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Introduction

The skin is our body's biggest organ. It is one of the five Gyanendriyas described in Ayurvedic scriptures, and it is responsible for the feeling of "Sparsha Gyan," or touch. Under the umbrella of Kushtha, the majority of skin problems have been documented.[1] The Twak rogas are known in Ayurveda as 'Kushtha,' which is derived from the root 'Kushu,' which indicates that it emerges from the interior to the outside parts of the body and kills the body's organs, hence the name. The Twak roga is described in the Atharvaveda 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 diagnosis and therapy of Kushtha are also mentioned in the Garuda Purana (Leprosy and other skin disorders). Ayurveda's golden age is known as the Samhita period. Almost all of the samhitas categorise Kushtha as Maha Kushtha or Kshudra Kushtha, however there is disagreement over the number of people in each group, which might be linked to the severity of the sickness.[2]

Concept of Kushtha Roga:

Kushta is a Tridoshaja vyadhi mentioned in Ayurveda that undergoes manifestation in the Bahya rogamarga. Kushta is considered a Mahagada due to its Durvijneya, Sudustara and Daruna swabhava. 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.

Nirukti:

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.

Vyakhya:

Kushnativapuetikushtam i.e., that which disfigures the body is known as Kushtha.

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[5,6]

(a) Consumption of liquid, unctuous, and weighty foods and beverages that are mutually contradictory.

(a) The need to vomit and other natural desires are suppressed.

b) Exercising in extreme heat and after consuming a large meal.

(d) Disobedience to the established order in terms of heat and cold, as well as fasting and food intake.

(e) Immediately after exposure to the blazing heat, exercise, or exposure to a terrifying scenario, use cold water.

(f) Consumption of raw or undercooked foods, as well as food consumed before the preceding meal has been digested.

(g) Violation of the panchakarma technique.

(h) Excessive consumption of freshly harvested grains, curd, fish, salt, and sour ingredients in meal preparations. Consumption of masa, mulaka, pastry, tila, milk, and jaggary in excess.

(j) Performing a sexual act while experiencing dyspepsia. (k) Get some rest during the day.

(l) Insults to brahmins and preceptors, as well as other sins.

Viharaj [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 identified numerous variables that have a detrimental effect on the psyche/mind, including Chinta (worry), Shoka (sorrow), Bhaya (fear), abusing deities and instructors, other types of immoral actions, and other sorts of anti-rituals and anti-social behaviours. This negative influence on the psyche causes stress, which plays a crucial role in the emergence and/or aggravation of dermatological illnesses, either directly or indirectly.

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]

According to Acharya Sushruta, Doshaja and Karmaja Hetus cause Pitta and Kapha to exacerbate, resulting in Avarana of Vata, which aggravates Vata. The Tiryaka Sira contains vitiated Vata together with two additional vitiated Doshas, and its spread causes more vitiation. It then travels to Bahya Rogamarga (Tvak, Rakta, Mamsa, Lasika) and spreads throughout the body, forming Mandala at the Doshas' meeting place. If these Doshas are not adequately addressed. After there, they go into the body's deeper Dhatus.[11]

chart

Basis of classification for Kushtha

• On the basis of Dosha Arambhata, Uttarottar Dhatu Anupraveshata, Lakshanas and Chikitsa Kushtha has been divided into Kshudrakushtha and Mahakushtha.
• On the basis of Dosha predominanace Kushtha can be grouped into three categories i.e. Vataja, Pittaja and Kaphaja
• On the basis of Dhatugatatva Kushtha can be classified into Rasagata, Raktagata, Mansagata, Medagata, Asthigata, Majjagata and Shukragata.

Premonitory symptoms:

Lack of perspiration or excessive perspiration, roughness of excessive smoothness, discolouration, itching, pricking pain, numbness, burning sensation, tingling sensation, horripilation, coarseness, production of heat, heaviness, frequent occurrence of oedema and acute spreading, sticking of excreta in the body specially in the orifices, excessive pain in case of suppuration, burn, bite, fracture and dislocation, putrefaction and non-healing of even small wounds.

Lakshanas:

Symptoms confined to skin[11]

1. Sparsha hani (loss of sensation on touch)
2. Svedanatwa (Anhydrosis.)
3. Kandu (Itching)
4. Vaivarnya (Discolouration! hypopigmentation)
5. Rukshatwa (Dryness of skin.)

Symptoms confined to Rakta Dnatu (Blood and Plasma)

1. Complete loss of sensation
2. Romaharsha
3. Kandu (Itching.)
4. Vipuyaka (severe accumulation of pus or formation of pastules).

Symptoms when infection carried to Mamsa[12]

1. Vaktrashosha (Dryness of the throat)
2. Karkashya(Patches become rough and hard)
   Pidakodrama (Macules appears.)

Symptoms Of Shukra Dhatu (Semen & Ovum)[13]

1. Kaunya (crippled state of hands and distoration of limbs)
2. Angagati Ksaya (loss of movement of limbs)
3. Sambheda (penetrating pain)

Sankramikatwa (Infectivity):

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.

Sadhyasadhyata (Prognosis):

In Sadhya Kushta, Eka Dosholbana, Vata-Kapha Pradhanata, which has solely impacted Twak, Rakta, and Mamsa, has a fair possibility of recovery in this situation. In Yapya Kushta if the Doshas are in Medo Dhatu and the Rogi practises correct Bheshaja and Pathya, he would be rid of the Roga's afflictions. Vyadhi is likely to relapse after he finishes the Aushadhis and follows the Apathya. Asadhya Kushata Lakshanas are those that exhibit the following characteristics: Sarva Lingayukta, Abala, Trushna, Daha, Santhagni, presence of Jantu, Doshas that have attained Asthi, Majja, and Shukra Dhatus.

Chikitsa:

For practically all sorts of ailments, including dermatological disorders, Ayurveda stresses three-fold therapeutic management of diseases: Samshodhana (biopurification),

Samshamana (pacification), and Nidana Parivarjana (avoiding causative factors).[14] According to Acharya Charaka, Vaman (therapy emesis) is employed in Kapha predominant Kushtha, and Virechan (therapeutic purgation) and Raktamokshana (therapeutic blood-letting) are used in Pitta prominent Kushtha. For the treatment of Kushtha Roga, Acharya Sushruta recommends Nasya Karma (nasal medicament) every third day, Vaman every fifteenth day, Virechan every month, and Raktamokshana every six months.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. In Ayurveda, most of the medications used to treat dermatological problems are endowed with Rasayana properties. Immunomodulator, adaptogenic, antioxidant, and antistress are only a few examples. As a result, Rasayana medicines are critical in the treatment of dermatological problems. Skin health can be restored and maintained by directly addressing the many layers and cells of the skin that are involved in the ageing and functioning of the skin, as well as in disease aetiology.

Discussion

Kushta is a tridoshaja vyadhi that manifests in the bahya rogamarga, according to Ayurveda. Due to its durvijneya, sudustara, and daruna swabhava, Kushta is regarded a mahagada. Depending on the intensity of the samprapti 

ghataka, the samprapthi of kushta begins with the myriad of interactions of tridosa with twak, rakta, mamsa, and lasika, and progresses to affect other dhathus. Under the umbrella of Kushtha, the majority of dermatological problems have been documented. Physical, physiological, genetic, psychological, psychosocial, and Papakarma, among others, are etiological factors. Eighteen types of Kushtha are Mahakustha (seven type) and Kshudrakusthas (eleven types). Symptoms like Shweta, Tamra Varna, Tanu, Rajoghrushta, and Alabu Pushpavat are discussed in Charaka's Chikitsa Sthana. 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. Ahara (diet or dietary supplementation) is very much emphasized in Ayurvedic system of medicine for the prevention as well as management of wide range of disorders including dermatological disorders. The diet rich in Amla, Lavana and Katu Rasa, milk, curd, jaggery, heavy diet and diet which aggravated Kapha Dosha should be avoided. 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.

Kushtha is one of humanity's earliest recognised ailments. It is classified as one of the most chronic diseases in the Ayurvedic medical system. Ayurveda classified a vast range of dermatological illnesses, as well as their etiopathogenesis, clinical appearance, prevention, and therapy. Acharya Charaka has described four Dushyas as Twak, Raktha, Mamsa and Lasika Dhathu which are primarily involved in the manifestation of Kushta. It is considered as one of the most chronic disorders which is very difficult to cure.

Conclusion

Kushtha is one of humanity's earliest recognised ailments. It is classified as one of the most chronic diseases in the Ayurvedic medical system. Ayurveda classified a vast range of dermatological illnesses, as well as their etiopathogenesis, clinical appearance, prevention, and therapy. Acharya Charaka has described four Dushyas as Twak, Raktha, Mamsa and Lasika Dhathu which are primarily involved in the manifestation of Kushta. It is considered as one of the most chronic disorders which is very difficult to cure.