Chapter XXII - The affections of the mouth

Now we shall discourse on the medical treatment of the affections of the mouth (Mukha- Roga). 1.

Treatment of Vataja Oshtha-kopa:—

In a case of inflammation of the lips (Oshtha-Kopa) due to the action of the deranged Vayu, the affected part should be rubbed with (an ointment composed of) the four kinds of lardacious (Sneha) substances mixed with wax. Fomentations in the manner of Nadi-Sveda should also be resorted to by an intelligent physician Applications of the Salvana poultices and those of the medicated oils, possessed of the virtue of subduing the deranged Vayu, as errhines and Mastikya (Shiro-vasti) are also recommended. The lips should be treated with the powder composed of Shriveshlaka,^[1] Sarja rasa, Sura-daru, Guggulu and Yashti-madhu. 2-4.

Treatment of Pittaja Oshtha-kopa, etc.:—

In a case of Oshtha-kopa of traumatic origin, (Abhighataja) or one due to the deranged action of the blood (Raktaja) or of the Pitta bleeding of the affected part should be effected by the application of leeches and all the measures and remedies (Samshodhana and Samshamana) mentioned in connection with the treatment of the Pitta-Vidradhi should be likewise employed. 5.

Treatment of Kaphaja Oshthakopa:—

The use of medicated Shiro-virecana (errhines). fumigations, (Vairechanika Dhuma), fomentation and (Sveda) Kavala (gurgles), prepared from the Kapha subduing drugs should be recommended after blood-letting in the Kaphaja type of Oshtha-kopa. The swollen and inflamed lips should be treated (Prati sarana) with a compound consisting of Trikatu, Sarjika-kshara, Yava Kshara and Vid-lavana (black-salt)^[2] pounded together and made into a thin paste with the admixture of honey. 6.

Treatment of Medoja Oshtha-kopa:—

In a case of the fatty type of Oshtha-kopa, the affected part should be fomented and opened (when suppurated;; and should then be purified and cauterised with fire. A paste compound of Priyangu, Triphala, Lodhra and honey should be rubbed over the affected part (Prati-sarana). These are the remedies for the curable types of Oshtha-kopa. 7-8.

Treatment of the Diseases of Danta-Mula:—

Now we shall describe the treatment of the affection of the roots of the teeth (Gingivitis). In a case of the Shitada type of the disease, the gums should be first bled and a decoction of Sarshapa, Nagara, Triphala and Musta^[3] mixed with Rasanjana should then be used as gurgles. The gums should be plastered (Pralepa) with Priyangu, Musta and Triphala and (clarified butter, cooked with) the decoction of Triphala, Madhuka, Utpala and Padmaka should be used as an errhine. In an acute case of Danta-Pupputaka, the gums should be first bled and then rubbed (Prati-sarana) with the five officinal kinds of salt and Yava-Kshara mixed with honey. The use of errhines (Shiro-virecana), medicated snuffs (Nasya) and demulcent food is recommended. 9-10.

Treatment of Danta-Veshta, etc.:—

In a case of Danta-Veshta, the swelling should be first bled and then rubbed with a pulverised compound of Rodhra, Pattanga, Yashti-madhu and Laksha mixed with a profuse quantity of honey. A decoction of (the bark of) the Kshiri trees, mixed with sugar, honey and clarified butter (as an after-throw) should be used as gurgles (Gandusha). Clarified butter, cooked with the drugs of the Kakolyadi group with ten times its own weight of milk, should be used as snuff (Nasya). In a case of Shaushira, the affected parts, after being properly bled, should be plastered (Lepa) with Lodhra, Musta and Rasanjana, pounded together and mixed with honey. A decoction of the Kshiri trees should be used as gurgles (Gandusha), and clarified butter cooked with the paste-compound of Sariva, Utpala, Yashti-madhu, Savara (Lodhra), Aguru, (red) Chandana and ten times its own weight of milk should be recommended as an errhine. 11-12.

Treatment of Pari-dara, etc.:—

In a case of Pari-dara the treatment should consist of the remedies described in connection with Shitada. In a case of Upakusa as well,^[4] the system of the patient should be cleansed both ways (by means of emetics and purgatives), and his head should be cleansed with Shiro- virecana. The affected part (in a case of Upa-kusha) should, in addition, be bled (by rubbing it over) with the leaves of the Kakodumbarika, or of the Goji, or with the application of a medicinal compound composed of the five officinal kinds of salt and Trikatu mixed with honey. Tepid watery solutions^[5] of Pippali, (white) Sarshapa, Nagara, and Nichula fruits should also be used as gurgles (Kavala). The use of clarified butter cooked with the drugs of the Madhura (Kakolyadi) group as errhine (Nasya) and gurgle (Kavala) is also recommended. 13-14.

Treatment of Danta Vaidarbha, etc.:—

In a case of Danta-Vaidarbha, the regions about the roots of the teeth should be cleansed by opening them with a (Mandalagra) instrument and subsequently treated with alkaline applications. Cooling measures should also be resorted to (during the treatment of this disease). In a case of Adhika-danta, the additional tooth should be uprooted and removed; then (in order to arrest the bleeding, if any), the part should be cauterised with fire, and then an experienced physician should apply the remedies mentioned under the head of worm-eaten teeth (Krimi-dantaka), 15-16 Treatment of Adhi-mamsa:—In a case of Adhi-mamsa, the additional fleshy growth about the roots of a tooth should be removed (with a knife) and treated with a compound of Vaca, Tejovati, Patha, Sarjika and Yava-kshara, pasted together with honey. Powdered Pippali, mixed with honey, should be used as a gurgle (Kavala); and a decoction of Patola, Triphala and Nimba for washing the affected part. Errhines (Shiro-virecana) and inhalation of Vairecana smoke, (that lead to the secretion of mucus from the head), would likewise prove efficacious in such cases. 17.

Treatment of Danta-Nadi:—

In a case of Danta-Nadi, the treatment of Nadi (Sinus) about the teeth is identical with that of sinus in general. The specific remedial measure, however, is that the gum of the affected tooth should be incised, and the tooth should be extracted, if it be not in the upper jaw. The affected part should then be purified and cauterised with an alkali or fire. Hence in a case of Sinus (Nadi), a complete extraction of any fragment of the broken bone, or tooth, is essentially necessary (for its cure), inasmuch as, if left u iextracted, it may cause the sinus to affect (run below) the jaw-bone. If the affected tooth be in the upper jaw, and if it be found to be firm and steady at its roots, though attended with tooth-ache,^[6] it should not be extracted, inasmuch as it might produce an excessive hemorrhage from its roots, and usher in blindness, facial paralysis, or other dangerous affections (such as convulsion, etc.) due to the excessive loss of blood. Hence in the case of a looseness of such a tooth in the upper jaw, it should not be extracted A decoction^[7] of Jati, Madana, Svadu-Kantaka and Khadira should be used to wash the mouth An oil cooked with Jati, Madana, Katuki, Svadu-Kantaka. Yashti-madhu, Rodhra, Manjishtha and Khadira should be used to cleanse and heal a sinus invading the roots of a tooth. The remedial measures to be employed in the diseases affecting the roots of the teeth have thus been described above. We shall now proceed to describe the medicinal remedies to be employed in the diseases which confine themselves exclusively to the teeth 18-21.

Treatment of the diseases of Tooth proper:—

A case of Danta-harsha yields to the use of any lukewarm Sneha,^[8] or the Traivrita-ghrita (mentioned in Chapter V), or of the decoction of the Vayu-subduing drugs as gurgles (Kavala). An application of Snaihika Dhuma (emulsive fumes) and the use of snuff (Nasya), emulsive articles of food, meat soups, gruel prepared with meat (Rasa-Yavagu), milk, milk- cream, clarified butter, Siro-vasti and the other Vayu- subduing measures generally prove efficacious. 22.

In a case of Danta Sharkara (Tartar-calcareous deposits on the teeth), the deposit should be removed in such a way as not to hurt the roots oi the tooth, after which the part should be dusted (Prati-sarana) with powdered Laksha with honey. All the remedies mentioned in connection with the treatment of Danta- harsha may as well be employed in this disease. 23

Treatment of Kapalika, etc.:—

These remedies are also efficacious in a case of Kapalika (caries of the tooth) which is extremely hard to cure. In a case of Krimi-Danta (worm-eaten tooth)found to be firm and unloosed (in its socket), the affected tooth should be fomented, and the accumulation (i.e., the pus, blood, etc.) should be removed. It should then be treated with some Vayu-subduing errhines of the Ava-pida form and with emollient gurgles (Gandusha), as well as with plasters, prepared with Varshabhu and the drugs of the Bhadra-Darvadi group and with a diet of emulsive articles of food. In the case, however, where the tooth is found to be loose (in the socket\ the loose tooth should be extracted, and the cavity cauterised with fire or an alkali (for the purpose of arresting the bleeding). An oil cooked with the pastes (Kalka) of Vidari, Yashti-madhu, Shringataka, and Kasheruka and with ten times its own weight of milk should be administered as an errhine (in such cases). The course of treatment in a case of Hanu- moksha is the same as in one of facial paralysis. 24-27.

A person suffering from any affection of the teeth should refrain from taking acid fruits, cold water, dry (Ruksha) food, excessively hard articles of food and from brushing his teeth (with a twig). The treatment fof the curable types of tooth-diseases has been thus described above, we shall now (proceed to) describe the treatment of the curable types of tongue-diseases. 28 29.

Treatment of Tongue-diseases:—

In the Vataja type of Jihva-kantaka (Papilla), the treatment should be the same as in the case of Vataja Oshtha-kopa. In the Pittaja type (of Jihva kantakaì, the vitiated blood should be made to secrete from the affected organ by rubbing it with any article of rough surface (such as the leaves of Shakhotaka, etc.), and the drugs of the Madhura (Kakolyadi) group should be used for gurgles and errhines, as well as for being rubbed over (Prati-sarana) the affected organ, In the Kaphaja type (of Jihva-kantaka), the organ should be bled by scarifying it (with a Mandala patra and such other instrument); it should then be rubbed with the powders of the drugs of the Pippalyadi group mixed with honey. A compound of powdered white mustard- seed and Saindhava should be administered as gurgles (Kavala), and the patient should be made to take his food with the soup of Patola, Nimba, and Vartaku, mixed with (a liberal quantity of) Yava-Kshara 30.

Treatment of Upa-Jihva:—

In a case of Upa-jiva (Ranula),the affected part should be scarified and rubbed with an alkali, and the patient should be treated with errhines (Shiro-vireka), gurgles (Gandusha) and inhalations of smokes (Dhuma), The treatment of the tongue diseases has been thus described above. We shall now describe the medical treatment of the affections of the palate (Talu-gata Roga). 31–32.

Treatment of the Talu-gata diseases:—

In a case of Grala-shundika, the Sundika (protuberance) should be drawn out along the tongue with the help of the thumb and the second finger of the hand, or with a Samdamsha (forceps) and then cut off with a Mandalagra instrument. But it should be severed neither more nor less than three-quarters of the appendage, inasmuch as profuse hemorrhage might follow an excessive incision, and death might result therefrom; whereas, a case of lesser severance is usually found to be attended with swelling, excessive salivation, somnolence,^[9] vertigo, darkness of vision, etc. Hence a surgeon, well-versed in the science of surgery and well- skilled in practical operations, should carefully operate a Gala-shundika (with a knife) and subsequently adopt the following measures. The incidental ulcer should be treated with the pulverised compound of Marica, Ati-visha, Patha, Vaca, Kushtha and Kutannata, mixed with honey and rock-salt. A decoction of Vacay Ati-visha, Patha, Rasna, Katuka-rohini and Pichu-marda should be used as gurgle (Kavala). The five drugs, viz., Ingudi, Apamarga, Danti, Sarala and Deva-daru should be pasted together and made into Vartis (sticks), well flavoured by the addition of perfuming drugs. Twice every day (once in the morning and again in the evening), should the patient be made to inhale the fumes of these burning Vartis (sticks) which have the property of subduing the (deranged) Kapha, and should be made to take the soup of Mudga boiled in alkaline water.^[10] In cases of Tundikeri, Adhrusha, Kurma, Mamsa samghata and Talu pupputa, the preceding measures should be adopted, but the surgical operation should vary with the nature of the particular disease under treatment. 33–34.

Treatment of Talu-paka, etc.:—

Remedies which destroy the deranged Pitta should be employed in Talu-paka (suppuration of the palate); while applications of Sneha (oil, etc.) and Sveda (fomentations),as well as Vayu-subduing measures should be the remedies in a case of a Talu-Shopha (swelling of the palate). The remedies to be employed in the diseases affecting the palate have been thus described above. Now hear me discourse on the remedial measures in Kantha-Roga (diseases of the throat). 35–36.

Treatment of Throat-diseases:—

In a curable type of Rohini, blood letting and the applications of emetics, gurgles, inhalations (of medicated fumes) and errhines (Nasya) are efficacious. In cases of Vataja Rohini, blood letting should be first effected, and the affected part should then be rubbed with salts. Gurgles (Gandusha) of tepid Sneha (oil, clarified butter, etc.) should be constantly resorted to In cases of the Pittaja Rohini, the powdered Pattanga, honey and sugar should be rubbed (Prati-sarana) over (the affected part), and the decoctions^[11] of Draksha and of Parushaka, should be used as gurgles (Kavala). In the Kaphaja type of Rohini, the affected part should be rubbed with Katuka and Agara-dhuma (soot of a house—chimney-soot). An oil properly cooked with Shveta Vidanga, Danti and Saindhava should be employed as (Nasya) and employed as gurgles (Kavala). In a case of Riktaja Rohini, a physician shall employ the same measures of treatment as in the Pittaja type of the disease. 37.

Treatment of Kantha-Shaluka, etc.:—

In a case of Kantha-Saluka, it should be bled and treated as a case of Tundikeri, and the patient should be enjoined to take a single meal in the day consisting only of a small quantity of Yavanna (barley-rice) with clarified butter. The treatment of a case of Adhi- jihvika should be the same as that of Upa-jihvika. In a case of Eka-vrinda, blood-letting of the affected part should be resorted to (by the application of leeches), and Shodhana^[12] (purifying) remedies should be employed. The medical treatment of a case of Gilayu (Shilayu.-D.R.) consists of a surgical operation (on the seat of thi disease). Incision should be made into a Gala-Vidradhi (throat-abscess' in its suppurated stage and appearing at a part other than a Marma (vulnerable part). 38–42.

Treatment of Sarva-sara Mukha- Roga:—

The affected part should be rubbed with powdered salts^[13] in a case of Sarva-sara Mukha-roga (invading the entire cavity of the mouth) due to the aggravated Vayu. Oil cooked with the (decoction and the pastes of) Vayu-subduing drugs (such as, the Bhadra- darvadi group, etc.) and used as errhines (Nasya) and gurgles (Kavala) is efficacious in this disease. After the application of this oil, the patient should be treated with the Snaihika form of fumigation (Dhuma) in the following manner. Tuntuka leaves smeared with honey should be plastered with a compound of the Sara of Shala, Piyala and castor wood, the marrow of Ingudi and Madhuka, Guggulu, Dhyamaka (Gandhatrina), Mamsi, Kalanu-sariva, Shri (Lavanga), Sarja-rasa, Shaileya and wax pounded together and mixed with an adequate quantity of clarified butter or oil. It should then be burnt, and the patient made to inhale the fumes. This medicinal fumigation (Dhuma) proves remedial in the disease. It destroys the deranged Vayu and Kapha, and proves curative in all affections of the mouth. In the Pittaja type of the Sarva-sara Mukha-roga, all the morbific principles (Doshas) should be eliminated from the patient’s body (with emetics and purgatives), and all kinds of- sweet, soothing and Pitta-subduing drugs should be administered. Medicated gurgles (Gandusha), fumigation (Dhuma), Pratisarana (rubbings) and purifying (Shodhana) measures as well as the Kapha-subduing remedies should be employed in the Kaphaja type of the Sarva-sara-Mukha-roga, and the patient should be made to take one Dharana measure (Twenty-four Ratis) of powdered Ati-visha, Patha, Musta, Deva daru, Katuka and Kutaja seeds, with an adequate quantity of cow’s urine. This medicine acts as a potent remedy for all the Kaphaja disorders of the body. Gurgles (Kavala) with milk, sugarcane juice, cow’s urine, curd-cream, Kanjika, oil, or clarified butter (Sneha) should be prescribed according to the nature of the aggravated Doshas involved in each case (of the Sarva-sara-Mukha-roga). We have described above the medical treatment of the affections of mouth which yield to medical remedies. 43-45.

Incurable Types:—

Now we shall enumerate the different incurable types of mouth-diseases. Of the types of Oshtha-paka, those due to the vitiated condition of the flesh, or of blood, and those due to the concerted action of the aggravated Doshas (Sannipata) should be deemed as incurable. Of the diseases peculiar to the roots of the teeth, the affections known as the Sannipatika Danta-nadi (Sinus in the gums) and the Sannipatika Shaushira (Maha-Saushira) should be also deemed as incurable. Of the affections of the teeth, those known as the Shyava-dantaka, Dalana and Bhanjana, and of the diseases which restrict themselves to the tongue, the one known as the Alasa should be looked upon as incurable. Similarly, of the affections of the palate, the Arvuda should be deemed as incurable. Of those of the throat, the Svaraghna, Valaya, Brinda, Balasa, Bidarika, Galaugha, Mamsa-tana, Shataghni and Rohini should be regarded as beyond the pale of medicine. The nineteen kinds of the disease mentioned above are incurable, and the medical treatment of these diseases should be taken in hand without holding out any definite hope of recovery. 46–49.

 

Thus ends the Twenty-second Chapter of the Chikitsita-Sthana in the Sushruta Samhita which deals with the medical treatment of the diseases of the mouth.

Footnotes and references:

[1]:

Vagbhata reads “madhuciṣṭaṃ (madhṛciṣṭaṃ?)” i.e., wax, in place of “shrīveṣṭaka |”

[2]:

Vrinda and Chakrapani do not read Vid-lavana.

[3]:

Vrinda and Chakra-datta do not read Musta, nor Rasanjana.

[4]:

This shows that cleansing the system by means of emetics and purgatives, as well as with Shiro-virecana should be resorted to in a case of Pari-dara as well.

[5]:

The solution may be prepared with the drugs taken together or separately.

[6]:

Both Vrinda and Chakradatta quote this passage from the text, but boh of them read “shoṇita samprasicyate (?)” (excessive bleeding takes place) in place of “sashṛle syirabandhane (?)” (if it be found to be firm and steady at its roots, though attended with tooth-ache). Shri-kantha Datta, again, in his commentary quotes another reading “samūle'sthirabandhane (?)” (if it be loose in its sockets and be extracted with its roots). In our humble opinion, however, the current reading of the text seems to be the correct one, inasmuch as both the readings quoted above seem to be redundant in the presence of the two following sentences “raktatiyonat......” and “calamapyuttaraṃ danta (?)”—Ed.

[7]:

According to Shrikantha and Shivadása, it appears that the application of this decoction as a wash is not to be found in all editions of the Sushruta Samhitá, but they say that it is found only in Jejjatá’s reading. Jejjatá’s reading and explanation seem to be correct and have been followed by us in the translation.—Ed.

[8]:

All the four kinds of Sneha should be used separately or combinedly.

[9]:

Shrikantha Datta, in his commentary on Vrinda’s compilation, quotes this passage from the text, but does not include “somnolence” therein. He reads “lalasravo bhramastamaḥ” in place of “lala nidra bhramastamaḥ |”

[10]:

The alkaline water to be used in the Mudga-soup should be prepared from Yava-kshara according to Dallana. But according to Shiva* dasa, alkaline water prepared from the ashes of Mushkaka, Apamarga, etc., should be used.

[11]:

According to Chakra-pani, Draksha and Parushaka should be combinedly used in preparing the decoction.

[12]:

The “purifying remedies” here means Shiro-virecana, fumigation, plasters and applications of alkali, etc., for purifying the Doshas in the throat.

[13]:

Dallana and Nishchala explain the term “cūrṇairlavaṇaiḥ” as the powders of the five officinal kinds of salt. Shiva-dasa, however, holds that powdered Saindhava salt only should be used. Vrinda reads “cūṇairlavaṇaiḥ” and the commentator Shri-kantha Datta explains it to mean either the powders of “lavaṇa”, i.e., Jyotishmati or those of “lavaṇa” i.e., the five officinal kinds of salt.—Ed.