Chapter 68 – Bala Roga Nidanam

The 68th chapter of Madhava Nidana is Bala Roga Nidanam which deals with Diseases of Children. The term childhood disease refers to disease that is contracted or becomes symptomatic before the age of 18 or 21 years old.

Sequel of consuming vata vitiated milk

वातदुष्टं शिशुः स्तन्यं पिबन् वातगदातुरः |
क्षामस्वरः कृशाङ्गः स्याद्बद्धविण्मूत्र – मारुतः || १ ||

vātaduṣṭaṁ śiśuḥ stanyaṁ piban vātagadāturaḥ |
kṣāmasvaraḥ kr̥śāṅgaḥ syādbaddhaviṇmūtra – mārutaḥ || 1 ||

Diseases of Vata Origin can develop in those children who drink milk which is vitiated by provocation of Vata in the lactating mother. The child could become afflicted by constipation and blockage of urine. Consequently, the child would develop a feeble voice and would get emaciated. 1

Sequel of consuming Pitta vitiated milk

स्विन्नो भिन्नमलो बालः कामला – पित्तरोगवान् |
तृष्णालुरुष्णसर्वाङ्गः पित्तदुष्टं पयः पिबन् || २ ||

svinnō bhinnamalō bālaḥ kāmalā – pittarōgavān |
tr̥ṣṇāluruṣṇasarvāṅgaḥ pittaduṣṭaṁ payaḥ piban || 2 ||

The child who takes milk, which is vitiated by pitta will be afflicted with diseases of Pitta origin, it will manifest such symptoms as

• Perspiration
• Diarhhoea
• Jaundice
• Thirst while the body of the child would remain warm. 2

Sequel of consuming Kapha vitiated milk

कफदुष्टं पिबन् क्षीरं लालालुः श्लेष्मरोगवान् |
निद्रान्वितो जडः शूनवक्त्राक्षश्च्छर्दनः शिशुः || ३ ||

kaphaduṣṭaṁ piban kṣīraṁ lālāluḥ ślēṣmarōgavān |
nidrānvitō jaḍaḥ śūnavaktrākṣaścchardanaḥ śiśuḥ || 3 ||

Drinking milk which is vitiated by promoted Kapha, will make the child afflicted by diseases of kapha origin. This child would have excessive salivation and sleep, and remain inactive. The child may develop swelling of the face and eyes and a tendency of vomiting.3

Clinical Examination

शिशोस्तीव्रामतीव्रां च रोदनल्ल्क्षयेद्रुजम् ||४ ||
स यं स्पृशेद्भृशं देशं यत्र च स्पर्शनाक्षमः |
तत्र विध्याद्रुजं, मूर्ध्नि रुजं चाक्षिनिमीलनात् ||५ ||
कोष्टे विबन्ध – वमथु – स्तनदंशान्त्रकूजनैः |
आध्मान – पृष्टनमन – जठरोन्नमनैरपि || ६ ||
बस्तौ – गुह्ये च विण्मूत्रसङ्ग – त्रास – दिगिक्षणैः |
स्रोतांस्यङ्गानि सन्धींश्च पशेयेद् यत्नान्मुहुर्मुहुः || ७ ||

śiśōstīvrāmatīvrāṁ ca rōdanallkṣayēdrujam ||4 ||
sa yaṁ spr̥śēdbhr̥śaṁ dēśaṁ yatra ca sparśanākṣamaḥ |
tatra vidhyādrujaṁ, mūrdhni rujaṁ cākṣinimīlanāt ||5 ||
kōṣṭē vibandha – vamathu – stanadanśāntrakūjanaiḥ |
ādhmāna – pr̥ṣṭanamana – jaṭharōnnamanairapi || 6 ||
bastau – guhyē ca viṇmūtrasaṅga – trāsa – digikṣaṇaiḥ |
srōtānsyaṅgāni sandhīnśca paśēyēd yatnānmuhurmuhuḥ || 7 ||

Severe or mild pain in the child should be judged by its severe or mild crying respectively. The part of the body that the child touches by its hands or the part, which the child does not allow touching by others is to be recognised as the painful part or the part pathologically affected. Headache or other diseases of the head is to be understood by the closure of the eyes by the child; the abdominal colic pain is identified in terms of constipation, vomiting, biting of the breast, gurgling sound in the intestines, abnormal distension, bending backward or forward by the stomach.

The problem of the urinary bladder and rectum are identified in terms of the supprression of urine or feces, and through a frightened and unsteady vision. The physician should carefully, and repeatedly examine all the orifices, parts, and joints of the child. 4-7

Kukunaka (Opthalmin Neonatorum)

कुकूणकः क्षीरदोषाच्छिशूनामेव वर्त्मनि |
जायते तेन तन्नेत्रं कण्डुरं च स्रवेन्मुहुः || ८ ||
शिशुः कुर्याल्ललाट अक्षिकूट – नासावघर्षणम् |
शक्तो नार्कप्रभां दृष्टुं न वर्त्मोन्मीलनक्षमः ||९ ||

kukūṇakaḥ kṣīradōṣācchiśūnāmēva vartmani |
jāyatē tēna tannētraṁ kaṇḍuraṁ ca sravēnmuhuḥ || 8 ||
śiśuḥ kuryāllalāṭa akṣikūṭa – nāsāvagharṣaṇam |
śaktō nārkaprabhāṁ dr̥ṣṭuṁ na vartmōnmīlanakṣamaḥ ||9 ||

The Kukunaka is a disease of the eyelids caused  to children due to the effect of vitiated breast milk. In this condition there is itching in the eyes and exudation; The child could be found rubbing its forehead, eyes and round about areas and nose, he is unable to tolerate the sunrays (i.e., has photophobia) and is not able to properly open his eyelids. 8-9

Parigarbhika

मातुः कुमारो गर्भिण्याः स्तन्यं प्रायः पिबन्नपि |
कासाग्निसाद – वमथु – तन्द्रा – कार्श्यारुचि – भ्रमैः || १० ||
युज्यते कोष्टवृद्ध्या च तमाहुः पारिगर्भिकम् |
रोगं परिभवाख्यं च, युञ्जयात् तत्राग्निदीपनम् || ११ ||

mātuḥ kumārō garbhiṇyāḥ stanyaṁ prāyaḥ pibannapi |
kāsāgnisāda – vamathu – tandrā – kārśyāruci – – bhramaiḥ || 10 ||
yujyatē kōṣṭavr̥ddhyā ca tamāhuḥ pārigarbhikam |
rōgaṁ paribhavākhyaṁ ca, yuñjayāt tatrāgnidīpanam || 11 ||

The children suckling the milk of a pregnant mother sometimes suffer from

• cough
• poor digestive ability
• vomiting
• stupor
• emaciation
• Loss of appetite
• Giddiness
• enlargement of the stomach.

This disease is known as Parigarbhika or Paribhava. It could be treated with the appetizers. 10 – 11

Taalukantaka

तालुमांसे कफः क्रुद्धः कुरुते तालुकण्टकम् |
तेन तालुप्रदेशस्य निम्नता मूर्ध्नि जायते || १२ ||
तालुपातः स्तनद्वेषः कृच्छ्रात् पानं शक्रुद्द्रवम् |
तृडक्षि – कण्ठास्यरुजा ग्रीवाद्रुर्धरता वमिः || १३ ||

tālumānsē kaphaḥ kruddhaḥ kurutē tālukaṇṭakam |
tēna tālupradēśasya nimnatā mūrdhni jāyatē || 12 ||
tālupātaḥ stanadvēṣaḥ kr̥cchrāt pānaṁ śakruddravam |
tr̥ḍakṣi – kaṇṭhāsyarujā grīvādrurdharatā vamiḥ || 13 ||

Aggravated Kapha in the palatal (uvular) tissues produces a pathological condition called Talukantaka. The palate develops a depression in its upper curvature or it hangs down. Child will have aversion to breasts, difficulty on sucking, has watery stools, would have a morbid thirst, pain in the eyes, neck (throat) and mouth, inability to hold the neck (head)upright and vomiting. 12-13

Mahaapadma

विसर्पस्तु शिशोः प्राणनाशनो बस्तिशीर्षजः |
पद्मवर्णो महापद्मानामा दोषत्रयोद्भवः || १४ ||
शङ्खाभ्यां हृदयं याति ह्रुदयाद्वा गुदं व्रजेत् |

visarpastu śiśōḥ prāṇanāśanō bastiśīrṣajaḥ |
padmavarṇō mahāpadmānāmā dōṣatrayōdbhavaḥ || 14 ||
śaṅkhābhyāṁ hr̥dayaṁ yāti hrudayādvā gudaṁ vrajēt |

Visarpa occuring in the urinary  bladder region and the head is fatal for the children. By the vitiation of all the three doshas together the patches of visarpa resembles the lotus flower in colour. It is termed as Mahapadma. It may also appear in the temples spreading to the chest and from the chest to the rectum. This is fatal disease. 14

Ajagallika and Ahiputana

क्षुद्ररोगे च कथिते त्वजगल्लयहिपूतने || १५ ||

kṣudrarōgē ca kathitē tvajagallayahipūtanē || 15 ||

Ajagallika and Ahiputana, the two diseases described under Ksudra Rogas will also manifest in children commonly. 15

Diseases afflicting the adults may involve the children also

ज्वराध्या व्याधयः सर्वे महतां ये पुरेरिताम् |
बालदेहे अपि ते तद्वद्विज्ञेयाः कुशलैः सदा || १६ ||

jvarādhyā vyādhayaḥ sarvē mahatāṁ yē purēritām |
bāladēhē api tē tadvadvijñēyāḥ kuśalaiḥ sadā || 16 ||

Jvara and all other major diseases as described earlier for adults may also afflict the children in the same way; this should always be remembered by the experts. 16

General features of graha affliction

क्षणादुद्विजते बालः क्षणात् त्रस्यति रोदिति |
नखैर्दन्तैदार्यति धात्रिमात्मानमेव वा || १७ ||
ऊर्ध्वं निरीक्षते दन्तान् खादेत् कूजति जृम्भते |
भ्रुवौ क्षिपति दन्तौष्टं फेनं वमति चासकृत् || १८ ||
क्षामो अति निशि जागर्ति शूनाक्षो भिन्नविट् – स्वरः |
मांसशोणितगन्धिश्च न चाश्नाति यथा पुरा || १९ ||
सामान्यं ग्रहजुष्टानां लक्षणं समुदाहृतम् |

kṣaṇādudvijatē bālaḥ kṣaṇāt trasyati rōditi |
nakhairdantaidāryati dhātrimātmānamēva vā || 17 ||
ūrdhvaṁ nirīkṣatē dantān khādēt kūjati jr̥mbhatē |
bhruvau kṣipati dantauṣṭaṁ phēnaṁ vamati cāsakr̥t || 18 ||
kṣāmō ati niśi jāgarti śūnākṣō bhinnaviṭ – svaraḥ |
mānsaśōṇitagandhiśca na cāśnāti yathā purā || 19 ||
sāmānyaṁ grahajuṣṭānāṁ lakṣaṇaṁ samudāhr̥tam |

The general features seen in cases of possession by Grahas (evil spirits) —

• The child suddenly becomes emotional (irritable)
• Freighted (afflicted by fear)
• Begins to cry without any apparent reason,
• he scratches body of the mother or his own,
• would stare upward, bites himself.

Without any apparent reason, the child would moan and yawn excessively, would frown with the brows and would lick the gums and lips. The child even emits froth in vomiting, turns emaciated and does not sleep at nights, has his eyes swollen; would have his body emit bad smell like that of flesh and blood and would not take normal diets.

In addition, the child would have loose motions and a broken voice. 17-19

Affliction with skanda graha

एकनेत्रस्य गात्रस्य स्रावः स्पन्दन – कम्पनम् || २० ||
ऊर्ध्वं दृष्ट्या निरीक्षेत वक्रास्यो रक्तगन्धिकः |
दन्तान् खादति वित्रस्तः स्तन्यं नैवाभिनन्दति || २१ ||
स्कन्दग्रहगृहीतानां रोदनं चाल्पमेव च |

ēkanētrasya gātrasya srāvaḥ spandana – kampanam || 20 ||
ūrdhvaṁ dr̥ṣṭyā nirīkṣēta vakrāsyō raktagandhikaḥ |
dantān khādati vitrastaḥ stanyaṁ naivābhinandati || 21 ||
skandagrahagr̥hītānāṁ rōdanaṁ cālpamēva ca |

If the child is possessed by Skandagraha, he shows feature like —

• Lacrimation from one eye,
• Twitching,
• Convulsions
• Gazing with the eyes rolled upwards,
• Facial deformity
• Smells of blood from the body,
• Biting of teeth,
• Fretfulness,
• Aversion to take the breast and
• Diminished crying. 20 -21

Skandaapsmaara (Epilepsy due to skandagraha)

नष्टसंज्ञो वमेत् फेनं संज्ञावानतिरोदिति |
पूयशोणितगन्धित्वं स्कन्दापस्मारलक्षणम् || २२ ||

naṣṭasañjñō vamēt phēnaṁ sañjñāvānatirōditi |
pūyaśōṇitagandhitvaṁ skandāpasmāralakṣaṇam || 22 ||

The following are the features of child possesses by Skandapasmaara —

• Frothy Vomiting
• Fainting
• and too much of crying on gaining consciousness
• His body emitting the smell of pus and blood. 22

Affliction with Shakuni Graha

स्रस्ताङ्गो भयचकितो विहङ्गगन्धिः सास्रावव्रणपरिपीडितः समन्तात् |
स्फोतैश्च प्रचिततनुः सदाहपाकैर्विज्ञेयो भवति शिशुः क्षतः शकुन्या || २३ ||

srastāṅgō bhayacakitō vihaṅgagandhiḥ sāsrāvavraṇaparipīḍitaḥ samantāt |
sphōtaiśca pracitatanuḥ sadāhapākairvijñēyō bhavati śiśuḥ kṣataḥ śakunyā || 23 ||

The child shows symptoms like

• drooping of the limbs,
• fretfulness
• his body emitting smell of birds.

He develops

• Ulcers that exudates,
• his skin being studded with papules that form pus and
• there is burning sensation.

The following conditions are indicated if a child is possessed by Shakuni graha. 23

Affliction with the Revati Graha

व्रणैः स्फोतैः चितं गात्रं पङ्कगन्धं स्रवेदसृक् |
भिन्नवर्चा ज्वरी दाही रेवतीग्रहलक्षणम् || २४ ||

vraṇaiḥ sphōtaiḥ citaṁ gātraṁ paṅkagandhaṁ sravēdasr̥k |
bhinnavarcā jvarī dāhī rēvatīgrahalakṣaṇam || 24 ||

If body of the child is covered with boils and ulcers exuding blood and having the smell of silt, watery motions, fever, and burning sensation, this condition is indicative of a child possessed by Revati graha. 24

Affliction with the Putana Graha

अतीसारो ज्वरस्तृष्णा तिर्यक् प्रेक्षण – रोदनम् |
नष्टनिद्रस्तथोद्विग्नो ग्रस्तः पूतनया शिशुः || २५ ||

atīsārō jvarastr̥ṣṇā tiryak prēkṣaṇa – rōdanam |
naṣṭanidrastathōdvignō grastaḥ pūtanayā śiśuḥ || 25 ||

The child seized with the Putana Graha suffers from –

• Diarrhoea
• Fever
• Thirst
• His/her body bents side wards
• He /she remains crying, and
• There is loss of sleep and irritability. 25

Affliction with the Andhaputana Graha

छर्दिः कासो ज्वरस्तृष्णा वसागन्धो अतिरोदनम् |
स्तन्यद्वेषो अतिसारश्च अन्धपूतनया भवेत् || २६ ||

chardiḥ kāsō jvarastr̥ṣṇā vasāgandhō atirōdanam |
stanyadvēṣō atisāraśca andhapūtanayā bhavēt || 26 ||

In cases of affliction with the Andhaputana graha, there is —

• Vomiting
• Cough
• fever
• thirst
• emission of smell of muscle fat.

The afflicted child remains crying profusely and he/she develops an aversion to breast milk and suffers from diarrhoea as well. 26

Affliction with the Shitaputana Graha

वेपते कासते क्षीणो नेत्ररोगो विगन्धिता |
छर्ध्यतीसारयुक्तश्च शीतपूतनया शिशुः || २७ ||

vēpatē kāsatē kṣīṇō nētrarōgō vigandhitā |
chardhyatīsārayuktaśca śītapūtanayā śiśuḥ || 27 ||

In a case of affliction with the sheetaputana graha, the child has

• Convulsions
• Cough
• Emaciation
• Eye diseases
• Bad odour
• Vomiting and
• Diarrhoea. 27

Affliction with the Mukhamandika Graha

प्रसन्नवर्ण – वदनः सिराभिरभिसंवृतः |
मूत्रगन्धी च बह्वाशी मुखमण्डिकया भवेत् ||२८ ||

prasannavarṇa – vadanaḥ sirābhirabhisanvr̥taḥ |
mūtragandhī ca bahvāśī mukhamaṇḍikayā bhavēt ||28 ||

The signs and symptoms of Mukhamandika Graha —

• Bright complexion of the face with prominent appearance of veins on the surface of the body,
• Smell of urine from the body and
• The child eating too much of eatable. 28

Affliction with the Naigamesha Graha

छर्दि – स्प (स्य) न्दन – कण्ठास्यशोष – मूर्च्छा – विगन्धिताः |
ऊर्ध्वं पश्येद् दशेद् दन्तान् नैगमेषग्रहं वदेत् || २९ ||

chardi – spa (sya) ndana – kaṇṭhāsyaśōṣa – mūrcchā – vigandhitāḥ |
ūrdhvaṁ paśyēd daśēd dantān naigamēṣagrahaṁ vadēt || 29 ||

The features of the children possessed by Naigameya Graha —

• Vomiting
• Visible pulsations in the neck
• Dryness of the mouth
• Fainting
• bad smell from the body
• A gaze that is fixed up and the
• Biting of teeth. 29

Prognosis

प्रस्तब्धाक्षः स्तनद्वेषी मुह्यते चानिशं मुहुः |
तं बालमचिराद्दन्ति ग्रहः सम्पूर्णलक्षणः || ३० ||

prastabdhākṣaḥ stanadvēṣī muhyatē cāniśaṁ muhuḥ |
taṁ bālamacirāddanti grahaḥ sampūrṇalakṣaṇaḥ || 30 ||

As regards, the features of an incurable kind of possession by the different grahas, it may be noted that in that condition, the child loses movement of eyes, develops an aversion to the breast, repeated attacks of unconsciouness throughout (the day) and the night; as well as manifestation of all the symptoms of an affliction by evil spirits. 30

इति श्री माधवकरविरचिते माधवनिदाने बालरोगनिदानं समाप्तम् || ६८ ||

iti śrī mādhavakaraviracitē mādhavanidānē bālarōganidānaṁ samāptam || 68 ||

Thus concludes the Chapter on Bala roga. 68

Source — 

1. Diseases of Children