We shall now describe (the features of the diseases known as) Kshudra-kushthas (M.Text): - The type known as Sthulárushka 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 Mahákushtham 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 Ekakushthain (Ichthyosis) type the skin assume reddish black colour. It is incurable. In the form known as Charmadalam (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 Kuslitham. The form in which a number of exuding pustules gradually extend ever the surface of the body is called Parisarpa Kushtham. 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 Sidhrna (Maculae atrophicae). 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 Vipádiká. 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 Pámá (Eczema). The preceding kinds of pimples attended with burning vesicles, are called Kachchus 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 Rakasá (dry Erythema). 9-10.
The forms known as Sthulárushka, Sidhma, Rakasá, Mahákushtham and Ekakushtham should be considered as offspring of the deranged Kapham. Parisarpa-kush-tham alone is due to the action of the deranged Váyu, while the remaining types (of minor Kushtham) owe their origin to the action of the deranged Pittam. II.
Kilásam: - The disease known as Kilásam is but another form of Kushtham. It may be divided into three types according as it is brought about through the action of the deranged Váyu, Pittam or Kapham. The difference between Kilásam and Kushtham is that the former confines itself only to the Tvaka (the skin)and is marked by the absence of any secretion.* A case of Kilasam caused by the action of the deranged Váyu is circular, vermilion-coloured and rough to the touch. The affected part when rubbed peals off" scales of morbid skin. A case of Kilásam. due to the action of the deranged Pittam. 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 Kapham, 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 Kilásham, which is the outcome of a burn (cicatrix) should be likewise considered as incurable. 12.
* A case of Kushtham has its primary feat 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.
A preponderance of the deranged Váyu in a case of Kushtham (leprosy) is indicated by a contraction of the skin, local anaesthesia, 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 Pittam in a case of Kushtham, 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 cars, from the redness of the eyes and from the germination of parasites in the incidental ulcer. An excessive action of the deranged Kapham. in a case of Kushtham, gives rise to itching, discolouring and swelling of the affected part which becomes heavy and exudes the characteristic secretion. The types, Pundarika and Kákanam, 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.
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 (Kushtham), 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 Dhátus are attacked by its virus in the course of time. 14.
The symptoms of a case of Kushtbam 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 anaesthesia, horripilation, absence of perspiration, itching and excessive accumulation of pus in the affected parts, The symptoms of Kushtham 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 (Kushtham) 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 (Kushtham) 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 arc 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 Kushtham, should be likewise regarded as a Kushthi. 21.
Prognosis: - A case of Kushtham 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 Bráhmana, 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. Uncurcd Kushtham (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.
Kushtham (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. Kushtham (Leprosy), fever, pulmonary consumption, ophthalmia and other Aupasar-gika 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 Nidánasthánam in the Sushruta Samhitá which treats of the Nidanam of cutaneous affections (Kushtham).