Traditional Indian Medicine in
Dermatology
HIRAK BEHARI ROUTH, MBBS
KAZAL REKHA BHOWMIK, MBBS
C
omplementary or traditional medical systems
play a very important role in the Indian subcon-
tinent, where the population exceeds 1250 mil-
lion, or one-fourth of world’s population. Many people
live in rural or remote areas not accessible to modern
medical facilities. They are subject to poverty and sub-
standard living conditions. For medical treatment they
mostly depend on remedies other than conventional or
standard therapies. These may range from folklore
medicine to Ayurvedic medicine, a traditional and es-
tablished Indian system of medicine known for thou-
sands of year. In the urban places where conventional
medical therapies are available, a large population takes
advantage of various types of alternative medications
such as Ayurvedic or Unani systems of treatment for
their ailments.
Systems Currently Practiced
Various systems of complementary medical therapies
are currently in use.1– 6
1. Folklore medicine employs different materials ranging
from ritualistic purified water by religious spells, by
priests, indigenous herbs, massage, and a combina-
tion of various elements.
2. Faith healers involve supernatural remedies such as
sacrifices, magic, mysticism, exorcism, and rites,
with or without use of herbs or mineral products.
3. Ayurvedic medicine uses traditional medicine on the
Indian subcontinent, based on classifying people into
specific constitutional types and recommending spe-
cific and appropriate dietary and herbal remedies for
diseases.
4. Unani system represents a blend of Indian traditional
medicine, especially Ayurvedic medicine with
Greek, Arabic, and Persian influence, following the
Muslim appearance in India.
5. Siddha system is based on systemic observation, on
the study of nature and its elements. It originated by
sage Agastayan and is mainly practiced in southern
India, especially in Tamilnadu.
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nia
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6. Tibetan system of traditional medicine uses medicine
and herbs along with massage, acupuncture, and
surgery and is based on elements from Indian and
Chinese traditions.
Origin and Development of Ayurveda
Ayurveda, a Sanskrit word, is comprised of two sepa-
rate words of Ayu (life) and Veda (knowledge).
Ayurveda means “knowledge of life” or “science of
life.” Ayurvedic medicine has its roots in the Vedas, the
oldest Hindu religious scripture, followed by other sa-
cred commentaries, the Brahmanas, the Aranyakas, and
the Upanishads. It was developed by sages to the pure
cosmic consciousness.7–9 Ayurveda, a holistic science of
natural healing of prevention oriented in nature, devel-
oped about 3000 b.c.e. Ayurvedic medicine is a combi-
nation of both physiologic and holistic medicine, defin-
ing life as the union of body, mind, and soul, reaching
beyond physical well-being to spiritual enlightment
and fullness. Humans are considered in terms of com-
plex categories and subcategories in which physical,
mental, environmental, and spiritual factors coexist
with harmony. In Ayurvedic concepts, the human body
is made up of five energy elements that are the same in
the case of the universe namely earth, water, fire, air,
and space.10,11
The development of Ayurvedic medicine may be
divided into four periods.1,11–14
3000 b.c.e. to 800 b.c.e.
The different Vedas or books of knowledge consist of
the following: four main Vedas, Rigveda or books of
hymns of praise; the Samveda, or knowledge of mala-
dies; the Yazurveda, or knowledge of sacrificial formu-
las; and Atharvavedas, or knowledge of a compilation
of magic formulas. The theory of three main elements of
life, includes material existence, such as air, fire, and
water related to human life.15 In this period, medicine
involved supernatural, magic, demons, and incanta-
tions, this phase of “magico-religious” involving
prayers and supplications to the gods. In the Athar-
vaveda, many conditions were described such as ab-
scesses, tumors, scrofula, colic, diarrhea, venereal dis-
eases, gout, epilepsy, leprosy, and heart disease. The
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42 ROUTH AND BHOWMIK
Aswinis were the chief healing gods. Diseases were
thought to be caused by demons and, sometimes, as
well as by a healing god. Illness was deemed to be a
punishment inflicted by the gods as a retribution for
sins or bad deeds in the past. Healing herbs were con-
sidered as a gift from the healing god.
800 b.c.e. to 1000 c.e.
This phase of original research and classical authors the
highest development of Hindu medicine occurred. The
main medical treatises or Samhitas, written in Sanskrit,
are known as Charaka Samhita, Sushrata Samhita, and
Astaranga sangraha by Vaghbata.
1100 –1600 c.e.
This was a period of documentation. Symbolic diagno-
sis or tantras were written and documented in this
period. Many treatises were written that discussed pe-
diatrics; obstetrics and gynecology with Caesarian sec-
tion; and surgery, including rhinoplasty and lithotomy.
Rhinoplasty and correction of other disfigurements
were performed in patients to restore normal contour
and structure of those whose noses had been cut as a
punishment. As a result, Indian physicians are credited
as the pioneers of modern day plastic surgery. Knowl-
edge of preventive medicine, bacteriology, immunol-
ogy, and isolation of persons suffering from infectious
diseases were also recorded.
1700 c.e. to the Present Era
This is considered a stage of stagnation and re-emer-
gence. By the Middle Ages, Ayurvedic medicine had a
profound influence upon Arabic and other Middle East-
ern medicine and medical authorities. With the inter-
change of cultural relations and the conquest of the
Indian subcontinent by Muslim rulers, many Indian
scholars were invited to Baghdad and other Muslim
centers. Ayurvedic medicine spread rapidly through
the Arab world. The term, Unani medicine, represent-
ing a combination of Ayurvedic, Arabic, and Greek
medicine was developed later.
Two major schools of Ayurvedic medicine are
Atreya, or school of physicians, and Dhanwantari, or
school of surgeons. These are again subdivided for
subspecialties—internal medicine (kayachikitsa), pedi-
atrics (kaumarbhuitya), surgery (shalyatantra), psychi-
atry (bhutavidhya), sexology, aphrodisiacs (vajikarma),
and rejuvenation (rasayana).
Indian Medical Figures
There are a number of figures important in Indian
medicine.14 –16
Clinics in Dermatology Y 1999;17:41– 47
The Ashwinis
The mythical Ashwinis were described in the Rigveda,
as the most powerful physicians. They could cure and
heal any disease, and their devotees could easily reach
old age in good physical condition and with sharp
eyesight. Ashwinis helped to rejuvenate Sage Chyavana
and revive other sages.
Atreya
Atreya was considered as the father of Indian medicine.
He was the son of the semimythical god, Atri, and
wrote “Atrerya Samhita”, describing diseases as cur-
able and incurable. Diseases can be cured by magic.
Charaka
Charaka is believed to have lived before the 6th century
b.c.e. He is thought to be the author of “Charaka Sam-
hita,” a revision of works of a previous author such as
Agnivesa, a disciple of Atryea. This Samhita is a com-
bination of religion, philosophy, and medicine. Descrip-
tions of various diseases can be found, such as seven
varieties of leprosy, eight types of gastric maladies, and
five types of anemia, asthma, and hiccups.
Sushrata
He is the author of “Sushrata Samhita” and lived
around 500 b.c.e. He described the treatment of many
medical conditions, and discussed dietary supplements
and medical ethics. Anatomical dissection of humans
was also mentioned. The human body consists of hu-
mors, excretions, and the fundamental principles of life.
The humors are Vayu, pitta, and kapha. In the descrip-
tion of leprosy, he discussed its contagion and the loss
of perception to touch. His diagnosis of elephantiasis
contains the pertinent comment that the disease is prev-
alent in regions where much stagnant water is found.16
Phthisis was described as wasting or general emacia-
tion of the body, with hoarseness of the voice, aching
pain in the chest, contraction of the sides and stoop at
the shoulder, fever, burning sensation and expectora-
tion of blood, cough, and feeling of a lump or plug in
the throat. The surgical section is outstanding, with
descriptions of surgical instruments and surgical pro-
cedures. He mentioned 760 medicinal plants, such as
opium, aconite, solanum, cassia, acacia, pomegranate,
castor oil, croton oil, cinnamon, ginger, chenopodium,
and cannabis. Minerals such as antimony, borax, cop-
per, sulfate, mercury, silver, and sodium carbonate
were also described. Henbane (Hyoscyamus niger) and
Indian hemp (Cannabis sativa) were used for anesthetic
and analgesic purposes respectively.17
Vaghbata
Astragna Sangraha was written by Vaghbata around
the 7th century c.e. It is a comprehensive treatise on
Clinics in Dermatology Y 1999;17:41– 47 TRADITIONAL INDIAN MEDICINE IN DERMATOLOGY 43

Table 1. Basics of Ayurveda

Five elements of life
Akash (ether)
Vayu (air)
Teja (fire)
Aap (water)
Earth (prithivi)
Three doshas
Vayu or wind (air and ether),
Pitta or sun (earth and fire),
Kapha or moon (earth and water)
Two body types (physical constitution)
Purusha or outward–flowing conscious person,
Prakiti or inward–flowing unmanifested person
Human types (mental status)–Three gunas or state of self contentment
Sattya or balanced self content
Rajas or positive thinking
Tamas or negative
These are very important for diagnosing a human type to detect a specific condition
Organ of senses or Indriyas
Granendriyas or senses of sight, taste, touch, smell, hearing, and sexual or reproductive senses
Karmandriyas, or organs that controlled by senses, such as tongue, the arms, the legs, and reproductive organs
Shrotas or channel of the body
Internal, such as veins, arteries, lymphatic systems, liver, and intestine
External, such as eyes, ears, mouth, nostrils, breast, and vagina
Disease classification—3 categories
Adhyatmika: diseases originating from the body, such as hereditary diseases, congenital diseases, and diseases caused by one or more
doshas combined
Adhibhautika: originating outside the body, such as accidents; or may include bacterial, viral, and parasitic conditions
Adhidaivika: due to supernatural sources ranging from planetary influence to seasonal changes

medicine, hygiene, anatomy, surgery, pathology, oph- Pitta or bile

thalmology, and obstetrics. It consists of chapters on
leprosy, anemia, diabetes, asthma, hemorrhoids, and
dementias. Treatments consist of astringent, clyster,
and purgatives. Antidotes for insect and snake bites
were recommended.
Fundamentals of Ayurveda
According to Ayurveda, life is considered as the union
of body, sense, mind, and soul. The five basic elements
of life are earth, air, fire, water, and space (Table
1).9,13,18,19 Interaction between these gives rise to all that
exists, creating three doshas (forces), seven dhatus (tis-
sues), and three malas (waste products). The three
doshas are vayu or vata, pitta, and kapha. An imbalance
of equilibrium of the three doshas causes diseases indi-
cated by an increase or decrease of one, two, or all of the
three doshas.
Doshas
Vayu or Vata
This means wind and is represented by air and light-
ness that controls motor and nervous function. Distur-
bance causes manifestations of gas and muscular or
nervous energy, leading to pain. Dryness, atrophy,
pricking pain, contraction, dilation, hardness, rough-
ness, horripilation, and dusky red coloration are the
findings for skin lesions.
It is the vehicle for digestion, metabolism, and energy
productions. Composed of fire and water, it is respon-
sible for pigmentation, body temperature, hunger,
thirst, sight, courage, and mental activities. Disruption
of normal function causes imbalance of acid and bile
leading to inflammation. Skin manifestations are burn-
ing sensations, redness, exudation, suppuration, soften-
ing, and sloughing of affected areas.
Kapha
This represents earth and water, and it is a liquid. It is
responsible for passive energy and regulates the body’s
structural elements, cohesiveness, and strength. By reg-
ulating vayu and pitta, it helps keep the body lubricated
and maintains its solid nature, tissues, sexual power,
and strength. Disruption causes its manifestation in
liquid and mucus, leading to swelling with or without
discharge. Skin changes ranges from whiteness, cold-
ness, pruritus, heaviness, sliminess, and softening.
Dhatus
The seven dhatus are important for sustaining the
whole body.
1. Rasa or body juice–plasma, lymph and tissue fluids
help to nourish the body and originated from di-
gested foods.
2. Rakta or blood, including red blood cells.
44 ROUTH AND BHOWMIK
3. Majya, or flesh, keeps body stabilized.
4. Med, or fat and fatty tissue, lubricates the body.
5. Asthi, or bone, bony and cartiligenous parts of the
body supporting the body structure.
6. Majya, or marrow, including red and yellow bone
marrow for filling the bone.
7. Shukra, or male and female sexual fluids, help re-
production and immunity.
Malas
There are three malas. Malas are the waste products of
the body from digested food and drink. These are urine,
feces, and sweat. Products from skin and intestine, ear
wax, nasal mucous secretion, tears, saliva, hair, and
nails are considered as malas.
Amas
Amas are considered the chief cause of disease. When
there is a deficiency or imbalance of an enzyme activity
along with changes in dhatus, manifestations of a dis-
ease occur. Diseases may be caused from a variety of
factors, ranging from food, drink, seasonal variation, to
change in mental status. All this may lead to formation
of disease conditions or ama. Channels may be blocked
by the circulating ama. A combination of doshas and
ama afflicted a specific body part, and disease occurs at
that site.
Dermatology in Ayurvedic Medicine
Dermatologic conditions elaborately described and var-
ious treatment options are mentioned in Ayurveda.15,17
The causes or factors of different dermatoses range
from dietary practices, to daily activities to climatic
conditions, to sexual acts. The diseases are caused by
imbalance of the one, two, or all three doshas of vayu,
pitta, or kapha. When these elements are changed, der-
matoses occur. Eighteen types of skin afflictions are due
to these changes. Description of skin diseases with eti-
ology, pathogenesis, clinical features, and treatment are
mentioned in Ayurvedic medicine.
Disease Conditions
Kustha, or obstinate skin conditions including leprosy,
is caused by imbalances in various doshas. Responsible
factors for these diseases range from intake of contra-
dictory liquids and foods, uncooked or undercooked
food, fasting, excessive exercise, use of cold water after
prolonged exposure to the sun, and early intake of food
before the previous one is digested, transgression of the
procedures of emetic therapy, purgative therapy, med-
icated enema, and inhalation therapy. Excessive intake
of radish, sesame seeds, milk, and pastry, and sinful
acts also regarded as causative factors.
The imbalances in the doshas vayu, pitta, and kapha
cause changes in the skin, blood, muscle tissue, and
Clinics in Dermatology Y 1999;17:41– 47
lymph. These changes are responsible for seven types of
kustha (Table 2). In excessive aggravation of vayu, kus-
tha is characterized by roughness, blackish-brown
patches, and red lesion with ununctousness and pain
occur. Aggravation of pitta causes kustha that is char-
acterized by pus formation, burning sensation, redness
and exudation. In case of kapha aggravation, kustha is
characterized by stickiness, compactness, coldness, itch-
ing and heaviness.
Classification of Kustha
Seven types of kustha are: vatika, paittika, kaphaja,
vat–pittaja, pitta-kaphaja, vata– kaphaja, and sanni–pa-
tika. Imbalance in doshas determines occurrence of
each variety of kustha.
Salient Features of Kustha
Finding of the following features in the skin and body
helps to determine the type of kustha. Skin may be
smooth or rough to touch, sweating may be excessive or
absent, change of color, presence of itching, a burning
sensation, numbness, and pain, urticarial eruption,
painful ulcers, and chronicity of ulcer, roughness of
skin even after ulcer healed, easy reactivation of ulcer,
and blood color changed to black (Table 2). Location of
kustha is important in Ayurvedic medicine for diagno-
sis, treatment and prognosis. It is manifested by discol-
oration of the body, unctousness, numbness, excessive
sweating, and hair changes. Should kustha be located in
the blood, itching; pus formation; presence of many
patches, roughness, and eruption of skin; and dryness
of mouth may occur. Location of kustha in muscle
tissue may cause pain, pustular eruption, stability,
fleshy smell, difficulty in movement of extremities, cal-
lus formation, and spreading of ulcer. If kustha is lo-
cated in fatty tissue, manifestation are same of muscle
tissue. Location of kustha in the bone or bone marrows
is characterized by deformity of nose, redness of eyes,
presence of maggots in the ulcer, and hoarseness of
voice.
Transmission of kustha can occur in the following
conditions: intimate personal contact with the diseased
person, touching of the body parts of the affected per-
son, through inhalation of air, eating together with
infected person, using the same bed and seat, clothing
and accessories, garland, and unguent of infected per-
son.
In Ayurvedic medicine, diagnosis is based on an
elaborate system that includes an examination of the
physical features, taking the pulse, and observing the
urine. The further examinations by visual observation,
touch, and interrogation are done, followed by an eight-
fold detailed examination to determine the type of the
patient’s physical and mental constitution and to find
the causes of and determine the appropriate therapy for
the diseases.
Clinics in Dermatology Y 1999;17:41– 47
Table 2. Types of Kustha with Characteristic Findings
Types of Kustha Characteristic Findings
Kapala kustha Black and reddish skin patches
Patches ununctous, rough, and thin
to touch
Presence of excessive pain
Difficult to cure
Audumbara kustha Pain, burning sensation, and
excessive itching
Brown hair present in the patches
Mandala kustha Red or white in color
Stable, compact, and circular patches
Patches may coalesce
Rsya–Jihva kustha Rough patches with red edges and
brown inside
Painful lesions
Patches resemble rysa or a type of
antelope with blue testicles
Sidhma kustha Patches white and coppery in color
Small particles of skin seen when
rubbed, with thin lesions
Located mainly in the chest
Pundarika kustha White patches with red edges
resembling lotus leaf
Exacerbated with inflammation
Kakana kustha Red patches like seed of gunja
(Abrus precatorius)
Suppuration occurs
Extremely painful
Caused by imbalance of all three
doshas
Lesion is incurable
Eka and carma kustha Extensively localized
Resembles scales of fish
Sweating absent
Presence of thick skin like elephant
in carma kustha
Kitiba and vaipaidka Blackish-brown patches
kustha Rough like a scar and hard when
touched
In vaipadika kustha cracks and
severe pain in the palms and soles
Alasaka and dadru kustha Growth of nodules
Extremely itchy and red
Pimples and circular patches redness
and itching in dadru kustha
Carmadla kustha Redness with itching, pain and
tenderness
Pustules and cracks present
Pama kustha Large number of subtle eruptions
Exudate, itching and burning
sensation present
Kacchu kustha Same as pama, including pustular
eruption, excessive burning
sensation
Hands and buttocks involved
Sphota kustha Blackish–brown pustular eruption
Sataru kustha Many blackish–brown ulcers
Pain and burning sensation present
Vicarcika kustha Blackish brown eruption
Increased itching and exudate
present
TRADITIONAL INDIAN MEDICINE IN DERMATOLOGY 45
In the treatment of skin disorders, the many prepa-
rations used include healing plants, tinctures, paste,
pills, salves, emulsion, suppositories, plasters, oils, bou-
gie, lotions, and liniments. Mineral substances such as
gold, silver, copper, tin, lead, zinc, mercury, borax,
sulfur, alum, iron sulfate, and zinc carbonate were men-
tioned. Mercury was prescribed first for types of skin
diseases and later for syphilis. Charaka Samhita recom-
mended more than 100 prescriptions for leprosy and
other skin diseases.8,14,15
In kustha, manifestations due to aggravation of vayu
can be treated with oleation therapy or administration
of clarified butter or ghee with other herbal prepara-
tions. If kustha is produced by kapha predominance,
emetic therapy and in pitta predominance kustha,
blood letting and purgation therapies, are indicated
before any other therapy. Different medicated and
herbal oil, paste, milk, animal excreta, and mineral
preparations are used in the treatment of skin disease.
In the treatment of skin disorders herbal, animal, and
mineral products have been used for many years. In
Sushrata Samhita, diet and therapeutic regimens have
been mentioned. Consumption of milk, curd, meat, and
oil were restricted, at least temporarily, for skin lesions.
Overindulgence of certain foods, prolonged exposure to
the sun, and alkaline or acidic preparations and certain
herbs are also forbidden.
In Charak Samhita, purification, systemic therapy
and application of local medication are described. Ex-
posure to sunlight after massaging the body with oil is
mentioned. A thin gruel is recommended for next three
days after the initial purgative therapy. According to
Charak, leukodermic skin blisters should be punctured
so that serum exudates. This is followed by drinking a
decoction of redwood, fig, spinous kino, perfumed
cherry, and dill or palas alkali with liquid gur for two
weeks. A decoction of catechu is also useful. Clarified
butter, jati flower, and other herbal medicinal plasters
may be indicated for skin disorders. Herbs rich in zinc
are used in the skin lesions; for example, Vetiveria zizo-
nioides is employed to alleviate a burning sensation. It
contains volatile essential oils, resin, coloring material,
a free acid, a salt of lime, oxide of iron, and woody
residue. It is a cooling medicine. A paste of the root
used to soothe skin and a mixed with red sandalwood
has been used as an aromatic bath.
Elimination therapy, blood letting therapy, is recom-
mended every six months for patients suffering from
kustha. Application of an ointment once a day for three
days is used. Purgation once a month and emetic ther-
apy every two weeks is useful in the treatment of skin
diseases. Blood letting therapy is done by scratching. In
major varieties of kustha, venesection is performed. In
case of kustha caused by more than one dosha, blood
letting is more frequently done. In emetic and purga-
tion therapy, intake of decoctions of Adhatoda vasica
46 ROUTH AND BHOWMIK
(Vasak), Acorus calamus (Vaca), Trichosanthes dioica (Pa-
tola), Azadiracka indica (neem) and Randia dumetorum
(madana) with honey is indicated.
Use of ointment or lepas, a paste that applied exter-
nally, is indicated after elimination therapy and emetic
and purgative therapy. In the treatment of dadru or
ringworm, a paste made of root is triturated in clarified
butter and cow’s urine, and intake of this medication
helps to cure ringworm. Six recipes of herbal prepara-
tions are indicated in the treatment of kustha. A paste is
made from these recipes by adding water triturated
with gorocna or cow’s bile. A medicated oil is prepared
by boiling the paste with mustard oil. In the treatment
various types of kustha, this paste can be applied to a
type of leucoderma, alopecia, ringworm, anal fistula,
piles, scabies, and tubercular adenitis.
In the Unani–Tibb system, purification of blood and
body fluids by the use of herbs and mineral prepara-
tions are recommended in the treatment of skin diseas-
es.20,21 Blood helps to eliminate bacteria, viruses, and
other foreign objects. Forty plants are used as blood
purifiers such as Acacia catechu, Aleo vera, Lowsania ni-
ermis, Dalbergia sisso, Lawsania alba, Cassia orgustofolia,
Psorelia corylifloriaare.
Siddha System
According to the Siddha system, the color of the skin is
considered as one of the eight indicators of the mani-
festation of any disease. Skin diseases are classified as
dermatitis (Sarumap-pun), abscess (katti), tumor
(hazhalai), leprosy (kuttum) and cancer (putru).15
Treatment of skin diseases includes both external
application and internal intake of different herbal and
mineral preparations. Treatment of some of the skin
disorders are Pruritus and Urticaria (Thinvup-pun), of
which there are two types.
Pruritus (Thinvup)
Application of a paste of red sandalwood with vinegar
or a paste of turmeric (Curcuma longa) and juice of
Aadaa thoda (Adatoda vasica) externally is helpful. In-
take of one part of silajit parapam and one part of
Seednil sarkari, about 500 mg with milk twice daily for
5–10 days is helpful.
Urticaria (Thinvup-Pun)
This is a paste made of seemai agathi (Cassis alata) with
lime juice or a mixture of sandalwood oil and linseed
oil, applied externally; internally, sanguparapam and
silajit parapam is given in equal parts in doses of 500
mg twice a day.
Laceration and Cut Wounds (Vettuck–Kayam)
A preparation of Cynodon dactylon, Lawsonia alba, Acacia
catchulonga, Curcuma longa, and Terminalia chebula,
mixed in specified amounts with alcohol and water to
Clinics in Dermatology Y 1999;17:41– 47
form a paste is made after boiling and filtering, cooling
and adding camphor.
Acne (paru)
In the treatment of acne, rubbing of fresh lemon is
recommended. Terminalia arjuna or Vernonia antihelmi-
nitica with vinegar may also be used. Purified powder
of Withania somnifera can be taken internally.
Specific medications
Also recommended are specific medications for psori-
asis, dermatitis, dermatophytosis, syphilis, gonorrhea,
chancroid, alopecia, boil, and abscess.
Conclusions
Complementary therapy for the treatment of dermato-
logic conditions remains a major option for thousands
of people in the Indian subcontinent. It is popular,
inexpensive, and convenient. New researches are being
conducted in many institutes in these region. Govern-
ments and other private institutes of Southeast Asian
countries subsidize development and research for in-
digenous medicine. Ayurveda, Unani, and Siddha sys-
tems of medicine have the same legal status as Western
medicine. There is a renewed interest in the Indian
traditional medicine in Western countries.
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