೨೨. ಮುಖರೋಗಚಿಕಿತ್ಸಿತಮ್

Meaning of the śloka

Now the treatment of diseases of the mouth will be explained, as taught by Bhagavān Dhanvantari. In a vāta-origin disorder of the lips, an informed physician should apply one or more of the four kinds of sneha combined with beeswax and then use nāḍīsveda. A salted warm poultice and vāta-alleviating oil are also indicated for the lip disorder, including use on the head and as nasya. Powdered śrīveṣṭaka, sarjarasa, suradāru, guggulu, and yaṣṭīmadhuka is prescribed for rubbing onto the affected part. A lip disorder arising from pitta, blood, or trauma is treated with leeches and with the full set of measures described for pittaja vidradhi. For a kapha-origin lip disorder, after blood has been removed, the passage prescribes evacuation through the head, medicinal smoke, fomentation, and kavala. A rubbing preparation is made from tryūṣaṇa, svarjikākṣāra, yavakṣāra, and viḍa with honey. In a medas-origin disorder, the lesion is fomented, opened, cleared, and then treated with cautery; a rubbing preparation of priyaṅgu, triphalā, and lodhra with honey is also given. These are the measures stated for curable disorders of the lips.

Key terms

oṣṭhakopa

The lip disorder or pathological disturbance treated in this passage.

nāḍīsveda

Fomentation delivered through a tube, prescribed here after oleation.

pratisāraṇa

Rubbing a medicinal preparation onto the affected area.

mastiṣka

A head treatment distinguished by the commentary from a bound śirobasti; an alternative textual reading is also preserved.

jvalana

Application of fire or cautery in the management of the medas-origin lesion.

Meaning of the śloka

The treatment of diseases situated at the roots of the teeth will now be stated. In śītāda, after blood removal, a warm gargle is prepared from a decoction of nāgara, sarṣapa, triphalā, and musta, together with rasāñjana. Priyaṅgu, musta, and triphalā are used as a local paste. A nasya preparation cooked with triphalā, madhuka, utpala, and padmaka is also prescribed. In a newly developed dantapuppuṭaka, bloodletting should be performed, followed by rubbing with kṣāra combined with the five salts and honey. Evacuation through the head, unctuous nasya, and unctuous food are also considered beneficial.

Key terms

śītāda

A named disease at the roots of the teeth addressed by the first set of measures.

dantapuppuṭaka

A named dental-root disorder for which the passage distinguishes a newly arisen stage.

gaṇḍūṣa

Retention or use of a medicinal liquid in the mouth as described here.

pañcalavaṇa

The group of five salts combined here with kṣāra and honey.

śirovireka

An evacuative treatment directed through the head.

Meaning of the śloka

After drainage in dantaveṣṭa, the wounds should be rubbed with powders of rodhra, pattaṅga, yaṣṭyāhva, and lākṣā in which honey predominates. The latex-bearing trees are prescribed for gaṇḍūṣa together with honey, ghee, and sugar. Ghee prepared with the kākolī group and ten parts milk is praised for use as nasya. In śauṣira, after blood removal, a paste of rodhra, musta, and rasāñjana with honey is recommended, while the latex-bearing trees are beneficial for gaṇḍūṣa. Ghee cooked in ten parts milk with sārivā, utpala, yaṣṭyāhva, sāvara, aguru, and candana is also praised for nasya. For paridara, an informed physician should use the treatment stated for śītāda.

Key terms

dantaveṣṭa

A named disorder around the teeth in which the passage first describes drainage.

śauṣira

A named disorder treated here after blood removal.

paridara

A named condition whose treatment is referred to that of śītāda.

kṣīrin

Latex-bearing trees, exemplified in the commentary by vaṭa.

madhūttara

Having honey as the predominant component.

Meaning of the śloka

In upakuśa, the body should be cleansed in both directions and the head should likewise be cleansed. Blood is then to be drained using leaves of kākodumbarikā and gojī, and the site rubbed with salts, vyoṣa, and honey. A kavala is described using pippalī, white sarṣapa, nāgara, and the fruit of naicula mixed with comfortably warm water. Ghee prepared with the sweet-group substances is beneficial for both kavala and nasya. In dantavaidarbha, the roots of the teeth are to be cleared with a surgical instrument, followed by kṣāra and cooling measures. An extra tooth is to be extracted and the site then cauterized; a knowledgeable physician should also apply the procedure described for kṛmidantaka.

Key terms

upakuśa

A named oral or dental-root disorder treated by the first sequence in this passage.

dantavaidarbha

A named dental condition for which surgical clearing of the tooth roots is described.

adhikadanta

An extra tooth described as being extracted.

kṣāra

An alkaline medicinal agent applied after the surgical measure.

kṛmidantaka

A named dental disorder whose previously stated treatment is used by reference.

Meaning of the śloka

After cutting away the adhimāṃsa, it should be treated with honey-mixed powders of vacā, tejovatī, pāṭhā, svarjikā, and yavashūka-derived alkali. Pippalī with honey is also prescribed here as a kavala. A decoction of paṭola, triphalā, and nimba is beneficial for washing, together with evacuation through the head and evacuative medicinal smoke.

Key terms

adhimāṃsa

The named excess fleshy growth described as being cut away.

tejovatī

A medicinal substance identified by the commentary as kākamardanikā.

yavashūkaja

An alkaline substance derived from barley awns, included in the rubbing powder.

kavala

Use of a medicinal liquid in the mouth; here described with pippalī, honey, and warm water.

vairecana dhūma

Evacuative medicinal smoke mentioned as part of the treatment.

Meaning of the śloka

First hear the general treatment of nāḍī lesions and the special approach in this setting: measures used for a nāḍīvraṇa should also be applied to dental sinus tracts. The tooth beside which such a tract has arisen should be removed after the surrounding tissue is incised, provided it is not an upper tooth. After cleansing, the site may be treated with alkali or fire, because neglect is said to allow the tract to penetrate the jaw bone. A broken, loose tooth should therefore be removed with its root. Removing an upper tooth that is firmly bound at the root may cause excessive bleeding and the grave disorders described earlier, including loss of sight in one eye and facial paralysis; therefore even a loose upper tooth should not be removed. For washing, decoctions containing jātī, madana, svādukaṇṭaka, khadira and related substances are prescribed, and a cleansing oil prepared with yaṣṭyāhva, rodhra, mañjiṣṭhā, khadira and the stated ingredients is said to resolve a dental tract. Treatment of the tooth root has now been stated; treatment of the teeth follows.

Key terms

dantanāḍī

A sinus-like tract arising beside a tooth in the context of this passage.

nāḍīvraṇa

A classical tract-forming lesion whose general treatment is extended here to dental tracts.

kṣāra

An alkaline cauterizing substance described for treating the cleansed site.

dhāvana

Washing or irrigation, as clarified by the commentary.

svādukaṇṭaka

A plant name identified as gokṣura by the commentator, with kaṇṭakārivṛkṣa preserved as an alternative identification.

Meaning of the śloka

For dental sensitivity, warm oil or trivṛt-ghṛta should be held in the mouth, and decoctions of vāta-pacifying substances should be used. Lubricating smoke, oily nasal therapy and unctuous foods are advised, together with meat broth, gruel prepared with such broth, milk, its cream, ghee, śirobasti and the other vāta-pacifying regimen. Dental calculus should be removed without injuring the tooth roots; afterward they should be rubbed with powdered lākṣā and honey, followed fully by the treatment for dental sensitivity. Kapālikā is described as especially difficult, though the same treatment is beneficial. A firm kṛmidantaka should be treated after fomentation and drainage, together with vāta-pacifying nasal preparations, retention of oily mouth rinses, applications beginning with bhadradāru and varṣābhū, and unctuous food. A loose tooth should be removed, and the socket, as well as the site of a tooth made hollow by pus, should be cauterized. Oil cooked in ten parts milk with vidārī, yaṣṭyāhva, śṛṅgāṭaka and kaseruka is said to be useful as nasya.

Key terms

dantaharṣa

The dental sensitivity for which warm and unctuous measures are prescribed.

śarkarā

Dental calculus or a hard deposit to be removed without harming the tooth roots.

kṛmidantaka

A named dental disorder treated here with drainage and vāta-pacifying measures.

pratisāraṇa

Rubbing a preparation onto the affected area.

śirobasti

A classical external oil-retention procedure for the head included in the vāta-pacifying regimen.

Meaning of the śloka

For displacement of the jaw, the treatment prescribed for ardita should be employed. A patient with dental disease should avoid sour fruits, cold water, dry food, cleaning the teeth, and excessively hard foods. Thus the treatment of curable dental disorders has been stated.

Key terms

hanumokṣa

Displacement or loss of normal articulation of the jaw in this passage.

ardita

A classical disorder whose treatment supplies the comparison for managing the jaw condition.

vātārdita

Ardita attributed to vāta, for which the commentary cites a specific group of treatments.

śyāvadanta

A named dental disorder omitted from treatment here because the commentary regards it as incurable.

upanāha

A classical poultice or wrapping measure included by the commentary among the referenced treatments.

Meaning of the śloka

The successful treatment of curable disorders situated on the tongue is now described. For tongue-thorn lesions arising from vāta, the treatment previously stated for a vāta-origin disorder of the lip should be used. Pitta-origin lesions should be rubbed; after the vitiated blood has flowed out, sweet-tasting applications, mouth rinses and nasal preparations are beneficial. Kapha-origin lesions should be scraped, and once bleeding has ceased, the group beginning with pippalī mixed with honey should be rubbed on. Mouthfuls prepared with gaura-sarṣapa and saindhava may be held, and the patient may be fed soups containing paṭola, nimba, vārtāku and alkali. Upajihvā should be scraped and treated with alkali, together with evacuative treatment of the head, mouth rinses and smoke. Thus treatment of tongue disorders has been stated.

Key terms

jihvākaṇṭaka

A thorn-like named lesion of the tongue classified here by doṣa.

pratisāraṇa

Rubbing or applying a medicinal substance onto the lesion.

upajihvā

A named tongue-region disorder for which scraping and other measures are described.

yavakṣāra

The barley-derived alkali intended by kṣāra in the commentary.

alāsa

A rapidly acting classical tongue disorder discussed additionally by the commentator and approached with a guarded prognosis.

Meaning of the śloka

Treatment of disorders of the palate is then described. Galāśuṇḍikā, situated above the tongue, should be drawn forward with the thumb and finger and partially excised with a maṇḍalāgra, avoiding both excessive and insufficient removal. Excessive excision may cause bleeding and death, while insufficient excision may lead to swelling, salivation, sleepiness, giddiness and darkness of vision. Therefore an experienced physician should excise it carefully and then apply the stated sequence: rubbing with honey, salt and the named substances; a mouth-holding decoction of vacā, ativiṣā, pāṭhā, rāsnā, kaṭukarohiṇī and picumanda; and aromatic smoke from a wick prepared with the five listed substances. The smoke is prescribed twice daily, and soup of mudga prepared with alkali is advised with food. The same general method applies to tuṇḍikerī, adhruṣa, kūrma, saṅghāta and tālupuppuṭa, with differences in surgical treatment. Tālupāka should receive pitta-pacifying treatment; tāluśoṣa should receive unctuousness, fomentation and a vāta-pacifying regimen. Thus treatment of palatal disorders has been stated.

Key terms

galāśuṇḍikā

A named structure or lesion above the tongue that the passage describes as partially excised.

maṇḍalāgra

The bladed instrument named for the described excision or scraping.

pañcāṅgī varti

An aromatic wick compounded from five listed substances for producing the prescribed smoke.

tāluśoṣa

A named condition characterized in the passage as dryness of the palate.

raktārbuda

A blood-associated arbuda for which treatment is omitted because the commentary regards it as incurable.

Meaning of the śloka

The text now states the management of diseases of the throat. For curable forms of rohiṇī, bloodletting is considered beneficial, together with emesis, medicated smoke, gaṇḍūṣa, and nasal treatment. In a vāta-associated form, after blood has been let, the lesion is to be rubbed with salts, and comfortably warm oily mouth-holds are to be used repeatedly. A pitta-associated form is to be rubbed with pataṅga, sugar, and honey; a decoction of grapes and parūṣaka is recommended as a kavala. A kapha-associated form is to be rubbed with house-soot and pungent substances. Oil prepared with śvetā, viḍaṅga, and dantī, together with rock salt, is prescribed for nasal use and as a mouth-hold. Blood-origin rohiṇī is to be managed like the pitta-associated form. Kaṇṭhaśālūka is to be drained and treated like tuṇḍikerī. The patient should take a small amount of unctuous barley food once daily. Adhijihvikā is to be managed like upajihvikā. Ekavṛnda is to be drained and then treated with cleansing measures, while gilāyu is described as requiring an instrument. A fully matured throat abscess situated away from a vital point is to be opened.

Key terms

rohiṇī

A named throat disease discussed here in vāta-, pitta-, kapha-, and blood-associated forms.

gaṇḍūṣa

A therapeutic mouth-hold included among the measures for throat disease.

kaṇṭhaśālūka

A named throat lesion that the passage directs should be drained and managed by comparison with tuṇḍikerī.

gilāyu

A named throat disorder for which the verse describes instrumental treatment.

galavidradhi

A throat abscess described as suitable for opening only when mature and away from a vital point.

Meaning of the śloka

For sarvasara arising from vāta, the mouth is to be rubbed with powdered salts. Oil prepared with vāta-pacifying substances is said to be suitable for kavala and nasal use, followed by the specified unctuous medicated smoke. The smoke formulation comprises the listed plant piths or extracts, guggulu, dhyāma, māṃsī, kālānusārivā, śrī, sarjarasa, śaileya, and beeswax. These are finely powdered, mixed with a suitable quantity of an unctuous substance, and applied with honey to a Tiṇṭūka stalk. This unctuous smoke is praised for sarvasara and is said to counter kapha and vāta and remove diseases of the mouth. In pitta-associated sarvasara, after bodily cleansing, the entire regimen should be pitta-pacifying, sweet, and cooling. In kapha-associated sarvasara, rubbing, gaṇḍūṣa, medicated smoke, cleansing, and other measures should be selected to reduce kapha. The verse then prescribes a drink made from equal dharaṇa portions of ativiṣā, pāṭhā, musta, suradāru, the plant called kaṭukā rohiṇī, and kuṭaja fruit with cow urine, and states that this formulation removes diseases caused by kapha.

Key terms

sarvasara

A named disorder described by the commentary as affecting the whole mouth.

kavala

An oral therapeutic procedure for which the medicated oil is prescribed.

snaihika dhūma

Unctuous medicated smoke described for the vāta-associated form.

pratisāraṇa

Rubbing or local application within the mouth.

dharaṇa

A classical unit of measure; the commentary reports a variant reading that defines it.

Meaning of the śloka

After assessing the responsible doṣa, kavala preparations may be made with milk, sugarcane juice, cow urine, the watery portion of curd, sour kāñjika, oil, or ghee, as appropriate.

Key terms

kavala

An oral therapeutic preparation selected here according to the assessed condition.

doṣa

The governing doṣic factor, including the disease understood as its effect, used to select the preparation.

dadhi-mastu

The watery portion of curd listed as one possible liquid.

kāñjika

A sour fermented liquid listed as one possible basis for kavala.

Meaning of the śloka

The treatment of curable diseases arising in the mouth has been described; the disorders declared incurable are now listed. Among lip disorders, those arising from muscle tissue, blood, or all three doṣas are to be avoided. Among disorders of the tooth roots, triliṅgagati and sauṣira are to be avoided. Among diseases of the teeth, śyāva, dalana, and bhañjana do not resolve. Alāsa among diseases of the tongue and arbuda of the palate are also included. The nine listed throat diseases—svaraghna, valaya, vṛnda, vidārī, alāsa, galauṣṭha, māṃsatāna, śataghnī, and rohiṇī—are declared incurable. These total nineteen disorders. In their case, the physician should state the unfavorable prognosis before undertaking any management.

Key terms

asādhya

Classified in this text as not amenable to successful treatment.

triliṅgagati

A tooth-root disorder explained as a nāḍī displaying the signs and form of all three doṣas.

arbuda

The named palatal lesion included among conditions classified as incurable.

pratyākhyāya

Having first communicated or declared the unfavorable prognosis.

rohiṇī

One of the nine named throat diseases in the incurable group.

Meaning of the śloka

Thus ends the twenty-second chapter of the Cikitsāsthāna in the Suśruta Saṃhitā, entitled ‘Treatment of Diseases of the Mouth.’

Key terms

Cikitsāsthāna

The section of the Suśruta Saṃhitā in which this chapter occurs.

mukharogacikitsita

The chapter title, meaning treatment of diseases of the mouth.

Nibandhasaṅgraha

The title of Dalhaṇa’s commentary on the Suśruta Saṃhitā.

Dalhaṇa

The commentator named in the closing statement, with a spelling variant marked in the source.