Article by Dr Raghuram Y.S. & Dr Manasa, B.A.M.S
Ayurveda explains skin disorders as Kushta. They are sub divided as 7 Maha-Kushta (major skin ailments) and 11 Kshudra-Kushta (minor skin diseases).
Kilasa kushta and its variants i.e. Shwitra and Vaaruna are variants of Kushta but have neither been included in Maha Kushtas nor in Kshudra Kushtas. They have been separately explained in chapters dealing with skin disorders. Treatment for the same has also been detailed.
In ‘Madhava Nidana’ treatise, chapter 49, ‘Kushta Nidanam’ the author has said ‘Twak Dosha Saamanyaat Kilaasam aaha’. This means that the 3 conditions Shwitra, Kilasa and Vaaruna have been explained in Kushta chapter because of their similarity with ‘twak dosha’.
Later the author explains that the causative factors and principles of treatment for these conditions are similar to Kushta.
Shwitra, Kilasa and Vaaruna
कुष्ठ एक संभवं श्वित्रं किलासं वारुणं भवेत्।
निर्दिष्टम् अपरिस्रावि त्रि धातु उद्भव संश्रयम्॥
वाताद् रूक्ष अरुणं पित्तात् ताम्रं कमल पत्रवत्।
स दाहं रोम विध्वंसि कफात् श्वेतं घनं गुरु॥
स कण्डुरं क्रमाद् रक्त मांस मेदसुः च आदिशेत्।
वर्णेनैव एदृक् उभयं कृच्छ्रं तत् च उत्तर उत्तरं॥(वा.नि.१४)
Shwitra, Kilasa and Varuna are the variants of skin aliments and are manifested from the same causative factors of Kushta. In fact, Shwitra and Vaaruna are variants of Kilasa.
Kilasa is characterized by –
Aparisravi – These variants of skin disorders are devoid of ‘parisrava’ or discharges (oozing of fluids from the lesions), which are typical of Kushta.
Tridhatu udbhava samshrayam – They are caused by 3 doshas i.e. Vata, Pitta and Kapha and are seated in 3 dhatus i.e. Rakta (blood tissue), Mamsa (muscle tissue) and Meda (fat tissue).
Dosha symptoms in Kilasa
Vata symptoms – When vata is aggravated, there is rukshata (dryness), arunam (golden yellow color)
Pitta symptoms – When pitta is aggravated, there is taamra (coppery color) varnata of the skin similar to that of kamala patra (lotus petal) associated with daha (burning sensation), this condition causes roma vidhwamsa (destruction of body hairs)
Kapha symptoms – When kapha is aggravated, there is shwetatva (whitish discoloration), ghanatwa (large lesions), gurutva (heaviness around the lesions or in the body), kandura (associated with itching)
Aruna Kushta (Vata predominant) is localized in Rakta,
Tamra Kushta (Pitta predominant) is localized in Mamsa and
Shweta Kushta is localized in Meda.
Causes of Kilasa
Apart from regular causative factors for skin diseases, the below mentioned causes have been specified by Charaka for Kilasa –
वचांस्यतथ्यानि कृतघ्न भावो निन्दा सुराणां गुरु धर्षणं च।
पाप क्रिया पूर्वकृतं च कर्मं हेतुः किलासस्य विरोधि च अन्नम्॥(च.चि.७/१७७)
- Vaachamsi atathyani – telling lies
- Krutaghna bhavo – un-grateful
- Suraanam ninda – abusing Gods
- Guru gharshanam – abusing and disrespecting the teachers and elders
- Papa karma – being involved in sinful acts
- Purva kruta karma – sins done in previous birth
- Virodhi anna etc – causes mentioned in Kushta nidana
Location of Kilasa, Vaaruna and Shwitra:
Kilasa is located only in the skin, Vaaruna and Shwitra variants are located deeper
Sushruta tells ‘Twak Gatam eva Kilaasam’ (Su.Ni.5)
which means Kilasa is a manifested only on the skin.
When the same Kilasa gets localized in Mamsa, it will be called Vaaruna.
When Kilasa is localized in Meda it will be called as Shwitra.
Thus if the twak dosha is manifested in the skin and is devoid of parisrava it is called Kilasa.
If the kilasa gets deep rooted into mamsa and meda it will be called vaaruna and shwitra.
Once the doshas enter deeper tissues like rakta, mamsa and meda it gets the nature of kushta. Therefore they will be called as Vaaruna Kushta and Shwitra Kushta.
Kilasa getting transformed into Vaaruna and Shwitra Kushtas
If the doshas are localized in deeper tissues and do not contaminate them too much, the symptoms are seen limited to the skin and this condition will be called kilasa.
By any chance if the doshas start contaminating the deeper tissues, the aruna etc colors are manifested along with dosha lakshanas, along with parisrava and will be called as
Aruna Kushta – if Vata is involved
Tamra Kushta – if Pitta is involved
Shweta kushta – if Kapha is involved. or
vaaruna – if Mamsa is afflicted
Shwitra if Meda is afflicted.
According to Bhaluki –
– Kilasa located in rakta is called Daaruna
– Kilasa located in mamsa is called Vaaruna
– Kilasa located in meda is called Shwitra
Daaruna, Vaaruna and Shwitra may be considered as synonyms or advanced stages of Kilaasa
Kilasa caused by vrana and doshas
Kilasa caused by Vrana (injury, wound) and doshas are said to be kruchrasaadhya (difficult to cure) when they get localized in deeper tissues (uttara uttara gambhira dhatu) i.e. Kilasa caused by vrana and doshas, located in meda (fat) is more difficult than that localized in mamsa or rakta. Rakta, Mamsa and Meda are deeper tissues in that chronological order.
Generally the Kilasa caused by both vrana and doshas is called Shwitra.
According to Bhoja – Shwitra is of 2 types i.e.
Doshaja Shwitra (caused by vitiated doshas) and
Vranaja Shvitra (caused by injury).
Vranaja Shwitra is caused by mismanagement of vranas as in accidental wounds, burns etc. Doshaja Shwitra again is of 2 types i.e.
Atmaja (caused by doshas vitiated in one’s own body) and
Paraja (when one acquires the contaminated doshas from other person due to contact).
Vagbhata in Ashtanga Sangraha has mentioned that Shwitra is also localized outside the body i.e. on the skin without the deeper tissues being involved.
Saadhya Asadhyata (Prognosis) of Kilasa
अ शुक्ल रोम अबहुलम् असंश्लिष्टम् अथो नवम्।
अनग्नि दग्धजं साध्यं श्वित्रं वर्ज्यम् अतो अन्यथा॥
गुह्य पाणि तल ओष्ठेषु जातम् अपि अचिरन्तनम्।
वर्जनीयं विशेषेण किलासं सिद्धिमिच्छता॥(मा.नि.४९/४१)
शुद्ध्या शोणित मोक्षैः विरूक्षणैः च सक्तूनाम्।
श्वित्रं कस्यचिद् एव प्रणश्यति क्षीण पापस्य॥(च.चि.७/१७२)
Kilasa with the below mentioned symptoms is said to be sadhya (curable) –
- Ashukla roma – If the body hairs have not turned to white color (have retained their black color)
- Abahula – If the lesions are not large or widespread
- Asamshlishtam – If the lesions have not blended with each other
- Navam – If the lesion is freshly manifested
- Anagni dagdajam – If the lesions are not caused due to burns
Below said symptoms indicate bad prognosis (asadhyata) in kilasa –
- Ato anyatha – Symptoms contrary to those mentioned in curable category
- Lesions occurring in guhya sthana (genitals), paani tala (dorsum of hands) and oshta (lips), in spite of it being Naveena Kilasa (fresh lesions)
- Charaka tells that in a ksheena-paapa person (person in whom the effects of sins have been reduced due to good deeds), shwitra can be curable by chance when shodhana (vamana, virechana etc cleansing measures), shonita mokshana (bloodletting), virookshana (drying therapies) and saktu (administration of nutritious drinks) are administered continuously in a comprehensive way and with religious approach. Otherwise it is said to be krichrasaadhya (difficult to cure).
Kilasa as per Charaka
Acharya Charaka’s version of Kilasa or Shweta Kushta
दारुणं चारुणं श्वित्रं किलासं नामभिः त्रिभिः।
विज्ञेयं त्रिविधं तत् च त्रिदोषं प्रायशः च तत्॥(च.चि.७/१७३)
Acharya Charaka tells that Daaruna, Chaaruna / Chaarana and Shwitra are the different names (presentations) of Kilasa. These are also considered as trividha kilasa (3 types of kilasa) and are essentially caused by vitiation of all the 3 doshas.
दोषे रक्त आश्रिते रक्तं ताम्रं मांस समाश्रिते।
श्वेतं मेदः आश्रिते श्वित्रं गुरु तत् च उत्तर उत्तरम्॥(च.चि.७/१७४)
Rakta (varna) Shwitra or Raktashrita Shwitra – When the vitiated doshas are lodged in rakta dhatu (blood), Rakta varna shwitra or Shwitra which has red color is manifested
Tamra (varna) Shwitra or Mamsashrita Shwitra – When the vitiated doshas are lodged in mamsa dhatu (muscles), Tamra varna shwitra or Shwitra which has coppery color is manifested
Shweta (varna) Shwitra or Medoshrita Shwitra – When the vitiated doshas are lodged in medo dhatu (fat), Shweta varna shwitra or Shwitra which has white color is manifested
These Kushtas are chronologically difficult to cure i.e. Shweta is tougher than Tamra and Tamra is tougher than Rakta Shwitra to cure
Symptoms of asadhya (incurable) shwitra
यत् परस्परतो अभिन्नं बहु यद् रक्त लोमवत्।
यत् च वर्ष गण उत्पन्नं तत् श्वित्रं न एव सिध्यति॥(च.चि.७/१७५)
- Parasparato abhinnam – many patches which are so closer to each other that they appear as a single big lesion
- Bahu – Large lesions, wide spread lesions or patches
- Rakta lomavat – the body hairs have turned red
- Varsha ganotpannam – has crossed a time period of 1 year (existing for more than 1 year)
Symptoms of sadhya (curable) shwitra
अरक्त लोम तनु यत् पाण्डु न अति चिरोत्थितम्।
मध्य अवकाशे चेत् शूनं श्वित्रं तत् साध्यम् उच्यते॥(च.चि.७/१७६)
- Arakta loma – body hairs have not turned red in color
- Tanu – thin or light colored lesions
- Pandu – pale colored patches
- Na ati chira uttitam – not chronic
- Madhya avakasho shoonam – presence of swelling in the center of the patch
Just Before Finishing –
This article deals with the causes, symptoms and treatment strategies of Kilasa Kushta or Shweta Kushta, the variants of which are often compared to leukoderma and vitiligo, along with its prognosis as explained in various Ayurvedic treatises
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