Manual of Twak vikara in ayurveda Kushta, visarpa, kshudra roga
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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 samprapthi of kushta begins with the multitude of interactions of tridosa with twak, rakta, mamsa and lasika and gradually may afflict other dhathus, 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 deform‟ or „to scrap out‟, by adding the suffix „kta‟ which stands for „certainty‟ or „firmness‟. Thus, the word Kushtha means that which destroys with certainty.
Vyakhya: Kushnativapuetikushtam i.e. that which disfigures the body is known as Kushtha.
Skin is an organ of complex physiology and any manifestation in skin should be explored in terms of general physical and mental health and also on the basis of the status of rasa and raktha dhatus, the physical and functional state of which is more often reflected through the skin.
Depending on the amsamsavikalpa of dosha- dushya, kushta has been classified into 7 maha kushta and 11 kshudra kushta. It also can be classified on the basis of the following:
Vedana- nature of pain – “काऩारं तोदफहुर”ं Varna- based on colour-“मत ्काकणन्ततकावणं” Samsthana- appearance -“म饃ष्मन्जह्वासंस्थानं” Prabhava- prognosis- साध्मतासाध्मतादद Nama – name-काऩार इत्मादद Chikitsa visesha –treatment
NIDANA (ETIOLOGICAL FACTORS)
Nidana or the etiological factors closely linked with the manifestation, transmission and progression of the disease are broadly classified in the classical Ayurveda texts in the following categories:
1. AHARAJA NIDANA- food related etiological factors 2. VIHARAJA NIDANA- regimen related etiological factors 3. MANASIKA NIDANA- psychological etiological factors. 4. VISESHA NIDANA- an etiology that is not common in all diseases, but specifically act as hetu in this disease. 5. SAHAJA NIDANA – those factors which causes disease due to beeja bhaga avayava dushti.
aharaja
sahaja visesha nidana viharaja
manasi ka
In kushta roga, following nidans could be identified according to samhitas.
Sannikrishta nidana –sannikrishta nidana is the chief components of roga samprapthi janana. “saptako dravya sangraha”. The Sapta Dravya includes three Doshas viz. Vata, Pitta and Kapha and four Dushyas viz. Tvaka (Rasa), Rakta, Mansa and Ambu or Lasika. Viprakrishta nidana – the factors that support the dosha-dusya sammurchana are included under this classification. Kushta is also considered as an adibala pravrtta vyadhi (hereditary )
Purvajanmakrta karma is considered as a nidana for kushta. (म्रिमते मदद कु ेन ऩुनजाातेऽपऩ ग楍छतत | नात् क तयो योगो मथा कु ं प्रकीततता भ)् su ni 5/31-32 Kushta is also considered as an upasaragaja vyadhi प्रस敍गाद्गात्रसंस्ऩर्ाान्तन ासात ् सहबोजनात ् |
सहर्य्मासना楍चापऩ वस्त्रभा쥍मानुरेऩनात ् ||३३|| कु ं 煍वय र्ोष नेत्राम्रबष्मतद एव च | औऩसर्गाकयोगा स敍राभन्तत नयातनयभ(su् ni 5/34)
AHARAJA NIDANA TYPE OF NIDANA DOSHA /CATEGORY DUSHTI PARTICULAR RASA SEVANA अततरवण: Salt predominant Pitta vridhi Visyandana foods like pickles, Kapha Kleda bhelpuri, papad, visyandana vridhi chips, namkeen Raktadusht i कु ष्णातत भांसातन प्रगारमतत कु ातन अततअम्र: Fermented products, Pitta Raktadusht pickles, bhelpuri, sour abhivridhi i fruit juices, sauces Kapha Mamsa – like tomato sauce, vilapayati vidahati excess intake of Shithileeka preserved foods, curd, rana -kaya buttermilk, pickles, lemon juice, vinegar, alcohol, sauce, squashes, cold drinks, SPECIAL HABITS RELATED WITH FOOD INTAKE पव셁 ाहाय: Sprouted Tridosha Rakta dushti vegetables/grains with dushti meat, milk with meat, honey with meat, black gram with meat, lotus stem with meat, muli with meat, jaggery with meat, milk or honey with leafy vegetables, curd with chicken, honey heated in any form or taken with hot water, alcohol with kheer, fish with jaggery or sugar, muli with honey or milk, pork
with jaggery, banana with milk, buttermilk or curd. Drinking milk after eating garlic or any species of tulsi, any sour taste substances such as unripe mango, badara, jambu, akshoda, jackfruit, cocunut, dadima, amla with milk, safflower with alcohol, sweet porridge with process: ghee kept in copper vessel, amount: honey and water inequal quantity, honey and ghee in equal quantity Pizza, cheese mixed Kapha Agni गुवता नऩानभ ् foods, bakery prakopa vaigunya products, kidney (annavaha beans, paneer etc, srotodushti) food items prepared Raktavaha mainly from black srotodushti gram such as dosa, Mamsa vaha idli, vada; beef, pork; srotodushti food prepared from flour. Regular intake of meat products Intake of milk shakes, kheer etc. न्स्नग्धातनऩानभ ् Excessively oily Kapha Rasavaha foods such as prakopa srotodushti biriyani, fried oily Raktadushti foods, meatsoups, Raktavaha sweets made of srotodushti excess ghee, milk etc Agni such as kheer vaisamya Food prepared with cheese& ghee, sweets etc
द्रवातनऩानभ ् Drinking excess Kapha Agni quantity of prakopa mandya water/juices/madya/ Kleda soft drinks/ milk / janana liquid foods like Raktavaha rasam/sambhar more srotodushti than needed for the Udakavaha body srotodushti Rakta dushti स्नेहाततसेवनभ ् Excessive intake of Kapha Agni ghee for medical prakopa, vaisamya, purposes or as part of Doshotkles Kleda diet. ha janaka
नवातन: Newly harvested Kapha Kleda grains prakopa janaka
म्रभत््माहाय: Intake of food Tridosha Rakta foregoing ahara visesha vidhi ayatana असात्म्माहाय: Foods which are not Tridosha Rasa and native to the place rakta dushti such as fruits of (such food foreign origin, eating may remain food which is not indigested native to the area such and may as chinese food, pasta produce or pizza, soyabean, vidaha) olive oil, अजीणााहाय: Intake of food before Tridosha Agni the previous food is dushti dourbalya properly digested. Rasadushti Rakta dushti अजीणााध्मर्नभ ् eating food before Tridosha Rasa rakta digestion of previous dushti dushti meal or when there is Agni no appetite vaisamya अदहताम्रर्न: Fast food/junk Tridosha Agni food/excessive spicy dushti vaisamya food/excessive oily Rakta dushti food (such ahara Food taken when the might individual does not remain in
mentally prefer to koshta partake. without proper absorption and assimilation to tissues) र्चम्ररर्चभ ं ्च ऩमसा Intake of Prawns in Tridosha Rakta dushti combination with dushti karaka milk . because of its virudha swabhava (seeta-ushna etc) ग्रा륍यानूपौदकमा車सानन पयसा अशनम् Non vegetarian food Tridosha Rakta dushti with lassi, ice cream (specific along with non type of vegetarian food, milk virudha, products with meat guna eg. Dishes like butter virudha, chicken veerya virudha ) Intake of cold and hot Tridosha Agni रभं भुक्तत्वा र्ीतोष्णाहाय सेवनभ ् food together or dushti vaisamya intake of cold food Rakta dushti soon after intake of Swedavaha hot food or vice versa. sroto dushti Using cold water with (guna hot lunch/dinner. virudha Using dessert along swabhava) with hot food. Using cold milk with hot samosae etc. Taking food which Tridosha Raktadushti, रभं भुक्तत्वा र敍घनाहाय सेवनभ ् are ill nourishing and vaisamya ruksha in improper order especially janana neglecting the rules vata (ati Agni mentioned for food langhana) vaisamya intake. Kapha(ati Intake of ill- brimhana) nourishing food when body requires nourishing food etc
सततं अततभात्रं अजीणे सभ त: Habit of taking Tridosha Raktadushti honey/jiggery/fish/art dushti (specific भधुपाणणतभत्स्म रकु च भूरक ocarpus lakucha/ type of काकभाची radish/solanum virudha nigrum etc in which might excessive quantity act as cause and especially when for kushta) previous food has not been properly digested. Tridosha rakatdushti ऺीयदर्धतरकोरकु रत्थभाषातसीकु सु dushti म्बस्नेहवन्तत हामनक मवक चीनको ारक कोयदषू प्रामाणी चातनातन Taking food such as Pitta- Raktadushti अहायजातं पवदग्धं अनुन्쥍रख्म Spicy and pungent predomina (prabala) पवदाहीतमभ्मवहायत: foods with more of nt dushti red chilli, pepper, with kapha kulatha, shukta, vata aaranaala, madya, involveme sprouts, fried foods nt while previously taken food is in vidagdavastha(semidi gested and acidic/chyme) and has not been eliminated by induced emesis. SPECIFIC FOOD ITEMS दर्ध: Curd in different Kapha – Abhisyandi forms such as raita, pitta dushti Kleda lassi, dahivada, mixed janaka in curry etc especially Agni after heating and in vaisamya autumn, summer and karaka spring seasons Rakta dushti karaka (ushna, amla) भत्स्म Excessive intake of Kapha- Rakta dushti
fish, regular intake of Pitta dushti (virudhas fish, various with matsya preparations is specific involving fish. causative Combination of fish factor for with milk is a kushta) causative factor for kushta भाष: Use of urad dal and Kapha pitta Raktadushti preparations such as dushti vada, idli, dosa etc Regular usage of Ama Specific भूरक: radish.(radish is mulaka- hetu for considered prakrsta pitta-kapha rakta dushti apathya) dushti *(snigdha swabhava) Suska mulaka (vatakapha gna)
Food prepared after Kapha – Raktadushti पऩ ातन:् grinding rice, gram pitta dushti hetu etc and preparations such as Dosha, idli, vada, dhokla etc ततर: Regular intake of Kapha – Rakta dushti Sesame especially in pitta krt the form of ladoo, chikki, gajak or as sesame itself. ऺीय Milk and milk Kapha Snigda guna products, ice creams Kleda
Use of Jaggery and Kapha – Rakta- गुड: products made with pitta-vata mamsa- jaggery regularly medo dushti karaka Krimikaraka VIHARAJA NIDANA Habit of using Tridosha Rasarakta अननुऩूर्वम ा सततऩाणाऩतऩाणाभ्मवहामा santarpana and dushti dushti
र्वमत्मासोऩसेवा apatarpana ahara- vihara simultaneously or one after other such as Heavy work out in gym soon after heavy food intake. Heavy and highly nutritive food intake soon after fasting etc Indulging in hot or Tridosha Swedavaha अननुऩूर्वम ा र्ीतोष्णर्वमत्मासोऩसेवा cold things together (type of srotodushti or one after other. virudha Rakta Eating hot and cold vihara) dushtikaraka food items together, frequent going in and out of ac room in summer, bathing in cold water just after exercise or coming from hot exterior, working or travelling in airconditioned atmosphere and then sudden exposure to hot climate outside.
bathing in cold water Virudha Swedavaha उष्णाम्रबत स्म अप्सु भ煍जनभ ् just after coming from vihara srotodushti hot exterior, Tridosha Raktadushti swimming in cold dushti water just after exercise or work आततभात्रा सौदहत्मानततयं र्वमवाम Indulgence in coitus Tridosha Sakha gati after excessive or dushti of doshas सेवनं heavy food intake Rasa rakta dushti आततभात्रा सौदहत्मानततयं र्वमामाभ/ Indulgence in Tridosha Sakha gati exercise when dushti of doshas अतत बुक्तत्वा र्वमामाभोऩसेवनभ ् stomach is full or Rasa rakta after heavy food. dushti आततभात्रा सौदहत्मानततयं संताऩ Excessive sun Tridosa Raktadushti exposure after heavy dushti
food or when stomach सेवनं/अततबुक्तत्वा is full. अततसतताऩोऩसेवनभ ् बमोऩहतस्म सहसा र्ीतोदक सेवनभ ् Drinking cold water Tridosha Raktadushti when mind is agitated dushti (karma with fear virudha) श्रभोऩहतस्म सहसा र्ीतोदक सेवनभ ् Drinking cold water Tridosha Raktadushti when body is tired dushti (karma with exertion. virudha) सतताऩोऩहतस्म सहसा र्ीतोदक Drinking cold water Tridosha Raktadushti when mind is afflicted dushti (karma सेवनभ ् with grief or stress virudha) छददा वेगधायण: Taking anti emetics, Tridosha Raktadushti habit of suppressing dushti Specific
vomiting predomina hetu for ntly kapha kushta –pitta utklesha and vata pratilomata वाततस्म र्वमामाभग्राम्मधभासेपवन: Indulging in Tridosha Rasa rakta vyayama after (sakha dushti vomiting gamana of Indulging in utklishta coitus after dosha ) vomiting ददवा तनद्रा Habit of indulging in Kapha pitta Rasa rakta day sleep. predomina dushti nt dosha dushti स्नेहपीतय व्यायामग्रा륍यधममसेनिन: Exercise, exertion, Utklishta Rasa rakta sexual activity after dosha dushti eating unctuous food Sakha such as ghee, butter, gamana cheese, biriyani Tridosha dushti PANCHAKARMA APACHARAJA HETU ऩ祍चकभााऩचाय Refraining Tridosha Dhatu dushti from doing vitiation In this case, panchakarma improper Not following virechana or pathya-apathya raktamoksha or peyadi / donot
karma during undergo and after virechana or panchakarma raktamoksha Doing : there is panchakarma possibility without of guidance of raktadushti physician and hence kushta VISESHA HETU पवप्र धषणा भ ् Offending Brahmins Karma Kushta hetu itself act as hetu for kushta Offending teachers Karmaja Karmaja गु셁 धषणा भ ् and elders hetu for kushta hetu kushta ऩाऩ कभा Indulging in sin – Karmaja Karmaja murder, rape, bribery, hetu for kushta hetu thievery, looting, any kushta crime that may harm others Offending or abusing Karmaja Karmaja साध ु तनतदा saintly people hetu for kushta hetu
kushta Murder of saintly Karmaja Karmaja साध ु वध people hetu for kushta hetu kushta अतमस्वहयण Looting or snatching Karmaja Karmaja things from others for hetu for kushta hetu personal benefit kushta
SYMPTOMATOLOGY OF KUSHTA
Ayurveda acharyas has classified kushta into mahakushta and ksudra kushta .
ICD code -ED-4-kushta
Purvarupa : कु -ऩूव셂ा ऩभ-् ED-4.1
स्ऩर्ााऻत्वभ ् Inability to perceive touch sensation अततस्वेद् Excessive sweating
अस्वेद् Anhidrosis/lack of sweating वैवर्णमभा /्पववणाता Discolouration of skin कोठानाभ ्उतनतत् Raised reddish patches. रोभहषा् Horripilation Itching कर्णडू् तोद् Pricking pain श्रभ् Exhaustion/fatigue क्तरभ् Exhaustion without exertion Excessive pain in the wounds व्रणानाभर्धकं र्ूरभ ् र्ीघ्रोत्ऩपत् Sudden onset of skin lesions without any apparent reason र्चयन्स्थतत् Lesions and wounds remain unhealed for long time. दाह् Burning sensation Loss of sensation of body parts/affected सु ा敍गता area अतत क्ष्णस्ऩर्ा् Excessive smoothness of skin अततखयस्ऩर्ा् Excessive roughness of skin 셂ढानाभपऩ 셂ऺत्वभ ् Improper healing of wounds तनम्रभते अ쥍ऩे अपऩ कोऩनभ ् Aggravation of skin lesions/healed wounds by minor causative factors Blackish colour of blood असजृ ् काष्र्णमभा ्
भहाकु ्- ED-4.2
ED-4.2.1: कऩार्/अ셁ण-कु ्/वाततककु ्-कु ( skin affliction) with lesions resembling black clay pot fragments/अ셁ण (reddish) patches
셂ऺ Dryness of skin lesion and/ surrounding area अ셁ण् reddish colour of skin over the lesion ऩ셁ष् rough/dry appearing lesion uneven spreading lesion पवषभपवसतृ ् खयऩमातत् rough margins of the lesion
Thin skin over lesion/atrophied skin/thin तनू lesion raised outer margins of the lesions उ ृतफदहस्तनु loss of touch sensation/numbness over the सु वत्सु ् lesion 셃पषतरोभार्चत् Lesion covered with raised hairs Excessive pricking pain over lesion. तनस्तोदफहुर् With minimal or absent itching compared अ쥍ऩकर्णडू with other skin conditions अ쥍ऩदाह् Less/minimal burning sensation Minimal/less/absent pus discharge अ쥍ऩऩूम् अ쥍ऩरसीका Absent /Minimal/less watery discharge Rapid spreading lesion आर्ुगतत् Rapid onset of lesion. आर्ुसभुत्थान् sudden onset of complications/rupture of आर्ुबेदद lesion blackish discoloration of overlying and कृ ष्णवण ा surrounding skin अ셁णवणा् slightly reddish discoloration of overlying skin कऩारवणा्/कऩाराबभ ् Discoloration/hue or appearance similar to that of earthen vessel पवसपऩाणण्/र्ीघ्रसपऩा् rapid spreading nature
ED4.2.2 : काऩारककु भ ्
कृ ष्णकऩाम्ररकाप्रकार्् -resembling black earthen vessel
ED-4.2.3: उदम्ु फय-कु ्/ऩैपतक-कु ्
ताि् coppery coloured lesion तािनख् copper coloured nails ताियोभयाजीम्रबयनव ् Lesion covered with copper coloured hairs फहरातन copious discharge excessive pus discharge फहुऩूम् excessive bloody discharge फहुयक्त् excessive watery discharge फहुरसीका thick pus discharge फहरऩूम् फहरयक्त् thick bloody discharge फहररसीका thick watery discharge Itching कर्णडू् क्तरेद् moistening /saddening of lesion कोथ् Putrefaction of skin and muscle दाह् burning sensation ऩाक् inflammation/suppuration rapid spreading lesions आर्ुगतत् rapid onset of skin lesions आर्ुसभुत्थान् sudden onset of complications/rapid suppuration आर्ुबेदद् and rupture ससंताऩ् associated with elevated temperature over the lesion associated with worms सकृ म्रभ् ऩक्तवौदम्ु फयपरवण्ा /उदम्ु फयपराबासभ ् resembling the ripe fruit of उदम्ु फय् गौयम्रसयार्चतभ ् with whitish veins over the lesion 셁जाकयभ ् Painful lesions sudden onset of putrefaction/cracking आर् ु अवदयणभ ् यागभ ् redness/congestion of lesion and surrounding area रोभपऩ祍जयभ ् tawny brownish coloured hairs
ED-4.2.4-भर्णडरकु ्/कपजकु ्-कु ( skin affliction) with lesions resembling maNDala (circular skin) lesions
न्स्नग्ध् smooth/unctuous /oily appearing skin ldesions Heaviness over the lesion or surrounding skin गु셁 उत्सेध् Raised lesion (papule/patch) क्ष्णऩमातत् glossy margins of lesion न्स्थयऩमातत् Hard/rigid margins ऩीतऩमातत् yellowish margins whitish appearance or hue र्ुक्तरावबासी यक्तावबासी reddish appearance or hue Lesion covered with whitish hairs र्ुक्तरयोभयाजीसततत्
excessive/copious discharge फहुस्राव् फहरस्राव् profuse discharge पऩन्楍छरस्राव् slimy discharge excessive moistness/saddening फहुक्तरेद् excessive itching फहुकर्णडू excess worms फहुकृ म्रभ् सक्तगतत् slow spread slow onset सक्तसभुत्थान् सक्तबेदी slow onset of complications/rupture
ED-4.2.5: ऋष्मन्जह्वक् - कु ( skin affliction) with lesions resembling tongue of RuShya type of deer Lesion looks like a tongue of a antelope ऋष्मन्जह्वाकृ तीतन/ऋष्मन्जह्वाप्रकार्् ऩ셁ष् rough/dry lesion अ셁णवणा् slightly reddish coloured appearence फदहयतत्श्माव् Blackish appearance- internal and external नीराबास् bluish tinge to lesion ऩीतावबास् yellowish tinge to lesion तािावबास् coppery hue to the lesion rapid spreading lesion आर्ुगतत् rapid onset आर्ुसभुत्थान् Less/mild itching अ쥍ऩकर्णडु अ쥍ऩक्तरेद् less /mild soddening only Less possibility of worm infestation अ쥍ऩकृ म्रभ excessive burning sensation दाहफहुर् severe splitting type of pain बेदफहुर् excessive pricking pain तनस्तोदफहुर् Lesion having pain as if pierced with bristles र्ूकोऩहतोऩभवेदना उत्सतनभध्म् raised middle part of lesion
thin margins तनुऩमता त् ककार्पऩडकार्चत् covered with rough eruptions दीघाऩरयभर्णडर् large circular patch खय् Rough
ED-4.2.6: ऩुर्णडयीक्कु (skin affliction) with lesions resembling a white lotus
ऩुर्णडयीकस敍कार््/ऩुर्णडयीकऩत्रप्रकार्् Lesion resembling the petals of a ऩुर्णडयीक (lotus) ऩरार्स敍कार्् Lesion resembling ऩरार् flower whitish appearance of lesion र्ुक्तरावबास् यक्तावबास् reddish appearance यक्तऩमातत् reddish margins यक्तयाजीसततत् full of red streaks यक्तम्रसयासततत् associated with reddish veins उत्सेधवन्तत Raised lesion excessive pus discharge फहुऩूम् excess bloody discharge फहुयक्त्
excessive watery discharge फहुरसीका thick pus discharge फहरऩूम् फहरयक्त् thick bloody discharge फहररसीका thick watery discharge itching कर्णडू् Worm infestation कृ म्रभ् दाह् burning sensation ऩाक् inflammation/suppuration rapid spread आर्ुगतत् rapid onset आर्ुसभुत्थन् sudden onset of complications आर्ुबेदद्
ED-4.2.7: म्रसध्भ्-कु (skin affliction) with lesions resembling alAbu (bottle gourd) flower
resembling flowers of a gourd अराफुऩुष्ऩस敍कार्भ ् ऩ셁ष् rough/dry skin lesions अ셁ण् reddish in colour पवर्ीणा broken, shattered appearance of overlying skin Thin appearing skin outside फदहस्तनूतन अतत्न्स्नग्धातन unctuous inside whitish and reddish tinged lesions र्ुक्तरयक्तावबास् Numerous lesions फहूतन अ쥍ऩवेदना mild pain less itching अ쥍ऩकर्णडू अ쥍ऩदाह् less burning sensation less pus discharge अ쥍ऩऩूम् अ쥍ऩरसीका less watery discharge light onset रघुसभुत्थान् अ쥍ऩबेद् less complications less worms अ쥍ऩकृ म्रभ dust on itching घ ृ ं यज् ककयेत ् दौन्ग्धकऩुष्ऩवत ् resembles दौन्ग्धक flower प्रामेण ऊध्वाकामे स्मात ् usually affects upper part of the body
ED-4.2.8: काकणक्- कु ( skin affliction) with lesions resembling gu~jja (Abrus precatorius) seed
काकणान्ततकावणा्/काकणान्ततकापरस饃र्् Lesion resembling colour of काकणान्ततका सवका ु म्रर敍गसभन्तवत् with symptoms of all the कु अतीवयक्त् dark red in colour dark black in colour अतीवकृ ष्ण् तीव्रदाह् severe burning sensation severe pain तीव्र셁क्
ED-4.3: ऺुद्रकु भ:्
ED-4.3.1: एककु ् कु (skin affliction) with lesions resembling fish scales
अस्वेदनभ ् anhidrosis/lack of sweating broad based भहावस्त/ु भहाश्रमभ ् भत्स्मर्करोऩभभ ् looks like the scales of a fish
ED-4.3.2: चभका ु ् - कु (skin affliction) with lesions resembling elephant’s skin
फहरभ ् large in size हन्स्तचभवा त ् resembling the skin of elephant
खयस्ऩर्भा ् rough on touch
ED-4.3.3-ककदिब् - कु ( skin affliction) with lesions with rough surface and scar like appearance
श्मावं bluish black colour
ककणखयस्ऩर्भा ् rough on touch ऩ셁षभ ् rough/dry 셂ऺभ ् dry itching sensation कर्णडूभत ् blackish discoloration अम्रसतभ ्
ED-4.3.4: पवऩाददका: cracks in palms and soles
Cracks/fissuring in the hands ऩाणणस्पु िनभ ् Cracks/fissuring in the feet ऩादस्पु िनभ ् तीव्रवेदनभ/्तीव्रातता् severe pain on the lesion mild itching only भतदकर्णडू याग् redness/congestion पऩिकार्चत् associated with eruptions
ED-4.3.5: अरसककु ्/अरसकु ्- कु (skin affliction) with nodular skin lesions
ED-4.3.6: दद्र-ु कु ्-कु (skin affliction) with lesions elevated pimple like skin lesions
associated with itching sensation कर्णडू् याग् reddish nodules पऩडका papule/eruptions उद्गत भर्णडरभ/् उत्सतनभर्णडरा elevated ring shaped plaque दीघाप्रताना् spreading out दवू ाावत ् resembling दवू ाा, in its character of spread अतसीकु सुभ楍छपव् resembling the flower of अतसी chronic (associated over a long अनुष敍र्गणी period)
ED-4.3.7-चभादर-कु ्
यक्तभ ् Redness of over lying /surrounding skin. Itching कर्णडू् स्पोि् Blister/vesicle formation. 셁जा Pain दरनभ ् Peeling of skin स्ऩर्ाासहत्वभ/् अस्ऩर्सा हभ ् tenderness/inability to tolerate touch ऊषा burning sensation with sweating and restlessness दाह् burning sensation
ED-4.3.8: ऩाभा ( क楍छू ): कु ( skin affliction) with lesions with white, reddish, blackish- brown eruptions