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Chapter 56 – Mukha Roga Nidanam

The 56th chapter of Madhava Nidana is Mukha Roga Nidana and deals with Diseases of the mouth.



General Etiological Factors —

आनूपपिशित – क्षीर – दधि – मत्स्यातिसेवनात् |
मुखमध्ये गदान् कुर्युः क्रुद्धा दोषाः कफोत्तराः || १||

ānūpapiśita – kṣīra – dadhi – matsyātisēvanāt |
mukhamadhyē gadān kuryuḥ kruddhā dōṣāḥ kaphōttarāḥ || 1||

Excessive intake of the flesh of animals of aquatic regions, milk, curd, fish, and the like, all the three doshas with the predominance of kapha among them undergo abnormal growth and generate various diseases of the mouth.  1

Eight Diseases of the Lips
Vataja Disease of the lips (? Cracked Lips) —

कर्कशौ परुषौ स्तब्धौ सम्प्राप्तानिलवेदनौ |
दाल्येते परिपाट्येते औष्टौ मारुतकोपतः || २ ||

karkaśau paruṣau stabdhau samprāptānilavēdanau |
dālyētē paripāṭyētē auṣṭau mārutakōpataḥ || 2 ||

With the morbid increase in Vata, the lips turn rough, hard, immovable, and painful and develops cracks and fissures. 2

Pittaja disease of the lips  (? Stomatitis) —

चीयेते पिडकाभिश्च सरुजाभिः समन्ततः |
सदाहपाकपिडकौ पीताभासौ च पित्ततः || ३ ||

cīyētē piḍakābhiśca sarujābhiḥ samantataḥ |
sadāhapākapiḍakau pītābhāsau ca pittataḥ || 3 ||

With the vitiation of pitta, the lips develop painful pidakas. It has a burning sensation. Moreover, there could be formation of ulcers and yellowish discoloration of the lips. 3 

Kaphaja Disease of the lips (? Multiple mucilaginous cysts) — 

सवर्णाभिश्च चीयेते पिडकाभिरवेदनौ |
भवतस्तु कफादोष्टौ पिच्छिलौ शीतलौ गुरु || ४ ||

savarṇābhiśca cīyētē piḍakābhiravēdanau |
bhavatastu kaphādōṣṭau picchilau śītalau guru || 4 ||

With the morbid increase in kapha, the lips develop slightly painful, non discolored pidakas. The lips in such cases remain unctuous, cold, and heavy. 4

Sannipataja Disease of the lips ( ? Herpes labialis)

सकृत्कृष्णौ सकृत्पीतौ सकृच्छवेतौ तथैव च |
सन्निपातेन विज्ञेयावनेक पिडकाचितौ || ५ ||

sakr̥tkr̥ṣṇau sakr̥tpītau sakr̥cchavētau tathaiva ca |
sannipātēna vijñēyāvanēka piḍakācitau || 5 ||

Morbid increase in all the three doshas together will turn the lips black, yellow, or white; from time to time and generate several pidaka (vesicles) around them. 5

Raktaja disease of the lips (? Erythema multiformae)

खर्जुरफलवर्णाभिः पिडकाभिर्निपिडितौ |
रक्तोपसृष्टौ रुधिरं स्रवतः शोणितप्रभौ || ६ ||

kharjuraphalavarṇābhiḥ piḍakābhirnipiḍitau |
raktōpasr̥ṣṭau rudhiraṁ sravataḥ śōṇitaprabhau || 6 ||

If rakta (blood) is vitiated, pidakas (vesicles) resembling fruits of date palm in shape, red in complexion and discharging blood develop there on the lips. 6

Disease of the lips due to vitiated Mamsa ( ?Cancrumoris)

गुरु स्थूलौ मांसदुष्टौ मांसपिण्डवदुद्गतौ |
जन्तवः अत्र मूर्च्छन्ति नरस्योभयतो मुखात् || ७ ||

guru sthūlau mānsaduṣṭau mānsapiṇḍavadudgatau |
jantavaḥ atra mūrcchanti narasyōbhayatō mukhāt || 7 ||

If muscles (mamsa) are infected, the lips turn heavy and thick with lumps of muscles, they discharge liquid containing worms from the angles of the mouth. 7

Disease of the lips due to vitiated medas (? weeping eczema) —

सर्पिर्मण्डप्रतिकाशौ मेदसा कण्डुरौ गुरु |
अच्छं स्फटिकसङ्काशमास्रावं स्रवतो भृशम् || ८ ||
तयोर्व्रणो न संरोहेन्मृदुत्वं च न गच्छति |

sarpirmaṇḍapratikāśau mēdasā kaṇḍurau guru |
acchaṁ sphaṭikasaṅkāśamāsrāvaṁ sravatō bhr̥śam || 8 ||
tayōrvraṇō na sanrōhēnmr̥dutvaṁ ca na gacchati |

If fat (medas) is agitated, the lips appear like upper layer of the ghee. They develop itching and heaviness; exude clear, colorless fluid in large quantity and forms an ulcer which does not heal and the lips do not assume the normal softness in future. 8

Disease of the lips due to chronic trauma —

क्षतजाभौ विदीर्येते पाट्येते चाभिघाततः || ९ ||
ग्रथितौ च तथा स्यातामोष्टौ कण्डूसमन्वितौ |

kṣatajābhau vidīryētē pāṭyētē cābhighātataḥ || 9 ||
grathitau ca tathā syātāmōṣṭau kaṇḍūsamanvitau |

If the lips become the place of assault by weapons, etc., there could be bleeding. There develops cracks, and fissures and a sense of itching as well. 9

Sixteen diseases of the Gums
Sheetada (Spongy gums)

शोणितं दन्तवेष्टेभ्यो यस्याकस्मात् प्रवर्तते |
दुर्गन्धीनि सकृष्णानि प्रक्लेदीनि मृदूनि च || १० ||
दन्तमांसानि शीर्यन्ते पचन्ति च परस्परम् |
शीतादो नाम स व्याधिः कफ – शोणितसम्भवः || ११ ||

śōṇitaṁ dantavēṣṭēbhyō yasyākasmāt pravartatē |
durgandhīni sakr̥ṣṇāni praklēdīni mr̥dūni ca || 10 ||
dantamānsāni śīryantē pacanti ca parasparam |
śītādō nāma sa vyādhiḥ kapha – śōṇitasambhavaḥ || 11 ||

Occasional bleeding from the gums, with foul smell, gums becoming black, exudative, and soft, the muscles tear up and result in formation of pus. This disease has been identified as sheetada and is allegedly caused by vitiated kapha and rakta. 10-11

Dantapupputaka (Periodontitis)

दन्तयोस्त्रिषु वा यस्य श्वयथुर्जायते महान् |
दन्तपुप्पुटको नाम स व्याधिः कफ – रक्तजः || १२ ||

dantayōstriṣu vā yasya śvayathurjāyatē mahān |
dantapuppuṭakō nāma sa vyādhiḥ kapha – raktajaḥ || 12 ||

Severe swelling of the gums of two or three teeth together, generated by morbid increase in kapha and rakta has been identified as the disease Dantapupputaka. 12

Dantaveshta (Pyorhoea alveolaris) —

स्रवन्ति पूयरुधिरं चला दन्ता भवन्ति च |
दन्तवेष्टः स विज्ञेयो दुष्टशोणितसम्भवः || १३ ||

sravanti pūyarudhiraṁ calā dantā bhavanti ca |
dantavēṣṭaḥ sa vijñēyō duṣṭaśōṇitasambhavaḥ || 13 ||

The pus and blood coming out, teeth becoming shaky are the features of a disease identified as Dantaveshta produced by vitiated blood.  13

Saushira (Gingivitis)

श्वयथुर्दन्तमूलेषु रुजावान् कफ – रक्तजः |
लालास्रावि स विज्ञेयः शौषिरो नाम नामतः || १४ ||

śvayathurdantamūlēṣu rujāvān kapha – raktajaḥ |
lālāsrāvi sa vijñēyaḥ śauṣirō nāma nāmataḥ || 14 ||

A swelling at the root of the tooth, painful and causing free flow of saliva is a disease known as Saushira. It is generated by vitiated kapha and rakta in combination. 14

Maha Saushira (Severe Gingivitis) —

दन्ताः चलन्ति वेष्टेभ्यस्तालु चाप्यवदीर्यते |
यस्मिन् स सर्वजो व्याधिर्महाशौषिरसंज्ञितः || १५ ||

dantāḥ calanti vēṣṭēbhyastālu cāpyavadīryatē |
yasmin sa sarvajō vyādhirmahāśauṣirasañjñitaḥ || 15 ||

On occasions, the teeth get loosen from the gums, palate becomes fissured in addition to the other features of Saushira described above. This disease has been known as Maha Saushira. It is allegedly generated by the morbid increase in all the three doshas in combination. 15

Paridara (Bleeding Gums)

दन्तमांसानि शीर्यन्ते यस्मिन् ष्टिवति चाप्यसृक् |
पित्तासृक्कफजो व्याधिर्ज्ञेयः परिदरो हि सः || १६ ||

dantamānsāni śīryantē yasmin ṣṭivati cāpyasr̥k |
pittāsr̥kkaphajō vyādhirjñēyaḥ paridarō hi saḥ || 16 ||

The gums undergoing decomposition and causing frequent spitting of blood signifies the symptoms identified as Paridara, resulting from morbid increase of pitta, rakta and kapha. 16

Upakusha (Suppurative Gingivitis)

वेष्टेषु दाहः पाकश्च ताभ्यां दन्ताः चलन्ति च |
यस्मिन् सोपकुशो नाम पित्त रक्तकृतो गदः || १७ ||

vēṣṭēṣu dāhaḥ pākaśca tābhyāṁ dantāḥ calanti ca |
yasmin sōpakuśō nāma pitta raktakr̥tō gadaḥ || 17 ||

The gums having burning sensation, ulcers on them, teeth shaky are features of the disease Upakusha. It is generated by morbid increase in pitta and rakta in combination. 17

Vaidarbha (Traumatic periodontitis)

घृष्टेषु दन्तमांसेषु संरम्भो जायते महान् |
चला भवन्ति दन्ताश्च स वैदर्भो अभिघातजः || १८ ||

ghr̥ṣṭēṣu dantamānsēṣu sanrambhō jāyatē mahān |
calā bhavanti dantāśca sa vaidarbhō abhighātajaḥ || 18 ||

On occassions, the gums are excoriated with a burning sensation and ulcers appear on them. Subsequently, the teeth turn shaky.  This disease is produced by trauma and it has been identified as Vaidarbha. 18

Khalivardhana (Supernumerary tooth)

मारुतेनाधिको दन्तो जायते तीव्रवेदनः |
खलिवर्धनसंज्ञो असौ, जाते रुक् च प्रशाम्यति || १९ ||

mārutēnādhikō dantō jāyatē tīvravēdanaḥ |
khalivardhanasañjñō asau, jātē ruk ca praśāmyati || 19 ||

At times, an extra tooth erupts over an existing one causing severe pain during sprouting. The pain however, subsides afterwards. This is condition has been identified as Khalivardhana. This occurs due to vitiation of Vata. 19

Karaala (Irregular Teeth)

शनैः शनैः प्रकुरुते वायुर्दन्तसमाश्रितः |
करालान् विकटान् दन्तान् करालो न स सिध्यति || २० ||

śanaiḥ śanaiḥ prakurutē vāyurdantasamāśritaḥ |
karālān vikaṭān dantān karālō na sa sidhyati || 20 ||

Vata getting provoked make the teeth turn irregular and ugly over a long period. This disease has been identified as Karaala. It is not possible to manage this ailment. 20

Adhimamsaka (impacted wisdom tooth)

हानव्ये पश्चिमे दन्ते महान् शोथो महारुजः |
लालास्रावी कफकृतो विज्ञेयः सो अधिमांसकः ||

A severe swelling at the site of the last molar tooth, highly painful and causing dribbling of saliva is a disease that has been identified as Adhimamsaka and is allegedly generated by vitiated Kapha.

Dantanaadi (Alveolar sinuses)

दन्तमूलगता नाल्यः पञ्च ज्ञेया यथेरिताः || २१ ||

dantamūlagatā nālyaḥ pañca jñēyā yathēritāḥ || 21 ||

There are five kinds of sinus ulcers (nadi vranas) of the gums, identical to those described previously. 21

Eight diseases of the teeth
Daalana (Odontalgia)

दीर्यमाणेष्विव रुजा यस्य दन्तेषु जायते |
दालनो नाम स व्याधिः सदागतिनिमित्तजः || २२ ||

dīryamāṇēṣviva rujā yasya dantēṣu jāyatē |
dālanō nāma sa vyādhiḥ sadāgatinimittajaḥ || 22 ||

Severe pain in the tooth as though it is going to split up is the symptom of a disease known as Dalana. It is provoked by Vata. 22

Krimi dantaka (Caries tooth)

कृष्णच्छिद्रः चलः स्रावी संरम्भो महारुजः |
अनिमित्तरुजो वाताद् विज्ञेयः क्रिमिदन्तकः || २३ ||

kr̥ṣṇacchidraḥ calaḥ srāvī sanrambhō mahārujaḥ |
animittarujō vātād vijñēyaḥ krimidantakaḥ || 23 ||

Tooth having black holes that discharge blood; that are swollen and very painful is the symptom disease called Krmi dantaka. In it, pain appears without apparent reasons. The symptom is generated by the vitiated Vata. 23

Bhanjanaka (Fracture tooth)

वक्त्रं वक्रं भवेध्यस्य दन्तभङ्गश्च जायते |
कफ – वातकृतो व्याधिः स भञ्जनक संज्ञितः || २४ ||

vaktraṁ vakraṁ bhavēdhyasya dantabhaṅgaśca jāyatē |
kapha – vātakr̥tō vyādhiḥ sa bhañjanaka sañjñitaḥ || 24 ||

In the disease identified as Bhanjanaka, face of the patient assumes an irregular shape while his teeth turn irregular. It is generated by the action of provoked kapha vata in combination. 24

Dantaharsha (Dental hyperaesthesia)

शीत – रुक्ष – प्रवाताम्ल – स्पर्शानामसहा द्विजाः |
पित्त – मारुतकोपेन – दन्तहर्षः स नामतः || २५ ||

śīta – rukṣa – pravātāmla – sparśānāmasahā dvijāḥ |
pitta – mārutakōpēna – dantaharṣaḥ sa nāmataḥ || 25 ||

In the disease identified as Dantaharsha the teeth becomes incapable of tolerating the touch of cold breeze, sour things, and the like. This symptom is generated by morbid increase in pitta and vaata in combination. 25

Dantasharkara (Tartar)

मलो दन्तगतो यस्तु पित्त – मारुतशोषितः |
शर्करेव खरस्पर्शा सा ज्ञेया दन्तशर्करा || २६ ||

malō dantagatō yastu pitta – mārutaśōṣitaḥ |
śarkarēva kharasparśā sā jñēyā dantaśarkarā || 26 ||

The dirt on the teeth (sordes) being dried up by the action of pitta and vata, assume lardness and accumulate on the teeth. This condition has been identifed as Danta Sharkara. 26

Kapaalika (Non vital teeth)

कपालेष्विव दीर्यत्सु दन्तानां सैव शर्करा |
कपालिकेति विज्ञेया सदा दन्तविनाशिनी || २७ ||

kapālēṣviva dīryatsu dantānāṁ saiva śarkarā |
kapālikēti vijñēyā sadā dantavināśinī || 27 ||

The disease identified as Kapaalika pertains to a condition in which big flakes of accretions peel off along with parts of the tooth, finally destroying it. 27

Shyava dantaka (Discoloured teeth)

यो असृङ्गमिश्रेण पित्तेन दग्धो दन्तस्त्वशेषतः |
श्यावतां नीलतां वा अपि गतः स श्यावदन्तकः || २८ ||

yō asr̥ṅgamiśrēṇa pittēna dagdhō dantastvaśēṣataḥ |
śyāvatāṁ nīlatāṁ vā api gataḥ sa śyāvadantakaḥ || 28 ||

Tooth becoming black or blue, being burnt up by pitta combined with rakta is disease that has been identified as Syavadantaka. 28

Danta Vidradhi (Root abscess)

दन्तमांसे मलैः सास्रै बार्ह्यान्तः श्यवथुर्गुरुः |
सदाहरुक् स्रवेद् भिन्नः पूयास्रं दन्तविद्रधिः || २९ ||

dantamānsē malaiḥ sāsrai bārhyāntaḥ śyavathurguruḥ |
sadāharuk sravēd bhinnaḥ pūyāsraṁ dantavidradhiḥ ||

An abscess developing at the gums, containing thick pus and blood inside and discharging them after bursting accompanied with burning sensation and pain has been identified Dantavidradhi. 29

Five diseases of the tongue
The three Jihvakantakas (Glossitis)

जिह्वा अनिलेन स्फुटिता प्रसुप्ता भवेच्च शाकच्छदनप्रकाशा |

jihvā anilēna sphuṭitā prasuptā bhavēcca śākacchadanaprakāśā |

The patient will feel pain when one taps the tooth, biting or closing the mouth tightly also increases the pain. The gums can be swollen. It could drain thick material.

पित्तेन दह्यत्युपचियते च दीर्घैः स रक्तैरपि कण्टकैश्च |
कफेन गुर्वी बहुलाचिता च मांसोच्छ्रयैः शाल्मलिकण्टकाभैः || ३० ||

pittēna dahyatyupaciyatē ca dīrghaiḥ sa raktairapi kaṇṭakaiśca |
kaphēna gurvī bahulācitā ca mānsōcchrayaiḥ śālmalikaṇṭakābhaiḥ || 30 ||

The tongue affected by provocation of vata would turn fissured, there would be loss of sensation, and the tongue would resemble to a leaf of  a tree. The tongue affected by morbid increase in pitta would develop burning sensation that would turn the tongue studded with reddish thorny lesions. The tongue affected by vitiation of kapha would turn thick, grown in size and would develop a muscular sprout resembling lumps on the bark of Shalmali Tree. 30

Alaasa (? Carcinoma tongue)

जिह्वाताले यः श्वयथुः प्रगाधः सो अलाससंज्ञः कफ – रक्तमूर्तिः |
जिह्वां स तु स्तम्भयति प्रवृद्धो मूले च जिह्वा भृशमेति पाकम् || ३१ ||

jihvātālē yaḥ śvayathuḥ pragādhaḥ sō alāsasañjñaḥ kapha – raktamūrtiḥ |
jihvāṁ sa tu stambhayati pravr̥ddhō mūlē ca jihvā bhr̥śamēti pākam || 31 ||

A profound swelling on the tongue, having all the features of vitiation of kapha and rakta together is a disease identified as Alaasa. It turns the tongue incapable of movement and generates an ulcer at the root of the tongue. 31

Upajihvikaa (Sublingual swelling ? ranula)

जिह्वाग्ररूपः श्वयथुर्हि जिह्वामुन्नम्य जातः कफ – रक्तमूलः |
लालाकरः कण्डुयुतः सचोषः सा तूपजिह्वा पठिता भिषग्भिः || ३२ ||

jihvāgrarūpaḥ śvayathurhi jihvāmunnamya jātaḥ kapha – raktamūlaḥ |
lālākaraḥ kaṇḍuyutaḥ sacōṣaḥ sā tūpajihvā paṭhitā bhiṣagbhiḥ || 32 ||

Such symptoms as severe swelling underneath the tip of the tongue, accompanied with excessive salivation, itching and localized burning sensation as though touched by fire, has been identified by the expert physicians as Upajihvaka. It is allegedly generated by provocation of kapha and rakta together. 32

Nine diseases of the Palate
Kanthashundi (Uvulitis)

श्लेष्मासृग्भ्यां तालुमूले प्रवृद्धो दीर्घः शोथो ध्मातबस्तिप्रकाशः |
तृष्णा – कास – श्वासकृतं वदन्ति व्याधिं वैध्याः कण्ठ शुणडीति नाम्ना || ३३ ||

ślēṣmāsr̥gbhyāṁ tālumūlē pravr̥ddhō dīrghaḥ śōthō dhmātabastiprakāśaḥ |
tr̥ṣṇā – kāsa – śvāsakr̥taṁ vadanti vyādhiṁ vaidhyāḥ kaṇṭha śuṇaḍīti nāmnā || 33 ||

Kapha and rakta getting provoked together, generate an elongated swelling resembling in shape to an inflated bag at the root of the palate. It is associated with thirst, cough and difficult breathing. This disease has been identified by the physicians as Kantha Shundi. 33

Tundikeri (Acute tonsillitis)

शोथः स्थूलस्तोद – दाह – प्रपाकी प्रागुक्ताभ्यां तुण्डिकेरी मता तु |

śōthaḥ sthūlastōda – dāha – prapākī prāguktābhyāṁ tuṇḍikērī matā tu |

The same condition as described above has been identified as Tundikeri if the swelling becomes more severe, leading to severe pain and burning sensation along with the formation of pus or ulcer.

Adhrusa ( ? Acute inflammation of the soft palate)

मृदुः शोथो लोहितः शोणितोत्थो ज्ञेयो अधृषः सज्वरस्तीव्ररुक् च || ३४ ||

mr̥duḥ śōthō lōhitaḥ śōṇitōtthō jñēyō adhr̥ṣaḥ sajvarastīvraruk ca || 34 ||

 A soft, reddish swelling generated by provoked Rakta, accompanied with fever and severe pain has been identifed as the disease Adhrusa. 34

Kacchapa (Torus palatinus)

कूर्मोन्नतो अवेदनो अशीघ्रजन्मा रोगो ज्ञेयः कच्छपः श्लेष्मणा तु |

kūrmōnnatō avēdanō aśīghrajanmā rōgō jñēyaḥ kacchapaḥ ślēṣmaṇā tu |

A roundly, big and painless swelling resembling a tortoise shell and developing very slowly has been identified as the disease Kacchapa. It is generated by Kapha.

Arbuda (Tumour of the palate)

पद्माकारं तालुमध्ये तु शोथं विध्याद्रक्तादर्बुदं प्रोक्तलिङ्गम् || ३५ ||

padmākāraṁ tālumadhyē tu śōthaṁ vidhyādraktādarbudaṁ prōktaliṅgam || 35 ||

Mamsasanghaata (Soft tissue tumour of the palate)

दुष्टं मांसं नीरुजं तालुमध्ये कफाच्छुनं मांससङ्घात माहुः |

duṣṭaṁ mānsaṁ nīrujaṁ tālumadhyē kaphācchunaṁ mānsasaṅghāta māhuḥ |

A swelling in the centre of the palate resembling a lotus, having the same features as that of raktaarbuda is known as Taalu Arbuda and is due to vitiation of rakta; an identical swelling involving the mamsa in the centre of the palate, without pain and generated by provoked kapha has been identified as Mamsa sanghata. 35

Taalupupputa (Cyst mixed salivary tumour of the palate)

नीरुक् स्थायी कोलमात्रः कफात् स्यान्मेदोयुक्तात् पुप्पुटस्तालुदेशे || ३६ ||

nīruk sthāyī kōlamātraḥ kaphāt syānmēdōyuktāt puppuṭastāludēśē || 36 ||

Taalupaaka ( Palatal Abscess)
Taalu sosha (Dryness of the palate)

शोषो अत्यर्थं दीर्यते चापि तालुः श्वासस्चोग्रस्तालुशोषो अनिलाच्च |
पित्तं कुर्यात् पाकमत्यर्थघोरं तालुन्येनं तालुपाकं वदन्ति || ३७ ||

śōṣō atyarthaṁ dīryatē cāpi tāluḥ śvāsascōgrastāluśōṣō anilācca |
pittaṁ kuryāt pākamatyarthaghōraṁ tālunyēnaṁ tālupākaṁ vadanti || 37 ||

A papule size of a jujube (the plant Zizyphus jujuba) fruit, painless and immovable developing in the palate by the combination of provoked kapha and medas together is Talu pupputa. Dryness and fissures of the palate associated with difficulty in breathing is known as Talu shosha. It has been accepted as the one generated by provoked Vata. The pitta getting provoked generated an ulcer in the palate. It has been identified as Taalu paka. 36-37

Eighteen diseases of the throat
Rohini (Diphtheria)

गले अनिलः पित्त – कफौ च मूर्छितौ प्रदूष्य मांसं च तथैव शोणितं |
गलोपसंरोधकरैस्तथा अङ्कुरैर्निहन्त्यसून् व्याधिरयं हि रोहिणी || ३८ ||

galē anilaḥ pitta – kaphau ca mūrchitau pradūṣya mānsaṁ ca tathaiva śōṇitaṁ |
galōpasanrōdhakaraistathā aṅkurairnihantyasūn vyādhirayaṁ hi rōhiṇī || 38 ||

The aggravated Vata in the throat, combined with pitta and kapha, having afflicted the soft tissues and blood, produces sprout like projections which obstruct the throat; it kills the pateint in no time. This very disease has been identified as Rohini. 38

Vaata rohini

जिह्वासमन्ताद्भृशवेदनास्तु मांसान्कुराः कण्ठनिरोधिनो ये |
सा रोहिणी वातकृता प्रदिष्टा वातात्मकोपद्रवगाढयुक्ता || ३९ ||

jihvāsamantādbhr̥śavēdanāstu mānsānkurāḥ kaṇṭhanirōdhinō yē |
sā rōhiṇī vātakr̥tā pradiṣṭā vātātmakōpadravagāḍhayuktā || 39 ||

That rohini, in which painful fleshy buds are present around the tongue obstructing the throat, it is said to be due to Vata; it is associated with serious Vatika complications as well. 39

Pittaja Rohini

क्षिप्रोद् गमा क्षिप्रविदाहपाका तीव्रज्वरा पित्तनिमित्तजा तु |

kṣiprōd gamā kṣipravidāhapākā tīvrajvarā pittanimittajā tu |

Kaphaja Rohini

स्रोतोनिरोधिन्यचलोद्गता च स्थिराङ्कुरा या कफसम्भवा सा ||४० ||

srōtōnirōdhinyacalōdgatā ca sthirāṅkurā yā kaphasambhavā sā ||40 ||

If pitta is predominant, the sprouts appear quickly; they undergo a quick pus formation. In addition, there is a quick ulceration, accompanied with high fever and other features of pitta vriddhi. However, if kapha would ve dominant dosha in the case, there would be bigger, immovable, and hard sprouts blocking the throat totally. 40

Sannipataja Rohini

गम्भिरपाकिन्यनिवार्यवीर्या त्रिदोषलिङ्गा त्रितयोत्थिता च |

gambhirapākinyanivāryavīryā tridōṣaliṅgā tritayōtthitā ca |

Raktaja Rohini

स्फोतैश्चिता पित्तसमानलिङ्गा साध्या प्रदिष्टा रुधिरात्मिका तु || ४१ ||

sphōtaiścitā pittasamānaliṅgā sādhyā pradiṣṭā rudhirātmikā tu || 41 ||

Rohini due to provocation of all the three doshas in combination would produce extensive suppuration with an uncontrollable intensity besides manifesting other symptoms of all the three doshas vitiated. 41

Kanthashaluka (Tonsillitis)

कोलास्थिमात्रः कफसंभवो यो ग्रन्थिर्गले कण्टकशूकभूतः |
खरः स्थिरः शस्त्र निपातसाध्यस्तं कण्ठशालूकमिति ब्रुवन्ति || ४२ ||

kōlāsthimātraḥ kaphasambhavō yō granthirgalē kaṇṭakaśūkabhūtaḥ |
kharaḥ sthiraḥ śastra nipātasādhyastaṁ kaṇṭhaśālūkamiti bruvanti || 42 ||

On occasions, morbid increase in kapha develops a tumor of the size of seed of jujube fruit inside the neck. It is found in the throat shaped like a thorn. It is hard, immovable and curable only by surgical treatment. This condition has been identified as Kanthashaluka. 42

Adhijihva (? Epiglotic inflammation)

जिह्वाग्र रूपः श्वयथुः कफात्तु जिह्वोपरिष्टादपि रक्तमिश्रात् |
ज्ञेयो अधिजिह्वः खलु रोग एष विवर्जयेदागतपाकमेनम् || ४३ ||  

jihvāgra rūpaḥ śvayathuḥ kaphāttu jihvōpariṣṭādapi raktamiśrāt |
jñēyō adhijihvaḥ khalu rōga ēṣa vivarjayēdāgatapākamēnam || 43 ||

Kapha undergoing a morbid growth and involving rakta generates a swelling at the root of the tongue on its top. This pathological condition has been identified as Adhijihva.; if it is found with formation of pus or ulcer. As it is incurable symptom, the wise should refuse the case. 43

Valaya ( ? Oesophageal cancer)

बलास एवायतमुन्नतं च शोथं करोत्यन्नगतिं निवार्य |
तं सर्वथैवाप्रतिवार्यवीर्य विवर्जनीयं वलयं वदन्ति || ४४ ||

balāsa ēvāyatamunnataṁ ca śōthaṁ karōtyannagatiṁ nivārya |
taṁ sarvathaivāprativāryavīrya vivarjanīyaṁ valayaṁ vadanti || 44 ||

Kapha undergoing vitiation generates large sized swelling in the throat, causing blockage to the passage of food particles, this condition identified as Valaya, is an unmanageable disease and so fit to be refused treatment by the wise. 44

Balasha

गले तु शोथं कुरुतः प्रवृद्धो श्लेष्मानिलौ श्वासरुजोपपन्नम् |
मर्मच्छिदं दुस्तरमेनमाहुर्बलाशसंज्ञं निपुणा विकारम् || ४५ ||

galē tu śōthaṁ kurutaḥ pravr̥ddhō ślēṣmānilau śvāsarujōpapannam |
marmacchidaṁ dustaramēnamāhurbalāśasañjñaṁ nipuṇā vikāram || 45 ||

Kapha and vata, together undergoing vitiation might generate a swelling in the throat, causing difficulty in breathing, pain in the throat, and pain in the other vital organs. This disease, identified as Balasha, is also incurable as opined by the experts. 45

Ekavrnda 

वृत्तोन्नतो अन्तः श्वयथुः सदाहः सकण्डुरो अपाक्य मृदुर्गुरुश्च |
नाम्नैकवृन्दः परिकिर्तितो असौ व्याधिर्बलाश – क्षतजप्रसूतः || ४६ ||

vr̥ttōnnatō antaḥ śvayathuḥ sadāhaḥ sakaṇḍurō apākya mr̥durguruśca |
nāmnaikavr̥ndaḥ parikirtitō asau vyādhirbalāśa – kṣatajaprasūtaḥ || 46 ||

Such symptoms as swelling inside the throat that is roundly shaped, elevated, accompanied with burning sensation, itching, and that is hard indicate to the disease identified as Ekavrnda. It is without pus or ulcer formation. It is supposed to have generated by kapha and rakta in combination. 46

Vrnda

समुन्नतं वृत्तममन्ददाहं तीव्रज्वरं वृन्दमुदाहरन्ति |
तच्चापि पित्त – क्षतजप्रकोपाज्ज्ञेयं सतोदं पवनात्मकं तु || ४७ ||

samunnataṁ vr̥ttamamandadāhaṁ tīvrajvaraṁ vr̥ndamudāharanti |
taccāpi pitta – kṣatajaprakōpājjñēyaṁ satōdaṁ pavanātmakaṁ tu || 47 ||

Elevated, and round swelling in the throat associated with severe burning sensation and a high fever, generated by the provoked pitta as well as the rakta has been identified as Vrnda; it could be painful if vitiated Vata also is involved in the disease. 47

Shataghni (Malignancy Throat)

वर्तिर्घना कण्ठनिरोधिनी या चिता अतिमात्रं पिशितप्ररोहैः |
अनेकरुक् प्राणहरी त्रिदोशाज्ञेया शतघ्नी च शतघ्निरुपा || ४८ ||

vartirghanā kaṇṭhanirōdhinī yā citā atimātraṁ piśitaprarōhaiḥ |
anēkaruk prāṇaharī tridōśājñēyā śataghnī ca śataghnirupā || 48 ||

A swelling obstructing the throat studded all over with sprouts of muscle resembling to the weapon Shataghni, presenting different kinds of pain and causing death has been identified as Shataghni. It results from morbid increase in all the three doshas together. 48

Galayu (Polyp/ Adenoma)

ग्रन्थिर्गले त्वा मलकास्थि मात्रः स्थिरो अतिरुग्यः कफ – रक्तमूर्तिः |
संलक्ष्यते सक्तमिवाशनं च स शस्त्रसाध्यस्तु गलायुसंज्ञः || ४९ || 

granthirgalē tvā malakāsthi mātraḥ sthirō atirugyaḥ kapha – raktamūrtiḥ |
sanlakṣyatē saktamivāśanaṁ ca sa śastrasādhyastu galāyusañjñaḥ || 49 ||

The disease Galaayu is marked by that swelling in the throat of the size of seeds of amalaka ( the plant Phyllonthus embliea) that are immovable, very painful, having other features of kapha and rakta, and causing difficultly in swallowing of food items. It requires surgical therapy. 49 

Gala Vidradhi (Retropharyngeal Abscess)

सर्वं गलं व्याप्य समुत्थितो यः शोथो रुजः सन्ति च यत्र सर्वाः |
स सर्वदोषैर्गलविद्रधिस्तु तस्यैव तुल्यः खलु सर्वजस्य || ५० ||

sarvaṁ galaṁ vyāpya samutthitō yaḥ śōthō rujaḥ santi ca yatra sarvāḥ |
sa sarvadōṣairgalavidradhistu tasyaiva tulyaḥ khalu sarvajasya || 50 ||

A particular swelling that develops involving all the areas of the throat, presenting different kinds of pain and generated by the vitiation of all the three doshas together has been identified as the Gala Vidradhi. 50

Galaugha (Quinsy)

शोथो महानन्न – जलावरोधी तीव्रज्वरो वायुगतेर्निहन्ता |
कफेन जातो रुधिरान्वितेन गले गलौघः परिकीर्त्यते तु || ५१ ||

śōthō mahānanna – jalāvarōdhī tīvrajvarō vāyugatērnihantā |
kaphēna jātō rudhirānvitēna galē galaughaḥ parikīrtyatē tu || 51 ||

A profound swelling in the throat, causing blockage to swallowing of eatables, water and even of respiration, accompanied with severe fever has been identified as Galugha. It is generated by provoked kapha and is associated with provoked blood. 51

Svaraghna (Carcinoma Larynx)

यस्ताम्यमानः श्वसिति प्रसक्तं भिन्नस्वरः शुष्क – विमुक्तकण्ठः |
कफोपदिग्धेष्वनिलायनेषु ज्ञेयः स रोगः श्वसनात् स्वरघ्नः || ५२ ||

yastāmyamānaḥ śvasiti prasaktaṁ bhinnasvaraḥ śuṣka – vimuktakaṇṭhaḥ |
kaphōpadigdhēṣvanilāyanēṣu jñēyaḥ sa rōgaḥ śvasanāt svaraghnaḥ || 52 ||

The features of the disease identified as Svaraghna that is generated by vaata include the following:

  • Patient breathing with difficulty
  • seeing darkness before the eyes,
  • Having a broken voice
  • Dryness and
  • loss of movement of the throat,
  • and the passages of air in his neck obstructed by kapha (sputum). 52
Mamsataana (Malignancy throat)

प्रतानवान् यः श्वयथुः सुकष्टो गलोपरोधं कुरुते क्रमेण |
स मांसतानः कथितो अवलम्बी प्राणप्रणुत् सर्वकृतो विकारः || ५३ ||

pratānavān yaḥ śvayathuḥ sukaṣṭō galōparōdhaṁ kurutē kramēṇa |
sa mānsatānaḥ kathitō avalambī prāṇapraṇut sarvakr̥tō vikāraḥ || 53 ||

A broad swelling in the throat, with severe painful features, gradually obstructing the throat by hanging down and proving fatal has been identified as Mamsatana. This symptom results from the vitiation of all the three dosas together. 53

Vidaari (Oral malignancy)

सदाहतोदं श्वयथुं सुताम्रमन्तर्गले पूति – विशीर्णमांसम् |
पित्तेन विध्याद्वदने विदारीं पार्श्वे विशेषात् स तु येन शेते || ५४ ||

sadāhatōdaṁ śvayathuṁ sutāmramantargalē pūti – viśīrṇamānsam |
pittēna vidhyādvadanē vidārīṁ pārśvē viśēṣāt sa tu yēna śētē || 54 ||

A dark coppery swelling inside the throat with burning and pricking pain and foul smelling and fumigating sift tissues is called Vidari. It is the disease of the mouth; it is produced due to pitta. It develops particularly on the side in which the pateint usually remains while sleeping. 54

Sarvasara (Stomatitis)

स्फोतैः सतोदैर्वदनं समन्ताध्यस्याचितं सर्वसरः स वातात् |
रक्तैः सदाहैस्तनुभिः सपीतैर्यस्याचितं चापि स पित्तकोपात् |
अवेदनैः कण्डुयुतैः सवर्णोर्यस्याचितं चापि स वै कफेन || ५५ ||

sphōtaiḥ satōdairvadanaṁ samantādhyasyācitaṁ sarvasaraḥ sa vātāt |
raktaiḥ sadāhaistanubhiḥ sapītairyasyācitaṁ cāpi sa pittakōpāt |
avēdanaiḥ kaṇḍuyutaiḥ savarṇōryasyācitaṁ cāpi sa vai kaphēna || 55 ||

In a case of sarvasara due to provoked vata, the oral cavity turns full of vesicles all over with pricking sensation. If the disease has developed due to pitta, it is full of tiny, yellowish red and painful vesicles. If the disease has developed due to kapha, it is full of painless itching vesicles of the colour resembling the normal oral mucosa. 55

Prognosis of oral diseases 

ओष्टप्रकोपे वर्ज्याः स्युर्मांस – रक्त – त्रिदोषजाः |
दन्तमूलेषु वर्ज्योर च त्रिलिङ्ग गति – शौषिरौ || ५६ ||
दन्तेषु च न सिध्यन्ति श्याव – दालन – भञ्जनाः |
जिह्वारोगे बलाशस्तु ताल्व्येष्वर्बुदं तथा || ५७ ||
स्वर्घ्नो वलयो वृन्दो बालाशश्च विदारिका |
गलौघो मांसतानश्च शतघ्नी रोहिणी गले || ५८ ||
असाध्याः कीर्तितो ह्येते रोगा नव दशैव तु |
तेषु चापि क्रियां वैध्यः प्रत्याख्याय समाचरेत् || ५९ ||

ōṣṭaprakōpē varjyāḥ syurmānsa – rakta – tridōṣajāḥ |
dantamūlēṣu varjyōra ca triliṅga gati – śauṣirau || 56 ||
dantēṣu ca na sidhyanti śyāva – dālana – bhañjanāḥ |
jihvārōgē balāśastu tālvyēṣvarbudaṁ tathā || 57 ||
svarghnō valayō vr̥ndō bālāśaśca vidārikā |
galaughō mānsatānaśca śataghnī rōhiṇī galē || 58 ||
asādhyāḥ kīrtitō hyētē rōgā nava daśaiva tu |
tēṣu cāpi kriyāṁ vaidhyaḥ pratyākhyāya samācarēt || 59 ||

Among the diseases of lips, osthaprakopa generated by provoked Mamsa, rakta and all the three doshas together could be rejected for treatment of the wise. Similarly, among the diseases of the gums, the nadivrana and atisausira if produced by the combination of all the three doshas are incurable. Among the diseases pertaining to the teeth the syavadantaka, dalana, and bhanjanaka are incurable. The following diseases are also incurable:

 a) Among the diseases of the tongue, Balasha
b) Among the diseases of the palate, Arbuda;
c) Among the diseases of the Throat, Svaraghna, Valaya, Vrnda, Balasha, Vidarika, Galaugha, Mamsataana, Shataghni, and Rohini.

Thus the nineteen diseases discussed above are considered as incurable and the physician should consider them as available. 56-59

इति श्री माधवकरविरचिते माधवनिदाने मुखरोगनिदानं समाप्तं || ५६ ||

iti śrī mādhavakaraviracitē mādhavanidānē mukharōganidānaṁ samāptaṁ || 56 ||

Thus concludes the chapter on Mukha Roga.