Charaka Kushta Nidana: 5th chapter

The 5th chapter of Charaka Samhitha Nidana Sthana is Kushta Nidana. It deals with causes, pathology, types,and symptoms of Kushta – skin Diseases, as per Ayurveda.

अथातः कुष्ठ निदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātaḥ kuṣṭha nidānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall now explore the chapter on the Diagnosis of Kushta (skin Diseases including leprosy). Thus said Lord Atreya [1-2]

Table of Contents

Kushta Dravya

Kushta Dravya – Morbid factors that are involved in Kushta:
सप्त द्रव्याणि कुष्ठानां प्रकृति र्विकृतिमापन्नानि भवन्ति|
तद्यथा- त्रयो दोषा वात पित्त श्लेष्माणः प्रकोपण विकृताः, दूष्याश्च शरीरधातवस्त्वङ्मांस शोणित लसीकाश्चतुर्धा दोषोपघातविकृता इति|
एतत् सप्तानां सप्तधातुकमेवङ्गतमाजननं कुष्ठानाम्, अतःप्रभवाण्यभिनिर्वर्तमानानि केवलं शरीरमुपतपन्ति||३||
sapta dravyāṇi kuṣṭhānāṃ prakṛtirvikṛtimāpannāni bhavanti|
tadyathā- trayo doṣā vāta pitta śleṣmāṇaḥ prakopaṇa vikṛtāḥ, dūṣyāśca śarīradhātavastvaṅmāṃsa śoṇita lasīkāścaturdhā doṣopaghātavikṛtā iti|
etat saptānāṃ saptadhātukamevaṅgatamājananaṃ kuṣṭhānām, ataḥprabhavāṇyabhinirvartamānāni kevalaṃ śarīramupatapanti||3||

Morbid factors that are involved in Kushta:
Kushta is caused by the morbidity of 7 factors. They are the 3 Doshas, Viz,
Vata
Pitta and
Kapha which get vitiated by causative factors and
4 Dhatus of the body, viz
Tvak (skin or rasa)
Mamsa (Muscle)
Shonita (blood) and
Lasika (lymph) which get vitiated by the morbid Doshas.

Thus the 7 types of Kusthas are produced by the 7 morbid Dhatus (which include 3 Doshas). The Kushta so caused spreads to the entire body after its manifestation. [3]

Kushta classification

Innumerable classification of Kushta:
न च किञ्चिदस्ति कुष्ठमेकदोष प्रकोप निमित्तम्, अस्ति तु खलु समान प्रकृतीनामपि कुष्ठानां दोषांशांश विकल्पानुबन्धस्थानविभागेन वेदना वर्ण संस्थान प्रभाव नाम चिकित्सित विशेषः|
स सप्तविधोऽष्टादशविधोऽपरिसङ्ख्येय विधो वा भवति|
दोषा हि विकल्पनैर्विकल्प्यमाना विकल्पयन्ति विकारान्, अन्यत्रासाध्यभावात्|
तेषां विकल्प विकार सङ्ख्यानेऽतिप्रसङ्गमभिसमीक्ष्य सप्तविधमेव कुष्ठ विशेषमुपदेक्ष्यामः||४||
na ca kiñcidasti kuṣṭhamekadoṣa prakopa nimittam, asti tu khalu samānaprakṛtīnāmapi kuṣṭhānāṃ doṣāṃśāṃśavikalpānubandhasthānavibhāgena vedanāvarṇasaṃsthānaprabhāvanāmacikitsitaviśeṣaḥ|
sa saptavidho’ṣṭādaśavidho’parisaṅkhyeya vidho vā bhavati|
doṣā hi vikalpanairvikalpyamānā vikalpayanti vikārān, anyatrāsādhyabhāvāt|
teṣāṃ vikalpa vikāra saṅkhyāne’tiprasaṅgamabhisamīkṣya saptavidhameva kuṣṭha viśeṣamupadekṣyāmaḥ||4||

Innumerable classification of Kushta:
No Kushta manifests itself due to the aggravation of only one Dosha.
Depending upon the permutation and combination of the various factors of Dosha and their location in the body, there is variation in the
Vedana(pain),
Varna (colour),
Samsthana(shape),
Prabhava (specific manifestations),
Nama (name) and
Chikitsa (treatment) of the various types of skin disorders.

They may be of 7 types and according to another classification, 18 types. But in general, Kushta are of innumerable types.
Doshas due to various forms of permutation and combination bring about varieties in these diseases excepting those which are incurable. As all the variations of the disease are too exhaustive to be narrated here, only the 7 fold classification of Kushta will be explained here [4]

Nature of Kushta

Specific nature of Kushta:
इह वातादिषु त्रिषु प्रकुपितेषु त्वगादींश्चतुरः प्रदूषयत्सु वातेऽधिकतरे कपालकुष्ठमभिनिर्वर्तते, पित्ते त्वौदुम्बरं, श्लेष्मणि मण्डलकुष्ठं, वात पित्तयोरृष्यजिह्वं, पित्तश्लेष्मणोः पुण्डरीकं, श्लेष्म मारुतयोः सिध्म कुष्ठं, सर्व दोषाभिवृद्धौ काकणकमभिनिर्वर्तते; एवमेष सप्तविधः कुष्ठविशेषो भवति|
स चैष भूयस्तरतमतः प्रकृतौ विकल्प्यमानायां भूयसीं विकारविकल्पसङ्ख्यामापद्यते||५||
iha vātādiṣu triṣu prakupiteṣu tvagādīṃścaturaḥ pradūṣayatsu vāte’dhikatare kapālakuṣṭhamabhinirvartate, pitte tvaudumbaraṃ, śleṣmaṇi maṇḍalakuṣṭhaṃ, vātapittayorṛṣyajihvaṃ, pittaśleṣmaṇoḥ puṇḍarīkaṃ, śleṣmamārutayoḥ sidhmakuṣṭhaṃ, sarvadoṣābhivṛddhau kākaṇakamabhinirvartate; evameṣa saptavidhaḥ kuṣṭhaviśeṣo bhavati|
sa caiṣa bhūyastaratamataḥ prakṛtau vikalpyamānāyāṃ bhūyasīṃ vikāravikalpasaṅkhyāmāpadyate||5||

The specific nature of the 7 types of Kusthas manifested due to
vitiation of 4 Dhatus, viz, Tvak (skin on Rasa dhatu) etc.,
by the 3 Doshas, Viz, Vata etc., is as follows:

Kapala due to Vata
Audumbara due to Pitta
Mandala due to Kapha
Rushyajihva Kushta due to Vata and Pitta
Pundarika due to the Kapha and Pitta
Sidhma due to Kapha and Vata
Kakanaka due to involvement of all the three Doshas.
Depending upon the degree of affliction of these etiological factors and their permutation and combinations, this disease is of innumerable type. [5]

Nidana

Kushta Nidana: – Etiology
तत्रेदं सर्वकुष्ठनिदानं समासेनोपदेक्ष्यामः- शीतोष्णव्यत्यासमनानुपूर्व्योपसेवमानस्य तथा सन्तर्पणापतर्पणाभ्यवहार्यव्यत्यासं, मधु फाणित मत्स्य लकुच मूलक काकमाचीः सततमतिमात्रमजीर्णे च समश्नतः, चिलिचिमं च पयसा, हायनक यवक चीन कोद्दालक कोरदूष प्रायाणि चान्नानि क्षीर दधि तक्र कोल कुलत्थ माषातसी कुसुम्भ स्नेहवन्ति, एतैरेवातिमात्रं सुहितस्य च व्यवाय व्यायाम सन्तापानत्युपसेवमानस्य, भय श्रम सन्तापोपहतस्य च सहसा शीतोदकमवतरतः, विदग्धं चाहारजातमनुल्लिख्य विदाहीन्यभ्यवहरतः, छर्दिं च प्रतिघ्नतः, स्नेहांश्चातिचरतः, त्रयो दोषाः युगपत् प्रकोपमापद्यन्ते; त्वगादयश्चत्वारः शैथिल्यमापद्यन्ते; तेषु शिथिलेषु दोषाः प्रकुपिताः स्थानमधिगम्य सन्तिष्ठमानास्तानेव त्वगादीन् दूषयन्तः कुष्ठान्यभिनिर्वर्तयन्ति||६||
tatredaṃ sarvakuṣṭhanidānaṃ samāsenopadekṣyāmaḥ- śītoṣṇavyatyāsamanānupūrvyopasevamānasya tathā santarpaṇāpatarpaṇābhyavahāryavyatyāsaṃ, madhu phāṇita matsya lakuca mūla kakākamācīḥ satatamatimātramajīrṇe ca samaśnataḥ, cilicimaṃ ca payasā, hāyanaka yavaka cīna koddālaka koradūṣa prāyāṇi cānnāni kṣīra dadhi takra kola kulattha māṣātasī kusumbha snehavanti, etairevātimātraṃ suhitasya ca vyavāya vyāyāma santāpānatyupasevamānasya, bhaya śrama santāpopahatasya ca sahasā śītodakamavatarataḥ, vidagdhaṃ cāhārajātamanullikhya vidāhīnyabhyavaharataḥ, chardiṃ ca pratighnataḥ, snehāṃścāticarataḥ, trayo doṣāḥ yugapat prakopamāpadyante; tvagādayaścatvāraḥ śaithilyamāpadyante; teṣu śithileṣu doṣāḥ prakupitāḥ sthānamadhigamya santiṣṭhamānāstāneva tvagādīn dūṣayantaḥ kuṣṭhānyabhinirvartayanti||6||

Etiology of Kushta:
Now we shall describe the etiology of all types of Kusthas in brief. All the 3 Doshas get simultaneously vitiated by the following:
Shītoṣṇavyatyāsamanānupūrvyopasevamānasya tathā santarpaṇāpatarpaṇābhyavahāryavyatyāsaṃ – Non –compliance of the prescribed rules with regard to the order of responding to hot and cold regimens and intake of nourishing and depleting diets:
Madhu phāṇita matsya lakuca mūla kakākamācīḥ satatam atimātramajīrṇe ca samaśnataḥ – Continuous intake of honey, pendium, fish, Lakucha (Artocarpus Lakooch Roxb), Radish and Kakamachi (Solanum Nigrum Linn) in large quantity while suffering from indigestion.
Chilicimaṃ ca payasā – Intake of Cilicima (fish) with milk
Intake of food mostly containing Hayanaka (Oryza sativa linn), Yavaka (a type of Hordeum Vulgare Linn), Cinaka (cucumis utilissimus), Uddalaka (paspalum scrobiculatum) and Koradusa (Paspalum Scorbiculatum Linn) along with milk, curd, butter, milk, Kola (Zizyphus Radiatus Linn), Atasi (Linumustitatissimum Linn), Kusumbha (carthamus Tinctorious Linn), and unctuous substances
Etairevātimātraṃ suhitasya ca vyavāya vyāyāma santāpānatyupasevamānasya – Excessive indulgence in cohabitation, physical exercise and exposure to heat after taking the above mentioned food to one’s satisfaction

Bhaya śrama santāpopahatasya ca sahasā śītodakamavatarataḥ – Entering into cold water immediately after one is afflicted with Bhaya (fear), Shrama (exhaustion) and Santapa (grief)
Vidagdhaṃ cāhārajātamanullikhya vidāhīnyabhyavaharataḥ – Intake of such food as would cause burning sensation without vomiting out the undigested food (in the stomach)
Chardiṃ ca pratighnataḥ – Suppression of the urge for emesis and
Snehāṃścāticarataḥ – Excessive oleation

The above factors also loses the 4 Dhatus, viz. Tvak (skin or Rasa dhatu) etc. the aggravated Doshas localized in these Dhatus vitiate the latter due to their looseness and so produce Kusthas. [6]

Purvaroopa

Kushta Purvarupa: Premonitory symptoms:
तेषामिमानि पूर्वरूपाणि भवन्ति; तद्यथा- अस्वेदनमतिस्वेदनं पारुष्यमतिश्लक्ष्णता वैवर्ण्यं कण्डूर्निस्तोदः सुप्तता परिदाहः परिहर्षो लोमहर्षः खरत्वमूष्मायणं गौरवं श्वयथु र्वीसर्पागमनमभीक्ष्णं च काये कायच्छिद्रेषूपदेहः पक्व दग्ध दष्ट भग्न क्षतोपस्खलितेष्वतिमात्रं वेदना स्वल्पानामपि च व्रणानां दुष्टिरसंरोहणं चेति||७||
teṣāmimāni pūrvarūpāṇi bhavanti; tadyathā- asvedanamatisvedanaṃ pāruṣyamatiślakṣṇatā vaivarṇyaṃ kaṇḍūrnistodaḥ suptatā paridāhaḥ pariharṣo lomaharṣaḥ kharatvam ūṣmāyaṇaṃ gauravaṃ śvayathur vīsarpāgamanamabhīkṣṇaṃ ca kāye kāyacchidreṣūpadehaḥ pakva dagdha daṣṭa bhagna kṣatopaskhaliteṣvatimātraṃ vedanā svalpānāmapi ca vraṇānāṃ duṣṭirasaṃrohaṇaṃ ceti||7||

The premonitory symptoms of Kushta:
Asvedanamatisvedanaṃ – No sweating or more sweating
Pāruṣyamatiślakṣṇatā – Having rough edges, thin and slightly elevated in purify
Vaivarṇyaṃ – Discoloration of the skin
Kandu – severe itching
Nistoda – Pricking sensation
Suptatā – There is excessive numbness
Paridaha – Burning sensation
Pariharṣo lomaharṣaḥ – They are covered with horrent hairs and associated with excessive pain
ūṣmāyaṇaṃ – There is less of discharge of pus and serous exudation.
They are causation, manifestation and ulceration are instantaneous.
They are infested with germs and appear like pieces of earthen pot having black or reddish color.

Signs and symptoms

Signs and symptoms of different types of Kushta:
ततोऽनन्तरं कुष्ठान्यभिनिर्वर्तन्ते, तेषामिदं वेदनावर्णसंस्थानप्रभावनामविशेषविज्ञानं भवति;
tato’nantaraṃ kuṣṭhānyabhinirvartante, teṣāmidaṃ vedanāvarṇasaṃsthānaprabhāvanāmaviśeṣavijñānaṃ bhavati;

Hereafter, characteristic features, pain, colour, shape and specific manifestations of Kushtas are explained.

1. Kapala Kushta

तद्यथा- रूक्षारुणपरुषाणि विषमविसृतानि खरपर्यन्तानि तनून्युद्वृत्तबहिस्तनूनि सुप्तवत्सुप्तानि हृषितलोमाचितानि निस्तोदबहुलान्यल्पकण्डूदाहपूयलसीकान्याशुगतिसमुत्थानान्याशुभेदीनि जन्तुमन्ति कृष्णारुणकपालवर्णानि च कपालकुष्ठानीति विद्यात्(१)
tadyathā- rūkṣāruṇaparuṣāṇi viṣamavisṛtāni kharaparyantāni tanūnyudvṛttabahistanūni suptavatsuptāni hṛṣitalomācitāni nistodabahulānyalpakaṇḍūdāhapūyalasīkānyāśugatisamutthānānyāśubhedīni jantumanti kṛṣṇāruṇakapālavarṇāni ca kapālakuṣṭhānīti vidyāt (1)

Kapala Kushta:
Kapala type of Kushta is dry, red coloured, rough skin surface, uneven shape, with rough edges, thin, slightly elevated at the periphery. It is characterized by numbness.
The affected skin patches are covered erect hairs and are associated with severe pain.
There is less itching, burning sensation, pus discharge and serous exudation.
They occur instantaneously. They are infected with microbes and appear like pieces of earthern pot with black or red colour. Hence the name – Kapala.

2. Audumbara Kushta

ताम्राणि ताम्र खर रोम राजीभिरवनद्धानि बहलानि बहु बहल पूय रक्त लसीकानि कण्डू क्लेद कोथ दाह पाकवन्त्याशुगति समुत्थान भेदीनि ससन्ताप क्रिमीणि पक्वोदुम्बर फल वर्णान्यौदुम्बर कुष्ठानीति विद्यात् ||
tāmrāṇitāmra khara roma rājībhiravanaddhāni bahalāni bahu bahala pūya rakta lasīkāni kaṇḍū kleda kotha dāha pākavantyāśugati samutthāna bhedīni sasantāpa krimīṇi pakvodumbara phala varṇānyaudumbara kuṣṭhānīti vidyāt

Audumbara type of Kushta is:
Tāmrāṇitāmra khara roma – Coppery color and they are covered with hair of coppery color.
Bahalāni bahu bahala pūya rakta lasīkāni – They are very thick and associated with thick pus, blood and serous exudation in large quantity.
Kaṇḍū kleda kotha dāha pākavantyāśugati – They are associated with Kandu(itching), Kleda(sticky exudation), Koth a(sloughing), Daha(burning sensation) and Paka (suppuration).
Samutthāna bhedīni sasantāpa krimīṇi – Their causation, manifestation and ulceration are instantaneous.
Pakvodumbara phala varṇānyaudumbara kuṣṭhānīti – There are like the ripe fruit of Udumbara (ficus Racemosa Linn), in colour.

3. Mandala Kushta

शुक्ल रक्तावभासा निशुक्ल रोमराजी सन्तानानि बहु बहल शुक्ल पिच्छिल स्रावीणि बहु क्लेद कण्डू क्रिमीणि सक्तगति समुत्थान भेदीनि परिमण्डलानि मण्डल कुष्ठानि विद्यात् |
śukla raktāvabhāsā niśukla romarājī santānāni bahu bahala śukla picchila srāvīṇi bahu kleda kaṇḍū krimīṇi saktagati samutthāna bhedīni parimaṇḍalāni maṇḍala kuṣṭhāni vidyāt
Mandala type of Kushta is
śukla raktāvabhāsā niśukla romarājī – They are white and red in color and are covered with white hairs in large color.
Bahu bahala śukla picchila srāvīṇi bahu kleda kaṇḍū krimīṇi – They are associated with excessive sticky exudation and itching, and infested with numerous germs.
Saktagati samutthāna bhedīni parimaṇḍalāni – Their causation, manifestation and ulceration are sluggish and they are round in shape.

4. Rushyajihva Kushta

परुषाण्यरुण वर्णानि बहिरन्तःश्यावानि नील पीत ताम्रावभासान्याशुगति समुत्थानान्यल्प कण्डू क्लेद क्रिमीणि दाह भेद निस्तोद (पाक)बहुलानि शूकोपहतोपमवेदनान्युत्सन्नमध्यानि तनु पर्यन्तानि कर्कश पिडकाचितानि दीर्घ परिमण्डलान्यृष्यजिह्वाकृतीनि ऋष्यजिह्वानीति विद्यात् |
paruṣāṇyaruṇa varṇāni bahirantaḥśyāvāni nīla pīta tāmrāvabhāsānyāśugati samutthānānyalpa kaṇḍū kleda krimīṇi dāha bheda nistoda (pāka)bahulāni śūkopahatopamavedanānyutsannamadhyāni tanu paryantāni karkaśa piḍakācitāni dīrgha parimaṇḍalānyṛṣyajihvākṛtīni ṛṣyajihvānīti vidyāt

Rushyajihva type of Kustha is
Parushya – rough
aruṇa varṇāni bahirantaḥśyāvāni nīla pīta tāmrāvabhāsānyāśugati samutthānā – reddish in color and dark brown in the centre as well as in the periphery. They are of blue, yellow and coppery shade.
Alpa kaṇḍū kleda krimīṇi – There is less of itching, sticky exudation and germs
Dāha bheda nistoda (pāka) bahulāni – They are associated with excessive burning sensation, cutting and piercing pain and suppuration.
śūkopahatopamavedanānyutsanna madhyāni tanu paryantāni karkaśa piḍakācitāni dīrgha parimaṇḍalānyṛṣyajihvākṛtīni ṛṣyajihvānīti – There is pain as if inflicted with bristles. In the center they are elevated and their peripheries are thin. They are associated with rough pimples and are elongated and round in shape like the tongue of a deer.

5. Pundareeka Kushta

शुक्ल रक्तावभासानि रक्त पर्यन्तानि रक्तराजी सिरासन्ततान्युत्सेधवन्ति बहु बहल रक्त पूय लसीकानि कण्डू क्रिमि दाह पाकवन्त्याशुगति समुत्थानभेदीनि पुण्डरीक पलाश सङ्काशानि पुण्डरीकाणीति विद्यात् |
śukla raktāvabhāsāni rakta paryantāni raktarājī sirāsantatānyutsedhavanti bahu bahala rakta pūya lasīkāni kaṇḍū krimi dāha pākavantyāśugati samutthānabhedīni puṇḍarīka palāśa saṅkāśāni puṇḍarīkāṇīti vidyāt

Pundarika type of Kustha is of
Shukla raktāvabhāsāni rakta paryantāni raktarājī sirā – white and red shade. Their borders are red, and they are covered with red lines and blood vessels.
Santatānyutsedhavanti bahu bahala rakta pūya lasīkāni kaṇḍū krimi dāha pākavantyāśugati samutthāna bhedīni – There is swelling and discharge of thick blood, pus and serum in excessive quantity. There is itching, germ infestation, burning sensation and suppuration. Their causation, manifestation and ulceration are instantaneous.
Puṇḍarīka palāśa saṅkāśāni puṇḍarīkāṇīti vidyāt – They appear like the petals of lotus flower.

6. Sidhma Kushta

परुषारुणानि विशीर्णबहिस्तनून्यन्तःस्निग्धानि शुक्ल रक्तावभासानि बहून्यल्पवेदनान्यल्प कण्डू दाह पूय लसीकानि लघु समुत्थानान्यल्प भेदक्रिमीण्यलाबु पुष्प सङ्काशानि सिध्मकुष्ठानीति विद्यात् |
paruṣāruṇāni viśīrṇabahistanūnyantaḥsnigdhāni śukla raktāvabhāsāni bahūnyalpavedanānyalpa kaṇḍū dāha pūya lasīkāni laghu samutthānānyalpa bhedakrimīṇyalābu puṣpa saṅkāśāni sidhmakuṣṭhānīti vidyā

Sidhma type of Kustha is:
Paruṣāruṇāni viśīrṇabahistanūnyantaḥsnigdhāni – rough and reddish in color, in the periphery they are fissured and thin and in the centre, they are smooth.
śukla raktāvabhāsāni – They are of white and red shade.
Bahūnyalpavedanānyalpa kaṇḍū dāha pūya lasīkāni laghu samutthānānyalpa bheda krimi — They appear in large number and there is less of pain, itching, burning sensation, pus and serous discharge. Their causation of ulceration is sluggish and there is less of germs infestation.
Alābu puṣpa saṅkāśāni – They appear like the flower of alabu (Lagenaria Siceraia standl).

7. Kakanika kushta

काकणन्तिकावर्णान्यादौ पश्चात्तु सर्व कुष्ठलिङ्ग समन्वितानि पापीयसा सर्वकुष्ठलिङ्गसम्भवेनानेकवर्णानि काकणानीति विद्यात्|
तान्यसाध्यानि, साध्यानि पुनरितराणि||८||
kākaṇantikāvarṇānyādau paścāttu sarvakuṣṭhaliṅga samanvitāni pāpīyasā sarvakuṣṭhaliṅgasambhavenānekavarṇāni kākaṇānīti vidyāt|
tānyasādhyāni, sādhyāni punaritarāṇi||8||

Kakana type of Kustha are the:
Kākaṇantikāvarṇānyādau paścāttu sarvakuṣṭhaliṅga – Color of Kakanantika (Abrus Precatorius Linn) in the beginning and subsequently symptoms of all types of Kusthas are manifested there
Pāpīyasā sarvakuṣṭhaliṅgasambhavenānekavarṇāni kākaṇānīti vidyāt – Because of the combination of these painful characteristics of all other types of Kushta those belonging to Kakanantika category are of many colors
Tānyasādhyāni, sādhyāni punaritarāṇi – Kusthas those belonging to this category are incurable other curable. [8]

Sadhya Asadhyata

तत्र यदसाध्यं तदसाध्यतां नातिवर्तते, साध्यं पुनः किञ्चित् साध्यतामतिवर्तते कदाचिदपचारात्|
साध्यानि हि षट् काकणकवर्ज्यान्यचिकित्स्यमानान्यपचारतो वा दोषैरभिष्यन्दमानान्यसाध्यतामुपयान्ति||९||
tatra yadasādhyaṃ tadasādhyatāṃ nātivartate, sādhyaṃ punaḥ kiñcit sādhyatāmativartate kadācidapacārāt|
sādhyāni hi ṣaṭ kākaṇakavarjyānyacikitsyamānānyapacārato vā doṣairabhiṣyandamānānyasādhyatāmupayānti||9||

Prognosis of Kushta:
Curable Kushtas may become incurable if the patient indulges in unwholesome regimens even after the manifestation of the disease.
Excluding Kakanantika, other types of Kusthas, which are normally curable may become incurable in the even of the saturation of the vitiated Doshas due to the lack of proper regimen or resort to unwholesome regimen. [9]

Complications

Complications caused by Negligence:
साध्यानामपि ह्युपेक्ष्यमाणानां त्वङ्मांस शोणित लसीका कोथ क्लेद संस्वेदजाः क्रिमयोऽभिमूर्च्छन्ति; ते भक्षयन्तस्त्वगादीन् दोषाः पुनर्दूषयन्त इमानुपद्रवान् पृथक् पृथगुत्पादयन्ति- तत्र वातः श्यावारुणवर्णं परुषतामपि च रौक्ष्य शूल शोष तोद वेपथु हर्ष सङ्कोचायास स्तम्भ सुप्तिभेदभङ्गान्, पित्तं दाह स्वेद क्लेद कोथ स्राव पाक रागान्, श्लेष्मा त्वस्य श्वैत्य शैत्य कण्डू स्थैर्य गौरवोत्सेधोपस्नेहोपलेपान्, क्रिमयस्तु त्वगादींश्चतुरः सिराः स्नायूश्चास्थीन्यपि च तरुणान्याददते ||१०||
अस्यां चैवावस्थायामुपद्रवाः कुष्ठिनं स्पृशन्ति; तद्यथा- प्रस्रवणमङ्गभेदः पतनान्यङ्गावयवानां तृष्णा ज्वरातीसार दाह दौर्बल्यारोचकाविपाकाश्च, तथाविधमसाध्यं विद्यादिति||११||
sādhyānāmapi hyupekṣyamāṇānāṃ tvaṅmāṃsa śoṇita lasīkā kotha kleda saṃsvedajāḥ krimayo’bhimūrcchanti; te bhakṣayantastvagādīn doṣāḥ punardūṣayanta imānupadravān pṛthak pṛthagutpādayanti- tatra vātaḥ śyāvāruṇavarṇaṃ paruṣatāmapi ca raukṣya śūla śoṣa toda vepathu harṣa saṅkocāyāsa stambha suptibhedabhaṅgān, pittaṃ dāha sveda kleda kotha srāva pāka rāgān, śleṣmā tvasya śvaitya śaitya kaṇḍū sthairya gauravotsedhopasnehopalepān, krimayastu tvagādīṃścaturaḥ sirāḥ snāyūścāsthīnyapi ca taruṇānyādadate ||10||
asyāṃ caivāvasthāyāmupadravāḥ kuṣṭhinaṃ spṛśanti; tadyathā- prasravaṇamaṅgabhedaḥ patanānyaṅgāvayavānāṃ tṛṣṇā jvarātīsāra dāha daurbalyārocakāvipākāśca, tathāvidhamasādhyaṃ vidyāditi||11||

The complications caused by negligence are:
Tvaṅmāṃsa śoṇita lasīkā kotha kleda saṃsvedajāḥ krimayo’bhimūrcchanti – Germs or on the slough of the skin, muscle tissue, blood and serous exudation , other softened tissues and sweet, appear even in the curable types of Kusthas when their treatment is neglected.
krimayo’bhimūrcchanti – While infesting the skin etc. these germs further vitiate the Doshas leading to complications which are described below separately (for each Doshas and germs).
Vātaḥ śyāvāruṇavarṇaṃ paruṣatāmapi ca raukṣya śūla śoṣa toda vepathu harṣa saṅkocāyāsa stambha suptibhedabhaṅgān – Complication due to Vata are blackish brown or reddish color, roughness, dryness, piercing pain, emaciation, pricking pain, trembling, horripilation, contraction, exhaustion, stiffness, numbness, ulceration and fissures.
Pittaṃ dāha sveda kleda kotha srāva pāka rāgān – Complications due to Pitta are burning sensation, sweating, softening of tissues, purification, serous exudation, suppuration and redness.
Shleṣmā tvasya śvaitya śaitya kaṇḍū sthairya gauravotsedhopasnehopalepān – Complications due to Kapha are whiteness, coldness, itching, steadiness, heaviness, swelling, unctuousness and adhesion.
Krimayastu tvagādīṃścaturaḥ sirāḥ snāyūścāsthīnyapi ca taruṇānyādadate – Germs afflict (eat away) the 4 Dhatus viz, skin etc vessels, ligaments, bones and cartilages.
During this stage, the patient shares the following complications:-
A patient having such complications is incurable:
Prasravaṇam – Excessive exudation
Aṅgabhedaḥ – ulceration of organs
Patanānyaṅgāvayavānā – sequestration of the organs of the body
Tṛṣṇā – thirst
Jvara – fever
Atisara – diarrhoea
Daha – burning sensation
Daurbalya – weakeness
Arochaka – anorexia and
Avipaka – indigestion [10-11]

Warning regarding treatment:
साध्यानामपि ह्युपेक्ष्यमाणानां त्वङ्मांस शोणित लसीका कोथ क्लेद संस्वेदजाः क्रिमयोऽभिमूर्च्छन्ति; ते भक्षयन्तस्त्वगादीन् दोषाः पुनर्दूषयन्त इमानुपद्रवान् पृथक् पृथगुत्पादयन्ति- तत्र वातः श्यावारुणवर्णं परुषतामपि च रौक्ष्य शूल शोष तोद वेपथु हर्ष सङ्कोचायास स्तम्भ सुप्ति भेद भङ्गान्, पित्तं दाह स्वेद क्लेद कोथ स्राव पाक रागान्, श्लेष्मा त्वस्य श्वैत्य शैत्य कण्डू स्थैर्य गौरवोत्सेधोपस्नेहोपलेपान्, क्रिमयस्तु त्वगादींश्चतुरः सिराः स्नायूश्चास्थीन्यपि च तरुणान्याददते ||१०||
अस्यां चैवावस्थायामुपद्रवाः कुष्ठिनं स्पृशन्ति; तद्यथा- प्रस्रवणमङ्गभेदः पतनान्यङ्गावयवानां तृष्णाज्वरातीसार दाह दौर्बल्यारोचकाविपाकाश्च, तथाविधमसाध्यं विद्यादिति||११||
sādhyānāmapi hyupekṣyamāṇānāṃ tvaṅmāṃsa śoṇita lasīkā kotha kleda saṃsvedajāḥ krimayo’bhimūrcchanti; te bhakṣayantastvagādīn doṣāḥ punardūṣayanta imānupadravān pṛthak pṛthagutpādayanti- tatra vātaḥ śyāvāruṇavarṇaṃ paruṣatāmapi ca raukṣya śūla śoṣa toda vepathu harṣa saṅkocāyāsa stambha supti bheda bhaṅgān, pittaṃ dāha sveda kleda kotha srāva pāka rāgān, śleṣmā tvasya śvaitya śaitya kaṇḍū sthairya gauravotsedhopasnehopalepān, krimayastu tvagādīṃścaturaḥ sirāḥ snāyūścāsthīnyapi ca taruṇānyādadate ||10||
asyāṃ caivāvasthāyāmupadravāḥ kuṣṭhinaṃ spṛśanti; tadyathā- prasravaṇamaṅgabhedaḥ patanānyaṅgāvayavānāṃ tṛṣṇājvarātīsāra dāha daurbalyārocakāvipākāśca, tathāvidhamasādhyaṃ vidyāditi||11||

Thus it is said:-the individual, who neglects the disease in the beginning thinking it as curable, comes to know of the reality while approaching death after some time. The individual who resorts to proper treatment of the disease before it is manifested or in its early stage, enjoys happiness for long.
As a young tree can be cut very easily and its cutting involves excessive effort when the tree is well grown, so also, the disease is easily curable in its primary stage; it becomes incurable or difficult for cure as and when it reaches the advanced stage. [1-15]

Subject matter:-
तत्र श्लोकः- सङ्ख्या द्रव्याणि दोषाश्च हेतवः पूर्वलक्षणम्|
रूपाण्युपद्रवाश्चोक्ताः कुष्ठानां कौष्ठिके पृथक्||१६||
tatra ślokaḥ- saṅkhyā dravyāṇi doṣāśca hetavaḥ pūrvalakṣaṇam|
rūpāṇyupadravāścoktāḥ kuṣṭhānāṃ kauṣṭhike pṛthak||16||
Number, materials, Doshas causative, factors, premonitory symptoms (actual) symptoms, complications of various types of Kusthas all these are described in this chapter. [16]

To sum up:
इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते निदानस्थाने कुष्ठ निदानं नाम पञ्चमोऽध्यायः||५||
ityagniveśakṛte tantre caraka pratisaṃskṛte nidānasthāne kuṣṭhanidānaṃ nāma pañcamo’dhyāyaḥ||5||
Thus ends the 5th chapter on the Diagnosis of Kushta (obstinate skin diseases) of the section on the “Diagnosis of Diseases” (Nidanasthana) of Agnivesha’s work as redacted by Charaka