Chapter XVI - Diagnosis of diseases of mouth

Now we shall discourse on the Nidana of Mukharoga (diseases which affect the cavity of the mouth in general), 1.

General Classifications:—

Sixty five^[1] different forms of mouth disease are known in practice. They are found to attack seven different localities viz. the lips, the gums of the teeth, tongue, palate, throat and the entire cavity; of these eight are peculiar to the lips; fifteen, to the roots of the teeth; eight to the teeth; five to the tongue; nine to the palate; seventeen to the throat; and three to the entire cavity. 2—3.

Diseases of the lips:—

The eight forms which affect the lips, are either

1. Vataja,
2. Pittaja,
3. Kaphaja,
4. Sannipatika,
5. Raktaja,
6. Manshaja,
7. Medaja
8. or Abhighataja (Traumatic). 4.

The Vataja Type:—

The lips become dry, rough, numbed, black, extremely painful and the affected part seems as if it were smashed and pulled out or cracked by the action of the aggravated Vayu.

In the Pittaja type —the lips become blue or yellow-coloured and studded with (a large number of small) mustard- seed-like eruptions, which suppurate and exude a purulent discharge attended with a burning sensation (in the locality).

In the Kaphaja type—the affected lips are covered with small eruptions, which are of the same colour as the surrounding part, and become slimy, heavy or thick, cold and swollen. Pain is absent in this type and the patient feels an irresistible inclination to scratch the parts.

In the Sannipataja type, the lips change colour, becoming black, yellow, or ash-coloured (white) at intervals and are found to be studded with various sorts of eruptions. 5–8.

The Raktaja type (Produced by the vitiated condition of the blood) the affected lips look as red as blood and profusely bleed and crops of date coloured (chocolate-coloured) eruptions appear on their surface.

In the Mansaja type (due to the vitiated condition of the local flesh), the lips become heavy, thick and gathered up in the form of a lump of flesh. The angles of the mouth become infested with parasites which germinate and spread themselves in the affected parts. In the Medaja(fat-origined) type the lips become numbed, soft, heavy and marked by an itching sensation. The skin of the inflamed surface becomes glossy and looks like the surface layer of clarified butter exuding a thin crystal-like (transparent) watery discharge.

In the Abhighataja (Traumatic) type, the lips become red, knotty and marked by an itching sensation and seem as if pierced into or cut open with an axe and (become cracked and fissured). 9†12.

Disease of the roots of the teeth:—

Diseases which are peculiar to the roots of the teeth, are known as Shitada, Danta-pupputaka, Danta-veshtaka, Shaushira, Maha-Saushira, Paridara, Upakusha, Danta- vaidarbha, Vardhana, Adhimansa and the five sorts of Nadi (sinus). 13.

Sitada (Scurvy):—

The gums of the teeth suddenly bleed and become putrified, black, slimy and emit a fetid smell. They become soft and gradually slough off. The disease has its origin in the deranged condition of the local blood and Kapha.

Danta-pupputaka (gum boil):—The disease in which the roots of two or three teeth at a time is marked by a violent swelling and pain is called Danta-pupputaka. The disease is due to the vitiated condition of the blood and Kapha.

Danta-veshtaka:—The teeth become loose in the gums, which exude a discharge of blood and pus. This disease is due to the vitiated blood of the locality.

Shaushira:—The disease in which an itching painful swelling appears about the gums attended with copious flow of saliva is called Saushira (Alveolar abscess). It is caused by the deranged blood and Kapha of the locality.

Maha- Shaushira:—The disease in which the teeth become loose, the palate marked by sinuses or fissures, the gums putri- fied, and the whole cavity of the mouth inflamed, is called Mahashaushira, the outcome of the concerted action of the deranged Doshas of the body. 14–18.

Paridara:—

The disease in which the gums become putrified, wear off and bleed is called Paridara (bleeding gums). The disease has its origin in the deranged condition of the blood, Kapha and Pitta.

Upakusha:— The disease in which the gums become marked by a burning sensation and suppuration and the teeth become loose and shaky (in their gums) in consequence and bleed at the least shaking, is called Upakusha. There is a slight pain, and the entire cavity of the mouth becomes swollen and emits a fetid smell; this disease is due to the vitiated condition of the blood and Pitta. 19.

Danta-Vaidarbha:—

The disease which is consequent upon the friction of the gums marked by the appearance of a violent swelling about the portion (so rubbed and in which) the teeth beeome loose and can be moved about, is called Danta-vaidarbha which is due to an extraneous cause such as a blow etc.

Vardhana:—the disease which is marked by the advent of an additional tooth (the last molar) through the action of the deranged Vayu with a specific excruciating pain of its own, is called Vardhana or eruption of the Wisdom tooth. The pain subsides with the cutting of the tooth.

Adhimansa:— The disease in which a violent and extremely painful tumour appears about the root of the tooth, and is situated in the farthest end of the cavity of the cheek-bone accompanied by a copious flow of saliva is called Adhimansa or Epulis. It is due to the deranged Kapha.

The five sorts of Nadi (sinus) which affect the roots of the teeth (are either

1. Vataja,
2. Pittaja,
3. Kaphaja,
4. Sannipataja
5. or Abhighataja),

their symptoms being respectively identical with those of the types of Nadi-vrana. 20—24.

Diseases to the teeth proper:—

Diseases which are restricted to the teeth proper are named as,

1. Dalana,
2. Krimi-dantaka,
3. Danta-harsha,
4. Bhanjaka,
5. Sarkara,
6. Kapalika,
7. Syava-dantaka
8. and Hanu-moksha. 25.

Dalana:—

The disease in which the teeth seem as if being cleft asunder with a violent pain is called Dalana or toothache, the origin of which is ascribed to the action of the aggravated state of the bodily Vayu.

Krimi-dantaka:—The disease in which the teeth are eaten into by worms, is called Krimi-dantaka (caries). The teeth become loose and perforated by black holes accompanied by a copious flow of saliva. The appearance of an extremely diffused swelling (about the roots of decayed teeth) with a sudden aggravation of the accompanying pain without any apparent cause is also one of its specific features.

Danta-harsha:—The disease in which the teeth cannot bear the heat, cold or touch is called Danta-harsha. It is due to the deranged condition of Vayu.

Bhanjaka:—The disease in which the face is distorted, the teeth break, and the accompanying pain is severe, is called Bhanjaka (degeneration of the teeth). The disease is due to the deranged condition of the Vayu and Kapha.

Sharkara:—The disease, in which sordes, formed on the teeth and hardened (by the action of the deranged Vayu), lie in a crystallised form at the roots of the teeth, is called Sarkara (Tartar). Such deposits tend to destroy the healthy growth and functions of the teeth.

Kapalika:—The disease in which the preceding crystallised deposits get cemented together and afterwards separate from the teeth taking away a part of their coating (enamel) is called Kapalika (calcareous deposit) which naturally makes an erosion into and destroys the teeth.

Syava-dantaka:—The disease, in which the teeth variously scorched by the action of the deranged Pitta assumes a blackish or blue colour, is named as Syava-dantaka (black teeth).

Hanu-moksha:—The disease in which the Vayu aggravated (by such causes, as by loud talking, chewing of hard substances, or immoderate yawning) produces the dislocation of the jawbones is called Hanu-moksha It is identical with Arddita as regards its symptoms. 26-33.

Diseases of the tongue:—

The five kinds of diseases which affect the organ of taste are the three sorts of Kantakas due to the three deranged Doshas (Vataja, Pittaja and Kaphaja), Alasa and Upa-jihvika. 34.

The three Kantaks:—

In the Vataja Kantaka type the tongue becomes cracked, loses the sense of taste and becomes rough like a teak leaf (giving the organ a warty appearance).

In the Pittaja Kantaka form the tongue is coloured yellow and studded over with furred blood-coloured papillae with the burning sensation (of the Pitta in them).

In the Kaphaja Kantaka type the tongue becomes heavy, thick and grown over with vegetation of slender fleshy warts in the shape of Shalmali thorns.

Alasa:—The severe inflammatory swelling about the under surface of the tongue is called Alasa, which if allowed to grow on unchecked gives rise to numbness and immobility of the organ and tends to a process of rapid suppuration at its base. The disease is caused by the deranged blood and Kapha.

The Upa-jihva:—The disease in which a (cystic) swelling shaped like the tip of the tongue appears about the under-surface of that organ by raising it a little is called Upa-jihvika (Ranula). The accompanying symptoms are salivation, burning and itching sensations in the affected organ; these are due to the deranged Kapha and blood (of the locality). 35—37.

Disease of the palate:—

Diseases which are peculiar to the part of the palate are named

1. Gala-shundika,
2. Tundikeri,
3. Adhrusha,
4. Mansa-kaccapa,
5. Arvuda,
6. Mansa-sanghata,
7. Talu-shosha
8. and Talu-paka. 38.

Gala-shundika:—

The diffused and elongated swelling, caused by the deranged blood and Kapha, which first appears about the root of the palate and goes on extending till it looks like an inflated skin- bladder is called Gala-shundika (tonsilitis) by physicians. Thirst, cough, difficult breathing are the indications of the disease.

Tundikeri:—A thick swelling resembling the fruit of the Tundikeri plant in shape and appearing about the root of the palate attended with a burning, piercing or pricking pain and suppuration is called Tundikeri (abscess of the tonsil).

Adhrusha:—A red, numbed swelling appearing about the same region, as the effect of the vitiated blood of the locality, attended with severe fever and pain, is known by the name of Adhrusha.

Mansa-kaccapa:—A brownish and slightly painful swelling somewhat shaped like the back of a tortoise (and appearing about the region of the soft palate) is called Mansa-kacchapa. The disease is slow in its growth or development and is due to the deranged Kapha.

Arvuda:—A swelling^shaped like, the petal of the lotus lily and appearing in the region of the soft palate as an outcome of the aggravated condition of the local blood is called Arvuda. The swelling is identical with the Raktarvuda described before.

Mansa-Sanghata:—A vegetation of morbid flesh at the edge or extremity of the soft palate through the action of the deranged Kapha is called Mansa-Sanghata. It is painless.

Talu-pupputa:—A painless permanent swelling to the shape of the Kola fruit (plum) caused by the deranged fat and Kapha at the region of the soft palate is called Talu-pupputa. Talu-shosha The disease of the soft palate in which the patient feels a sort of parched sensation with dyspnea and a severe piercing pain in the affected part is called Talu-shosha, which has its origin in the aggravated condition of the bodily Vayu acting in concert with the deranged Pitta.

Talu-paka:—The disease in which the deranged Pitta sets up a very severe suppurative process in the soft palate is called Talu-paka. 39-47.

The diseases of the throat and larynx:—

The diseases peculiar to the throat and the larynx are seventeen in number and are known as the five types of Rohini, Kantha-Shaluka, Adhijihva, Valaya, Valasa, Eka-vrinda, Vrinda, Shataghni, Gilayu, Gala-vidradhi, Galaugha, Svaraghna, Mansatana. and Vidari. 48.

General features of Rohinis:—

The aggravated Vayu, Pitta, Kapha, either severally or in combination, or blood may affect the mucous of the throat and give rise to vegetations of fleshy papille, which gradually obstruct the channel of the throat and bring on death. The disease is called Rohini (Diphtheria). 49.

The Vataja Rohini:—

A vegetation of extremely painful fleshy Ankuras (nodules), crops up all over the tongue which tend to obstruct the passage of the throat and are usually accompanied by other distressing symptoms characteristic of the deranged Vayu.

Pittaja-Rohini:—The Ankuras (nodules) in the present type are marked by speedy growth and suppuration, and are accompanied by a burning sensation and high fever.

Kaphaja Rohini:—The Ankuras (nodules) become heavy, hard and characterised by slow suppuration gradually obstructing the passage of the throat. 50-52.

The Sannipatika Type:—

Suppuration takes place in the deeper strata of the membrane accompanied by all the dangerous symptoms peculiar to the three aforesaid types of the disease. It is rarely amenable to treatment.

Raktaja Type:—Symptoms characteristic of the Pittaja type of the disease are present and the fleshy outgrowth formed in the throat, is found to be covered with small vesicles. This type is incurable.^[2] 53–54

Kantha-Shal uka:—

The disease in which a hard rough nodular growth (Granthi) in the shape of a plum-stone crops up in the throat, which seems as if it has been stuffed with the bristle of a Shuka insect or been pricked by thorns is called Kantha-Shaluka. The disease is due to the action of the deranged Kapha. It is amenable to surgical treatment only.

Adhijihva:—A small swelling like the tip of the tongue caused by the deranged blood and Kapha over the root of the tongue is called Adhijihva, which should be given up as soon as suppuration sets in.

Valaya:— A circular or ring-shaped raised swelling obstructing or closing up the upper end of the esophagus (structure of oesophagus) is called Valaya. It cannot be cured and hence should be given up. It is due to the deranged action of the Kapha in the locality.

Valasa:—The disease in which the unusually aggravated Vayu and Kapha give rise to a swelling in the throat, which is extremely painful and causes a difficulty of respiration, ultimately producing symptoms of complete asphyxia is called Valasa by learned physicians and is very difficult to cure. 55—58.

Eka-vrinda and Vrinda^[3]:—

The disease in which a circular, raised, heavy and slightly soft swelling appears in the throat attended with itching, a slightly burning sensation and a slight suppuration is called Eka-vrinda. The disease is due to the effect of vitiated blood and Kapha. The disease in which a round elevated swelling attended with high fever and a slightly burning sensation is formed in the throat through the aggravated condition of the blood and Pitta is called Vrinda. A piercing pain in the swelling points to its Vataja origin. 59—60.

Shataghni:—

The disease in which, through the concerted action of the deranged Vayu, Pitta and Kapha, a hard throat obstructing Varti (jagged membrane) edged like a Shataghni^[4] and densely beset with fleshy excrescences is formed along the inner lining of that pipe is denominated as Sataghni. Various kinds of pains, (characteristics of each of the deranged Vayu, Pitta and Kapha) are present in this type which should be necessarily considered as irremediable. 61.

Gilayu:—

The disease in which the aggravated Kapha and blood give rise to a hard and slightly painful (D. R extremely painful,) glandular swelling in the throat to the size of the stone of the Amalaka fruit is called Gilayu. A sensation as if a morsel or bolus of food is stuck in the throat is experienced which by its very nature is a surgical case. 62.

Gala-Vidradhi:—

The disease in which an extensive swelling occurs along.the whole inner lining of the throat, owing to the concerted action of the deranged Vayu, Pitta and Kapha is called Gala-vidradhi which exhibits all the features present in a Vidradhi of the Sanipatika type. Galaugha:—

The disease in which a large swelling occurs in the throat so as to completely obstruct the passage of any solid or liquid food and also that of Udana-vayu (choking the pharynx, larynx and the mouth of the esophagus), attended with a high fever is called Galaugha, the origin of which should be ascribed to the action of the deranged blood and Kapha.

Svaraghna:—The disease in which the patient faints owing to the choking of the larynx by the deranged Kapha which is marked by stertorous breathing, hoarseness, dryness and paralysed condition of the throat is called Svaraghna which has its origin in the deranged Vayu. 63—65.

Mansatana:—

The disease in which a pendent, spreading and extremely painful swelling appears in the throat which gradually obstructs the pipe is called Mansatana. It invariably proves fatal and is caused by the deranged Vayu, Pitta and Kapha 66

Vidari:—

The disease in which a copper-coloured swelling occurs in the throat, marked by a pricking and burning sensation, and the flesh of the throat gets putrefied and sloughs off (and emits a fetid smell) is called Vidari. The disease is of a Pittaja origin and is found to attack that side of the throat on which the patient is in the habit of lying. 67.

The disease in the entire cavity:—

Cases which are found to invade the entire cavity of the mouth (without being restricted to any particular part thereof) may be either due to Vataja, Pittaja, Kaphaja or Raktaja type and are known by the general name—Savra-Sara. 68.

In the Vataja type the entire cavity of the mouth is studded with vesicles attended with a pricking sensation in their inside.

In the Pittaja type a large number of small yellow or red-coloured vesicles attended with a burning sensation crops up on the entire (mucous membrane lining the cavity of the mouth.

In the Kaphaja variety a similar crop of slightly painful, itching vesicles of the same colour as the skin (is found on the entire inner surface of the mouth.)

The blood-origined Raktaja type is nothing but a modification of the Pittaja one (giving rise to similar symptoms); it is also by others called Mukha-paka. 69-72.

 

Thus ends the sixteenth Chapter of the Nidana Sthana in the Sushruta Samhita which treats of the Nidana of the diseases of the mouth.

 

Here ends the Nidana Sthana.

Footnotes and references:

[1]:

According to others sixty-seven—but Dalian does not support this.

[2]:

The reading Sadhya (curable) which is to be met with in the several printed editions of Madhab’s Nidana in lieu of the reading Asadhya (incurable) is not to our mind correct.

[3]:

The diseases of the throat are 17 in number. Taking Vrinda as a separate disease they amount to 18; but Vrinda, affecting similar place and being similar in appearance with but a slight distinction of symptoms, is only a particular state of Eka-vrinda, and not a separate disease.

[4]:

Sataghni is a kind of weapon used in andient warfare.