Dermatology (d): Miscellaneous Skin Lesions

This subsection deals with the information on those skin diseases which are unspecified or are not classified into the previous subsections, as well as those records that include different types of skin diseases.

Theravāda:— “At that time a certain monk had a skin disease. ‘I allow, monks, to anoint with scented substances.’”^[1]

Dharmaguptaka:—“At that time a sick monk needed various types of fine powder-medicine for cleansing. The Buddha said: ‘[I] allow the use of various types of fine powder-medicine–herein, fine powder-medicine is: powder of poon tree, powder of common gurjun tree, [or] powder of silk-cotton tree–for cleansing. Either one makes [the powder] by himself or even makes [it] for each other.’^[2] There was a need of a pestle and a mortar. The Buddha said: ‘[I] allow possessing [them].’ There was a need of a dustpan, a sieve, [and] a broom. The Buddha said: ‘[I] allow possessing [them].’ Then the monks were fearful and cautious: they dared not add scented substance to the powder-medicine. The Buddha said: ‘[I] allow adding [it].’ Then there was no container for keeping the powder-medicine. The Buddha said: ‘[I] allow making a bottle [for that]. If there is a trouble of dust strewing [onto the powder-medicine], [I] allow making a lid [for the bottle]. If [you] want to cause [the powder-medicine] to be secure, [you] should keep it under the bed, or tie [it] to an ivory peg on the wall.’ At that time a sick monk used coarse powder-medicine to wash [his] body [and he] suffered from pain. The Buddha said: ‘[I] allow using fine powder [which is] like fine soil–taking [from things] like leaves, flowers, and fruits–to make the sick person be happy. Herein, sickness is: such as the body having a wound, or ringworm, or sore, or jielai 疥癩 (itching leprous disease?),^[3] [or] even foul body smell.’”^[4]

“Then there was a monk afflicted with blisters. The physician instructed [him] to use human fat. The Buddha said: ‘[I] allow the use.’”^[5]

In the above accounts, certain skin conditions–such as ringworm and wounds/sores–have been covered in the previous subsections. There are yet two skin lesions–jielai and blisters–that we will discuss. Jielai should belong to the category of leprous skin diseases, which is kuṣṭha in Sanskrit (or kuṭṭha in Pāli). This illness and its treatment are well taught in Āyurvedic texts. According to Āyurvedic lore, kuṣṭha is a group of skin disorders encompassing seven major (mahākuṣṭha) and eleven minor (kṣudrakuṣṭha) types of skin conditions (Caraka Saṃhitā Cikitsāsthāna 7. 13-26; Suśruta Saṃhitā Nidānasthāna 5. 5).^[6] By causative factors such as unsuitable diets, activities, or treatments, as well as sinful acts and ripening of previous deeds, all three humours are aggravated and they vitiate and loosen the skin, muscle tissues, blood and lymph. This gives rise to kuṣṭha. All types of kuṣṭha are caused by simultaneous aggravation of the three humours, but one or more humours dominate resulting in different types of this problem. Moreover, close contact and sharing with one having kuṣṭha can lead to the disease (Caraka Saṃhitā Nidānasthāna 5. 3, 4, 6; Cikitsāsthāna 7. 4-10, 31-32; Suśruta Saṃhitā Nidānasthāna 5. 3, 30, 3334; Cikitsāsthāna 9. 3; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 14. 1-7). The main principle of treatment is the alleviation of dominantly aggravated humours, followed by that of remaining humours. Various measures are used which may be repeated for healing, such as lubrication by intake of ghee or oil, emesis, purgation, and bloodletting;consumption of decoctions, medicinal powders, medicated oil or ghee; external application of ointments, pastes, powders, medicated ghee/oil; bathing with decoctions; massage with drugs; and so on. Skin patches, after fomentation, can be treated by scraping, incision, brushing, cauterisation by alkali, and so forth. Other measures–including taking wholesome foods and avoiding other diets, and observation of vows and discipline–are also important in treating this illness (Caraka Saṃhitā Cikitsāsthāna 7. 31-32, 39 ff.).^[7]

There is no distinct category of blistering skin lesions in Āyurvedic treatises. Blisters can occur in several diseases, such as visarpa, visphoṭa, and agnirohiṇī, while visphoṭa is regarded as a minor kuṣṭha ailment. These are different skin conditions with their pathogeneses and remedies.^[8]

Now we will briefly describe leprosy and blistering disease according to modern medical knowledge. Leprosy, also known as Hansen’s disease, is a bacterial infection caused by Mycobacterium leprae. This malady mainly affects the skin and peripheral nerves. The mode of transmission is not certain but nasal secretions may be responsible. Depending on the immune status of the infected person, this problem can present with two polar types: tuberculoid leprosy and lepromatous leprosy. The former is a localised disease in a patient with a competent immunity, while the latter is a generalised condition in one with an impaired immunity. Tuberculoid leprosy manifests with one or very few hypopigmented, anaesthetic, and flat lesions which have well-defined erythematous thickened edges and central atrophy. Nerves in the affected areas often are thickened. The lesions may heal spontaneously. Lepromatous leprosy has skin conditions more widespread with varied appearances. There are also hair loss in the affected skin (e.g. loss of eyelashes and eyebrows), mucosal involvement (affecting nose, mouth, and larynx), large area of anaesthesia, nerve palsies (giving rise to deformity and disability of limbs, as well as loss of sweating), and other tissue or organ involvement. Apart from these two forms of leprosy, clinical presentations can occur within the spectrum of these two poles and they are classified as three forms: borderline tuberculoid leprosy, borderline leprosy, and borderline lepromatous leprosy. Treatment of leprosy relies on multidrug therapy, using several antibiotics for six to twelve months. Other measures are also required, including management of lepra reactions (i.e. acute immunological reactions which often occur during drug treatments), education of the patient on the disease, prevention of injury to the anaesthetic hands and soles, rehabilitation of deformity and disability, and prevention of the infection by public health measures (Moss, Irving, and Anderson 2012, 130-132; Walker and Lockwood 2007, 165-171).

Blisters in skin can occur in many disorders. Causes of blistering diseases are: genetic (e.g. some types of epidermolysis bullosa);physical (e.g. contact with irritants or chemicals, heat and cold, irradiation, and trauma); infective (bacteria, viral, and fungal); inflammatory (e.g. eczema, insect bites); immunological (e.g. bullous pemphigoid, dermatitis herpetiformis, systemic lupus erythematosus, etc.); drug-related; and systemic (e.g. carcinoma, amyloidosis, etc.). Treatments are administered according to causes (Wojnarowska 2005, 76).

Several accounts relating to skin problems not examined in the previous three subsections have been studied in this subsection. In these cases, topical application of powders was the major treatment. Jielai should be associated with kuṣṭha, which is taught in detail in Āyurveda. Blisters can also occur in different skin conditions, but there is no separate section for blistering diseases in Āyurvedic texts. According to modern medicine, leprosy is a complex disease with many manifestations. Treatment for it mainly relies on multidrug therapy. There are numerous causes for blistering disorders, and remedies for such skin problems depend on the diagnoses.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 206: “tena kho pana samayena aññatarassa bhikkhuno chavidosābādho hoti. anujānāmi bhikkhave gandhālepaṃ kātun ti.”

[2]:

These powders have been mentioned in Section 4. 2. 10. 2 on “Medicinal Powders.”

[3]:

疥癩 literally means “itching leprosy”. It probably refers to one of the itching forms of leprous skin diseases (kuṣṭha), which will be discussed below. It may be udumbara, puṇḍarīka, sidhma, kiṭibha, alasaka, dadru, carmadala, pāmā, rakasā, vipādikā, or vicarcikā (Caraka Saṃhitā Cikitsāsthāna 7. 14-26; Suśruta Saṃhitā Nidānasthāna 5. 8-16; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 14. 13-30). Hirakawa, in A Buddhist Chinese-Sanskrit Dictionary (1997, 854), states that this Chinese term is vicarcikā, but it is not clear on what basis he makes this rendering.

[4]:

Taishō Tripiṭaka 1428. 867b2-13: “爾時病比丘須種種細末藥洗，佛言：「聽用種種細末藥。是中細末藥者，胡桐樹末，馬耳樹末，舍摩羅樹末洗。若自作若更互作。」須杵臼，佛言：「聽畜。」須簸箕簁掃帚，佛言：「聽畜。」時諸比丘畏慎，不敢以塗香著末藥中。佛言：「聽著。」時末藥無器盛，佛言：「聽作瓶。若患坌塵，聽作蓋。若欲令堅牢，當著床下、若串壁上 象牙杙上。」爾時病比丘，以麁末藥洗身患痛，佛言：「聽細末若細泥，若葉、若華、若 菓取令病者得樂。是中病者，若體有瘡、若癬、若瘑、若疥癩、乃至身臭。」”

[5]:

Taishō Tripiṭaka 1428. 870c5-6: “時有比丘患皰，醫教用人脂，佛言：「聽用。」”

[6]:

It is even stated that there are innumerable types in kusṭha due to the permutation and combination of various fractions of the humours and their location in the body (Caraka Saṃhitā Nidānasthāna 5. 4).

[7]:

The above outlines of treatment are extracted from the Caraka Saṃhitā. There are also chapters giving details on the treatment of kuṣṭha in the Caraka Saṃhitā (Cikitsāsthāna 7), the Suśruta Saṃhitā (Cikitsāsthāna 9-10), and the Aṣṭāṅga Hṛdaya Saṃhitā (Cikitsāsthāna 19).

[8]:

Details of these diseases can be read in Suśruta Saṃhitā Nidānasthāna 10; Cikitsāsthāna 17; Aṣṭāṅga Hṛdaya Saṃhitā Uttarasthāna 31-32.