveda, a disease that tears or pulls out and destroy
the beauty of the body is called kushta. It is a condition in which skin produce discolouration and
if not treated properly then ultimately results in disfigurement known as kushta. Thus it is
necessary to conduct a critical study on skin diseases because most of the time patient present
with common clinical features with very little differentiation in the characteristics. This article
shows review of the skin diseases with detail description and its management according to three
main texts called Bruhatrayees i.e Caraka Samhita, Susruta Samhita, Ashtangahridaya. To
complete the knowledge gap, Madhava Nidana and Basavarajeeyam were also considered;
which may help for proper diagnosis.

DISCUSION:

Kustha is a skin disease equally effect on mind that require timely therapy to improve long-term
outcomes. The different sign and symptoms are due to percentage of involvement of tridosa
along with rakta can be observed in kustha. The main causes which attribute to this disease are
viruddha-aahara, vega dharana, pollution, ultraviolet light, global warming, improper diet and
regimen, etc. According to texts, all Aacharyas have described eighteen types of kushta and
among them seven considered as Maha kushta and eleven as Kshudra kushta but the
nomenclature being different.

Table 1 - TYPES OF KUSTHA ASPER DIFFERENT ACHARYAS

CARAKA SUSRUTA ASHTANGA MADHAVA BASAVA

SAMHITA2 SAMHITA3 HRIDAYA4 NIDANAM5 RAJEEYAM6
MAHA KUSHTA
Kapala Kapala Kapala Kapala Kapala
Audumbara Udumbara Udumbara Udumbara Udumbara
Mandala Aruna Mandala Mandala Mandala
Rsyajihva Rsyajihva Rsyajihva Rsyajihva Rishyajihwaka
Pundarika Pundarika Pundarika Pundarika Pundareeka
Sidhma Dadru Sidhma Sidhma Sidhma
Kakana Kakanaka Kakana Kakana Kakanaka
KSHUDRA KUSHTA
Eka kushta Eka kushta Eka kushta Eka kushta Gajacharma
kushta
Charmakhya Maha kushta Carma kushta Carmakhya Maha kushta
kushta
Kitiba Kitibha kushta Kitibha Kitibha kushta Kittibha kushta
Vipadika Sidhma kushta Vipadika Vaipadika Vaipadika kushta
kushta
Alasaka Visarpa kushta Alasa Alasaka kushta Kacchaka kushta
Dadru kushta Parisarpa Dadru Dadru- Galita kushta
kushta mandala
kushta
 Charmadala Carmadala Carmadala Carmadala Charmadadhru
kushta kushta kushta kushta kushta
Pama kushta Pama kushta Pama kushta Pama/Kacchu Pama kushta
Visphota Sthularuska Visphota Visphota Visphota kushta
kushta kushta
Shataru kushta Rakasa kushta Sataru kushta Sataru kushta Shatarushya
kushta
Vicharchika Vicarcika Vicarchi Vicarchika Vicharchika

CLINICAL FEATURES OF MAHA KUSHTA 6:

 KAPALA: Vata predominant, severe pain, black or red coloured, flat, dry, rough, thin
surfaced skin lesions.
 UDUMBARA: Pitta predominant, severe pain, burning sensation, oozing, itching,
reddish brown discolouration of the hair/skin, lesions appearing like udumbara fruit.
 MADALA: White or red coloured, stable, thick and unctuous skin lesions often found
overlapped between one another.
 RISHYAJIHWAKA: Roughened skin surface, reddish eruptions/lining around the lesion,
bluish black discolouration in the middle, severe pain, lesions similar to the tongue of the
frog.
 PUNDARIKA: Circular skin lesions like the leaves of lotus, white or red coloured,
thicker, heavy, with moisture, itching, reddish discolouration.
 SIDHMA: Vata-kapha predominant, white and red coloured patches which are thin and
on rubbing gives dust/powder looks like the flower of alabu pushpa.
 KAKANA: Aggravation of all three doshas, crow’s beak coloured eruptions, will undergo
ulceration with much pain, not curable completely.

CLINICAL FEATURES OF KSHUDRA KUSHTA2:

 EKA KUSHTA: Absence of perspiration and extensive localisation. It resembles the

scales of fish.
 CARMA KUSHTA: The skin over the patch becomes thick like the skin of the elephant.
 KITIMA KUSHTA: Blackish brown in colour, rough in touch like a scar tissue and hard
to touch.
 VIPADIKA: Associated with cracks in palms and soles of feet as well as excruciating
pain.
 ALASAKA: Characterized by nodular growth associated with excessive itching sensation
and redness.
 DADRU: Characterized by itching sensation, redness, pimples and circular patches with
elevated edges.
  CARMADALA: Characterized by redness, itching, pustules, pain, cracks in the skin and
tenderness.
 PAMA: Characterized by excessive itching, eruptions which are either white, reddish or
blackish brown in colour.
 SPHOTA: Characterized by pustules which are either white or reddish in appearance.
Pustules have a thin skin.
 SATARU: Characterized by several ulcerated patches which are red or blackish brown in
colour and which are associated with burning sensation as well as pain.
 VICARCIKA: Characterized by blackish brown eruptions associated with itching
sensation and excessive exudation.

Aacharya Basavaraja has not mentioned Charmadala, Ekakhya kushta, Alasaka, Sataru and he
added some more new types to the existing varieties which is tabulated below:

Table 2- EXTRA VARIETIES OF KUSHTA FROM BASAVARAJEEYA 7

VARIETIES CLINICAL FEATURES

Gajacharma kushta Skin lesions without perspiration, severe itching,
eruptions like scaling of the fish, thickened skin like
the skin of elephant, dark black discoloration.
Kacchaka kushta Caused due to kapha dosha, reddish and often bluish
black skin lesions, unctuous, dense, severe itching,
found in thigh, arm, waist, etc.
Galita kushta Caused due to vitiation of all three doshas, blackish
discoloration of the tongue, increased temperature in
the foot, wrinkles of the breadth of 3angulas, bleeding
from the nostrils, and hoarseness of the voice. Patient
dies within 3months of suffering.
Shatarushya kushta Caused due to pitta and kapha doshas, skin patches
with red or bluish black in colour, dense/thick,
oozing/moisturized, unctuous, itching, pain, burning
sensation, observed in multiple regions, if not treated
in time causes multiple ulcers.

MANAGEMENT:

The patients suffering from kushta dominated by vayu should first be administered ghee
internally. The patients suffering from kushta dominated by kapha should first be administered
emetic therapy. The patients suffering from kushta dominated by pitta should first be
administered blood-letting and purgation therapies. Blood-letting should be performed in the less
acute stage of kushta by pracchana and in more acute stage of kushta by venesection. The
patient of kushta with more of vitiated doshas should be given eliminative therapies for several
times. After the elimination of doshas from body by emesis and purgation therapies and from the
blood by blood-letting therapy, the patient should be given sneha (oil, ghee, etc) to drink8.

Acharyas of Bruhatrayee mentioned the common treatment of kushta as raktamokshana(blood-

letting), lepana (external application), vamana (emesis), virechana (purgation), asthapana
(decoction enema), nasya (purificatory errhines). Once in fifteen days emesis, once in a month
purgation, once in six months blood-letting and nasya (errhines) once in seven days are
recommended. Once in three days, medicinal anointing is followed during these times. Such a
kind of treatment schedule will relieve from all kinds of skin diseases. If the patients, who are
suffering from skin diseases, are having enough body strength, after proper oleation and
sudation, blood-letting is carried. In this condition, a small incision is made and shringa, alabu
or jalouka are placed over it repeatedly and blood-letting is carried. Emesis and purgation are
carried very often in all kinds of chronic skin diseases9.

Table 3 - SOME COMMON YOGAS FROM BASAVARAKEEYAM10

S.No. KUSTA SPECIFIC RASAYOGA

1. Pundareeka kushta Sarvanga sundara rasa
2. Udumbara kushta Kanaka sankocha rasa
3. Kakana kushta Sooryakanta rasa
4. Kakana kushta Karanja tailadi lepana
5. Gajacharma kushta Lankeshwara rasa
6. Vicharchika Kushtantaka rasa
7. Rishyajihwaka kushta Shailendra rasa
8. Shatarushya kushta Lankadhipeshwara rasa
9. Kacchaka kushta Kutara rasa
10. Mandala kushta Sarveshwara rasa
11. Vaipadika kushta Mahakala rasa
12. Visphotaka kushta Badavanala rasa
13. Pama kushta Bakuchi taila
14. Kapala kushta Someshwara rasa
15. Mandala kushta Vidyadhara rasa
16. Kittibha kushta Vajrapani rasa
17. Dadru kushta Paribhadra rasa
18. Sidhma kushta Betala rasa and Paradadi lepa
19. Vicharchika kushta Kushtanikrintana rasa
20. Sarva kushta rogas Gandhaka kalpas

Table 4 - PROBABLE MODERN CORRELATION 11,12

KUSTHA VARIETIES MODERN CORRELATION

Mahakusta Kapala Scleroderma
Audumbara Boil/Furuncle
 Mandala Psoriasis
Rsyajihva Lichen Plannus
Pundarika Urticaria
Sidhma Pityriasis Versicolor
Kakana Squamous cell carcinoma
Kshudra Eka kushta Icthyosis Vulgaris
kustha Charmakhya Lichen simplex chronicus
Kitiba Psoriasis
Vipadika Cracked feet
Alasaka Prurigo nodularis
Dadru Tinea infection
Charmadala Impetigo
Pama Scabies
Visphota Superficial folliculitis
Shataru Pyoderma gangrenosum
Vicharchika Eczema

Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint
involvement that is underdiagnosed and undertreated despite its prevalence and considerable
effect on quality of life13. It has a bimodal age of onset (16 to 22 and 57 to 60 years)14 and
affects both sexes equally15. Psoriasis is clinically classified in 2 groups: pustular and non-
pustular lesions. Non-pustular psoriasis includes Psoriasis vulgaris (early and late onset), Guttate
psoriasis, Palmoplantar psoriasis, Psoriatic arthritis (PsA), Inverse psoriasis and Pustular
psoriasis includes Generalized pustular psoriasis (von Zumbusch type), Impetigo herpetiformis,
Localized pustular psoriasis, Erythrodermic psoriasis16. The most common of which is chronic
plaque psoriasis (affecting 80% to 90% of patients). Although there is no cure for psoriasis, but
topical therapy is the standard of care for treatment of mild to moderate disease. Which includes
Corticosteroid, Calcipotriol, Calcipotriol-steroid combination13.

PATHYA-APATHYA IN SKIN DISEASES17:

Patya ahara advised to the kustha patients are Purana shali, Yava, Godhuma, Mudga, Masura,
Tuvari, Tikta shaka, Jangala mamsa, Triphala, Patola, Khadira, Nimba, Brihatiphala, Kasturi,
Gandhasara, Kumkuma, Hingu and Apatya are Sour food, Salty food, Pungent food, Curd, Milk,
Jaggery, Soup added with sesame and black gram.

CONCLUSION:

Kustha is a skin disease equally effect on mind that require timely therapy to improve long-term
outcomes. The different sign and symptoms are due to percentage of involvement of tridosa
along with rakta can be observed in kustha. Rakthamokshana and sodana are planed as per dosa
predominance, strength of the patients. Rasaousadhi’s also playing important role in the
management of kustha.
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