Twak Roga (Skin Disease)

Twak Roga (Skin Disease)

TWAK ROGA (SKIN DISEASE)

When prakupita doṣa (vitiated doṣa) find sthāna-saṃśraya in twacā (skin) it develops lakṣaṇa like vaivarṇya (discoloration), prabhāhāni (loss of glow/ complexion) etc and upon neglection eventually lead to kotha (putrefaction/ destruction of dhātu).

Aśtanga Hṛdaya Nidanasthāna 14 says specifically that kuṣṭha is contagious.

Classification : Mahā (great/major) kuṣṭha and Kṣudra (miscellaneous/ minor) kuṣṭha.

This classification is done on the basis of :

  • appearance of most/all lakṣaṇa
  • acuity (acuteness) and intensity of lakṣaṇa
  • efforts needed for cikitsā
  • dhātu gata avasthā – involvement of deeper dhātu
  • sādhyāsādhyatva – the curability of the disease.

If above points are more, (lot of lakṣaṇa, acute, involvement of deeper dhātu etc)… then it falls in the mahākuṣṭha category.

If there are minimal symptoms and the disease is cured with minimal efforts, it falls under kṣudrakuṣṭha category.

It is wise to remember that kṣudra kuṣṭha if neglected can convert into a mahākuṣṭha.

Hetu:

  • Improper āhāra-vihāra especially viruddha āhāra
  • Vega dhāraṇa of vega like cchardi
  • Being exposed to ‘agni’ for long periods
  • As complication of improperly performed pañcakarma
  • Excessive exercise or physical activity after heavy meals
  • Maithuna (sexual activity) before consumed food is digested
  • Pāpa karma (sin/ inauspicious/ evil), Stress. (Idea of pāpa is subjective and changes with context… The guilt of pāpa can create stress…)

Saṃprāpti:

Above hetu cause doṣa prakopa. They find sthāna-saṃśraya in different duṣya esp. twacā, lasikā, rakta, maṃsa. Thus these 7 factors (3 doṣa + 4 duṣya) are mainly involved in the manifestation of twak roga.

  • Involvement of one or all doṣa
  • Origin in rasa, raktādi dhātu
  • Adhiṣthāna – location/ site of expression – Twacā
  • Sañcāra – Movement – all over the body.

Pūrvarūpa:

Depending on the doṣa / dūṣya involved:

  • Excessive or no sweating
  • Excessively smooth or rough skin
  • Vaivarṇya - Discoloration
  • Pain/ burning/ itching sensations
  • Altered sensation
  • Wound/ bleeding even on slight pressure
  • etc

Lakṣaṇa:

Going by the different mahā and kṣudra kuṣṭha described in Caraka, Aśtanga Hṛdaya, Suśṛta there a numerous names and each is given a set of lakṣaṇa.

For example,

  • Kāpāla kuṣṭha is a mahā kuṣṭha, vāta dominant, extremely dry skin, blackish or blackish-red discoloration, hardening of skin, irregularly shaped lesion, etc
  • Mandal kuṣṭha is a mahā kuṣṭha, kapha dominant, whitish or whitish-red discoloration, snigdha skin, usually wet type, more or less circularly shaped lesion, etc
  • Eka kuṣṭha is a kṣudra kuṣṭha, vata-kapha dominant, scaly skin (like fish), no sweating, red discoloration…

Also Mādhava nidāna speaks a lot about dhātu involvement; eg. Twakgata, rakta gata, maṃsa gata, meda gata…. śukra gata.

  • Twak/Rasa gata kuṣṭha: Vaivarṇya (discoloration), twak rukṣata (drying of skin), sūpti (reduced sensation), excessive/no sweat…
  • Raktagata : Kanḍu, Pūyotpatti with daurgandhya, Dāha…
  • Māṃṣagata : Large sized lesion, usually a piḍakā, hard to touch, toda (piercing pain), dryness in mouth, piḍaka stays for a long time, kuṣṭha stays for long time in a place (does not spread much)…
  • Medagata : All above symptoms, additionally bheda (splitting of the dhātu), loss of organs (they fall off) eg in leprosy, spreading of vraṇa, difficulty in movements…

  • Asthi-Majjāgata : Loss of nose (drops off) as in leprosy, vraṇa, kṛmi in vraṇa, swaropaghāta (loss of voice)…
  • Śukragata : Affects śukra/ artava… If a child is conceived in this stage, it is born with the kuṣṭha…

All stages until māmsagata are sādhya/ kaṣṭa sādhya. Medagata onwards are extremely kaṣṭasādhya or asādhya.

Kuṣṭha with kṛmi formation tends to be asādhya although it can be kaṣṭa sādhya.

Above there are multiple names, multiple lakṣaṇa.

But more importantly, it is necessary to understand the doṣa and effectively the mahābhuta involvement to treat skin diseases successfully. So let us focus more on the doṣic lakṣaṇa.

Vātaja kuṣṭha:

Dry, wrinkled, rough, blackened skin; irregularly shaped lesions; toda (piercing or hitting pain); kampa (tremor), sūpti (loss of sensation), roma-harṣa (hair standing on end) etc are noted.

Pittaj kuṣṭḥa:

Dāha (burning), pāka (ulcer formation), red discoloration; daurgandhya (foul smell), kotha (decomposition) etc.

Kaphaj kuṣṭha:

Kledayukta, snigdha, sthira, itching, cold to touch, circular lesions, whitish discoloration, possibility of kṛmi etc.

Cikitsa:

  • Pañcakarma according to doṣa involved.
  • Important medicines include : haridra, gandhak rasayan, arogyavardhini, pancatikta ghrta guggulu, mahatiktak ghrta, niśā-klita-sāra, khadira, khadirāriśṭa, mahamanjiṣṭhadi kwatha, jātyādi ghṛta/taila, vraṇa śodhaka taila…
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