The commentary says that after the chapter on śvāsa and kāsa, beginning svarabheda is fitting because of similarity of upward movement and because it is curable by the śvāsa and kāsa treatments. Svarabheda means injury to the voice.
अत्युच्चभाषणविषाध्ययनातिगीतशीतादिभिः प्रकुपिताः पवनादयस्तु |
स्रोतःसु ते स्वरवहेषु गताः प्रतिष्ठां हन्युः स्वरं भवति चापि हि षड्विधः सः ||३||
Meaning of the śloka
From talking too loudly, poison, excessive study, excessive singing, cold and similar factors, the aggravated vāta and other doṣas go into the channels that carry voice and obstruct its foundation and damage the voice. It is sixfold.
The commentary gives cause, pathogenesis and number. Adhyayana is continuous recitation of the Veda and the like; atigīta is unceasing singing; 'cold etc.' includes causes of pitta and kapha aggravation. The verse names mainly vāta-aggravating causes to show that vāta is chief in injuring the voice. Others take 'etc.' as heavy, light, unctuous and dry qualities. The voice-carrying channels are the sound-carrying vessels. The six kinds: three by the doṣas separately, one by sannipāta, and two from meda (fat) and depletion. An objection: Caraka lists six as vāta, pitta, kapha, cough, blood-flow, and running nose, so how do the two agree? The reply: cough-born and running-nose-born are counted as vāta-type; blood-born is counted under kapha since blood with kapha causes it. So the count is not exceeded.
The commentary gives the signs of vātaja svarabheda. 'Dark' applies to eyes, face, urine and stool. 'Broken' means unsteady. Another tantra says: 'from vāta, the voice becomes rough, weak and unsteady'. Some read 'gardabhavat' (like a donkey) for 'gadgadavat' (stammering-like).
The commentary gives the signs of pittaja svarabheda. 'Yellow' attaches to face, eyes, stool and urine. Some read 'with burning' as attached to the speaker, the person with voice impairment.
From kapha: with difficulty and constantly, his throat blocked by kapha, he speaks slowly and softly, and there is a special improvement in the daytime.
The commentary gives the signs of kaphaja svarabheda. 'Constantly' means without break; 'throat blocked by kapha' means enveloped in phlegm; 'softly, slowly' means very slowly. The improvement in the day is from reduced kapha. Some read 'from improvement by day', explaining that at night, the throat being blocked by kapha, he cannot speak at all, but by day, kapha diminishing, he speaks a little.
The commentary gives the signs of sānnipātika svarabheda: all the signs of vāta and the others appear, and speech is unclear. That sannipāta voice impairment is called incurable.
One with voice loss from depletion, when speaking, seems to emit smoke from the mouth, and his voice reaches destruction; such a person, one who has lost his voice, is to be avoided.
The commentary gives the signs of kṣayaja svarabheda. 'Seems to emit smoke' means as though smoke leaves the mouth while he speaks. 'Reaches destruction of speech' is completed with 'from vāta'.
अन्तर्गलं स्वरमलक्ष्यपदं चिरेण मेदश्चयाद्वदति दिग्धगलौष्ठतालुः ||६||
क्षीणस्य वृद्धस्य कृशस्य चापि चिरोत्थितो यश्च सहोपजातः |
मेदस्विनः सर्वसमुद्भवश्च स्वरामयो यो न स सिद्धिमेति ||७||
Meaning of the śloka
From accumulation of meda (fat), one speaks with the voice inside the throat, with indistinct words and after a delay, with the throat, lips and palate smeared as if with grease. In one who is depleted, aged or emaciated; in one where it has long been present or has arisen with (another illness); in the fat person; and the type from all (doṣas): the voice disorder does not reach cure.
The commentary gives the signs of the fat-caused voice impairment. Antargala means in the interior of the throat; 'says the voice' means makes sound; digdha means smeared with fat. Some read 'antargataṃ' with the same sense, and 'medo'nvayāt' for 'medaścayāt'.
Those afflicted in voice, oleated and with doṣas drawn out by emesis, purgation and enemas in the right manner, should be treated with various nasal drops, avapīḍa, mouth-cleansing, smokes, licks and gargles.
The commentary gives general treatment. Although oleation is not proper in kapha- and fat-caused voice impairment (they need depletion), oleation with sneha opposed to the doṣa, or cooked with drugs opposing it, is fitting; or since vāta is present even in the kapha and fat types, oleation is advised. 'Doṣas drawn out' means by emesis, purgation and enemas, each done properly. Avapīḍa is a kind of nasya given by pressing; mukhadhāvana is gargling and the like. The two types of gargle are distinguished: kavala when it cannot be moved freely, gaṇḍūṣa when it can be moved comfortably.
In voice injury from vāta, after a meal, ghṛta cooked in the juices of kāsamarda, vārtāka or mārkava (bhṛṅgarāja) may be drunk; ghṛta cooked in the juice of ārtagala (kakubha) destroys vāta.
The commentary gives the special regimen. 'After the meal' means on top of food; mārkava is bhṛṅgarāja; 'cooked' means boiled. 'Destroys vāta' is figurative for vātaja voice impairment; ārtagala is kakubha (arjuna).
The commentary lists three ghṛtas for the vāta type. Agnika is ajamodā. 'Goat's' is supplied for ghṛta; 'with honey' means mixed with honey; 'drunk' is supplied.
Key terms
yavakṣāra
Barley alkali.
ājaṃ ghṛtam
Goat's ghṛta.
Adhikarana ੧੪ (੧੨) · Śloka ੧੨
ਸੁਖੋਦਕਾਨੁਪਾਨੋ ਵਾ ਸਸਰ੍ਪਿਸ੍ਕੋ ਗੁਡੌਦਨਃ ||੧੨||
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सुखोदकानुपानो वा ससर्पिष्को गुडौदनः ||१२||
Meaning of the śloka
Or rice cooked with jaggery and ghṛta, taken with lukewarm water as after-drink.
The commentary says lukewarm water is slightly warm water. Some take this for pitta type; the commentators reject that since in similar tantras it is used only for vātaja voice impairment.
The commentary gives a wholesome food for the pitta type. Yaṣṭīmadhu-pāyasa is rice cooked in milk cooked with yaṣṭīmadhu, or pāyasa mixed with yaṣṭīmadhu.
The commentary says pungent things are trikaṭu and the like; urine is chiefly cow's urine. 'Loss of voice' means voice impairment. He may lick them with honey and oil, or eat them after eating.
Key terms
kaṭu (kaṭūni)
Pungent substances such as trikaṭu.
gomūtra (mūtra)
Cow's urine.
Adhikarana ੧੯ (੧੬) · Śloka ੧੬
ਸ੍ਵਰੋਪਘਾਤੇ ਮੇਦੋਜੇ ਕਫਵਦ੍ਵਿਧਿਰਿਸ੍ਯਤੇ |੧੬|
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स्वरोपघाते मेदोजे कफवद्विधिरिष्यते |१६|
Meaning of the śloka
In voice injury from fat, the regimen is as for kapha.
The commentary says that even for the incurable sannipātaja and kṣayaja types, treatment is to be done. 'After declaring incurable' means having ruled it out as incurable. 'Treatment' means all the treatments of vāta and the other doṣa types in sannipāta, and the depletion regimen in kṣayaja; others say the general treatment in both.
Key terms
pratyākhyāya
Having declared it incurable (informing the patient/family).
The commentary says that although voice impairment from loud speaking is of vāta nature, a special treatment is given by reason of its cause. Milks cooked with kākolī and similar drugs, mixed with sugar and honey, are drunk. The plural 'milks' includes cow, buffalo and goat milk.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे छर्दिप्रतिषेधो नाम (पञ्चदशोऽध्यायः, आदितः) त्रिपञ्चाशत्तमोऽध्यायः ||५३||
Meaning of the śloka
Thus ends the fifty-third chapter (the fifteenth from the beginning of this section) in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā. (The sloka source names it 'Chardipratiṣedha'.)
Thus ends the fifty-third chapter, named Svarabhedapratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.