This document presents on a comparative study of the treatment principles (Chikitsa Sutra) for the skin disease Kushta according to the three ancient Ayurvedic texts - Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya. It discusses the general treatment approach based on the dosha predominance in Kushta - using ghee or medicated ghee for vata-predominant Kushta, virechana and raktamokshana for pitta-predominant Kushta, and vamana for kapha-predominant Kushta. It also highlights the importance of targeting the predominant dosha

2. Title of this seminar
A Comparative study on Chikitsa-Sutra of Kushta
Vyadhi of Bruhatrayee
Presenter
Dr.Bharath V,
Final year pg scholor,
Dept of Ayurveda Samhitha
and siddhanta,
GAMC Mysuru
Under the guidance of
Dr Shreevatsa
Prof and HOD
Dept of Ayurveda Samhitha
and siddhanta,
GAMC Mysuru
2

3. Contents of this presentation
 Introduction
 Reference (शास्त्र सन्दर्भ)
 Understanding the Vyadhi
 सामान्य चिचित्सा सूत्र from बृहत्रयी
 Discussion on - सामान्य चिचित्सा सूत्र from बृहत्रयी
 Special points about the disease Kushta
 Conclusion
• Note: as this presentation is oriented towards comparative Chikitsa sootra from Bruhatrayee, Chikitsa
components are highlighted, other components like Samprapti, individual types of Kushta, individual
formulations in detail are not elaborately discussed. However related information is stated wherever
necessary.
• No contemporary correlations comparisons are carried out
3

4. Introduction
• Chikitsa-sutra is a guideline that provides an idea to physician based
on which one can plan the treatment.
• Considering the word meaning; ‘Chikitsa’ is ‘treatment’, and ‘sutra’ is
the ‘formula’.
• Chikitsa is defined as
याचर्िः चियाचर्र्ाभयन्ते शरीरे धातविः समािः|
सा चिचित्सा चविाराणाां िमभ तचिषर्ाां स्मृतम्||३४|| (Cha.Su.16/34)
• The procedure from which the components of ‘Shareera’ (Dosha,
Dhatu, Mala and so on) attains normalcy, is known as ‘Chikitsa’ for
that disease and that is the duty of ‘Bhishak’.
4

5. • Synonyms of the term Chikitsa used in Charaka samhitha are as
follows (Cha chi 1/1/3-4)
• चिचिचत्सतां व्याचधहरां पथ्यां साधनमौषधम्|
प्रायचित्तां प्रशमनां प्रिृचतस्थापनां चहतम्||३||
चवद्यािेषर्नामाचन, ...|४|
• As it can be seen among all Bruhatrayee, every disease passes through
a pathway known as ‘Samprapti’ to exhibit itself. Disintegrating this
pathway i.e., ‘Samprapti Vighatana’ itself is prime consideration in
Chikitsa. Whole of the formulations mentioned for that disease would
be firmly adhere to this basic principle
5

6. • The later part would be recovering the damage caused by manifested
disease, to attain normalcy of Dhatus. In general, this is the normal
protocol in treating every disease seen in Bruhatrayee.
• In most of the diseases initially Shodhana therapy is advised as first
line of treatment based on predominance of Doshas. In some diseases
Karmukata (roughly, special actions) such as Vaatanulomana, Marga-
avarana-harana, Agni-deepana, even surgical procedures like
Chedana-Bhedana parasurgical procedures like Kshara-karma, Agni-
karma also comes under the category of Chikitsa Sutra.
• Secondary part treatment focus on the damage control and avoiding
the re-occurrence of the diseases.
6

7. Characteristics of Shuddha-Chikitsa (Cha Ni 8/23)
• प्रयोगिः शमयेद्व्याचधां योऽन्यमन्यमुदीरयेत्|
नासौ चवशुद्धिः, शुद्धस्तु शमयेद्यो न िोपयेत्||२३||
• Any treatment is said as Shuddha-Chikitsa when, it is capable of
curing the disease for which it is administered for and not leading to
any complications.
• In this presentation comparative Chikitsa sutra of Kushtavyadhi from
Bruhatrayee are dealt.
7

8. Reference (शास्त्र सन्दर्भ)
• िरि सांचहता चिचित्सास्थान -7th chapter
• सुश्रुत सांचहता चिचित्सास्थान -9th and 10th chapters
• अष्टाङ्ग हृदय चिचित्सास्थान -19th chapter
8

9. Understanding the Vyadhi
• As seen previously ‘Samprapti Vighatana’ itself is prime consideration
in Chikitsa, here with the quick look about Samanya-Samprapti-
Ghataka of Kushta.
• सम्प्राप्ति घटक
• Note - सम्प्प्राचि घटि of each type of Kushta varies, the information given
is in broad sense and combination of all three Samhithas, it changes
from one type to another type of Kushta. In general
9

10. • दोष - चत्रदोष
• दूष्य - त्वि् माांस रक्त लसीिा (सििोद्रव्य सङ्रह) / सिधातु as per अिायभ सुश्रुत
• अचधष्ठान-त्वि् माांस रक्त लसीिा and other धातुs
• स्रोतस्- रसवहा रक्तवहा माांसवहा उदिवहा अन्नवहा स्वेदवहा
(सुश्रुताियभ - धातुगत िुष्ठ so all Dhatuvaha srotas mentioned by him can
be considered)
• स्रोतोदुचष्ट- सङ्ग चवमागभगमन
• अचनन- र्ाठराचनन धात्वाचनन
• उिवस्थान- आमाशय / पक्वाशय 10

11. • सञ्िारस्थान- सवभशरीर
• व्यक्तस्थान- त्वि् (and other धातु)
• रोगमागभ- बाह्य / आभ्यन्तर
• व्याचध स्वर्ाव- चिरिारर and दारुण
• साध्यासाध्यता- िृच्छ्रसाध्य
• Apart from these िृचम सम्प्प्राचि, चित्र सम्प्प्राचि, सन्तपभणोक्त व्याचध सम्प्प्राचि are also
similar to Kushta sampraapti
• These points play an important role in deciding the treatment.
11

12. साध्यासाध्यता
• Before entering into Chikitsa-Sutra, it is important to consider the साध्यासाध्यता
of the disease.
• साध्यानामचप ह्युपेक्ष्यमाणानाां त्वङ्ाांसशोचणतलसीिािोथक्लेदसांस्वेदर्ािः चिमयोऽचर्मूच्छ््भचन्त; ते र्क्षयन्तस्त्वगादीन् दोषािः
पुनदूभषयन्त इमानुपद्रवान् पृथि् पृथगुत्पादयचन्त
• If the Sadhya-Kushta are neglected then they will lead to formation of the
Krimi of various types, they will spread by consuming the twagadi
avayavas, again causing the vitiation of Doshas. Final stage of the disease
would reach to following conditions,
• प्रस्रवणमङ्गर्ेदिः पतनान्यङ्गावयवानाां तृष्णाज्वरातीसारदाहदौबभल्यारोििाचवपािाि, तथाचवधमसाध्यां चवद्याचदचत||११||
• It could reach so severe that the patient may lose his body parts as such. In
that condition the disease becomes incurable.
12

13. • सवैचलभङ्गैयुभक्तां मचतमान् चववर्भयेदबलम्|
तृष्णादाहपरीतां शान्ताचननां र्न्तुचर्र्भनधम्||३७||
वातिफप्रबलां यद्यदेिदोषोल्बणां न तत् िृच्छ्रम्|
िफचपत्त-वातचपत्तप्रबलाचन तु िृच्छ्रसाध्याचन||३८||
• If the Kushta is manifested with all the Tridoshaja lakshanas in a weak
person, if the person is affected with Trushna, Daaha, if his Agni is
lost, if he is affected by the Krumi then the disease becomes Asadhya.
• Kapha-pitta and Vata-pitta dominant Kushta are Kruchhrasadhya in
nature.
• The Kushta of Vata-kapha dominant and localised to particular part of
the body is easily curable.
13

14. • Another important factor to consider in case of Kushta
disease is, all types of Kushta are Tridoshaja, as it mentioned
as,, न िैिदोषर्ां चिचञ्ित् िुष्ठां समुपलभ्यते||१०||
• Further it is said as,
• सवं चत्रदोषर्ां िुष्ठां दोषाणाां तु बलाबलम्|
यथास्वैलभक्षणैबुभद्ध्वा िुष्ठानाां चियते चिया||३१||
14

15. • All Kushta are Tridoshaja in nature, by considering the predominance
of dosha it is categorised under specific Doshas. By looking into the
dominance of Doshas one has to plan for the treatment.
• दोषस्य यस्य पश्येत् िुष्ठेषु चवशेषचलङ्गमचद्रक्तम्|
तस्यैव शमां िुयाभत्ततिः परां िानुबन्धस्य||३२||
• By countering the predominant Dosha Lakshana through treatment,
one has to go for Anubandha lakshana treatment.
15

16. सामान्य चिचित्सा सूत्र
• िरि सांचहता चिचित्सा स्थान 7/39-40
• वातोत्तरेषु सचपभवभमनां श्लेष्मोत्तरेषु िुष्ठेषु|
चपत्तोत्तरेषु मोक्षो रक्तस्य चवरेिनां िारे||३९||
• In Vaatadosha predominance conditions, Sarpi prayoga
• In Shleshmadosha predominance conditions, Vamana karma
• In Pittadosha predominance conditions, Raktamokshana and
Virechana karma.
16

17. • अरे इचत सचपभराचदषु योज्यां; तेन वातोत्तराचदषु सचपभराचद प्रथमां ितभव्यां, तदनु वक्ष्यमाणा चिचित्सा िायेत्यथभिः|-
Acharya Chakrapani opines that, the word अरे has to be joined with all
the treatment procedures mentioned in the Sootra later the next
treatments.
• Preferable line of treatment based on Doshas could be as follows,
• In Vaatadosha predominant Kushta- महाचतक्ति घृत, चतक्तषट्फलिां घृतां, महाखचदरां
घृतां (all these are mentioned in same chapter) and other similar Ghrutas
processed with the drugs of िुष्ठघ्न दशेमाचन महािषाय can be used.
17

18. • Though in the main चिचित्सा-सूत्र there is no mentioning of बचस्तिमभ, बचस्तप्रयोग
is mentioned as a चिचित्सा in वातप्रधान िुष्ठ in same chapter.
• दावीबृहतीसेव्यैिः पटोलचपिुमदभमदनिृतमालैिः|
सस्नेहैरास्थाप्यिः िुष्ठी सिचलङ्गयवमुस्तैिः||४६||
• Nirooha basti with drugs like दारुहररद्रा बृहती पटोल चपिुमदभ मदनफल िृतमाला इन्द्रयव
नागरमुस्ता
• After चनरूहबचस्त if the patient is अनुवासनयोनय, then physician can plan for
अनुवासन बचस्त with मदनफल, मधुि, चनम्प्ब, िुटर्फल पटोलसाचधत तैल.
18

19. • In Shleshmadosha predominance Kushta- conditions and also in the
conditions of उचत्क्लष्ट दोष in हृदय(उरोर्ाग) and in ऊध्वभर्ाग शरीर, Vamana karma
is first line of treatment by using िुटर्फल, मदनफल, मधुि, पटोलरस, चनम्प्बरस, मधु,
शीतरस- शीतिषाय,
• दोषोचत्क्लष्टे हृदये वाम्प्यिः िुष्ठेषु िोध्वभर्ागेषु|
िुटर्फलमदनमधुिै िः सपटोलैचनभम्प्बरसयुक्तै िः||४३||
शीतरसिः पक्वरसो मधूचन मधुिां ि वमनाचन|
• वमनचवरेिनयोगािः िल्पोक्तािः िुचष्ठनाां प्रयोक्तव्यािः|- अनागतावेक्षण तन्त्रयुचक्त is used to understand
this sloka.
• Utilization of Vamana-Virechana yogas, mentioned in Kalpasthana.
• वमनयोग mentioned specifically for िुष्ठफलशृचत in िल्पस्थान are इक्ष्वाकु कल्प,
जीमूतकल्प, कृ तवेधनकल्प 19

20. • In Pittadosha predominance Kushta conditions, Raktamokshana and
Virechana karma
• प्रच्छ््नमल्पे िुष्ठे महचत ि शस्तां चसराव्यधनम्||४०||
• Administering प्रच्छ््न्न िमभ in case of अल्प िुष्ठ (अल्पदोषलक्षण), चसराव्यधन in case of
महचत िुष्ठ. (बहुदोषलक्षण)
• The drugs mentioned for चवरेिन िमभ, in the same chapter are चत्रवृत् दन्ती चत्रफला
• िुष्ठेषु चत्रवृता दन्ती चत्रफला ि चवरेिने शस्ता||४४||
• The चवरेिन योगs mentioned for Kushta in िल्पस्थान are, प्तिवृत् योग- कल्याणक गुड,
सुधा कल्प, सिला शङ्प्तिप्तन कल्प
20

21. • Further specific consumables are mentioned instead of regular
Samsarjana krama as,
सौवीरिां तुषोदिमालोडनमासवाि सीधूचन|
शांसन्त्यधोहराणाां यथाचवरेिां िमिेष्टिः||४५||
• The mode of administering the Shodhana karma is specified in the
same context like,
• बहुदोषिः सांशोध्यिः िुष्ठी बहुशोऽनुरक्षता प्राणान्| दोषे ह्यचतमात्रहृते वायुहभन्यादबलमाशु||४१||
• In case of बहुदोषावस्था; स्तोि-स्तोि दोष हरण through multiple सांशोधन, by
protecting the प्राण. If Doshas are removed excessively then, the
aggravated Vaatadosha will take off the life immediately.
21

22. स्नेहपान indication after शोधनिमभ
• स्नेहस्य पानचमष्टां शुद्धे िोष्ठे प्रवाचहते रक्ते |
वायुचहभ शुद्धिोष्ठां िुचष्ठनमबलां चवशचत शीघ्रम्||४२||
• After Koshta-shuddi by Shodhana-karma and after Rakta-mokshana
one has to go for Snehapana administration. Because for a weak
person affected with Kushta; after Shodhana karma there is a tendency
of Vaatadosha to get lodged in Koshta.
22

23. रक्तमोक्षण िमभ specified for treating Kushta
• चस्थरिचठनमण्डलानाां चस्वन्नानाां प्रस्तरप्रणाडीचर्िः|
िूिैचवभघरितानाां रक्तोत्क्लेशोऽपनेतव्यिः||५०||
• आनूपवाररर्ानाां माांसानाां पोिलैिः सुखोष्णैि|
चस्वन्नोत्सन्नां चवचलखेत् िुष्ठां तीक्ष्णेन शस्त्रेण||५१||
रुचधरागमाथभमथवा शृङ्गालाबूचन योर्येत् िुष्ठे|
प्रचच्छ््तमल्पां िुष्ठां चवरेियेद्वा र्लौिोचर्िः||५२||
• the indication for specific रक्तमोक्षण िमभ are seen here, along with the
Poorvakarma and associated procedures with them. Thus, in a gist,
that particular place has to be made Mrudu with Swedana karma,
should be made loose / lax with surgical instruments later it should be
subjected for रक्तमोक्षण िमभ. Notable point here is all 4 types of रक्तमोक्षण िमभ
mentioned in SushrutaSamhita are seen here.
23

24. • ये लेपािः िुष्ठानाां युज्यन्ते चनहृभतास्रदोषाणाम्|
सांशोचधताशयानाां सद्यिः चसचद्धर्भवेत्तेषाम्||५३||
• After रक्तमोक्षण िमभ, िुष्ठघ्नलेप प्रयोग is done to get faster results.
• Some of the special treatment principles mentioned in Kushta Vyadhi
शस्त्रिमभ, क्षारप्रयोग, अगद प्रयोग, घषभण प्रदेह प्रयोग
• येषु न शस्त्रां िमते स्पशेचन्द्रयनाशनाचन याचन स्युिः|
तेषु चनपात्यिः क्षारो रक्तां दोषां ि चवस्राव्य||५४||
• In conditions where शस्त्रिमभ cannot be possible and स्पशभज्ञान is lost there
क्षारप्रयोग is indicated, after रक्तमोक्षण
24

25. • पाषाणिचठनपरुषे सुिे िुष्ठे चस्थरे पुराणे ि|
पीतागदस्य िायो चवषैिः प्रदेहोऽगदैिानु||५५||
• In stony hard conditions of Kushta, which has lost its sensations,
which is immobile and chronic in nature one has to go for a special
treatment. Initially patient is given with Agada-Aushadha, later Visha
is applied over the place as pradeha, after its removal again Agada-
Aushadha is applied over that area.
25

26. • स्तब्धाचन सुिसुिान्यस्वेदनिण्डुलाचन िुष्ठाचन|
िूिैदभन्तीचत्रवृतािरवीरिरञ्र्िुटर्ानाम्||५६||
र्ात्यिभ चनम्प्बर्ैवाभ पत्रैिः शस्त्रैिः समुद्रफेनैवाभ|
घृष्टाचन गोमयैवाभ ततिः प्रदेहैिः प्रदेह्याचन||५७||
• One more special mode of applying the Pradeha has been mentioned
here as, initially doing the घषभण (methodical rubbing) with the
mentioned drugs, then applying the Pradeha with Kushtaghna
Dravya.
26

27. Due importance has been given to Rasadravyas in
this chapter,
• लेलीतिप्रयोगो रसेन र्ात्यािः समाचक्षििः परमिः|
सिदशिुष्ठघाती माचक्षिधातुि मूत्रेण||७०||
श्रेष्ठां गन्धियोगात् सुवणभमाचक्षिप्रयोगाद्वा|
सवभव्याचधचनबहभणमद्यात् िुष्ठी रसां ि चनगृहीतम्||७१||
वज्रचशलार्तुसचहतां सचहतां वा योगरार्ेन|
सवभव्याचधप्रशमनमद्यात्िुष्ठी चनगृह्य चनत्यां ि||७२||
• Drugs like are noticed here गन्धि,स्वणभमाचक्षि, रस(पारद),
वज्रचशलार्तु,माचक्षि
27

28. Non re-occurrence of Sadhya-Kushta
• दोषे हृतेऽपनीते रक्ते बाह्यान्तरे िृते शमने |
स्नेहे ि िालयुक्ते न िुष्ठमनुवतभते साध्यम्||१५१||
• This is an important Sootra found in this chapter highlighting
the अपुनर्भव-चिचित्सा. For the sake of convenience, it will be
shown in flowchart.
• दोषहरण through सांशोधन, रक्तमोक्षण, अभ्यन्तर-बाह्यशमन, स्नेह-प्रयोग
साध्यिुष्ठ will become अपुनर्भवत्व
28

29. • In the same Adhikarana of Kushta chikitsa, at the end of
the chapter, Kilaasa nidana are mentioned. Notable point
here is except Viruddhaahara, all others are related with
Papakarma. Due to similarity in the Nidanas and the
Chikitsa this might have placed in this context.
• विाांस्यतथ्याचन िृतघ्नर्ावो चनन्दा सुराणाां गुरुधषभणां ि|
पापचिया पूवभिृतां ि िमभ हेतुिः चिलासस्य चवरोचध िान्नम्||१७७||
29

30. चिचित्सा सूत्र from सुश्रुतसांचहता
९. िुष्ठचिचिचत्सतम्
• साध्यासाध्यता as per सुश्रुतसांचहता before चिचित्सा
• िुष्ठमात्मवतिः साध्यां त्वरक्तचपचशताचश्रतम् |
मेदोगतां र्वेद्याप्यमसाध्यमत उत्तरम् ||२९||
• Kushata reached till माांसधातुगत and the person is चर्तेचन्द्रय - साध्य, मेदोधातुगत-याप्य,
rest of the Dhatus-असाध्य
• In Sushruta samhitha the chapter begins with Vishesha nidaana which
contributes for the kushta vyadhi, as चनदान पररवर्भन is the first treatment.
(This method is seen in Charaka samhitha too).
30

31. • Immediately contra indication i.e., अपथ्य is seen
• तत्र त्वनदोषी माांसवसादुनधदचधतैलिुलत्थमाषचनष्पावेक्षुचपष्टचविाराम्प्लचवरुद्धाध्यशनार्ीणभचवदाह्यचर्ष्यन्दीचन
चदवास्वप्नां व्यवायां ि पररहरेत् ||४||
• After this पथ्य has been mentioned
• ततिः शाचलषचष्टियवगोधूमिोरदूषश्यामािोद्दालिादीननवान् र्ुञ्र्ीत मुद्गाढक्योरन्यतरस्य यूषेण सूपेन वा
चनम्प्बपत्रारुष्िरव्याचमश्रेण, मण्डूिपण्यभवल्गुर्ाटरूषिरूचपिापुष्पैिः सचपभिःचसद्धैिः सषभपतैलचसद्धैवाभ, चतक्तवगेण
वाऽचर्चहतेन; माांससात्म्प्याय वा र्ाङ्गलमाांसममेदस्िां चवतरेत्; तैलां वज्रिमभ्यङ्गाथे;
आरनवधाचदिषायमुत्सादनाथे; पानपररषेिावगाहाचदषु ि खचदरिषायम्; इत्येष आहारािारचवर्ागिः ||५||
31

32. • As seen in Kushta samprapti from Sushruta samhitha, he has
classified Kushtha based on the Dhatugataavasthaa, and chikitsa also
explained based on same pattern.
• तत्र पूवभरूपेषूर्यतिः सांशोधनमासेवेत |
• Initially both Vamana and Virechana should be administered (that is
Oordhva and Adhah Shodhana)
• Later in same sloka, Dhatugata-Kushta Chikitsa sutra has been
narrated as
32

33. अवस्था प्तिप्तकत्सा
ति त्वक्सम्प्रािे शोधन आलेपनाचन
शोप्तणतरािे सांशोधन आलेपन िषायपान शोचणतावसेिनाचन
माांसरािे शोधन आलेपन िषायपान शोचणतावसेिन अररष्ट-मन्थप्राशािः
ितुथथकमथगुणरािां याप्यमात्मवतिः सांचवधानवति
तत्र सांशोधनाच्छ््ोचणतावसेिनाच्छ्िोध्वं र्ल्लात चशलार्तु धातु माक्षीि गुनगुल्
अगुरु तुवरि खचदरा असना अयस्िृचतचवधानम आसेवेत
पञ्िमां नैवोपिमेत्
Rest others असाध्य
33

34. Planning for the Chikitsa should be like, initially Ghrutayogas and tailayogas are mentioned for the
shodhanakarma (for snehapaana)
Dosha
predominance
Ingredients of Sneha
वात रधान मेषशृङ्गीिदांष्राशाङ्भगेष्टागुडूिीचद्वपञ्िमूलीचसद्धां तैलां घृतां वा वातिुचष्ठनाां
पानाभ्यङ्गयोचवभदध्यात्
प्तपत्त रधान धवाििणभििुर्पलाशचपिुमदभपपभटिमधुिरोध्रसमङ्गाचसद्धां सचपभिः चपत्तिुचष्ठनाां
श्लेष्मा रधान चप्रयालशालारनवधचनम्प्बसिपणभचित्रिमररिविािुष्ठचसद्धां श्लेष्मिुचष्ठनाां
र्ल्लातिार्याचवडङ्गचसद्धां वा
सवथ कु ष्ठ सवेषाां तुवरितैलां र्ल्लातितैलां वेचत ||७||
34

35. • In further slokas महाचतक्ति सचपभ, चतक्ति सचपभ 2,3,4, or 5 चसराव्यधन (places), 7
types of लेपिल्प and various kinds of क्षारिल्प are explained. Here also
mentioning of रसौषचध द्रव्य are seen.
• Point of discussion
• वायसीफल्गुचतक्तानाां शतां दत्त्वा पृथि् पृथि् ||२९||
द्वे लोहरर्सिः प्रस्थे चत्रफलात्र्याढिां तथा |
चत्रद्रोणेऽपाां पिेद्याविागौ द्वावसनादचप ||३०||
चशष्टौ ि चवपिेिूय एतैिः श्लक्ष्णप्रपेचषतैिः |
िल्िै ररन्द्रयवव्योषत्वनदारुितुरङ्गुलैिः ||३१||
35

36. • Cont…
पारावतपदीदन्तीबािुिीिे शराह्वयैिः |
िण्टिायाभ ि तत्पक्वां घृतां िुचष्ठषु योर्येत् ||३२||
दोषधात्वाचश्रतां पानादभ्यङ्गात्त्वनगतां तथा |
अप्यसाध्यां नृणाां िुष्ठां नाम्प्ना नीलां चनयच्छ््चत ||३३||
• In the Phalashruti, Neelam ghruta is said to cure even Asadhya-
Kushta.
• If it can cure then how the disease become Asadhya?
• If the Kushta is Asadhya then how it can be curable by any medicine?
36

37. Protocol to administer Shodhana karma in case of Kushta, it’s a special
contribution from Sushrutaacharya, and the same is followed by
Acharya Vagbhata too.
• पक्षात् पक्षाच्छ््दभनान्यभ्युपेयान्मासान्मासात् स्रांसनां िाचप देयम् |
स्राव्यां रक्तां वत्सरे चह चद्वरल्पां नस्यां दद्याच्छ्ि चत्ररात्राचत्त्ररात्रात् ||४३||
शोधन Time gap duration
वमन 15 days
स्रांसन/ प्तवरेिन 30 days
रक्त मोक्षण 6 months
नस्य 3 days
37

38. • Complete elimination of Doshas are stressed by Acharya Sushruta,
because if any small residual of Doshas are left behind in Kushta
patient then it will spread again all over the body, even it may progress
to incurable conditions. Hence one should take care of complete
elimination of Doshas and also procedure of conduction of Shodhana
karma, i.e., Samyak karma should be taken care of
• दुवाभन्तो वा दुचवभररक्तोऽचप वा स्यात् िुष्ठी दोषैरुद्धतैव्याभिदेहिः |
चनिःसचन्दनधां यात्यसाध्यत्वमाशु तस्मात् िृत्स्नाचन्नहभरेत्तस्य दोषान् ||४२|
38

39. • At the end of all the Yogas importance of Khadiraprayoga has been
told
• चददृक्षुरन्तां िुष्ठस्य खचदरां िुष्ठपीचडतिः |
सवभथैव प्रयुञ्र्ीत स्नानपानाशनाचदषु ||७०||
यथा हचन्त प्रवृद्धत्वात् िुष्ठमातुरमोर्सा |
तथा हन्त्युपयुक्तस्तु खचदरिः िुष्ठमोर्सा ||७१||
• The one who wants to see the end of Kushtavyadhi then he must try to
admister Khadira from all the possible ways. As Pravruddha Kushta
destroys the Ojas of the patient similarly Khadira destroys the power
of Kushta vyadhi.
39

40. • Point to be noted here in Sushruta Samhita is Kushta chikitsa is
explained in two chapters. िुष्ठचिचिचत्सतम्, महा-िुष्ठचिचिचत्सतम् this will be dealt
in discussion part.
• In महा िुष्ठचिचिचत्सतम् along with Kushta Chikitsa other सन्तपभण र्न्य चविारs like,
प्रमेह, दारुण सवाभङ्गशोफ, मेदुर, िफामय and औषधयोग for all these together can be
seen. Most of these yogas seems to be Vyadhi specific रसायन औषधयोग.
40

41. चिचित्सा सूत्र from अष्टाङ्ग हृदय (१९. िुष्ठचिचिचत्सताध्यायिः)
• The chapter of िुष्ठचिचिचत्सताध्यायिः in अष्टाङ्ग हृदय begins from Snehapaana, and
Dosha-specific Snehas are being mentioned
Dosha predominance Ingredients of Sneha
वात रधान तत्र वातोत्तरे तैलां घृतां वा साचधतां चहतम्||१||
दशमूलामृतैरण्डशाङ्भगेष्टामेषशृङ्चगचर्िः|
प्तपत्त रधान पटोलचनम्प्बिटुिादावीपाठादुरालर्ािः||२||
पपभटां त्रायमाणाां ि पलाांशां पाियेदपाम्|
द्व्याढिेऽष्टाांशशेषेण तेन िषोचन्मतैस्तथा||३||
त्रायन्तीमुस्तर्ूचनम्प्बिचलङ्गिणिन्दनैिः|
सचपभषो द्वादशपलां पिेत्तचत्तक्तिां र्येत्||४||
चपत्तिुष्ठपरीसपभचपचटिादाहतृड्रमान्|
िण्डुपाण्ड्वामयान् गण्डान् दुष्टनाडीव्रणापिीिः||५||
चवस्फोटचवद्रधीगुल्मशोफोन्मादमदानचप|
हृद्रोगचतचमरव्यङ्गरहणीचित्रिामलािः||६||
र्गन्दरमपस्मारमुदरां प्रदरां गरम्|
अशोऽस्रचपत्तमन्याांि सुिृच्छ्रान् चपत्तर्ान् गदान्||७|| 41

42. Dosha
predominance
Ingredients of Sneha
श्लेष्मा रधान िफोत्तरे घृतां चसद्धां चनम्प्बसिाह्रचित्रिै िः||११||
िुष्ठोषणविाशालचप्रयालितुरङ्गुलैिः|
सवथ कु ष्ठ सवेषु िारुष्िरर्ां तौवरां साषभपां चपबेत्||१२||
स्नेहां घृतां वा िृचमचर्त्पथ्यार्ल्लातिै िः शृतम्|
This pattern is similar to that of Sushruta samhitha.
42

43. • आरनवधस्य मूलेन शतिृत्विः शृतां घृतम्||१३||
चपबेन् िुष्ठां र्यत्याशु र्र्न् सखचदरां र्लम्| ……
• चस्ननधस्य शोधनां योज्यां चवसपे यदुदाहृतम्|
• अतीतावेक्षण तन्त्रयुचक्त is seen here as previous chapter is चवसपभचिचिचत्सतम्
• (treatment said in previous chapter is
• रसेन युक्तां त्रायन्त्या द्राक्षायास्त्रैफलेन वा|
चवरेिनां चत्रवृच्छ्िूणं पयसा सचपभषाऽथवा||३||
योज्यां, िोष्ठगते दोषे चवशेषेण चवशोधनम्|)
43

44. स्नेहपान in between शोधनिमभ is told as a special
treatment
• स्नेहैराप्याययेच्छ्िैनां िुष्ठघ्नैरन्तराऽन्तरा||१६||
मुक्तरक्तचवररक्तस्य ररक्तिोष्ठस्य िुचष्ठनिः|
प्रर्ञ्र्नस्तथा ह्यस्य न स्याद्देहप्रर्ञ्र्निः||१७||
• Further वज्रि,महावज्रि, दन्तीघृत are told by Acharya Vagbhata.
Interestingly mentioning of Pathya and Apathya, is seen in
between the formulations is seen. It’s a point for todays
discussion.
44

45. • Later the rasayana formulations similar to that of
महािुष्ठचिचिचत्सतम् सुश्रुत सांचहता are seen. And also, diseases specific
Rasayana are noted
• रसायनप्रयोगेण तुवरास्थीचन शीलयेत्|
र्ल्लातिां बािुचििाां वचिमूलां चशलाह्वयम्||५३||
• Different Lepa yogas have been mentioned according to the
conditions (ex, त्वि् गत िुष्ठ). These should be administered after
eliminating the Doshas through Shodhana procedures.
45

46. • Apart from Shodhana other treatment procedures are seen in this
chapter, such as स्वेदन, उल्लेखन using शस्त्र, क्षारपातन,चवषप्रयोग, प्रदेह followed after
घषभण all these procedures and indications are similar to that of िरि सांचहता.
• Most of the formulations mentioned in बृहत्रयी in िुष्ठचिचित्सा अचधिरण are not
pointing towards any specific names of Kushta, but here such
specificity can be noticed in some yogas for example,
मुस्तामृतासङ्गिटङ्िटेरी- िासीसिचम्प्पल्लििुष्ठरोध्रािः|
गन्धोपलिः सर्भरसो चवडङ्गां मनिःचशलाले िरवीरित्वि्||६७||
तैलाक्तगात्रस्य िृताचन िूणाभ- न्येताचन दद्यादविूणभनाथभम्|
दद्रूिः सिण्डूिः चिचटर्ाचन पामा चविचिभिा िेचत तथा न सचन्त||६८||
• Usage of रसौषचध द्रव्य is also noted in बाह्य आभ्यन्तर प्रयोग in this chapter.
46

47. • As seen in सुश्रुत सांचहता and in िरि सांचहता, usually for any disease
चिचित्सा सूत्र is mentioned at the beginning and औषधिल्प are
mentioned afterwards, but in अष्टाङ्ग हृदय, चिचित्सा सूत्र is mentioned
at the end of the chapter
• वातोत्तरेषु सचपभवभमनां श्लेष्मोत्तरेषु िुष्ठेषु|
चपत्तोत्तरेषु मोक्षो रक्तस्य चवरेिनां िारे||९२||
• This is similar to that of Charaka samhitha
47

48. • ये लेपािः िुष्ठानाां युज्यन्ते चनहृभतास्रदोषाणाम्|
सांशोचधताशयानाां सद्यिः चसचद्धर्भवचत तेषाम्||९३||
• दोषे हृतेऽपनीते रक्ते बाह्यान्तरे िृते शमने|
स्नेहे ि िालयुक्ते न िुष्ठमचतवतभते साध्यम्||९४||
• Special protocol mentioned by Acharya Vagbhata, after
administering the Shodhana-karma (Vamana & Virechana),
Raktamokshana and giving Shamanoushadhi one should opt
for Snehana karma (by considering the time factor). By doing
so all Sadhya Kushta can be treated.
48

49. • बहुदोषिः सांशोध्यिः िुष्ठी बहुशोऽनुरक्षता प्राणान्|
दोषे ह्यचतमात्रहृते वायुहभन्यादबलमाशु||९५||
• This is similar to that of Charaka samhitha. In case if excess removal
of Doshas are done then the aggravated Vaatadosha will do Balahaani
immediately.
49

50. • पक्षात्पक्षाच्छ््दभनान्यभ्युपेयान्मासान्मासाच्छ््ोधनान्यप्यधस्तात्|
शुचद्धमूभचघ्नभ स्याचत्त्ररात्राचत्त्ररात्रात् षष्ठे षष्ठे मास्यसृड्मोक्षणां ि||९६||
• यो दुवाभन्तो दुचवभररक्तोऽथवा स्यात् िुष्ठी दोषैरुद्धतैव्याभप्यतेऽसौ|
चनिःसन्देहां यात्यसाध्यत्वमेवां तस्मात् िृत्स्नाचन्नहभरेदस्य दोषान्||९७||
• This is similar to that of Sushruta samhitha.
50

51. • Importance given to सद्वृत्त and दैवव्यपाश्रय चिचित्सा is mentioned at
the end of the chapter as
• व्रतदमयमसेवा त्यागशीलाचर्योगो
चद्वर्सुरगुरुपूर्ा सवभसत्त्वेषु मैत्री|
चशवचशवसुततारार्ास्िराराधनाचन
प्रिचटतमलपापां िुष्ठमुन्मूलयचन्त||९८||
• Interesting point noted here is the फलश्रुचत for most of
formulations is सवभिुष्ठ, and specifications is highlighted
wherever necessary.
51

52. Discussion
• िरि सांचहता
• Understanding the disease through a simile (Cha.Ni.5/14-15)
• यथा ह्यल्पेन यत्नेन च्द्यते तरुणस्तरुिः|
स एवाचतप्रवृद्धस्तु च्द्यतेऽचतप्रयत्नतिः||१४||
एवमेव चविारोऽचप तरुणिः साध्यते सुखम्|
चववृद्धिः साध्यते िृच्छ्रादसाध्यो वाऽचप र्ायते||१५||
• By applying अचधिरण and हेत्वथभ तन्त्रयुचक्त, one can interpret the mechanism behind
व्याचधसांप्राचि and चिचित्सा चवधान. As the plant gets stronger by deepening its roots,
this disease also gets stronger by entering deeper. Early stage requires lesser
efforts to cure, whereas if its left untreated then more efforts needed to treat.
52

53. The same simile is used by Acharya Sushruta too,
in Nidaansthana as,
•यथा वनस्पचतर्ाभतिः प्राप्य िालप्रिषभणम् |
अन्तर्ूभचमां चवगाहेत मूलैवृभचष्टचववचधभतैिः ||२०||
एवां िुष्ठां समुत्पन्नां त्वचि िालप्रिषभतिः |
िमेण धातून् व्याप्नोचत नरस्याप्रचतिाररणिः ||२१||
53

54. • Firstly, one can notice that, though Shodhana is the prime line
of treatment mentioned by all Bruhatrayee, Basti-karma is not
mentioned by any of the three in Chikitsa-sutra, for
Vatadosha predominance Kushta. Rather it is said as बृांहण
बचस्तिमभ is contraindicated चवशोधनीय व्याचध condition, for example
िुष्ठ प्रमेह. (Cha.Si.1/36)
• न बृांहणीयान् चवदधीत बस्तीन् चवशोधनीयेषु गदेषु वैद्यिः|
िुष्ठप्रमेहाचदषु मेदुरेषु नरेषु ये िाचप चवशोधनीयािः||३६||
54

55. • But this doesn’t direct towards the absolute contra indication of
Bastikarma in Kushtavyadhi, Acharya Charaka provides a freedom to
Vaidya to administer Basti karma, based on his Yukti, (Cha.Si.2/27)
only if it follows the criteria of Shuddha Chikitsa
• अवस्थाां प्राप्य चनचदभष्टां िुचष्ठनाां बचस्तिमभ ि||२७||
• Ubhaya bhaga (i.e., Oordhva and Adho) shodhana is mentioned by all
the Bruhatrayee. Apart from this Acharya Charaka also accepted
Raktamokshana, which he doesn’t categorised under Shodhana
(Panchakarma). The probable justification would be considering Rakta
as a Dooshya among Sapta-Dooshya and it could be corrected by
Rakta sravana.
55

56. Acharya Charaka has given more importance to Doshas
in categorisation and treatment of Kushta
• सवं चत्रदोषर्ां िुष्ठां दोषाणाां तु बलाबलम्|
यथास्वैलभक्षणैबुभद्ध्वा िुष्ठानाां चियते चिया||३१||
दोषस्य यस्य पश्येत् िुष्ठेषु चवशेषचलङ्गमचद्रक्तम्|
तस्यैव शमां िुयाभत्ततिः परां िानुबन्धस्य||३२||
• िुष्ठचवशेषैदोषा दोषचवशेषैिः पुनि िुष्ठाचन|
(Cha.chi.7/33)
56

57. सुश्रुतसांचहता
• Different approach towards treatment can be seen in the views of
Acharya Charaka and Acharya Sushruta, which is based on the
Samprapti framed by individual texts.
• Acharya Sushruta given importance to Dhatus, both in explaining
Lakshana and Chikitsa. He also specified the time duration of
administering Shodhana-karma.
57

58. • Specialty is, Acharya Sushruta mentioned treatment of
Kushta in two chapters, िुष्ठचिचिचत्सतम् and महािुष्ठचिचिचत्सतम्. Achrya
Dalhana opines as
• …तस्माद्धात्वनुप्रचवष्टाचन सि कु ष्ठाप्तन महान्तीत्यतो महताां धात्वनुरप्तवष्टानाां कु ष्ठानाां
प्तिप्तकप्तत्सतप्तमप्तत व्याख्या ज्यायसीचत; गयी तु महताां सिानाां िािणिवचर्भतानाचमत्याह||१-
२||
• Any Kushta if not treated in the early stage then it enters into
उत्तरोत्तर धातु similar to the tree strengthens its roots by getting
deeper and accordingly the treatment varies. It can be
interpreted as, in this chapter the chronic stage of
Kushtachikitsa is explained.
58

59. • आियभ गयादास opines in Nidaanasthaana that
• तत्र सि महािुष्ठानीत्याचद| महत्त्वमेषामुत्तरोत्तरधात्वनुप्रवेशात्| धात्वन्तरप्रवेशोऽप्येषाां
बहुबहुलदोषारम्प्र्ात्| अत एव चिया महती महािुष्ठे, क्षुद्रे पुनरल्पा|
• Based on the efforts required to treat also, Kushta is
categorised as Maha and Alpa
• Only Mahakushta and other सन्तपभण र्न्य चविारs like, प्रमेह, दारुण
सवाभङ्गशोफ, मेदुर, िफामय are dealt in this chapter as there is चियाचवषेश,
that is अपतपभण and रसायन
59

60. • By looking into the contents, initially mentioning of पथ्य, later
मन्थिः, आसव, सुरा, अवलेह, िूणभचिया, अयस्िृचत, रसायनयोग, खचदरप्रयोग चवधान,
एिमूचलिा प्रयोग चवधान are seen in the chapter of महािुष्ठचिचिचत्सतम्.
• All these are to be followed after Shodhana-procedures and
are having व्याचधप्रत्यनीि रसायन effect. Single drug therapy
(एिमूचलिाप्रयोग) for longer period can also be seen as
• अमृतवल्लीस्वरसां क्वाथां वा प्रातिः प्रातरुपसेवेत, तचत्सद्धां वा सचपभिः, अपराह्णे
ससचपभष्िमोदनमामलियूषेण र्ुञ्र्ीत; एवां मासमुपयुज्य सवभिुष्ठैचवभमुच्छ्यत इचत ||१४||
60

61. अष्टाङ्ग हृदय
• While mentioning about Kushta-chikitsitam Acharya Vagbhata
initially mentions about the Shamanoushadhi (in the form of प्रलेप, िूणभ
आसव अररष्ट िषाय and so on) Chikitsa-sutra is mentioned at the end of the
chapter.
• While narrating the samprapti three diseases are dealt in together
(चनदानस्थान १४. िुष्ठचित्रिृचमचनदानाध्यायिः) but while mentioning the Chikitsa its
dealt independently (चिचित्सास्थान १९. िुष्ठचिचिचत्सताध्यायिः), which directs
towards though Kushtavyadhi has similar samprapti with other
diseases, its unique in its treatment. That is apart from सम्प्प्राचि चवघटन to
highlight the चिचित्सा-चवशेष this might have placed under separate अचधिरण.
61

62. • In अष्टाङ्ग हृदय, चिचित्सा सूत्र is mentioned at the end of the chapter.
This approach might have followed due to, blending the
views of both िरि सांचहता and सुश्रुत सांचहता. Acharya Vagbhata,
accepted both the views, and documented without much
changes in Chikitsa-sutra.
• In this chapter 92-95th slokas are exactly that of Charaka
Samhita, and 96-97th slokas are from Sushruta Samhitha.
• यथाचनदान-तथा चिचित्सा is seen at the end of the chapter, सद्वृत्त, पुण्यिमभ,
दैवव्यपाश्रय चिचित्सा are given due importance as a part of
treatment.
62

63. Never forget medicines in KushtaVyadhi
• After textual and practical analysis some of the important
drugs are mentioned here which are popularly known as
drugs of choice, they are
• खचदर, तुवरि, र्ल्लाति, मचञ्र्ष्ठा, िािोदुम्प्बर, चनम्प्ब, हररद्रा, आरनवध, बािुिी
• रसौषचध - गन्धि, िासीस, हरताल, पारदर्स्म
• योग- गन्धि रसायन, खचदराचद वचट, आरोनयवचधभचन वचट, महामचञ्र्ष्ठाचद िषाय, तुवरि तैल,
मररिाचद तैल, चसद्धाथभि िूणभ, अवल्गुर्ाचद लेप, हररद्राखण्ड
• Many more additions can be done to this list based on the Yukti of
Vaidya 63

64. Special points about िुष्ठ व्याचध
• It falls in all the three categories of दोषर् िमभर् दोषिमभर् व्याचध, accordingly the
treatment varies.
• Special importance has been given to पाप िमभ and पूवभर्न्मिृत िमभ (in both
manifestation of the disease and in treatment) by all Bruhatrayee.
• चियते यचद िुष्ठेन पुनर्ाभतेऽचप गच्छ््चत |
नातिः िष्टतरो रोगो यथा िुष्ठां प्रिीचतभतम् ||३१||
आहारािारयोिः प्रोक्तामास्थाय महतीं चियाम् |
औषधीनाां चवचशष्टानाां तपसि चनषेवणात् |
यस्तेन मुच्छ्यते र्न्तुिः स पुण्याां गचतमाप्नुयात् ||३२||
• (Su.ni.5)
64

65. • This vyadhi follows a person even from one birth to another birth,
until the karmakshaya occurs.
• आहारािारयोररचत अनेन युचक्तव्यपाश्रयां चिचिचत्सतमुक्तम्|
• तपसि चनषेवणाचदत्यनेन दैवव्यपाश्रयमुक्तम्|
• पुण्याां गचतमाप्नुयात् क्षीणपापत्वात्||३१-३२||
• In the Nidaana sthana of Sushruta samhitha itself Acharya
Chakrapaani gives a hint for further treatment based on the
sampraapti.
• िुष्ठां दीघभरोगाणाां, - in the context of Agrya prakarana.
65

66. Conclusion
• After analysing the Chikitsa-sutra from Bruhatrayee,
Similarities Dissimilarities
 All three texts mentioned
Shodhana as the prime line of
treatment, except Basti karma.
• सन्तपभणर्न्य व्याचध, दोष िमभ, िृचम-
चित्र in same Adikarana all
these concepts are
accepted in together
 Acharya Charaka’s Chikitsa
sutra is more oriented towards
Doshas,
 Whereas Acharya Sushruta
focuses on Dhatugata avastha
of Kushta in treatment.
66

67. Similarities Dissimilarities
• Through Shodhana
procedures अल्पाल्प दोष चनहभरण by
multiple administration of
procedures are accepted.
• Procedures for Karmakshaya
are highlighted by all.
• Such as स्वेदन, उल्लेखन using शस्त्र,
क्षारपातन,चवषप्रयोग, प्रदेह followed
after घषभण are accepted.
• Acharya Vaghbhata mentioned
samprapti in combined adhikarana
िुष्ठचित्रिृचमचनदानाध्यायिः and chikitsa in
separate adhikarana िुष्ठचिचिचत्सताध्यायिः
• Acharya Vaghbhata accepted both the
views from िरि सांचहता and सुश्रुत सांचहता
• Style of narration differs as it can be
seen in the placement of Chikitsa-
sutra, Pathyaapathya, Shodhana-
shamana formulations and
explanation of Sadvrutta.
67

68. • Samprapti Vighatana of Kushta-Vyadhi is a main protocol of Chikitsa,
among which Daiva Vyapashraya Chikitsa is evidently seen in
combating Papakarma. Though its not mentioned in main Chikitsa-
sutra, all three accepted this point in Samprapti.
• Thus, based on the Chikitsa-sutras discussed here one can plan for the
treatment of Kushtavyadhi by keeping the criteria of Shuddha Chikitsa
in centre.
68

69. Points of discussion
• दोषधात्वाचश्रतां पानादभ्यङ्गात्त्वनगतां तथा |
अप्यसाध्यां नृणाां िुष्ठां नाम्प्ना नीलां चनयच्छ््चत ||३३||
In the Phalashruti, Neelam ghruta is said to cure even Asadhya-Kushta.
1. If it can cure then how the disease become Asadhya?
2. If the Kushta is Asadhya then how it can be curable by any
medicine?
3. Interestingly mentioning of Pathya and Apathya, is seen in between
the formulations is seen. Neither at the beginning nor at the end.
69

70. Discussion
and
suggestions
70

71. Thank you
71