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Chapter 57 – Karna roga Nidanam

The 57th chapter of Madhava Nidana is Karna Roga Nidana which deals with Disease of the Ear.

Karna shula (Ear ache)

समीरणः श्रोत्रगतो अन्यथाचरन् समन्ततः शूलमतीव कर्णयोः | 
करोति दोषैश्च यथास्वमावृतः स कर्णशूलः कथितो दुराचरः || 1 || 

samīraṇaḥ śrōtragatō anyathācaran samantataḥ śūlamatīva karṇayōḥ |
karōti dōṣaiśca yathāsvamāvr̥taḥ sa karṇaśūlaḥ kathitō durācaraḥ || 1 ||

On occasions, the Vata functioning in the ears undergoes provocation. It begins to move in wrong direction subsequently. This condition generates severe pain in the ears, either alone or in association with other doshas. This symptom is called as Karna shula and is difficult to manage. 1

Karna Naada (Tinnitus)

कर्णस्रोतः स्थिते वाते शृणोति विविधान् स्वरान् |
भेरी – मृदङ्ग – शङ्खानां कर्णनादः स उच्चयते || २ ||

karṇasrōtaḥ sthitē vātē śr̥ṇōti vividhān svarān |
bhērī – mr̥daṅga – śaṅkhānāṁ karṇanādaḥ sa uccayatē || 2 ||

Vata affecting the canals of the ears makes the patient hear sounds as that is generated by kettledrum or a conch. This condition is known as Karnanaada. 2

Badhirya (Deafness)

यदा शब्दवहं वायुः स्रोत आवृत्य तिष्टति |
शुद्धः श्लेष्मान्वितो वा अपि बाधिर्यं तेन जायते || ३ ||

yadā śabdavahaṁ vāyuḥ srōta āvr̥tya tiṣṭati |
śuddhaḥ ślēṣmānvitō vā api bādhiryaṁ tēna jāyatē || 3 ||

When Vata either alone or in association with kapha blocks the passage of sound, the patient develops deafness. This disease has been identified as Badhirya. 3

Karna Srava (Labyrinthitis)

वायुः पित्तादिभिर्युक्तो वेणुघोषोपमं स्वनम् |
करोति कर्णयोः क्ष्वेदं कर्णक्ष्वेदः स उच्यते || ४ ||

vāyuḥ pittādibhiryuktō vēṇughōṣōpamaṁ svanam |
karōti karṇayōḥ kṣvēdaṁ karṇakṣvēdaḥ sa ucyatē || 4 ||

Vata in association with pitta or kapha generates a constant sound in the ears resembling the sound of a flute. This disease has been identified as Karnaksveda. 4

Karna Srava (Otorrhea)

शिरोभिघातादथवा निमज्जतो जले प्रपाकादथवा अपि विद्रधेः |
स्रवेद्धि पूयं श्रावणो अनिलार्दितः स कर्णसंस्राव इति प्रकीर्तितः || ५ ||

śirōbhighātādathavā nimajjatō jalē prapākādathavā api vidradhēḥ |
sravēddhi pūyaṁ śrāvaṇō anilārditaḥ sa karṇasansrāva iti prakīrtitaḥ || 5 ||

Injury to the head, remaining under water for long time or ripening of an abscess in the ears, produce discharge of pus from the ears, associated with other features of Vata. This disease has been identified as Karna Srava. 5

Karna Kandu (Itching sensation in the Ears, Otitis)

मारुतः कफसंयुक्तः कर्णकण्डु करोति च |

mārutaḥ kaphasanyuktaḥ karṇakaṇḍu karōti ca |

The disease Karnakandu is produced due to vitiation of Vata along with the kapha. It produces itching sensation , mainly.

Karna gutha (Ear wax)

पित्तोष्मशोषितः श्लेष्मा कुरुते कर्ण गूथकम् || ६ ||

pittōṣmaśōṣitaḥ ślēṣmā kurutē karṇa gūthakam || 6 ||

The kapha being solidified by heat of pitta generates the symptom known as Karnaguthaka that is hardness of  the wax as well as the Karnakandu. 6

Karnapratinaaha (Eustachean Tube catarhh)

स कर्णगूथो द्रवतां गतो यदा विलायितो घ्राणमुखं प्रपध्यते |
तदा स कर्णप्रतिनाहसंज्ञितो भवेद्विकारः शिरसो अर्धभेदकृत् || ७ ||

sa karṇagūthō dravatāṁ gatō yadā vilāyitō ghrāṇamukhaṁ prapadhyatē |
tadā sa karṇapratināhasañjñitō bhavēdvikāraḥ śirasō ardhabhēdakr̥t || 7 ||

This wax of the ears, becoming watery begins to exude through the nose accompanied with partial headache; the disease could be identified as Karnapratinaaha. 7

Krmikarna (Larva in the ear)

यदा तु मूर्च्छन्त्यथवा अपि जन्तवः सृजन्त्यपत्यान्यथवा अपि मक्षिकाः |
तद् व्यञ्जनत्वाच्छ्रवणो निरुच्यते भिषग्भिराध्यैः क्रिमिकर्णको गदः || ८ ||

yadā tu mūrcchantyathavā api jantavaḥ sr̥jantyapatyānyathavā api makṣikāḥ |
tad vyañjanatvācchravaṇō nirucyatē bhiṣagbhirādhyaiḥ krimikarṇakō gadaḥ || 8 ||

On occasion, insects or small worms enter into ears. At times, the flies produce thier larva inside the ears (in  the putrfied muscles of the ears). This situation results in the loss of the sense of hearing. This morbidity has been identifies by the expert physicians as Krmi Karnaka. 8

Insects in the ear

पतङ्गाः शतपध्यश्च कर्णस्रोतः प्रविश्य हि |
अरतिं व्याकुलत्वं च भृशं कुर्वन्ति वेदनाम् || ९ ||
कर्णो निस्तुध्यते तस्य तथा फरफरायते |
कीटे चरति रुक् तीव्रा निष्पन्दे मन्दवेदना || १० ||

pataṅgāḥ śatapadhyaśca karṇasrōtaḥ praviśya hi |
aratiṁ vyākulatvaṁ ca bhr̥śaṁ kurvanti vēdanām || 9 ||
karṇō nistudhyatē tasya tathā pharapharāyatē |
kīṭē carati ruk tīvrā niṣpandē mandavēdanā || 10 ||

If winged insects, centipede or other creatures have entered into the ears, they generate restlessness, a sense of fear or worry  and severe pain; there could be phar phar sound if they are alive and moving inside with severe pain. However, the pain is mild if they are dead. 9-10

Karna Vidradhi (Ear Inflammation/ Abscess)

क्षताभिघातप्रभवस्तु विद्रधिर्भवेतथा दोषकृतो अपरः पुनः |
सरक्त – पीतारुणमस्रमास्रवेत् प्रतोद – धूमायन – दाह – चोषवान् || ११ ||

kṣatābhighātaprabhavastu vidradhirbhavētathā dōṣakr̥tō aparaḥ punaḥ |
sarakta – pītāruṇamasramāsravēt pratōda – dhūmāyana – dāha – cōṣavān || 11 ||

An abscess developing inside the ears either due to injury or by increase in the doshas, produces discharge of red, yellow or crimson fluid, accompanied with pricking pain, burning sensation and feeling of a warm touch. This disease has been identified as the Karna vidradhi. 11

Karnapaaka (Suppurative Ear Disease)

कर्णपाकस्तु पित्तेन कोथ – विक्लेदकृद्भवेत् |
कर्णविद्रधिपाकाद्वा जायते चाम्बुपूरणात् || १२ ||

karṇapākastu pittēna kōtha – viklēdakr̥dbhavēt |
karṇavidradhipākādvā jāyatē cāmbupūraṇāt || 12 ||

The provoked pitta moving into the ear generated Karnapaaka with putrefaction and foul discharge; it may also result from Karna Vidradhi undergoing pus formation or from accumulation of water inside the ears. 12

Putikarna (Fetid Discharge from the ear)

पूयं स्रवति पूतिं वा स ज्ञेयः पूतिकर्णकः |

pūyaṁ sravati pūtiṁ vā sa jñēyaḥ pūtikarṇakaḥ |

If foul smelling pus is coming out of the ears, the problem is identified as Puti karnaka.

Shotha (Swelling), Arbud (Tumour) and Arshas (Polyp) of the Ear

कर्ण शोथार्बुदार्शांसि जानियादुक्तलक्षणैः || १३ ||

karṇa śōthārbudārśānsi jāniyāduktalakṣaṇaiḥ || 13 ||

Shotha, Arbuda or arshas might also develop in the ears with thier specific symptoms. 13

Symptomatology of ear diseases according to the Doshas

नादो अतिरुक् कर्णमलस्य शोषः स्रावस्तनुश्चाश्रवणं च वातात् |
शोथः सरागो दरणं विदाहः सपीत – पूतिस्रवणं च पितात् || १४ ||
वैश्रुत्य – कण्डु – स्थिरशोथ – शुक्ल – स्निग्धस्रुतिः स्वल्परुजः कफाच्च |
सर्वाणि रूपाणि च सन्निपातात् स्रावश्च तत्राधिकदोषवर्णः || १५ ||

nādō atiruk karṇamalasya śōṣaḥ srāvastanuścāśravaṇaṁ ca vātāt |
śōthaḥ sarāgō daraṇaṁ vidāhaḥ sapīta – pūtisravaṇaṁ ca pitāt || 14 ||
vaiśrutya – kaṇḍu – sthiraśōtha – śukla – snigdhasrutiḥ svalparujaḥ kaphācca |
sarvāṇi rūpāṇi ca sannipātāt srāvaśca tatrādhikadōṣavarṇaḥ || 15 ||

In all the diseases of the ears, presence of noise, severe pain, and hardening of wax, discharge of thin fluid and loss of hearing are the features generated by provoked Vata.

Features such as reddish swelling, burning sensation, discharge of yellowish pus and putrefaction signifies the ear problems produced by pitta. Likewise, such symptoms as hearing of abnormal sounds, itching, hard and immobile swelling, and discharge of white thick fluid and mild pain are the features of the ear problems produced by Kapha.

The presence of all the features signifies the instrumentality of all the three Doshas. It may also be noted that the discharge of the waste from the nose would have the complexion belonging to that Dosha which is predominant in the given case. 14-15

Paripota (Cracks in the ear lobule)

सौकुमर्याच्छिरोत्स्रुष्टे सहसा अतिप्रवर्धिते |
कर्णशोथो भवेत् पाल्यां सरुजः परिपोतवान् |  
कृष्णारुणानिभः स्तब्धः स वातात् परिपोतकः || १६ ||

To wear the ornaments, sometimes, a hole in the lobe of ear is created. In due course of time, the hole turns improper and a larger hole is required instead. If the desired hole is created suddenly, there develops a swelling in the pinna of the ears associated with pain. It even tears the skin there. It is black or brown in complexion and is hard due to involvement of Vata. This disease has been identified as Paripotaka. 16

Utpaata

गुर्वाभरणसंयोगात् ताडनाद्धर्षणादपि |
शोथः पाल्यां भवेच्छयावो दाह – पाक – रुजान्वितः || १७ ||
रक्तो वा रक्त – पित्त्ताभ्यामुत्पातः स गदो मतः |

Wearing of heavy ornaments and blow or friction on the ears result in the swelling of the pinna. It is black if it is due to the provoked vaata, red if it is due to the provoked Rakta or pitta. It is associated with burning sensation, formation of ulcer and pain. This disease has been identified as Utpaata. 17

Unmanthaka

कर्णं बलाद्वर्धयतः पाल्यां वायुः प्रकुप्यति ||१८ ||
कफं संगृह्य कुरुते शोथं स्तब्धमवेदनं |
उन्मन्थकः सकण्डुको विकारः कफ वातजः ||१९ ||

If one attempts to pierce the pinna of the ears by force, the vata is provoked and associating with kapha it generates a hard swelling. It is without pain but with itching. This disease has been identified as Unmanthaka. It is generated by vitiation of kapha vata in combination. 18-19

Duhkhavardhana (Secondary Infection)

संवर्ध्यमाने दुर्विद्धे कण्डु – पाक – रुजान्वितः |
शोथो भवति पाकश्च त्रिदोषो दुखः वर्धनः || २० ||

By improper piercing, the pinna develops swelling accompanied with itching, ulceration, pain and pus formation. This disease has been identified as Dukhavardhana. It is due to morbid increase in all the three doshas in combination. 20

Parilehi

कफास्रुक् – क्रिमयः क्रुद्धाः सर्षपाभा विसर्पिणः |
कुर्वन्ति पाल्यां पीडकाः कण्डु – दाह – रुजान्विताः || २१ ||
कफास्रुक् – क्रिमिसम्भूतः स विसर्पन्नितस्ततः |
लिहेत् सशुष्कलीं पालीं परिलेहीति स स्मृतः || २२ ||

Morbid increase in kapha and Rakta and presence of bacteria together generate pustules ( pidakas) on the pinna. It could be of the size of mustard seeds, spreading in nature, accompanied with itching, burning sensation, and pain. In due course of time, it might eliminate away the entire pinna. This disease is known as Parilehi. 21-22

इति श्रीमाधवकरविरचिते माधवनिदाने कर्णरोगनिदानं समाप्तम || ५७ ||

Thus concludes the chapter on Karna Roga.