Chapter CLXVIII - The Nidanam of Mukha-roga

Hear me, O Sushruta, now discourse on the Nidanam of Mukhoroga. Ingestion of such incompatible articles of fare as milk, mild-curd, and fishes living in swamps, in inordinate quantities, tends to enrage the Doshas, which give rise to a number of diseases in the mouth. A predominance of the deranged Kaphah should be understood as the exciting factor of all these distempers. The lips seem numbed and hard, are felt rough to the touch, and are characterised by a kind of bursting, thrashing pain in their body, through the aggravation of the deranged Vayu. In the Pittaja type of this disease, the lips assume a yellowish hue, become studded with crops of painful pustules, and are characterised by a burning sensation. In the Kaphaja type of this disease the lips assume a colour peculiar to that morbific principle (Kaphah) and become cold, glossy and slimy. In the Sannipatika type of this disease the lips assume a varied colour, successively changing from black (blue) to yellow and from yellow to white, and become studded with crops of pustular eruptions, In the type brought about through the agency of vitiated blood, crops of pustular eruptions, coloured like ripe date fruits, are found to appear on the lips, which bleed and are marked with streaks of blood. In the type due to the vitiation of the local flesh, the lips become thick and heavy, and are gathered up in knots like condylomatous growths. Vermins, which are often found to germinate in the affected lips, drop down from the two corners of the mouth. In the type due to the action of the deranged fat (areolar tissues) the lips assume a colour like that of the surface layer of clarified butter, and become heavy and marked by an itching sensation, and secrete a copious secretion of cold, crystal-like, white fluid. An ulcer occurring in such diseased lips can never be healed, nor it may be softened with the help of any medicine. In the traumatic type the lips seem as if they are being chopped with an axe.

Now hear me discourse on the Nidanam of diseases that affect the gums of teeth. The disease in which the gums are found to bleed without any apparent reason, and in which they become spongy, black and shiny, and emit a fetid smell, and begin to slough off, is called shitada. This disease is attributed to the action of the deranged blood and Kaphah. The disease in which large swellings (boils) appear about the root of two or three of the teeth is called Dantapupputaka, which is attributed to the action of the deranged Kaphah and blood. The disease, in which the teeth move and become loose, and the gums are found to bleed and to secrete pus, is called Danta-Veshta, of which the vitiated blood acts as the (sole) exciting factor. A painful swelling brought about through the agency of the deranged Kaphah and Vayu and appearing over the gums, accompanied by salivation and an itching sensation, is called shaushira. The disease in which the teeth move about in their sockets, the gums slough off, the roof of the palate cracks and bursts open, and the lining membrane of the cavity of the mouth is inflammed is called Maha Saushira. This disease is engendered by the concerted action of the deranged Vayu, Pittam, and Kaphah. The disease in which the gums become thin, and the patient spits blood, is called Paridara which is due to the action of the deranged blood, Pittam and Kaphah. The disease in which a burning sensation is felt in the gums which are ultimately found to suppurate, and the teeth become loose in their sockets, which when moved about with the hand, seem slightly painful and bleed, and in which the gums swell and a fetor comes out of the mouth if that bleeding is arrested, is called Supakusha, of which the deranged blood and Pittam act as the exciting factors. The disease in which inflammation occurs about the gums, if in any way rubbed, and the teeth are found to move about in their sockets, is called Vaidarbha, which should be regarded as of a traumatic origin. The disease in which the enraged and aggravated Vayu serves to force up an additional tooth, accompanied by an excruciating pain, and in which the pain subsides on the perfect cutting of that additional tooth, is called Khali-vardhana. A large swelling occurring about the gums, attended with pain and a burning sensation, is called Danta-Vidradhi (abscess of the gums), which, when lanced off, secretes blood and pus. A large and extremely painful swelling occurring about the posterior side of the last molar tooth is called Adhimansaka. This disease is due to the action of the deranged Kaphah and is marked by a copious salivation. The sinus of the gums developes the same characteristic features as the five kinds of ordinary sinuses.

Now hear me, O child discourse on the Nidanam of diseases that affect the teeth. The disease in which a bursting pain is felt in the bodies of the teeth, is called Dalana, which is due to the action of the deranged Vayu. The disease in which black holes are made into the teeth, which become loose, and in which an extremely painful inflammation occurs about their roots, which is aggravated by an exposure to air, is called Krimi Dantaka. The disease in which the face is distorted and the teeth are broken is called Bhanjana. This disease is due to the action of the deranged Kaphah and Vayu. The disease in which the teeth become incapable of bearing the least wind or the touch of any dry, cold or acid substance is called Dantaharsha (tooth-edge), of which the deranged Vayu and Pittam act as the exciting factors. The disease in which the deranged Vayu, by taking recourse to the teeth, make them jagged and uneven is called Karala, which should be regarded as incurable. Deposits of refuge (calcareous) matter on the teeth, dried up and hardened through the action of the Vayu and Pittam, become crystalised like sugar. These Crystals are called Danta-Sharkaras. When these crystalised deposits are extracted they invariably destroy the teeth. This disease is called Kapalika from the resemblance of the cracked deposits with bits of skeletal bones (Kapala). The disease in which the teeth, burned through the action of the deranged Pittam and blood, assume a black or blue colour, is called Shyava-Dantaka.

Now hear me discourse on the Nidanam of Mukha-Rogam which invades the tongue. In diseases of the tongue due to the action of the deranged Vayu, the tongue is cracked and covered over with a greenish deposit, resembling the paste of shaka leaves. In diseases of the tongue, due to the action of the deranged Pittam, the tongue becomes studded over with yellowish or red-coloured papillæ attended with a burning sensation in its body. In diseases of the tongue, due to the actionof the deranged Kaphah the tongue becomes heavy and is covered over with a large number of fleshy growths (papillæ) resembling the throns of a Shalmali tree. A deep swelling, occurring on the lower side of, and paralysing the tongue, is called Alasa, which is due to the action of the deranged Kaphah and blood. A swelling, resembling the tip of a tongue in shape, and occurring about the root of the tongue, so as to raise it up, is called Upajihva. This disease is due to the action of the deranged Kaphah and blood, and is attended with profuse salivation and a burning sensation in the inside of the tongue.

Now hear me discourse on the Nidanam of diseases that affect the palate. An extremely large and elongated swelling, due to the action of the deranged Kaphah and blood, and occurring about the root of the palate is called Kantha-Sunthi. The swelling assumes the shape of an inflated bladder, and thirst, cough, and dyspnœa are found to supervene. A thick swelling occurring at the root of the palate, attended with burning and suppuration, is called Tundakeri by the wise. A swelling of the palate due to the action of the vitiated blood is called Dhrushuna. It is of slow growth and is attended with fever and an extreme pain. A swelling, due to the action of the deranged Kaphah and occurring about the palate, raised like the back of a tortoise, is called Kachchhapa. This swelling is very slow in its growth. A circular swelling at the palate, characterised by all the specific features of a blood-tumour is called Talvarvuda. Painless condylomatous growths, brought about through the agency of the deranged Kaphah, are called Mansa-Sanghata. A jujube like fixed growth at the palate, unattended with pain, is called Talupupputa. In the disease known as Talupak the palate is cracked, a dry parchifying (arid) sensation is experienced therein, dyspnœa is present through the agency of the deranged Vayu, and the deranged Pittam induces suppuration.

Now hear me discourse, O child, on the Nidanam of diseases peculiar to the throat. The deranged Vayu and Pittam, by lying incarcerated in the throat, vitiates the local flesh and blood, and gives rise to membranous growths, which resemble paddy sprouts in shape and produce constriction (choking) of the passage of the throat, which results in death. This disease is called Rohini. The type of Rohini in which the entire tongue becomes numbed and extremely painful, and in which membranous growths, obstructing the passage of the throat, are formed, attended with the specific symptoms of the deranged and aggravated Vayu, should be regarded as belonging to the Vataja type. In the Pittaja type of Rohini the membranous growths are rapid in their formation and speedily suppurate. Fever becomes intense and symptoms peculiar to the deranged Pittam are found to supervene. In the Kaphaja type of Rohini, the membranous growth are fixed and do not obstruct the passage of the throat (larynx). The type due to the concerted action of the deranged Vayu, Pittam and Kaphah should be regarded as incurable in as much as suppuration sets in in the deeper strata of the membranous growths in this type. In the type due to the vitiation of blood, the membranous growths become studded with crops of red pustules and prove amenable to treatment, the other characteristics of this type being common with those of the Pittaja class. A fixed nodular growth in the throat, to the size of a jujube-stone, brought about through the action of the deranged Kaphah is called Kantha Shaluka. The patient in this disease feels as if his throat has been studded with the bristles of a shuka insect or thorns have pricked into it. The growth is rough to the touch and should be removed only with the knife. A swelling of the shape of the tip of the tongue, streaked with blood, is called Adhijihva. This disease is attributed to the action of the deranged Kaphah, and a patient suffering from Adhijihva should be abandoned as soon as suppuration would be found to have been established in the swelling. A circular (ring-like) elevated swelling around the passage of the throat, threatening to constrict the orifice of the œsophagns, is called Valaya. This disease is incurable and a patient suffering from Valaya should be given up as lost from its very out-set. A swelling caused by the deranged Vayu and Kaphah in the throat, and which is attended with pain and dyspnœa, is called Valasha. Expert physicians stand in dread of this disease, and pronounce it incurable. A raised and circular swelling in the throat caused by the deranged Kaphah and blood is called Ekavrinda. The swelling but scarcely suppurates and is felt a little soft to the touch, itching and burning sensations in the swelling being the further characteristics of this disease.

A thick, stick-like growth in the throat, studded over with fleshy papillae and attended with diverse kinds of pain, is called Shataghni. This disease is attributed to the concerted action of the deranged Vayu, Pittam and Kaphah, and invariably proves fatal. A fixed growth in the throat to the size of an Amalaka seed, brought about through the agency of the deranged Kaphah and blood, is called Shilayu. This disease in which the patient thinks that a morsel of food lies stuck into the throat is a purely surgical one. An extensive swelling, covering the entire passage of the throat and characterised by an uniform pain all through its inside, is called Gala-Vidradhi. This disease is due to the concerted action of the deranged Vayu etc. An extensive swelling in the throat, due to the action of the deranged Kaphah, which obstructs the deglutition of food and water, and doses the orifice of the larynx, is called Galaugha. This disease is always attended with high fever. The disease in which the patient, with a parched throat and mouth, suffers from difficult breathing owing to the choking of the bronchial tubes with mucous and which is further characterised by epileptic fits and hoarseness is called Svaraghna. An extremely pendent painful swelling with membranous offshoots, which gradually tends to close the passage of the throat, is called Mansatana. This disease is brought about through the concerted action of the deranged Vayu, Pittam and Kaphah and invariably ends in death. An extensive copper-coloured swelling in the throat and mouth attended with an aching pain and a burning sensation, and in which the flesh of the affected part is found to slough off, is called Vidari. This disease is attributed to the deranged Pittam and affects the same side of the throat on which the patient usually lies.

Now I shall describe the Nidanam of diseases that affect the entire cavity of the mouth (Sarvasara). In the Vataja type of Sarvasara Mukha-Roga (stomatitis) pustules attended with an aching pain appear all over the cavity of the mouth. In the Pittaja type of this disease red or yellowish pustules are found to crop up over the entire lining membrane of the mouth in which a burning sensation is also felt, while in the Kaphaja type painless, itching pustules appear on the lining membrane of the mouth. The type of Ostha-prapaka due to the action of the vitiated flesh and blood as well as the one due to the concerted action of the deranged Vayu, Pittam and Kaphah, should be given up as incurable. Of diseases of the gums, sinuses, due to the concerted action of the deranged Vayu, Pittam and Kaphah should be pronounced incurable; of diseases affecting the teeth those known as Shaushira and Bhanjana should be regarded as incurable. Of diseases of the throat Svaraghna, Valasa, Vrinda, Shataghni, Vidari and Rohini should be regarded as incurable. Of diseases of the tongue Valasha and Talvarvuda should be regarded as incurable.