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Chapter 49 – Kustha Nidanam

 

The 49th chapter of Madhava Nidana is Kushta Nidana which deals with Leprosy and other diseases of the skin.

 
 

Etiopathogenesis —

विरोधीन्यन्नपानानि द्रव -स्निग्ध – गुरूणि च |
भजतामागतां च्छर्दीं वेगांश्चान्यान् प्रतिघ्नताम् || १ ||
व्यायाममतिसन्तापमतिभुक्त्वा निषेविणाम् |
घर्म – श्रम – भयार्तानां द्रुतं शीताम्बुसेविनम् || २ ||
अजीर्णाध्यशिनां चैव पञ्चकर्मापचारिणाम् |
नवान्न – दधि – मत्स्यातिलवणाम्ल निषेविणाम् || ३ ||
माष – मूलक – पिष्टान्न – तिल – क्षीर – गुडाशिनाम् |
व्यवायं चाप्यजीर्णे अन्ने निद्रां च भजतां दिवा || ४ ||
विप्रान् गुरुन् धर्षयतां पापं कर्म च कुर्वताम् |
वातदयस्त्रयो दुष्तास्त्वग्रक्तं मांसमम्बु च || ५ ||
दूषयन्ति स कुष्टानां सप्तको द्रव्यसंग्रहः |
अतः कुष्टानि जायन्ते सप्त चैकादशैव च || ६ || 

virōdhīnyannapānāni drava -snigdha – gurūṇi ca |
bhajatāmāgatāṁ cchardīṁ vēgānścānyān pratighnatām || 1 ||
vyāyāmamatisantāpamatibhuktvā niṣēviṇām |
gharma – śrama – bhayārtānāṁ drutaṁ śītāmbusēvinam || 2 ||
ajīrṇādhyaśināṁ caiva pañcakarmāpacāriṇām |
navānna – dadhi – matsyātilavaṇāmla niṣēviṇām || 3 ||
māṣa – mūlaka – piṣṭānna – tila – kṣīra – guḍāśinām |
vyavāyaṁ cāpyajīrṇē annē nidrāṁ ca bhajatāṁ divā ||4 ||
viprān gurun dharṣayatāṁ pāpaṁ karma ca kurvatām |
vātadayastrayō duṣtāstvagraktaṁ mānsamambu ca || 5 ||
dūṣayanti sa kuṣṭānāṁ saptakō dravyasaṅgrahaḥ |

ataḥ kuṣṭāni jāyantē sapta caikādaśaiva ca || 6 ||

Causes for the morbid increase of the doshas are multiple. They include the following:

  • Indulgence in incompatible eatables and drinks,
  • Intake of eatables that are very watery, fatty, or hard to digest;
  • Suppression of the urges of vomiting etc.,
  • The doshas could be vitiated also due to heavy physical exercises and too much exposure to heat immediately after taking eatables.
  • The act of immersing in cold water soon after exposure to sunlight, hard work causing fatigue and incidents of fear;
  • Use of uncooked eatables and over eating,
  • Improper methods of administering the five purificatory therapies (emesis, purgation and the like),
  • Use of fresh grains, fish could vitiate doshas.

Moreover, doshas could be vitiated also by

  • Taking eatables that are very salty and sour, blackgram, radish;
  • dry or powdery eatables, sesame, milk and jaggery;
  • Over  indulging in sexual intercourse,
  • sleeping during day though suffering from indigestion.

They could be vitiated also by —

  • showing disrespect to gods, teachers, and
  • committing several other kinds of sinful acts.

Such factors derange the skin (tvak), blood (rakta), muscular tissue (mamsa), body fluids (ambu) and generate leprosy and identical skin diseases (kushta). Thus, seven and eleven kinds of kushta are produced by the group of the three doshas and four dhatus. 1-6

 Seven Major types —

 कुष्टानि सप्तधा दोषैः पृथग्द्वन्दैः समागतैः |
सर्वेष्वपि त्रिदोषेषु व्यपदेशो अधिकत्वतः || ७ || 

kuṣṭāni saptadhā dōṣaiḥ pr̥thagdvandaiḥ samāgataiḥ |
sarvēṣvapi tridōṣēṣu vyapadēśō adhikatvataḥ || 7 ||

There are seven kinds of leprosy (kushta),

  • One from each dosha
  • three from the combination of two doshas, and
  • one from the combination of all the three together.

Though all the three doshas are involved in the causation of all varieties of kustha, this kind of nomenclature is based on the dominance of the respective doshas. 7

Prodromal Features —

अतिश्लक्ष्ण – खरस्पर्श – स्वेदास्वेद – विवर्णताः |
दाहः कण्डूस्त्वचि स्वापस्तोदः कोठोन्नतिर्भ्रमः || ८ ||
व्रणानामधिकं शूलं शीघ्रोत्पत्ति चिरस्थितिः |
रूढानामपि रुक्षत्वं निमित्ते अल्पे अतिकोपनम् || ९ ||
रोमहर्षो असृजः कार्ष्ण्यं कुष्टलक्षणमग्रजम् |

atiślakṣṇa – kharasparśa – svēdāsvēda – vivarṇatāḥ |
dāhaḥ kaṇḍūstvaci svāpastōdaḥ kōṭhōnnatirbhramaḥ ||8||
vraṇānāmadhikaṁ śūlaṁ śīghrōtpatti cirasthitiḥ |
rūḍhānāmapi rukṣatvaṁ nimittē alpē atikōpanam || 9 ||
rōmaharṣō asr̥jaḥ kārṣṇyaṁ kuṣṭalakṣaṇamagrajam |

Main prodromal features of kustha include the following:

  • The skin of the patient becomes either very smooth or rough;
  • There is presence or absence of (i.e. abnormal) perspiration;
  • Discolouration,
  • Burning sensation,
  • Itching,
  • Loss of tactile sensation,
  • Pricking pain,
  • Appearance of elevated patches,
  • Giddiness,
  • Severe pain on injury,
  • Quick formation of ulcers and their sustained presence.

Apart from these,

  • There is a sustained roughness of skin.

Moreover, the patient faces re appearance of ulcers due to trivial factors. Frequent horripilation and blackish discoloration of the blood are also there. 8-9

Clinical features of the seven major kusthas —
Kapalakustha (Vataja) —

 कृष्णारुणकपालाभं यद्रूक्षं परुषं तनु || १० ||
कापालं तोदबहुलं तत् कुष्टं विषमं स्मृतम् | 

kr̥ṣṇāruṇakapālābhaṁ yadrūkṣaṁ paruṣaṁ tanu || 10 ||
kāpālaṁ tōdabahulaṁ tat kuṣṭaṁ viṣamaṁ smr̥tam |

Symptoms of Kapala Kustha include the following:

  • The skin resembles a brown coloured piece of potsherd;
  • It turns rough, course, thin;
  • Painful and intractable. 10
Audumbara Kustha —

 रुग्दाह – राग – कण्डूभिः परीतं रोमपिञ्जरम् || ११ ||
उदुम्बरफलाभासं कुष्टमौदुम्बरं वदेत् | 

rugdāha – rāga – kaṇḍūbhiḥ parītaṁ rōmapiñjaram || 11 ||
udumbaraphalābhāsaṁ kuṣṭamaudumbaraṁ vadēt |

 Features of Udumbara type of Kustha include the following:

  • Pain
  • Burning sensation,
  • Redness,
  • Itching,
  • Hairs turning pink in colour and
  • Appearance of nodules resembling the fruit of plant Ficus Infectoria (udumbara). 11
Mandala Kustha — (Kaphaja)

श्वेतं रक्तं स्थिरं स्त्यानं स्निग्धमुत्सन्नमण्डलम् || १२ ||
कृच्छ्रमन्योन्यसंयुक्तं कुष्टं मण्डलमुच्यते | 

śvētaṁ raktaṁ sthiraṁ styānaṁ snigdhamutsannamaṇḍalam || 12 ||
kr̥cchramanyōnyasanyuktaṁ kuṣṭaṁ maṇḍalamucyatē |

Symptoms of Mandala type of Kustha include the following:

  • Skin turned white or red in texture,
  • Tightened, thickened, and smooth skin with roundly elevated patches here and there joined to one another. 12
Rsyajihva Kustha (Vata – pittaja) —

कर्कशं रक्तपर्यन्तमन्तः श्यावं सवेदनम् || १३ ||
यदृष्यजिह्वसंस्थानमृष्यजिह्वं तदुच्यते | 

karkaśaṁ raktaparyantamantaḥ śyāvaṁ savēdanam || 13 ||
yadr̥ṣyajihvasansthānamr̥ṣyajihvaṁ taducyatē |

Features of Rsyajihva variety of kustha include the following:

  • Skin turned very rough,
  • Appearance of patches on the skin that are red in colour, outside and black inside,
  • they are painful and
  • In shape resembling to the tongue of black deer. 13
 Pundarika Kustha (Pitta kaphaja) —

 सश्वेतं रक्तपर्यन्तं पुण्डरीकदलोपमम् || १४ ||
सोत्सेधं च सरागं च पुण्डरीकं तदुच्यते |

saśvētaṁ raktaparyantaṁ puṇḍarīkadalōpamam || 14 ||
sōtsēdhaṁ ca sarāgaṁ ca puṇḍarīkaṁ taducyatē | 

Features of Pundarika kustha are —

  • Appearance of patches on the skin that are white in the centre and red in the edges, similar to the petal of lotus flower with reddish elevated patches.14
 Sidhma Kustha (Vata – kaphaja) —

श्वेतं ताम्रं तनु यद्रजो घृष्टं विमुञ्चति || १५ ||
प्रायश्चोरसि तत् सिध्ममलाबुकुसुमोपमम् | 

śvētaṁ tāmraṁ tanu yadrajō ghr̥ṣṭaṁ vimuñcati || 15 ||
prāyaścōrasi tat sidhmamalābukusumōpamam |

Symptoms of Sidhma variety of kustha include the following –

  • Skin is white or coppery red in color,
  • Thin, scales of flesh coming off on scratching,
  • More common on the chest, resembling the flower of pitchergourd. 15
Kakana Kustha (Tridoshaja) —
यत् काकणन्तिकावर्णं सपाकं तीव्रवेदनम् ||१६ ||
त्रिदोषलिङ्गं तत् कुष्टं काकणं नैव सिध्यति | 

yat kākaṇantikāvarṇaṁ sapākaṁ tīvravēdanam ||16 ||
tridōṣaliṅgaṁ tat kuṣṭaṁ kākaṇaṁ naiva sidhyati |

When a suppurative and excessively painful lesion of the color of a kakantika is associated with the symptoms of vitiation of all the three doshas it is called as Kakana Kustha; it is not curable. 16

Clinical features of the eleven minor kusthas — 
Eka kustha and Charma kustha — 

अस्वेदनं महावस्तु, यन्मत्स्यशकलोपमम् || १७ ||
तदेककुष्टं, चर्माख्यं बहलं हस्तिचर्मवत् |

Features of Eka kustha include the following:

  • Absence of perspiration,
  • Large area of skin involved and the
  • skin resembling the scales of a fish.

In Charmakhya kustha, the skin becomes thick like that of an elephant’s skin. 17

Kitibha Kustha —

श्यावं किणखरस्पर्शं परुषं किटिभं स्मृतं || १८ ||
śyāvaṁ kiṇakharasparśaṁ paruṣaṁ kiṭibhaṁ smr̥taṁ || 18 ||

In the Kitibha kustha there appear skin patches that are black, rough and course to touch. They produce noise on scratching as well. 18

Vaipadika Kustha —

 वैपादिकं पाणिपादस्फुटनं तीव्रवेदनम् | 

vaipādikaṁ pāṇipādasphuṭanaṁ tīvravēdanam |

The symptoms of Vaipadika kustha are noticed in form of cracking hands and feet and formation of painful fissures.

Alasaka Kustha —

कण्डूमद्भिः सरागैश्च गणदैरलसकं चितम् || १९ || 
kaṇḍūmadbhiḥ sarāgaiśca gaṇadairalasakaṁ citam || 19 ||

In the Alasaka kustha there appear nodules that are red in complexion and itching. 19

Dadru Kushta —

सकण्डू – राग – पिडकं दद्रुमण्डलमुद्गतं | 
sakaṇḍū – rāga – piḍakaṁ dadrumaṇḍalamudgataṁ |

Raised patches studded with small, itching and reddish papules are the features of Dadrumandala kustha.

Charmadala Kustha —

रक्तं सशूलं कण्डूमत् सस्फोट यद्गलत्यपि |
तच्चर्मदलमाख्यातं संस्पर्शासहमुच्यते || २० ||

raktaṁ saśūlaṁ kaṇḍūmat sasphōṭa yadgalatyapi |
taccarmadalamākhyātaṁ sansparśāsahamucyatē || 20 ||

Skin studded with red, painful, itching nodules that do not allow touching are the features of Charmadala Kustha. 20

Pama and Kacchu Kustha —

सूक्ष्मा बह्वयः पिडकाः स्राववत्यः पामेत्युक्ताः कण्डुमत्यः सदाहाः |
सैव स्फोतैस्तीव्रदाहैरुपेता ज्ञेया पाण्योः कच्छुरुग्रा स्फिचोश्च || २१ || 

sūkṣmā bahvayaḥ piḍakāḥ srāvavatyaḥ pāmētyuktāḥ kaṇḍumatyaḥ sadāhāḥ |
saiva sphōtaistīvradāhairupētā jñēyā pāṇyōḥ kacchurugrā sphicōśca || 21 ||

The pathological condition that is marked with small, plentiful, exudating pustules with itching and burning sensation are known as Pama. On the other hand, the same appearing in the hands and on the buttocks with severe pain and itching are called as Kacchu. 21

Visphota kustha —

स्फोटाः श्यावारुणाभासा विस्फोटाः स्युस्तनुत्वचः | 

sphōṭāḥ śyāvāruṇābhāsā visphōṭāḥ syustanutvacaḥ |

The boils on the skin, appearance of black or blackish red patches on the skin and thinness of skin are the symptoms of Visphota.

Shataaru Kustha —

रक्तं श्यावं सदाहार्ति शतारु स्याद्बहुव्रणं || २२ || 

raktaṁ śyāvaṁ sadāhārti śatāru syādbahuvraṇaṁ || 22 |

Likewise, innumerable small ulcers that are red or blue in complexion, with severe burning sensation and pain are the features of Shataru. 22

Vicharchika Kustha —

सकण्डूः पिडका श्यावा बहुस्रावा विचर्चिका | 

sakaṇḍūḥ piḍakā śyāvā bahusrāvā vicarcikā |

Symptoms of Vicharchika are itching, black colour , and copious exudation.

Clinical features due to doshas in the kustha lesions —

खरं श्यावारुणं रूक्षं वातात् कुष्टं सवेदनम् || २३ ||
पित्तात् प्रक्वथितं दाह – राग – स्रावान्वितं मतम् |
कफात् क्लेदि घनं स्निग्धं सकण्डू – शैत्य – गौरवम् || २४ ||
द्विलिङ्गं द्वन्द्वजं कुष्टं, त्रिलिङ्गं सान्निपातिकम् | 

kharaṁ śyāvāruṇaṁ rūkṣaṁ vātāt kuṣṭaṁ savēdanam || 23 ||
pittāt prakvathitaṁ dāha – rāga – srāvānvitaṁ matam |
kaphāt klēdi ghanaṁ snigdhaṁ sakaṇḍū – śaitya – gauravam || 24 ||
dviliṅgaṁ dvandvajaṁ kuṣṭaṁ, triliṅgaṁ sānnipātikam |

Symptoms of kustha originated through vitiation of Vata include the following:

  • Roughness,
  • Blue or bluish red complexion,
  • Dryness and pain;

 These are the symptoms of Kustha originated through vitiation of Pitta —

  • Putrefaction
  • Burning sensation,
  • Redness and
  • Exudation from the morbid patches on skin.

The symptoms of kustha originated through vitiation of Kapha —

  • Unctuousness,
  • Thickness,
  • Greasiness,
  • Itching,
  • Cold and
  • Feeling of heaviness.

The features of two doshas and all of the three doshas might also manifest in certain (combined) varieties of kustha. 23 -24

Skin —

त्वक्स्थे वैवर्ण्यमङ्गेषु कुष्टे रौक्ष्यं च जायते || २५ ||

tvaksthē vaivarṇyamaṅgēṣu kuṣṭē raukṣyaṁ ca jāyatē || 25 ||

Symptoms when the Skin (rasa dhatu) is involved by Kustha —

  •  Discoloration of the skin,
  • Roughness,
  • Loss of sensation,
  • Hairs standing on and
  • Frequently and profuse perspiration are seen. 25
Blood —

त्वक्स्वापो रोमहर्षश्च स्वेदस्यातिप्रवर्तनम् |
कण्डूर्विपूयकश्च इव कुष्टे शोणितसंश्रिते || २६ || 

tvaksvāpō rōmaharṣaśca svēdasyātipravartanam |
kaṇḍūrvipūyakaśca iva kuṣṭē śōṇitasanśritē || 26 ||

Itching and appearance of pustules in large numbers will manifest when kushta invades Blood (rakta). 26

Muscles —

बाहुल्यं वक्त्रशोषश्च कार्कश्यं पिडकोद्गमः |
तोदः स्फोटः स्थिरत्वं च कुष्टे मांससमाश्रिते || २७ ||

 bāhulyaṁ vaktraśōṣaśca kārkaśyaṁ piḍakōdgamaḥ |
tōdaḥ sphōṭaḥ sthiratvaṁ ca kuṣṭē mānsasamāśritē || 27 ||

There could be appearance of thick, elevated patches on the skin, dryness of the mouth, roughness, appearance of nodules, pricking pain, appearance of fissures and tightness of the skin when kusthaa invades muscle (mamsa). 27

Adipose Tissue —

कौण्यं गतिक्षयो अङ्गानां सम्भेदः क्षतसर्पणम् |
मेदः स्थानगते लिङ्गं प्रागुक्तानि तथैव च || २८ || 

kauṇyaṁ gatikṣayō aṅgānāṁ sambhēdaḥ kṣatasarpaṇam |
mēdaḥ sthānagatē liṅgaṁ prāguktāni tathaiva ca || 28 ||

Loss of fingers, loss of movement, pain, spreading of ulcer will also be seen in addition when kustha impacts fat. (medas) 28

Bone and bone marrow —

नासाभङ्गो अक्षिरागश्च क्षतेषु क्रिमिसम्भवः |
स्वरोपघातश्च भवेदस्थि – मज्जासमाश्रिते || २९ || 

nāsābhaṅgō akṣirāgaśca kṣatēṣu krimisambhavaḥ |
svarōpaghātaśca bhavēdasthi – majjāsamāśritē || 29 ||

Loss of the nose, redness of the eyes, appearance of worms in the ulcers and loss of voice will manifest when kustha impacts the bones (asthi) and bone marrow (majja). 29

Sperms and ovum —

दम्पत्योः कुष्ट बाहुल्याद्दुष्टशोणित – शुक्रयोः |
यदपत्यं तयोर्जातं ज्ञेयं तदपि कुष्टितम् || ३० ||

dampatyōḥ kuṣṭa bāhulyādduṣṭaśōṇita – śukrayōḥ |
yadapatyaṁ tayōrjātaṁ jñēyaṁ tadapi kuṣṭitam || 30 ||

The child might also acquire congenital leprosy when his parents are suffering from leprosy as both the sperm and ovum get affected by leprosy. 30

Prognosis —

साध्यं त्वग्रक्त – मांसस्थं वात – श्लेष्माधिकं च तत् |
मेदसि द्वन्द्वजं याप्यं, वर्ज्यं मज्जास्थिसंश्रितं || ३१ || 

sādhyaṁ tvagrakta – mānsasthaṁ vāta – ślēṣmādhikaṁ ca tat |
mēdasi dvandvajaṁ yāpyaṁ, varjyaṁ majjāsthisanśritaṁ || 31 ||

Those varieties that are caused by pre dominance of vata and kapha and the leprosy invading tvak, rakta and mamsa are curable, the leprosy that invades medas and that is caused by the combination of two doshas either becomes chronic. The leprosy that involves majja and asthi has been noted as the incurable ones. 31

क्रिमि – तृड् – दाह – मन्दाग्निसंयुक्तं यत् त्रिदोषजं |

 krimi – tr̥ḍ – dāha – mandāgnisanyuktaṁ yat tridōṣajaṁ |

Fatal cases —

‘ प्रभिन्नं प्रस्रुताङ्गं च रक्तनेत्रं हतस्वरम् || ३२ ||
पञ्चकर्मगुणातीतं कुष्टं हन्तीह मानवम् ‘ |

 ‘ prabhinnaṁ prasrutāṅgaṁ ca raktanētraṁ hatasvaram || 32 ||
pañcakarmaguṇātītaṁ kuṣṭaṁ hantīha mānavam ‘ |

The varieties of Kustha that might prove fatal include the following symptoms:

  • Presence of worms in the ulcers,
  • Morbid thirst,
  • Feeling of burning sensation,
  • Poor digestive capacity,
  • Involvement of all the three doshas vitiated together,
  • Mutilation and loss of body parts,
  • redness of the eyes,
  • Loss of voice.
  • A case of kustha might also prove fatal if it affects the patients who are not fit for the five purificatory treatments. 32
Doshika classification of kusthas —

वातेन कुष्टं कापालं, पित्तैनौदुम्बरं, कफात् ||३३ ||
मण्डलाख्यं विचर्चि च, ऋष्याख्यं वात – पित्तजम् |
चर्मैर्ककुष्टं किटिभं सिध्मालस – विपादिकाः || ३४ ||
वात – श्लेष्मोद्भवाः, श्लेष्म – पिताद्दद्रु – शतारुषी |
पुण्डरीकं सविस्फोतं पामा चर्मदलं तथा || ३५ ||
सर्वैः स्यात् काकणम्, पूर्वत्रिकं दद्रु सकाकणम् |
पुण्डरिकर्ष्यजिह्वे च महाकुष्टानि सप्त तु || ३६ ||

vātēna kuṣṭaṁ kāpālaṁ, pittainaudumbaraṁ, kaphāt ||33 ||
maṇḍalākhyaṁ vicarci ca, r̥ṣyākhyaṁ vāta – pittajam |
carmairkakuṣṭaṁ kiṭibhaṁ sidhmālasa – vipādikāḥ || 34 ||
vāta – ślēṣmōdbhavāḥ, ślēṣma – pitāddadru – – śatāruṣī |
puṇḍarīkaṁ savisphōtaṁ pāmā carmadalaṁ tathā || 35 ||
sarvaiḥ syāt kākaṇam, pūrvatrikaṁ dadru sakākaṇam |

puṇḍarikarṣyajihvē ca mahākuṣṭāni sapta tu || 36 ||

  • Kapala Kustha is caused by Vata
  • the Udumbara kustha by Pitta and
  • Mandala by kapha;
  • The rsyajihva is produced by the vitiated Vata and Pitta
  • Charmakhya, Eka, Kitibha, Sidhma, Alasa, Vipadika are generated by vitiated Vata and Kapha;
  • Dadru, Shataru, Pundarika, Visphota, Pama and Charmadala are vitiated by kapha and pitta;
  • Kakana is generated by all the three doshas together.

The seven maha kusthas are the —

  • Kapala
  • Udumbara
  • Mandala
  • Dadru
  • Kakana
  • Pundarika and
  • Rshyajihva
Leucoderma —

कुष्तैकसंभवं श्वित्रं किलासं वारुणं भवेत् |
निर्दिष्टमपरिस्रावि त्रिधातूद्भवसंश्रयं || ३७ ||
वाताद्रुक्षारुणं, पित्तात्ताम्रं कमलपत्रवत् |
सदाहं रोमविध्वंसि, कफाच्छवेतं घनं गुरु || ३८ ||
सकण्डुरं क्रमाद्रक्त – मांस – मेदःसु चादिशेत् |
वर्णेनैवेदृगुभयं कृच्छ्रं तच्चोत्तरोत्तरम् || ३९ || 

kuṣtaikasambhavaṁ śvitraṁ kilāsaṁ vāruṇaṁ bhavēt |
nirdiṣṭamaparisrāvi tridhātūdbhavasanśrayaṁ || 37 ||
vātādrukṣāruṇaṁ, pittāttāmraṁ kamalapatravat |
sadāhaṁ rōmavidhvansi, kaphācchavētaṁ ghanaṁ guru || 38 ||
sakaṇḍuraṁ kramādrakta – mānsa – mēdaḥsu cādiśēt |
varṇēnaivēdr̥gubhayaṁ kr̥cchraṁ taccōttarōttaram || 39 ||

Leucoderma (svitra) and leucoderma with pinkish tinge (kilasa) are generated by the causes that are instrumental also in producing leprosy (kustha); They are non exudative and tridoshaja in origin.

  • There is roughness and pink complexion (of the patches of skin) in this disease due to Vata;
  • there appear (on the patches of skin) coppery – red colour like that of the lotus petal, feeling of burning sensation and loss of hair due to pitta;
  • white complexion, thickness (of the patches of skin), feeling of heaviness and itching are there due to vitiation of kapha; 
  • Involvement of blood (rakta), muscles (mamsa) and fat (medas) cause various types of colors and pain.

Compared to the preceding ones the successive kinds of kustha are more dreadful. 37 – 39

Prognosis of Leucodermas —

अशुक्लरोमा अबहुलसंश्लिष्टमथो नवं |
अनग्निदग्धजं साद्यं श्वित्रं वर्ज्यमतो अन्यथा || ४० ||
गुह्य – पाणितलौष्टेषु जातमप्यचिरन्तनम् |
वर्जनीयं विशेषेण किलासं सिद्धिमिच्छता || ४१ ||

 aśuklarōmā abahulasanśliṣṭamathō navaṁ |
anagnidagdhajaṁ sādyaṁ śvitraṁ varjyamatō anyathā || 40 ||
guhya – pāṇitalauṣṭēṣu jātamapyacirantanam |
varjanīyaṁ viśēṣēṇa kilāsaṁ siddhimicchatā || 41 ||

The following cases of the disease could be understood as curable ones:

  • Leucoderma (svitra) in that the hairs have not turned white;
  • The skin has not got thick, patches have not joined each other that is of recent origin and
  • the one that has not been generated as an effect of burns.

All other kinds of leucoderma (svitra) are incurable. They include the ones with white patches on the genital organs, palms of the hands and soles of the foot and lips and that which has persisted for a long time. 40-41

Modes of spread of contagious diseases —

प्रसंगाद्गात्रसंस्पर्शा न्निःश्वासात् सहभोजनात् |
एकशय्यासनाच्चैव वस्त्रमाल्यानु लेपनात् || ४२ ||
कुष्टं ज्वरश्च शोषश्च नेत्राभिष्यन्द एव च |
औपसर्गिकरोगाश्च संक्रामन्ति नरान्नरम् || ४३ || 

prasaṅgādgātrasansparśā nniḥśvāsāt sahabhōjanāt |
ēkaśayyāsanāccaiva vastramālyānu lēpanāt || 42 ||
kuṣṭaṁ jvaraśca śōṣaśca nētrābhiṣyanda ēva ca |
aupasargikarōgāśca saṅkrāmanti narānnaram || 43 ||

The media of transmission of diseases from one person to another are

  • sexual intercourse,
  • physical contact with the air breathed out by a patient,
  • dining together
  • Sleeping on the same bed,
  • Common use of clothing, garlands, unguents and the like.

The diseases that are known as contagious diseases(Aupasargika rogas) are :

  • Leprosy,
  • Fevers,
  • Tuberculosis
  • Ophthalmic and
  • several other diseases that are transmitted in this manner. 42-43

 इति श्रीमाधवकरविरचिते माधवनिदाने कुष्टनिदानं समाप्तम् || ४९ || 

iti śrīmādhavakaraviracitē mādhavanidānē kuṣṭanidānaṁ samāptam || 49 ||

Thus concludes the chapter on Kustha.