Introduction

The largest organ in our body is the skin. It controls the feeling of "Sparsha Gyan," or touch, and is one of the five Gyanendriyas mentioned in Ayurvedic texts. The majority of skin issues have been studied under the Kushtha heading. [1] Twak rogas are known as "Kushtha" in Ayurveda; the name is derived from the root "Kushu," which denotes that the condition causes organ death by spreading from the interior to the outside regions of the body. In the Atharvaveda, Twak roga is described as Kilasa, palita, with the clinical image of grey and white patches, usually from deeper layers of skin, affecting the Asthi, Meda, Mamsa, and other parts of the body. The Garuda Purana also mentions Kushtha diagnosis and treatment (Leprosy and other skin disorders). The Samhita period is Ayurveda's golden age. Almost all of the samhitas classify Kushtha as either Maha Kushtha or Kshudra Kushtha, but there is some disagreement about the number of people in each group, which may be related to the severity of the illness. [2]

Concept of Kushtha Roga

The Samprapti of Kushtha begins with the multitude of interactions of Tridosa with Twak, Rakta, Mamsa and Lasika and gradually may afflict other Dhatus, depending upon the strength of Samprapti ghataka. Majority of the dermatological disorders have been described under the umbrella of Kushtha. The word “Kushtha? is derived from “Kusnishkarshane” + “Kta” which implies “to destroy”, “to scrap out. Suffix “Kta” stands for firmness. Thus, the word Kushtha means that which destroys with certainty.

 

Nidana

Ayurvedic system of medicine described a wide range of etiological factors for dermatological disorders. These can be classified into Sannikrishta Nidana and Vipkrishta Nidana as follows:

 

Sannikrishta Nidana - Saptko Dravya Sangraha i.e., seven Dravyas or factors involved in the pathogenesis of Kushtha are considered as Sannikrishta Nidana. The Sapta Dravya includes three Doshas viz. Vata, Pitta and Kapha and four Dushyas viz. Tvaka (Rasa), Rakta, Mansa and Ambu or Lasika. [3]

 

Vipkrishta Nidana - Such types of etiological factors are not involved directly in the pathogenesis, but they aggravate the actual causative factor (Sannikrishta Nidana) and thus play an important role in pathogenesis of the disease. These are further categorizing into three groups Adibala Pravratta or Kulaja (hereditary), Poorva Janmakrata and Janmottarakalaja. Kushtha is considered as Adibala Pravratta Vyadhi (a hereditary disorder). Acharya Sushruta clearly mentioned that if, the male and female gametes are vitiated with Kushtha than it results into the birth of a Kushthi child i.e., the newborn baby also suffers from a particular dermatological disorder. [4]

Janmottarakalaja The etiological factors in present life can be categorizes into three groups, Aharaja (diet & dietetic patterns), Viharaja (lifestyle related) and Mansika (psychological).

 

Aaharaj Nidana[5,6]

Consumption of mutually incompatible liquid, rich, and heavy foods and beverages. exercising in sweltering heat and right after a substantial lunch. Use cold water right away after being in the scorching sun, working out, or viewing a terrible incident. consuming too many freshly harvested grains, curd, fish, salt, and sour food items. excessive consumption of milk, tila, masa, mulaka, pastry, and jaggary.

 

Viharaj Nidana [7,8]

• Heavy work out in gym soon after heavy food intake. Heavy and highly nutritive food intake soon after fasting etc.
• Indulging in hot or cold things together or one after other. Eating hot and cold food items together, frequent going in and out of ac room in summer.
• Indulgence in coitus after excessive or heavy food intake.
• Indulgence in exercise when stomach is full or after heavy food.
• Taking anti emetics, habit of suppressing vomiting
• Exercise, exertion, sexual activity after eating unctuous food such as ghee, butter, etc.
• Not following pathya-apathya or peyadi karma during and after panchakarma.
• Doing panchakarma without guidance of physician.

Mansika Nidana:

Ayurveda highlighted several elements that have a detrimental effect on the psyche/mind, such as Chinta (worry), Shoka (sorrow), and Bhaya (fear), as well as mistreating deities and teachers, engaging in other immoral activities, and engaging in other anti-rituals and anti-social activity. Stress is a result of this damaging psychological influence, and stress either directly or indirectly aids in the development and/or progression of dermatological disorders.

Samprapti

Due to the irrespective Hetus, the Doshas become vitiated and distribute throughout the body, vitiating Dhatus and manifesting sickness. According to Acharya Charaka, when the Dravyas are disrupted, Kushtha is born. There are three doshas: Vata, Pitta, and Kapha, as well as four dushyas: Tvaka, Mamsa, Rakta, and Lasika (Ambu). The Prabhava of Kushtha then spreads throughout the entire body. Nidana's dual role in the Dhatus of Twak, Rakta, Mamsa, and Lasika has been stressed by Charaka, i.e., simultaneous vitiation of Tridosha and Shaithilyata in the Dhatus of Twak, Rakta, Mamsa, and Lasika. Thus, vitiated Tridoshas acquire impetus to vitiate Shithila Dhatus, resulting in the manifestation of the ailment Kushtha[9,10, 11].

• Premonitory symptoms

Lack of sweating or excessive sweating, roughness or excessive smoothness, discoloration, itching, pricking pain, numbness, burning sensation, tingling sensation, horripilation, coarseness, production of heat, heaviness, frequently occurring oedema and acute spreading, sticking of excreta in the body particularly in the orifices, excessive pain in cases of suppuration, burn, bite, fracture and dislocation, putrefaction, and non-healing of even small wounds.

•  
• Lakshanas [11-13]

Sparsha hani (loss of sensation on touch), Svedanatwa (Anhydrosis.), Kandu (Itching), Vaivarnya (Discolouration! hypopigmentation), Rukshatwa (Dryness of skin), Complete loss of sensation, Romaharsha, Kandu (Itching), Vipuyaka (severe accumulation of pus or formation of pastules), Vaktrashosha (Dryness of the throat), Karkashya (rough and hard patches), Pidakodrama (Macules appears), Kaunya (crippled state of hands and distoration of limbs), Angagati Ksaya (loss of movement of limbs).

• Sankramikatwa (Infectivity) [14]

The Kushtha (Leprosy and other skin diseases), Jwara, Shosha (Tuberculosis) and Netrabhisyanda (conjunctivitis) are the Aupasarqika" (infectious) diseases which are communicable from one person to the other through the following contacts with the patient.

1. Sexual intercourse
2. Physical contact
3. Respiration or droplet infection etc.

Chikitsa

Ayurveda emphasizes three types of therapeutic management of diseases, including dermatological disorders: Samshodhana (biopurification), Samshamana (pacification), and Nidana Parivarjana (avoiding causative factors). [14] According to Acharya Charaka, Vaman (therapeutic emesis) is used in Kapha dominant Kushtha, whereas Virechan (therapeutic purgation) and Raktamokshana (therapeutic blood-letting) are used in Pitta dominant Kushtha. Acharya Sushruta recommends Nasya Karma (nasal medicament) every third day, Vaman every fifteenth day, Virechan every month, and Raktamokshana every six months for the treatment of Kushtha Roga.[15]

In most dermatological illnesses, the aetiology involves a complicated interaction of immunologic, genetic, and environmental variables. Psychological stress and other associated variables have a significant role in the etiopathogenesis of dermatological illnesses.

Sidharthaka Snana Churna is an ayurvedic medicinal preparation in the powder form. It is used in treating skin diseases, leprosy, edema, and anemia. It improves the colour of the skin. It can be used for bathing, conducting Vamana, virechana or as a decoction for internal administration. In general, it is used as bath powder in skin diseases. Ingredients of Sidharthaka Snana Choorna are Mustha, Triphala (Haritaki, Vibhitaki, Amalaki), Madanaphala, Karanja twak, Aragwadha twak and Kalinga beeja. It is used as a bathing powder in skin diseases.  Rasayana characteristics are present in the majority of Ayurvedic drugs used to treat dermatological issues. Immunomodulator, adaptogenic, antioxidant, and antistress are a few examples. As a result, rasayana medicines are crucial in the management of dermatological problems. Haridra, Panchatikta Ghrita Guggulu, which encourages blood flow, circulation, and purification, relieves Kushta. [16,17] The Vata, Pitta, and Kapha Doshas are all in equilibrium. [18] Kushta Roga's itching, skin eruptions, and anguish are all relieved with Haridra. Brahmi in Kushtha lessens edoema and calms blood vitiation. Neem's katu, powerful, and antibacterial qualities help to alleviate Kushtha symptoms.

Discussion

According to Ayurveda, Kushta is a Tridoshaja Vyadhi that manifests in the Bahya Rogamarga. Kushtha is considered a Mahagada because of its Durvijneya, Sudustara, and Daruna swabhava. The Samprapti of Kushta begins with the myriad interactions of Tridosa with Twak, Rakta, Mamsa, and Lasika, and progresses to affect other Dhatus, depending on the intensity of the Samprapti Ghataka. The majority of dermatological problems have been documented under the umbrella of Kushtha.[18] Etiological factors include, among other things, physical, physiological, genetic, psychological, psychosocial, and Papakarma. Mahakustha (seven types) and Kshudrakusthas are two of the eighteen types of Kushtha (eleven types).

Symptoms like Shweta, Tamra Varna, Tanu, Rajoghrushta, and Alabu Pushpavat are discussed in Charaka's Chikitsa Sthana.[19] Sidhma is characterised by Kandu, Shweta Varna, Apayi, Tanu, and commonly occurs in Urdhwakaya, according to Acharya Susrutha. According to Charaka, the planning of treatment depends on the predominance of Dosha involved. If the disease is Vata predominant, Sarpi is advocated, Virechana and Rakthamokshana are recommended if the disease is Pitta predominant and Vamana is indicated for Kapha Dosha. Once Shodhana is done, Snehapana is advised by Acharya Charaka as the patient would have become weak and also may lead to aggravation of Vata. [20]. The recomonded diet for the patients of Kushtha Roga includes old wheat, barley, etc. Non-pharmacological therapies for the management of Kushtha Roga includes Daivavyapashraya Chikitsa, Satvavajaya Chikitsa and life style modification.

Conclusion

One of the first diseases that humans identified was kushtha. It is regarded as one of the most chronic disorders in the Ayurvedic medical system. Numerous dermatological conditions were classified by Ayurveda, along with their genesis, clinical manifestation, prevention, and treatment. Acharya Charaka identified four Dushyas as being significantly involved in the manifestation of Kushta: Twak, Raktha, Mamsa, and Lasika Dhathu. It is recognised as one of the most chronic illnesses with a very challenging course of treatment.