Sushruta Samhita, volume 2: Nidanasthana

by Kaviraj Kunja Lal Bhishagratna | 1911 | 37,609 words

This current book, the Nidana-sthana (english translation), is the second part of this voluminous medical work. It deals with diseases: their prognosis, their cause, their symptoms and their pathogenesis (development of the disease). The Sushruta Samhita is the most representative work of the Hindu system of medicine. It embraces all that can poss...

Chapter V - Diagnosis of leprosy and other skin diseases

Now we shall discourse on the Nidana of Kushtha (cutaneous affections in general), 1.

Improper diet or conduct; especially ingestion of improper, unwholesome, indigestible, or incongenial food; physical exercise or sexual intercourse immediately after partaking of any oleaginous substance, or after vomiting; constant use of milk in combination with the meat of any domestic, aquatic or amphibious animal; a cold water bath after an exposure to heat; and repression of any natural urging for vomiting etc. are the factors which tend to derange and aggravate the fundamental principle of Vayu in a person. The enraged or aggravated Vayu, in combination with the agitated Pitta and Kapha, enters into the vessels or ducts (Shira), which transversely spread over the surface of the body. Thus the enraged Vayu deposits the Pitta and Kapha on the skin through the medium of their channels and spreads them over the entire surface of the body. The regions of the skin in which the aforesaid morbific diatheses are deposited become marked with circular rings or patches. The morbific diatheses (Doshas), thus lodged in the skin, continue to aggravate, and having been neglected at the outset, tend to enter into the deeper tissues and thus contaminate the fundamental principles (Dhatus) of the body. 2.

Premonitory Symptoms:—

A roughness of the skin, sudden horripilation, an itching sensation in the surface of the body, excess or absence of perspiration, anethesia of the parts, a black colour of the blood, and a rapid growth and expansion of any ulcer (appearing on the body) are the symptoms which mark the premonitory stages of Kushtha. 3.


[Diseases, falling under the group of Kushtha, may be divided into two broad subdivisions], viz—Mahakushthas (major) and Kshudra (minor) Kushthas, the first consisting of seven, and the second of eleven different types, aggregating eighteen in all.

The Mahakushthas are classified as,

  1. Aruna,
  2. Audumvara,
  3. Rishya-Jihva,
  4. Kapala,
  5. Kakanaka,
  6. Pundarika,
  7. and Dadru.

The minor or Kshudra-kushthas (Lichen and Dermatitis) are

  1. Sthularushka,
  2. Mahakushtha,
  3. Ekakushtha,
  4. Carmadala,
  5. Visarpah,
  6. Parisarpah,
  7. Sidhma,
  8. Vicharchika,
  9. Kitima,
  10. Pama,
  11. and Rakasa.

All the types of Kushtha, whether major or minor, involve the action of the deranged Vayu, Pitta or Kapha, and are connected with the presence of parasites in those localities.[1] The preponderance of any particular morbific diathesis (Dosha) in any case of Kushtha should be looked upon as its originating cause. The type, known as Aruna Kushtha, is due to the action of the preponderant Vayu; Audumvara, together with Rishya-Jihva, Kapala and Kakanaka, to a preponderance of the deranged Pitta; while Pundarika and Dadru owe their origin to an excess of the deranged Kapha. These types of major or minor Kushthas are successively more extensive in their action and more incurable on account of their respectively invading a greater number of the bodily elements (Dhatus). 4—6.


Aruna-kushtha owes its origin to an exuberance of the deranged Vayu. It is slightly vermilion-coloured, thin and spreading in its nature. A sort of pricking, piercing pain (is experienced in the affected locality) which loses all sensibility to the touch. The type known as Audumbara is coloured and shaped like a ripe or mature Audumbara fruit and has its origin in the deranged Pitta. The type called Rishyajihva is rough and resembles the tongue of a Rishya (Deer) in shape and colour. The type known as Kapala (Macula cerule) resembles a black (deep blue) Kharpara (baked clay). The Kakanaka type is characterised by a dark red and black colour like the seed of the Gunja berry. A sort of sucking and burning pain is experienced in the affected locality in all the four preceding types of the disease which are the outcome of the deranged Pitta. The whole diseased surface seems as if burning with fire, and emitting hot fumes. They are speedy in their origin and rapidly suppurate and break. All these types soon become infested with parasites. These are the general features of these forms of Kushthas. 7.


The patches resemble the petals of a (full blown) lotus flower in colour, and Dadru (Ringworm) assumes the colour (Taint blue) of an Atasi flower, or of copper. They are spreading in their nature and are found to be overspread with pustules. Both the Dadru and Pundarika types are raised, circular, and characterised by itching and take a considerable time to be fully patent. These are the general characteristics of Dadru and Pundarika. 8.

Kshudra Kushthas:—

We shall now describe (the features of the diseases known as) Kshudra-kushthas (M.Text):—The type known as Sthularushka appears about the joints. It is extremely thick at its base, is cured with the greatest difficulty, and is strewn over with hard pustules (Arungshi). In the type known as of Mahakushtha the skin contracts, and with the bursting of the skin (a piercing pain is felt in the affected part), which loses all sensibility to the touch, accompanied by a general sense of lassitude in the limbs. In the Ekakushtha (Ichthyosis) type the skin assumes a reddish black colour. It is incurable. In the form known as Carmadala (Hypertrophy of the skin) a burning, sucking, drawing pain is experienced in the palms of the hands and in the soles of the feet which become characterised with an itching sensation. The disease, which affects in succession the (organic principles of) skin, blood and flesh, and speedily extends all over the body, like Erysipelas, and is attended with a burning sensation (Vidaha), restlessness, suppuration and a piercing pain and loss of consciousness (epileptic fits), is called Visarpa Kushtha. The form in which a number of exuding pustules gradually extend over the surface of the body is called Parisarpa Kushtha. The type of the disease which is white and thin, and is characterised by itching and does not create any disturbance (in the patient), is called Sidhma (Macule atrophice). This form is generally found to restrict itself to the upper part of the body. Vicharchika (Psoriasis) is characterised by excessive pain and itching and gives rise to extremely dry crack-like marks on the body [hands and feet]. The same form of malady attended with pain, burning and itching, and restricting itself solely to the lower extremities, is called Vipadika. The type in which the eruptions exude (a kind of slimy secretion) and which are circular, thick, excessively itching, glossy and black-coloured is called Kitima (Keloid tumours). Small pustules or pimples characterised by an itching, burning secretion and appearing on the surface of the body are called Pama (Eczema). The preceding kinds of pimples attended with burning vesicles, are called Kaccus and are found to be chiefly confined to the legs, hands and buttocks. A sort of dry and non-exuding pimples characterised by excessive itching and appearing all over the body, is called Rakasa (dry Erythema). 9-10.

The forms known as Sthularushka, Sidhma, Rakasa, Mahakushtha and Ekakushtha should be considered as offspring of the deranged Kapha. Parisarpa-kushtha alone is due to the action of the deranged Vayu, while the remaining types (of minor Kushtha) owe their origin to the action of the deranged Pitta. 11.


The disease known as Kilasam is but another form of Kushtha. It may be divided into three types according as it is brought about through the action of the deranged Vayu, Pitta or Kapha. The difference between Kilasam and Kushtha is that the former confines itself only to the Tvaka (the skin)and is marked by the absence of any secretion.[2] A case of Kilasam caused by the action of the deranged Vayu is circular, vermilion-coloured and rough to the touch. The affected part when rubbed peals off scales of morbid skin. A case of Kilasam, due to the action of the deranged Pitta, is marked by eruptions, resembling the petals of a lotus flower (in shape and colour), and are attended with an extremely burning sensation. In the type originated through the action of the deranged Kapha, the affected part (skin) assumes a glossy, white colour, becomes thick and is marked by an itching sensation. The form in which the eruptions or patches extend and become confluent, invading even the soles of the feet, the palms of the hands and the region of the anus, and in which the local hairs assume a red colour should be regarded as incurable. A case of Kilasha, which is the outcome of a burn (cicatrix) should be likewise considered as incurable. 12.

A preponderance of the deranged Vayu in a case of Kushtha (leprosy) is indicated by a contraction of the skin, local anesthesia, a copious flow of perspiration, swelling, and piercing or cutting pain in the affected part, together with a deformity of the limbs and hoarseness. Similarly, an excess of the deranged Pitta in a case of Kushtha, should be presumed from the suppuration of the affected part, from the breaking of the local skin, from the falling off of the fingers, from the sinking of the nose and ears, from the redness of the eyes and from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapha, in a case of Kushtha, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and Kakana, which are due to the germinal defect of the patient, are incurable, inasmuch as they involve (according to Dallana) the concerted action of the three simultaneously deranged Doshas from the very outset. 13.

Memorial verses:—

As a tree, full grown in the course of time, has driven its roots, which derive their nourishment from the rain water, deeper and deeper into the successive strata of the soil, so this disease (Kushtha), first affecting and confining itself to the upper layers of the skin, will invade the deeper tissues and organs etc. of the patient, if unchecked until almost all the fundamental principles or elements Dhatus are attacked by its virus in the course of time. 14.

The symptoms of a case of Kushtha confined only to the serous (Tvaka) fluid of the skin are the loss of the perception of touch, a scanty perspiration, itching and discoloration and roughness of the affected part. The symptoms which manifest themselves when the disease is confined to the blood are complete anesthesia, horripilation, absence of perspiration, itching and excessive accumulation of pus in the affected parts. The symptoms of Kushtha affecting only the flesh are thickness of the patches, dryness of the mouth, roughness and hardness of the patches which become covered with pustular eruptions and vesicles, and an excruciating pricking pain in, and numbness of, the affected part. The symptoms of (Kushtha) invading the principle of fat only are a fetid smell and an excessive accumulation of pus in the affected part and a breaking of the skin, exposing deep gashing wounds which soon become infested with parasites. The body seems as if covered with a plaster. Symptoms of (Kushtha) affecting only the bones and the marrow are a sinking (lit: breaking) of the nose, a redness of the eyes, loss of voice and the germination of parasites in the incidental ulcers. Symptoms of the disease restricting itself only to the principle of semen are a crippled state of the hands and distortion of the limbs, loss of the power of locomotion, spreading of ulcers and all the other symptoms peculiar to the preceding types of the disease. 15 —20.

A child, which is the offspring of the contaminated semen and ovum of its parents afflicted with Kushtha, should be likewise regarded as a Kushthi. 21.


A case of Kushtha appearing in a person of prudence and discretion and confined only to the serum (Tvaka), flesh and blood of his organism should be regarded as curable. A palliative treatment is the only remedy in cases where the disease is found to invade the principle of fat; whereas a case where the poison is found to have penetrated into any of the remaining organic principles should be given up as incurable. 22.

Wise men hold that, for killing a Brahmana, or a woman, or one of his own relations, for theft, as well as for doing acts of impiety, a man is sometimes cursed with this foul disease by way of divine retribution. The disease reattacks a man even in his next rebirth in the event of his dying with it. Uncured Kushtha (leprosy) is the most painful, and most troublesome of all diseases. 23—24.

A Kushthi (leper), getting rid of this foul malady by observing the proper regimen of diet and conduct and by practising expiatory penances and by resorting to proper medicinal measures, gets an elevated status after death. 25.

Kushtha (Leprosy) is a highly contagious disease; the contagion being usually communicated through sexual intercourse with a leper (Kushthi), or by his touch or breath, or through partaking of the same bed, and eating and drinking out of the same vessel with him, or through using the wearing apparel, unguents and garlands of flowers previously used by a person afflicted with this dreadful disease. Kushtha (Leprosy), fever, pulmonary consumption, ophthalmia and other Aupasargika disease (incidental to the influences of malignant planets or due to the effects of impious deeds) are communicated from one person to another. 26.


Thus ends the fifth Chapter of the Nidanasthana in the Sushruta Samhita which treats of the Nidana of cutaneous affections (Kushtha).

Footnotes and references:


Certain authorities hold that, all types of Kushtha (cutaneous affections) to be of parasitic origin. The Garuda Purana avers that, the parasites, which infest the external principles of the body, are the primary causes of cutaneous affections—Kushthaika-hetavontarjah shlemshaja vahya-sambhavah. Ch. CLXIXV. 4.


A case of Kushtha has its primary seat in the blood and skin (of the patient), in which it lies confined during the period of incubation, after which it attacks the skin and secretes the characteristic secretion of the deranged Dosha involved in it.

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