APPLICATION OF DIFFERENT

CLASSIFICATION OF NIDANA AND

SAMPRAPTI VIGHATANA OF KUSHTA

BY,
Dr Shilpashree K H
2nd yr MD
INTRODUCTION

• The word kusta derived from the root ‘kush nishkarsha’ by adding ‘kthan’ pratyaya,
which implies to destroy, to scrap out or to deform by adding suffix ‘kta’ which stands
for firmness or certainity.
• Kushta roga is considered as one of ashta mahagada.
• It is tridoshaja and santarpanajanya vyadhi and one among the sahaja or adibala pravrutta
vyadhi.
• It is considered as aupasargika roga which gets transmitted from one person to other.
• Different lesions are broadly classified and studied in two groups viz mahakushta and
kshudrakushta.
• Skin problems effects psychological harmony and social functioning of affected
individual.

Nirukti
 कुष्णाति सर्वं वपु: इति कुष्टम ्। - chakrapani
That which does विक्रुति in शरीर is called as Kushta

 Vishesha kushnati shareerasta shonitam vikrute

- (Halayudha kosha)
Vitiated rakta leads to destruction of shareera so it is called kushta.

 Twacha kurvanti vaivarnyam dustataha kustammushanti tat

A. H. Ni.14/3
One which produces discolouration over skin is said to be kushta.

Nidana:

Aharaja nidana:

 Virudhaahara - Chilichima matsya with ksheera,

mulaka with guda,
Ksheera with nimbuka
gramya anupa audaka mamsa with ksheera
Pippali, kakamachi,lakucha with dadhi and grita

 Mityaahara – adyashana
vishamashana
Atyashana
 Asatmya ahara
Atisevana of madhu,phanita,mulaka in ajirna avastha
Navanna,dadhi, masha, matsya, tila,
pistanna (bekery items like pizza, burger etc) ksheera, guda, Dushivisha

Viharaja nidana :
shitoshna vyatyasa sevana
Chardhi vegadharana
Divaswapna

Acharaja nidana:
Papa karma/ purva janmakrita karma
Sadhu ninda
Vipra guru tiraskara

Manasika nidana :Chinta, bhaya, krodha

Chikitsa sambandhi:
 Aushadhi krita –usage of improperly purified rasaoushadhis like Parada, gandhaka,
abhraka, haratala,vanga, vaikranta, etc

Panchakarma apacharaja :
Atisweda
Sneha vibhrama
Ayoga of vamana causes shopha, kota, kandu
Ayoga of virechana causes kandu, pitika
Pratidina anuvasana basti pranidana
Asamyak samsarjana krama

Kulaja nidana : Adibala pravrutta vyadhi

Aupasargika nidana:

Due to Prasanga,
Gatrasamsparshana,
Nishwasat,
saha bhojanat
saha shayyasana
vastra malanulepana

Raktaja Krimi

4 Types of Nidana :

 Sannikrista nidana - shitoshna vyatyasat sevana , viruddahara, asatmya ahara

  Viprakrista nidana – ajirna anna , adhyashana ,vidahi annapana during ajirna ,
divaswapna

 Vyabhichari - Bhaya ,chinta, krodha

 Pradhanika – ayoga of vamana,virechana, asamyak samsarjana karma

2 Types of Nidana :
 Vyadhi hetu - lavana , amla, madhura rasa, navanna, dadhi, matsya, guda, pistanna,
phanita, tila, kshara, lakucha, viruddahara, asatmya ahara

 Dosha hetu - ayoga of vamana,virechana, asamyak samsarjana karma

2 Types of Nidana :
 Utpadaka hetu – Viruddha ahara
Divaswapna
Panchakarma apacharaja nidana
Krimi
Chikitsa sambandhi nidanas

• Vyanjaka hetu - Manasika nidanas

Bija dosha

Effects of individual nidana on samprapti ghataka

• Ushna, Tikshna guna of Amla rasa causes rakta prakopa that leads to mamsa shaithilya .
• Ushna tikshna guna of lavana rasa provokes pitta and causes rakta dushti.
• Guru snigdha , abhishandi guna of madhura rasa causes kapha prakopa leads to
agnimandya and causes tridosha prakopa.
• Matsya with ksheera is samyoga and virya viruddha both have madhura rasa, madhura
vipaka, maha abhishyandi. However ksheera is shita virya while matsya is ushna virya
when taken together it causes rakta dusti and may produce kleda and amavisha.
• Divaswpna – it is snigdha and vitiates kapha and pitta causes kandu , kotha, pidaka.
• Maha abhishyandi guna of dadhi causes kaphakara , kustakara.
Samprapti:

cha chi 7
Nidana

Aharaja/Viharaja/Acharaja Beejadoshaja

Agimandhya Amotpatti

Tridosha prakopa

Dhatu shaitilya

Further vitiation of doshas

Sthana samshraya in twak,rakta, mamsa, ambu

Dosha dushya sammurchana

Srotodusti (rasavaha,raktavaha,mamsavaha, swedavaha)

lakshana pradurbhava

kushta roga

Samprapti ghataka
 Dosha - Tridosha
 Dushya - Twak, Rakta, Mamsa, Lasika
 Srotodushti - Sanga and Vimargagamana
 Agni – Jatharagni and Dhatvagni mandya
 Udbhavastana – Amashaya, Pakwashaya
 Sanchara stana– Tiryag sira
 Adhistana – Twacha
 Vyadhi marga – Bahya
  Svabhava – Chirakari
 Sadhyaasadyata – maha kusta- asadhya
ksudra kusta-Krichrasadhya

PURVAROOPA
स्पर्शज्नान अभाव
अतिस्वेद
अस्वेद
वैवर्ण्य
कोट
लोमहर्ष
कण्डु
तोद
श्रम
क्लम
व्रण

Classification of Kushta

Maha kusta

Kapalika Vata Borderline leprosy

Udumbara Pitta Borderline leprosy
Mandala Kapha Type one reaction leprosy
Rishyajihwa Vata pitta Tuberculoid borderline
leprosy
Pundarika Pitta kapha Tuberculoid leprosy
Sidma Kapha vata Tuberculoid leprosy
Kakanaka Tridoshaja Lepromatous leprosy
Kshudra kusta:

Eka kushta Vata kapha Chronic plaque psoriasis

Kitibha Vata kapha eczema
Alasaka Vata kapha
Charmakhya vata kapha
Vicharchika kapha
Vaipadika Vata kapha Palmao plantar keratoderma
Dadru Vata pitta Fungal
Pama Vata pitta Scabies
Charmadala Vata pitta Phemphigus
Visphota Vata pitta Bullous formation
Shataru Vata pitta Abscess

Dhatugata kushta lakshanas:

Tvakgata kushta
• Angavaivarnya
• Roukshya
• Twak swapa
• Sweda atipravartana
• Romaharsha

Raktagata kushta
• Kandu
• Pooya
• durgandha

Mamsagata kushta
• Sthula mandala
• Mukha shosha
• Karkasha
• Pidakodgama
• Toda
• Sphota
• Sthiratva

Medhagata kushta
• Kounyam gatikshaya
(confined body motions)
• Anga sambheda
(Disintegration of body parts)
• Kshata sarpana
(progressive ulcers)
• Delayed healing

Asti majjagata kushta

• Naasa bhanga
• Akshiraga
• Swaropaghata

Sukragata kushta
Shukra and shonita dushti- Give birth to a deformed baby

DOSHAGATA KUSHTA LAKSHANA:

Vatika kushta
रौक्ष्य शॊष स्तोदः शल
ू संकोचनं तथा।
पारुष्यं खरभावो हर्ष: शयावरुणत्वं च।
cha chi34/7
Pittaja kushta
• कुष्टषु वात लिंगम ्; दाहो राग; परिस्रव:

विस्रो गंध ;क्लेद;तथा अंगपातनं चापित्तक्रत ्।

Kaphaja kushta

श्वैत्यं शैत्यं कंण्डु : स्थैर्य्ंचोत्सेध गौरवं स्नेहा:

कुष्टे षु कफलिंगं जंतभि

ु रभख्शणं क्लेद:।

Saadhyasadhyata:
Ekadoshaja - sukha sadya
Vata Kaphaja -
Twak, Rakta and Mamsagata

Kaphapittaja - kasta sadhya

VataPittaja

Medo ashrita - Yapya

Durbala - Asadhya

Mandagni
Tridoshaja
sarvalingaja
Asthi majjashrit
Management :

All Kushtas are tridoshaja, the treatment should be planned cha chi 7
depending on the predominance of doshas as understood by their
features.

When the patient suffering from kushta has bahu dosa avasta, should be given samshodhana
keeping in view the bala of the patient.

Samprapti vighatana :
Nidana Nidana parivarjana

Aharaja/Viharaja/Acharaja Beejadoshaja

Agimandhya Amotpatti Amapachana

Tridosha prakopa

Dhatu shaitilya

Further vitiation of doshas

Sthana samshraya in twak,rakta, mamsa, ambu

Dosha dushya sammurchana srotodusti chikitsa

Srotodusti (rasavaha,raktavaha,mamsavaha, swedavaha)

lakshana pradurbhava

kushta roga samshodhana chikitsa

Shodhana :

cha chi 7/39

According to the predominance of dosha
Vata pradhana - sarpi pana
Pittaja pradhana - Raktamokshana , virechana
Kapha pradhana - vamana

पक्षात ् पक्षाच्छर्दनान्यभ्युपेयान्मासान्मासात ् स्त्रंसनं चापि दे यं |

स्त्राव्यं रक्तं वत्सरे हि द्विरल्पं नस्यं दाद्याच्च त्रिरात्रात्त्रिरात्रात ् ॥
su chi 9/43
For Deergakaaleena Vyadhi & in Bahu dosha avasta
Vamana - once in fortnight.
Virechana - once in month.
Nasya -on every third day( if the pathology is above the neck.)
Raktamokshana – 6 months

Shodhana dravyas

Vamana
 Kutajaphala, Madanaphala, Madhuka, Patola, Nimba
(C Ch 7/43)
Virechana
 Trivrut, Danti, Triphala ( C Ch 7/44)
 Danthi ghruta
 Manibadra guda (AH ch 19/31)
Niruha basti
 Daruharidra, bruhati, patola, madanaphala (C Chi 7/46)
Nasya
 Saindava, Dantimoola, Maricha, Tulasi beeja, Pippali, Karanja phala, Vidanga
 Shadbindu taila

Selection of ghritas for shodananga snehana in Kushta

o In Vata Dosha Pradanyata( Where rukshta is predominent)

 Guggulu tiktaka ghrita
 Brahmi kalyanaka ghrita

o In Pitta pradanayata( where Daha,raga,srava are predominent)
 Mahatiktaka ghrita
  Panchatiktaka ghrita
 Tiktaka ghrita
 Durva ghrita

o In Kapha pradhanyata( where kandu ,snigdatwa are more)
 Aragwada ghrita
 Aragwada mahatiktaka ghrita

o In Kapha pitta predominance( daha , kandu, srava)
 Vajraka ghrita
 Maha khadira ghrita
 Patoladhya ghrita

In tridosha predominance
 Maha khadira ghrita

Shamana
Antahaparimarjana :
• Ghritas
• Churna
• Kwathas
• Vati
• Avalehas
Ghrita
 Guggulu tiktaka ghrita
 Brahmi kalyanaka ghrita
 Mahatiktaka ghrita
 Panchatiktaka ghrita
 Tiktaka ghrita
 Aragvada ghrita

Churna
Nimbadi choorna – with guduchi kwatha
(B R 56/31)
Nimba haridradi choorna - ( S Y, churna)
Pancha nimba choorna with asana twak kashaya
Vidangadi choorna – with madhu (Y R kusta /70)
Khadira churna

Kwathas
• Manjistadi kwatha
• Patola Katurohinyadya kashaya
• Aragwadadi Kashaya
• Nimbadi kashaya (CD )
• Panchathikta kashaya (BR)
• Mahathiktha kashaya (B R)
• Guggulu thikta kashaya
 • Guduchyadi kwatha

Gulika
Panchatiktaka ghrita guggulu
Amruta guggulu
Pancha nimbadi gulika
Kaishora guggulu

Asava aristas:
Guggulu tiktakarishta
Kadirarista (BR 56/365)
Lodrasava (AH)
Ushirasava (SY)
Madhukasava (SY)
Babbularista
Nimbadyarishta

Rasa yogas
Arogyavardhini rasa
Thalakeshwara rasa (BR, kusta)
Rasaparpati (BR)
Rasamanikya –(B R 54/117)
Shudda gandhaka
Tamra bhasma
Tarilokya chintamani rasa

Bahirparimarjana :
 Lepa
 Udvarthana
 Snana
 Abhyanga- Taila
Lepa
Dashanga Lepa- with Ghruta
Karanjadi lepa -with Gomootra
Eladi lepa
Rasnadi lepa – with bringaraja swarasa
Marichadi lepa
Sindooradi lepa – with narikela taila

Malahara
Sarjarasa
Gandhaka malahara
Chanda maruta sindura
Gandhaka karpura
Taila
Karanja taila(B R )
Kustantaka taila (S Y)
Vajraka taila
Maha vajraka taila
Eladi taila
Nimbadi taila
Durvadi taila

LAKSHANIKA CHIKITSA

Kandu
Drugs useful are ( Kapha Vata shamaka)
 Brihat haridra khanda
 Laghusuta shekara rasa
 Yashtimadhu churna 6 gms bd
 chakramarda taila externally
Tailas useful are
 Eladi churna( Both externally and internally)
 Arka Taila,
 Sindooradya taila
 Karanja taila ,
 Marichadya taila
 chakramarda taila

Daha
 Chandanadi taila
 Shatadhouta ghrita
 Yashtimadhu taila
 Panchatikta Ghrita Both internally and externlly
 Mahatiktaka Ghrita
Srava
 Pariseka with pancha nimbadi kashaya ,triphala kashaya
 Dashanga lepa for E/A
 Vipadikara lepa
Internally
 Panchatikta ghrita guggulu

Vrana
• Triphala kashaya wash followed by application of
• Vrana ropana taila (S Y, taila )
• Jathyadi taila (S S, madhyama 97/168)
• Hareetakyadi taila
• Shaileyadi lepa
Internally
 Panchatikta ghrta guggulu (B R)
 Aragwadadi kashaya
DHATUGATA KHUSTA CHIKITSA
Rasa /tvak Samshodhana, lepana

Rakta dhatu Samshodhana, lepana, kashayapana,

raktamokshana

Mamsa dhatu Arista,mantha along with rakta dhatu

chikitsa

Meda dhatu Samshodhana , raktavasechana

SHWITRA

A H NI 14/37
The term shwitra is named because of its particular colour that is shwetha varnata.
Shwitra is derived from “shwetha varno shwitra” means white in colour .

Vitiligo is an aquired condition in which circumscribed ,depigmented white patches develop on

the skin, including face, limbs,groin,around eyes, nostrils, mouth and mucus membranes.

Management

Malapurasa for samsrana

Ekamoolika prayoga:
Khadira
Bakuchi
Tuvaraka
Bhallataka
Mulaka
Daruharidra
Karanja

Taila :
Bakuchi taila
Simaraji taila
Triphaladi taila
Tuvarakadi taila
Shwetakaraviradi taila

Lepa:
Avalgujadi lepa
Shwitranashaka lepa
Putikadi lepa (B.R.)

Churna:
Panchanimba churna
Hapushadi churna

Kashaya:
Manjistadi mahakashaya
Tiktaka grita
Mahanili grita
Dhatri khadira kwatha( B.R.)

Vati
Shwitragna vati
Shashilekha vati
Svayambuva guggulu (Bha. Pra)
Udayadithya rasa
Shwethari rasa( B.R)
Eka vimshatiko guggulu (chakradatta)

Pathya
Purana shali
shashtika shali
Godhuma
Yava
Mudga
Masoora
Mudga
Masoora
Jangala mamsa
Lashuna
Gomootra
Madu
Tikta Rasa
Khadira jala for snanapanaashanapralepa udvartana,
Pradeha,
Abhyanga,
Utsadana,
Parisheka,
Avagaha,
Neecha romanakha,
Vishranti,
Aushadha tatparata

Apathya
Navanna
Masha,
Tila,
Nishpava
Matsya,
anoopa mamsa
Amla phala
Dugdha,
Dadhi
Amla Lavana rasa
Guru drava vistambhi ahara, Vidahi annapana
Papakarma, Divaswapna, Vyayama, Vegavarodha, Sooryarashmi, Maithuna

DISCUSSION
 What is the relevance of nasya karma in kusta roga?
Nasya karma is done when vyadhi ( any type of kushta) is predominant in jatru
urdvagata pradesha. Ex- pigmental disorders like nyachha, vyanga

 What is the rationality behind implementing vamana- once in 15 days, virechana- once in
a month, nasya- every third day, raktmokshana- once in 6 months?

Conclusion
 All the Shodhana procedure play an important role in the management of Kushta, as they
are Bahudosha, dhatu gata, kledapradhana, santarpanottha vikara.

 Shodhana is mainly for the Dosha Pratyanika Chikitsa in Kushtha. Understanding the
dosha dushya involvement palys an important role in planning the treatment for kusta.