अथातः कुष्ठनिदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
Meaning of the śloka
Now the diagnosis of kuṣṭha will be explained, as taught by the revered Dhanvantari.
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athētyādi||1-2||
Meaning of the commentary
The commentary gives only the conventional opening and adds no separate explanation.
Key terms
kuShTha (kuṣṭha)
A broad classical category of chronic skin disorders.
nidAna (nidāna)
An account of causes and diagnostic features.
Adhikarana 2 (3) · Śloka 3
mithyāhārācārasya viśēṣādguruviruddhāsātmyājīrṇāhitāśinaḥ snēhapītasya vāntasya vā vyāyāmagrāmyadharmasēvinō grāmyānūpaudakamāṁsāni vā payasā'bhīkṣṇamaśnatō yō vā majjatyapsūṣmābhitaptaḥ sahasā chardiṁ vā pratihanti, tasya pittaślēṣmāṇau prakupitau parigr̥hyānilaḥ pravr̥ddhastiryaggāḥ sirāḥ samprapadya samuddhūya bāhyaṁ mārgaṁ prati samantādvikṣipati, yatra yatra ca dōṣō vikṣiptō niścarati tatra tatra maṇḍalāni prādurbhavanti, ēvaṁ samutpannastvaci dōṣastatra tatra ca parivr̥ddhiṁ prāpyāpratikriyamāṇō'bhyantaraṁ pratipadyatē dhātūnabhidūṣayan ||3||
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मिथ्याहाराचारस्य विशेषाद्गुरुविरुद्धासात्म्याजीर्णाहिताशिनः स्नेहपीतस्य वान्तस्य वा व्यायामग्राम्यधर्मसेविनो ग्राम्यानूपौदकमांसानि वा पयसाऽभीक्ष्णमश्नतो यो वा मज्जत्यप्सूष्माभितप्तः सहसा छर्दिं वा प्रतिहन्ति, तस्य पित्तश्लेष्माणौ प्रकुपितौ परिगृह्यानिलः प्रवृद्धस्तिर्यग्गाः सिराः सम्प्रपद्य समुद्धूय बाह्यं मार्गं प्रति समन्ताद्विक्षिपति, यत्र यत्र च दोषो विक्षिप्तो निश्चरति तत्र तत्र मण्डलानि प्रादुर्भवन्ति, एवं समुत्पन्नस्त्वचि दोषस्तत्र तत्र च परिवृद्धिं प्राप्याप्रतिक्रियमाणोऽभ्यन्तरं प्रतिपद्यते धातूनभिदूषयन् ||३||
Meaning of the śloka
The text attributes kuṣṭha to an unsuitable pattern of diet and conduct, especially repeated intake of heavy, incompatible, unaccustomed, undigested, or otherwise unwholesome food; exercise or sexual activity after taking oil or after vomiting; frequent consumption of meat from domestic, marsh-dwelling, or aquatic animals with milk; sudden immersion in water while overheated; and forcibly suppressing vomiting. It says pitta and kapha become aggravated, vāta increases and carries them through transverse vessels toward the body's surface, and lesions appear wherever the disturbed factors emerge. Beginning in the skin, the disorder is said to spread inward and progressively affect the tissues if not addressed.
The commentary says mithyāhārācāra means diet and behavior that depart from the prescribed rules. It then summarizes the pathogenic sequence: in a person following such practices, the disturbed factors are lifted and dispersed everywhere toward the external pathway. This is intended to show the condition's potential distribution throughout the body.
Key terms
mithyAhArAcAra (mithyāhārācāra)
Diet and conduct regarded as improper by the source's rules.
viruddhAshana (viruddhāśana)
Eating combinations regarded as incompatible in the classical framework.
snehapIta (sneha-pīta)
A person who has ingested an oily preparation as part of a classical regimen.
Prodromal features of kuṣṭha are roughness of the skin, unexplained horripilation, itching, either excessive sweating or absence of sweating in parts of the body, numbness of bodily regions, spreading of small injuries or sores, and darkening of the blood.
The text presents eighteen forms of kuṣṭha: seven major and eleven minor. The major forms are aruṇa, audumbara, ṛṣya- or ṛkṣajihva, kapāla, kākaṇaka, puṇḍarīka, and dadru. The minor forms are sthūlāruṣka, mahākuṣṭha, ekakuṣṭha, carmadala, visarpa, parisarpa, sidhma, vicarcikā, kiṭibha, pāmā, and rakasā.
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idānīṁ saṅkhyāmāha- tatrētyādi| mahattvamuttarōttaradhātvanupravēśāt| ēkādaśakuṣṭhānāṁ kṣudratvamuttarōttaradhātvananupravēśāt| aṣṭādaśa kuṣṭhāni bhavantīti diṅmātramidaṁ darśitaṁ, kuṣṭhānāmaniyatasaṅkhyatvāt; tathā ca carakaḥ- “saptavidhō'ṣṭādaśavidhō'saṅkhyēyavidhō vā” (ca. ni. 5) iti| mahākuṣṭhāni nāmataḥ prāha- tatra mahākuṣṭhānītyādi| kṣudrakuṣṭhāni nāmataḥ prāha- kṣudrakuṣṭhānyapītyādi||5||
Meaning of the commentary
The commentary says the major forms are considered major because they progressively enter deeper tissues, while the minor forms do not do so. The number eighteen is only an illustrative framework because the possible forms are not fixed in number; it cites Caraka as allowing seven, eighteen, or innumerable varieties. The verse then supplies the names of each group.
Key terms
mahAkuShTha (mahākuṣṭha)
One of the seven major forms, characterized in the commentary by deeper tissue progression.
kShudrakuShTha (kṣudrakuṣṭha)
One of eleven minor forms, said not to progress successively through deeper tissues.
RuShya/RukShajihva (ṛṣya/ṛkṣa-jihva)
A major form with a textual variant meaning antelope-tongue or bear-tongue.
dadru
A named circular, itching skin-disorder form in the classical list.
All forms of kuṣṭha are said to involve vāta, pitta, kapha, and krimi. A particular doṣa is named for a given type because it is predominant and overpowers the other two.
The commentary applies this shared involvement to both minor and major forms. It anticipates the question of why a form is nevertheless called vāta-produced, pitta-produced, or the like: the named doṣa is the most intense, while the other two are relatively dominated. Krimi are also held to be possible in every form.
Among the major forms, aruṇa is associated predominantly with vāta; audumbara, ṛṣya- or ṛkṣajihva, kapāla, and kākaṇaka with pitta; and puṇḍarīka and dadru with kapha. Their designation as major rests on difficult treatment, progressive entry into deeper tissues, and incurability.
The commentary says each form is assigned to the doṣa that predominates in it. The particle anu in the statement about progressive tissue entry also suggests that severity and incurability develop over time, except for kākaṇaka, which is considered incurable from its very onset because of the nature attributed to that disease. The conjunction after incurability should be construed after 'from tissue entry,' thereby also adding the unstated importance of the initiating doṣas.
Key terms
kriyAgurutva (kriyā-gurutva)
Difficulty or burden of treatment.
dhAtvanupravesha (dhātv-anupraveśa)
Progressive entry into deeper tissue categories.
asAdhyatva (asādhyatva)
Being considered incurable within the classical prognosis.
kAkaNaka (kākaṇaka)
A major pitta-associated form described as incurable from onset.
Aruṇa lesions are thin, spreading, reddish, and accompanied by pricking pain, splitting pain, and numbness. Audumbara lesions resemble ripe udumbara fruit in shape and color. Ṛṣya- or ṛkṣajihva lesions resemble the rough tongue of the named animal. Kapāla lesions resemble a black earthen shard. Kākaṇaka lesions resemble the fruit of kākaṇantikā and are intensely red and black. These four pitta-associated forms share heat, drawing or burning sensations, generalized burning or smoky sensations, rapid onset and suppuration, splitting, and the arising of krimi. Puṇḍarīka lesions resemble a white lotus leaf. Dadru lesions may be flax-flower colored or coppery, spread, and have eruptions. These two kapha-associated forms share elevation, a fully circular shape, itching, and slow onset.
The commentary identifies ṛṣya as the nīlāṇḍa animal popularly called roru; others read ṛkṣa, bear. A black earthen shard explains the kapāla comparison. Kākaṇantikā is identified as guñjā, locally called cirahaṇṭikā; the lesion is red like its fruit and black in the middle. Uṣa is explained either as heat felt near a fire or pain like scorching; coṣa as a drawing or sucking pain, though some interpret it as thirst; and dhūmāyana as feeling affected by smoke, with another explanation comparing it to smoke emerging from the limbs. Dadru has white and dark forms. Sushruta lists the dark form among major kuṣṭhas because it needs extensive treatment and is persistent, while Caraka lists white dadru among minor forms because it is readily treated, does not enter progressively deeper tissues, and causes less distress. Jejjhaṭa proposes that Sushruta and Caraka use the names dadru and sidhma differently; Gayī rejects this reconciliation. Perfect circularity explains parimaṇḍalatā.
Key terms
aruNa (aruṇa)
A thin, reddish, spreading major form associated with vāta.
audumbara
A form compared with ripe udumbara fruit.
RuShya/RukShajihva (ṛṣya/ṛkṣa-jihva)
A rough lesion compared with an antelope's or, in a variant, bear's tongue.
kAkaNaka (kākaṇaka)
An intensely red-and-black form compared with guñjā fruit.
puNDarIka (puṇḍarīka)
A raised form compared with a white lotus leaf.
dadru
A circular, itching, slowly arising form described in white and dark varieties.
The commentary takes sthūla to mean having a thick or broad root, dāruṇa to mean difficult to treat, and aruṣ as a wound or ulcer. It introduces sthūlāruṣka as the first of the minor kuṣṭhas.
Key terms
sthUlAruShka (sthūlāruṣka)
A minor kuṣṭha form with firm, broad-based lesions near joints.
In the form called mahākuṣṭha, there is contraction of the skin, splitting or fissuring of the skin, numbness of the skin, and weakness or fatigue of the limbs.
The commentary construes 'skin' separately with contraction, splitting, and numbness: tvakkoca is skin contraction, tvagbheda is tearing or fissuring, and tvaksvapana is loss of sensation in the skin. Aṅgasāda means fatigue or weakness of the limbs. The phrase 'kuṣṭha joined with mahat' identifies the form named mahākuṣṭha.
Key terms
mahAkuShTha (mahākuṣṭha)
The named minor-form entry described here by skin and limb symptoms.
The commentary identifies this as carmadala. Coṣa is explained as a sensation like being sucked or drawn, and tala refers to the palms of the hands and soles of the feet.
Key terms
carmadala
A classical minor kuṣṭha category affecting the palms and soles in this description.
The disorder that rapidly spreads in all directions like visarpa, overwhelms skin, blood, and flesh, and produces fainting, burning, distress, pricking pain, and suppuration is called the visarpa form of kuṣṭha.
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visarpakuṣṭhalakṣaṇamāha- visarpavadityādi| atrōktavisarpākhyakuṣṭhasya vakṣyamāṇavisarparōgasya ca ciravisarpaṇaśīghravisarpaṇatō bhēdaḥ||11||
Meaning of the commentary
The commentary distinguishes this kuṣṭha named visarpa from the separate visarpa disease described later: the present category spreads over a longer period, while the later disease spreads rapidly.
Key terms
visarpa kuShTha (visarpa-kuṣṭha)
A classical kuṣṭha category named for spreading lesions.
tvagraktamAMsa (tvag-rakta-māṃsa)
Skin, blood, and flesh, described as affected by the disorder.
pAka (pāka)
Suppuration or inflammatory maturation.
ciravisarpaNa (cira-visarpaṇa)
Slower or prolonged spreading, used to distinguish this category.
The commentary explains apāyin as not causing severe distress. ‘Mainly on the upper body’ allows occasional occurrence below it. It distinguishes two forms: puṣpikā-sidhma and sidhma. Because puṣpikā-sidhma is considered easy to cure, Suśruta places it among minor kuṣṭhas; because sidhma is considered difficult to cure, Caraka places it among major kuṣṭhas. The commentator regards these different placements as consistent rather than contradictory.
Key terms
sidhma
A thin, white, itchy classical kuṣṭha category.
apAyin (apāyin)
Interpreted here as relatively non-distressing.
puShpikAsidhma (puṣpikā-sidhma)
A form classified by Suśruta among minor kuṣṭhas because it is considered easier to cure.
UrdhvakAya (ūrdhva-kāya)
The upper part of the body, where the condition mainly appears.
In vicarcikā, very itchy, painful, dry lines appear on the limbs. When this same condition occurs on the feet with itching, burning, and pain, it is called vipādikā.
The commentary glosses rājī as lines, which are dry. Kaṇḍvarti means distress from itching, and ruja means pain; the intensifier applies to both itching and pain. Gātra here refers to the hands and feet. When vicarcikā is located on the feet, it gives up the name vicarcikā and receives the name vipādikā.
Key terms
vicarcikA (vicarcikā)
A classical itchy, painful condition marked by dry linear lesions.
rAjI (rājī)
A line or linear marking on the skin.
vipAdikA (vipādikā)
The name given to this condition when located on the feet.
kaNDvarti (kaṇḍvarti)
Distress or pain associated with itching.
Adhikarana 16 (14) · Śloka 14
yat srāvi vr̥ttaṁ ghanamugrakaṇḍu tat snigdhakr̥ṣṇaṁ kiṭibhaṁ(maṁ) vadanti |14|
Pāmā is recognized by minute eruptions that discharge and cause itching and localized burning. When that same condition has blister-like lesions with severe burning arising on the buttocks, hands, and feet, it is identified as kacchū.
The commentary connects pāmā with small eruptions accompanied by discharge, itching, and burning. Those who read a variant wording explain it as pāmā inferred by physicians from minute eruptions in persons who have discharging itch and burning. The same condition, when accompanied by intensely burning sphoṭas on the hands and buttocks, is called kacchū.
Key terms
pAmA (pāmā)
A classical condition of minute, itchy, burning, discharging eruptions.
kacchU (kacchū)
A related classical category with intensely burning blister-like lesions on specified sites.
Sthūlāruṣka, sidhma, rakasā, mahākuṣṭha, and ekakuṣṭha are classified here as kapha-origin conditions. Parisarpa alone is assigned to aggravated vāyu, and the remaining conditions are regarded as arising predominantly from pitta.
The commentary identifies aruḥ as sthūlāruṣka and the remaining pitta group as visarpa, kiṭibha, vicarcikā, pāmā, and carmadala. Gayadāsa rejects the verse as Jejjaṭa’s own composition because, in Gayadāsa’s view, ekakuṣṭha and mahākuṣṭha arise from vāta rather than kapha, while parisarpa arises from pitta rather than vāta. Gayadāsa also cites an alternative text beginning with aruṣka, but the commentator does not reproduce it because it is unavailable.
Key terms
kaphaja
Classified in this verse as arising predominantly from kapha.
vAtaja (vātaja)
Classified here as arising from aggravated vāta.
pittaprabhava (pitta-prabhava)
Regarded as arising predominantly from pitta.
svakapolakalpita (sva-kapola-kalpita)
Alleged by Gayadāsa to have been composed or supplied by Jejjaṭa himself.
Adhikarana 20 (17) · Śloka 17
kilāsamapi kuṣṭhavikalpa ēva; tattrividhaṁ- vātēna, pittēna, ślēṣmaṇā cēti |
kuṣṭhakilāsayōrantaraṁ- tvaggatamēva kilāsamaparisrāvi ca |
tadvātēna maṇḍalamaruṇaṁ paruṣaṁ paridhvaṁsi ca, pittēna padmapatrapratīkāśaṁ saparidāhaṁ ca, ślēṣmaṇā śvētaṁ snigdhaṁ bahalaṁ kaṇḍūmacca |
tēṣu sambaddhamaṇḍalamantējātaṁ raktarōma cāsādhyamagnidagdhaṁ ca ||17||
Kilāsa is discussed as a possible variety of kuṣṭha and is divided into vāta-, pitta-, and kapha-related forms. It differs from kuṣṭha in being confined to the skin and not discharging. The vāta form has reddish, rough patches that shed powder or scales when rubbed. The pitta form resembles a lotus leaf and is accompanied by burning. The kapha form is white, unctuous, thick, and itchy. Among these, lesions whose patches merge together, arise at terminal sites, contain red hair, or follow a burn are regarded as incurable.
The commentary treats api as expressing possibility: kilāsa may be a modification of kuṣṭha. Others use the particle to argue that some kilāsa is not a kuṣṭha variety, particularly when it is confined to skin and non-discharging. Kuṣṭha is said to involve skin, blood, and flesh while manifesting in the skin; kilāsa occupies skin alone. Another view says a skin-confined lesion is called kilāsa, but once it penetrates deeper dhātus it gives up that name and is called śvitra, supported by a cited verse. In vāta-type kilāsa, paridhvaṃsin means releasing dust-like scale when rubbed; bahala in kapha type means thick. Sambaddha-maṇḍala means patches not separated from one another. Ante jāta is interpreted as occurring at the lips, hands, feet, or genital region. Another reading is antar-jāta-rakta-roma, meaning red hairs arise within the lesion. Those authorities use the conjunction with ‘burn-produced’ to include the unstated lip, hand, foot, and genital locations among incurable forms.
Key terms
kilAsa (kilāsa)
A non-discharging, skin-confined classical pigmentary or surface lesion category.
shvitra (śvitra)
A name used by one interpretation when a kilāsa-like process penetrates beyond skin into deeper dhātus.
paridhvaMsin (paridhvaṃsin)
Releasing powder or scale when rubbed.
sambaddhamaNDala (sambaddha-maṇḍala)
Patches joined together without separation.
antejAta (ante-jāta)
Arising at terminal sites; a variant reads antar-jāta-rakta-roma, with red hairs within.
Adhikarana 21 (18) · Śloka 18
kuṣṭhēṣu tu tvaksaṅkōcasvāpasvēdaśōphabhēdakauṇyasvarōpaghātā vātēna, pākāvadaraṇāṅgulipatanakarṇanāsābhaṅgākṣirāgasattvōtpattayaḥ pittēna, kaṇḍūvarṇabhēdaśōphāsrāvagauravāṇi ślēṣmaṇā ||18||
In kushtha, vata involvement is associated with contraction and numbness of the skin, altered sweating, swelling, splitting, loss of hand function, and impairment of the voice. Pitta involvement is associated with suppuration, fissuring, loss of digits, damage to the ears and nose, redness of the eyes, and the appearance of living organisms in lesions. Shleshma involvement is associated with itching, change of color, swelling, discharge, and heaviness.
The commentary supplies dosha-specific signs beyond the earlier concise descriptions. Sweating among the vata signs is disputed: one reading has asveda, absence of sweating, while others retain sweating and explain that it may occur because of the disease's own nature. Kaunya means loss of use of the hand. Sattvotpatti is explained as the generation of worms or organisms.
Key terms
tvaksa~gkoca (tvaksankocha)
Contraction or tightening of the skin.
svApa (svapa)
Numbness or loss of sensation.
asveda/sveda
Absence of sweating in one reading, or sweating in another.
kauNya (kaunya)
Loss of functional use of the hand, according to the commentary.
sattvotpatti
Appearance of worms or other living organisms in a lesion.
The commentary understands adibalapravritta paundarika as arising from impairment of shukra and shonita and therefore calls it incurable. It cites Caraka for the view that other hereditary or familial disorders are also considered incurable, interpreting kulaja as arising from impaired reproductive seed and blood. Paundarika is taken as representative of all mahakushthas, because these are said to progress successively through the dhatus and become capable of affecting shukra. The commentator denies this adibalapravritta status to kshudrakushthas because they do not progress through the dhatus in that way. Kakana is also called incurable because all three doshas are considered powerful from its onset. A later passage is said to classify mahakushtha involving asthi, majja, and shukra as incurable.
Key terms
AdibalapravRutta (adibalapravritta)
A classical etiologic category associated here with inherited or reproductive factors.
pauNDarIka (paundarika)
A named mahakushtha used here to represent the larger group.
kAkaNa (kakana)
A named kushtha type described as tridosha-dominant from onset.
mahAkuShTha (mahakushtha)
A major kushtha category said to progress through successive dhatus.
Just as a tree, growing over a long time and strengthened by rain, sends its roots deep into the earth, kushtha that begins in the skin is said over time to spread successively through the dhatus of a person who has not undertaken a response.
The commentary uses the tree-root analogy to describe progressive involvement of deeper dhatus when the condition is not addressed. Kalaprakarsha means a prolonged passage of time. Although the verse says the condition begins in tvac, the commentary interprets tvac here as rasa because skin is considered to arise from rasa; thus it understands the initial location as the rasa dhatu.
Key terms
kAlaprakarSha (kalaprakarsha)
Prolongation or passage of considerable time.
apratikArin (apratikarin)
A person for whom no countermeasure or response has been undertaken.
dhAtu (dhatu)
A bodily constituent progressively involved in the classical account.
tvac
Skin in the verse, interpreted by the commentary as indicating rasa.
When kushtha is situated in tvac, the text lists loss of touch, altered sweating, slight itching, discoloration, and dryness. With shonita involvement it lists numbness of the skin, horripilation, increased sweating, itching, and foul odor. With mamsa involvement it lists thick or large lesions, dryness or distortion of the mouth, roughness, raised lesions, pricking pain, fissuring, and firmness. With medas involvement it lists foul smell, accumulation of waste, pus, organisms, and splitting pain in the limbs. With asthi and majja involvement it lists damage to the nose, redness of the eyes, organisms in wounds, and impairment of the voice. With shukra involvement it lists loss of hand function, reduced movement of the limbs, breaking pain, spreading wounds, and the earlier signs as well. The text further states that when both parents' shonita and shukra are affected by kushtha, their child is also regarded as affected.
The commentary explains signs according to the dhatu involved. Some hold that rasa is already encompassed when the doshas initiate kushtha and therefore needs no separate signs; others say tvac itself denotes rasa. Vipuyaka means foul odor. Bahulya is a thick or broad patch, sphota is splitting of the skin, and sthiratva is a hard patch. Some alternative readings for the mamsa and medas verses are mentioned but not recorded because their full text was unavailable. Upadeha means increased accumulation of waste. In shukra involvement, api indicates that the earlier signs from rasa through majja may also occur. For the offspring statement, readings include kushthita, kushthavat, and kushthila, all interpreted as affected with kushtha. The commentary adds that severely impaired reproductive factors prevent conception, whereas lesser impairment is said to transmit affliction to offspring.
Key terms
dhAtugata kuShTha (dhatugata kushtha)
Kushtha classified according to involvement of successive bodily constituents.
For a self-controlled person, kushtha situated in tvac, rakta, or mamsa is described as curable; when it has reached medas it is considered manageable but persistent, and beyond medas it is described as incurable in this historical prognosis.
The text reports a historical belief that kushtha, described here as a disease associated with wrongdoing, may arise from acts such as killing a learned religious person, a woman, or a virtuous person, and taking another person's property.
The text portrays kushtha as an exceptionally difficult long-lasting disease that may follow a person into another birth. It says that one who becomes free from it by undertaking the extensive prescribed regimen of diet and conduct, using specified medicines, and practicing tapas attains a meritorious state.
The commentary calls kushtha foremost among chronic diseases and explains its continuation into another birth as resulting from the persistence of the karma believed to cause it. Asthaya means adopting or relying upon the prescribed regimen. Attainment of a meritorious state is explained through the exhaustion of wrongdoing.
Key terms
janmAntara (janmantara)
Another birth within the text's rebirth framework.
The text states that kushtha, fever, shosha, netrabhishyanda, and other communicable disorders may pass from one person to another through repeated close association, bodily contact, breath, eating together, sharing a bed or seat, and sharing clothing, garlands, or unguents.
Using kushtha as a principal example of a condition understood to arise through contact, the commentary advises avoiding repeated close exposure to affected persons. Prasanga means repeated or habitual contact and qualifies each listed route individually. Sahashayyasana means occupying the same bed or seat, malya means flowers or a garland, and aupasargika diseases include shitalika and similar conditions. Sankramanti means that they pass into or affect another person.
Key terms
prasa~gga (prasanga)
Repeated or habitual close association.
gAtrasaMsparsha (gatrasamsparsha)
Bodily contact.
sahashayyAsana (sahashayyasana)
Sharing or occupying the same bed or seat.
aupasargika roga
A communicable or contact-associated disorder in the classical classification.
The commentary colophon states that the fifth chapter of the Nidanasthana is complete in Shri Dalhana's explanation of Sushruta entitled Nibandhasangraha.
Key terms
kuShThanidAna (Kushthanidana)
The chapter on causes and diagnostic description of kushtha.
nidAnasthAna (Nidanasthana)
The division concerned with causes and diagnostic descriptions.