त्रिपञ्चाशत्तमोऽध्यायः अथातः स्वरभेदप्रतिषेधमध्यायं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of hoarseness of voice (Svara bheda Pratisedha). 1.
Etiology of hoarseness of voice
अत्युच्चभाषणविषाध्ययनातिगीत शीतादिभिः प्रकुपिताः पवनादयस्तु | स्त्रोतःसु ते स्वरवहेषु गताः प्रतिष्ठां हन्युः स्वरं भवति चापि हि षड्विधः सः ॥ २ ॥
Etiology – The Vayu and the other Dosas are deranged and aggravated by such causes as extremely loud speaking, taking poison, reading at the top of the voice, external hurt or injury and exposure to cold, etc.¹ and finding lodgment in the sound carrying channels, they affect the voice. The disease is called Svara-bheda (hoarseness of voice) and is classified into six different types. 2.
Specific Symptoms of hoarseness of voice
वातेन कृष्णनयनाननमूत्रवर्चा भिन्नं शनैर्वदति गद्गदवत् स्वरञ्च ॥ ३ ॥ पित्तेन पीतवदनाक्षिपुरीषमूत्रो ब्रूयाद् गलेन परिदाहसमन्वितेन ॥ ४॥ कृच्छ्रात् कफेन सततं कफरुद्धकण्ठो मन्दं शनैर्वदति चापि दिवा विशेषः । सर्वात्मके भवति सर्वविकारसम्पदव्यक्तता च वचसस्तमसाध्यमाहुः ॥ ५ ॥
Specific Symptoms – The Vataja type imparts a black colour to the face, eyes, urine and stool and the voice acquires the sound of the rough and hoarse braying of an ass’. The face, eyes and the stool and urine of the patient are tinged yellow in a case of the Pittaja type and the voice sounds sunken as if proceeding from the throat with an internal burning sensation. In the Kaphaja type the patient constantly feels a sense of constriction in his throat with mucus and is only enabled to speak slowly and softly and that specially in the day. Symptoms specifically belonging to the three preceding Dosa-originated types, are simultaneously present in the type due to the concerted action of the three Dosas (Tri-Dosaja) together with indistinctness of speech and incapability of articulation. This type should be deemed as incurable. 3-5.
1. Here Pitta-aggravating and Vayu-aggravating causes also are intended by the word ‘आदि’ i.e., etc. in ‘शीतादिभि:’।
Symptoms of Ksayaja and Medoja Svarabheda
धूप्येत वाक् क्षयकृते क्षयमाप्नुयाच्च वागेष वापि हतवाक् परिवर्जनीयः ॥ ६ ॥ अन्तर्गलं स्वरमलक्ष्यपदं चिरेण मेदश्चयाद् वदति दिग्धगलौष्ठतालुः ॥७॥
Symptoms of Ksayaja and Medoja types – In the Ksayaja type the voice emits vapour and becoming lower and lower, it ultimately disappears. This stage of Svara-bheda ( loss of voice) should be given up as incurable. In an attack of the Medoja type the patient speaks very indistinctly, the voice remaining, as it were, inside his throat. And his throat, lips and palate become sticky. 6-7.
Prognosis of Svarabheda
क्षीणस्य वृद्धस्य कृशस्य चापि चिरोत्थितो यश्च सहोपजातः । मेदस्विनः सर्वसमुद्भवश्च स्वरामयो यो न स सिद्धिमेति ॥ ८ ॥
Prognosis – Svara-bheda in cases of weak, old, emaciated, or fatty patient, as well as a long-standing, congenital or Tri-Dosaja one should be regarded as incurable. 8.
General Treatment of Svarabheda
स्निग्धान् स्वरातुरनरानपकृष्टदोषान् न्यायेन तान् वमनरेचनबस्तिभिश्च । नस्यावपीडमुखधावनधूमलेहैः सम्पादयेच्च विविधैः कवलग्रहैश्च ॥ ९ ॥ यः श्वासकासविधिरादित एव चोक्तस्तञ्चाप्यशेषमवतारयितुं यतेत । वैशेषिकञ्च विधिमूर्ध्वमतो वदामि तं वै स्वरातुरहितं निखिलं निबोध ॥ १० ॥
General Treatment – The body of the patient should be first rubbed with a Sneha (clarified butter, lit. – treated with emulsive measures) and the deranged bodily Dosa underlying the root of the attack should be curbed with the help of emetics, purgatives, Basti, errhines, Avapida- Nasya, lambatives, smoke-inhalations or gargles. Measures and remedies previously mentioned in connection with the treatment of cough and asthma should be as well employed in their entirety in the present disease. Now hear me describing the medicinal remedies whcih are specifically beneficial to a patient afflicted with an attack of Svarabheda. 9-10.
1. Dalhana’s reading evidently is गद्गदवत् (indistinct).
Treatment of Vataja Svarabheda
स्वरोपघातेऽनिलजे भुक्तोपरि घृतं पिबेत् । कासमर्दकवार्ताक-मार्कवस्वरसे शृतम् ॥ ११ ॥ पीतं घृतं हन्त्यनिलं सिद्धमार्तगले यवक्षाराजमोदाभ्यां चित्रकामलकेषु वा ॥ १२ ॥ देवदार्वग्निकाभ्यां वा सिद्धमाजं समाक्षिकम् । सुखोदकानुपानो वा ससर्पिष्को गुडौदनः ॥ १३ ॥ रसे।
Treatment of Vataja Type – In the Vataja type of the disease, the patient should take, after a full meal, clarified butter mixed with the expressed Juice of Kasa-marda, Vartaku and Markava with Artagala (Arjuna). In the alternative, Ghrita prepared from goat’s milk and duly cooked with Yava-Kshara and Ajamoda or with Chitraka and Amalaka or with Deva-daru and Agni (Chitraka) should be taken with honey. The diet of the patient in such a case should consist of boiled rice taken with treacle and clarified butter, followed by draughts of tepid water. 11-13.
Pittaja and Kaphaja Svarabheda
क्षीरानुपानं पित्ते तु पिबेत् सर्पिरतन्द्रितः । अश्रीयाच्च ससर्पिष्कं लिह्यान्मधुरकाणां वा चूर्णं मधुघृताप्लुतम् । बलाचूर्णमथापि शतावरीचूर्णयोगं पिबेत् कटूनि मूत्रेण कफजे स्वरसंक्षये। लिह्याद् वा मधुतैलाभ्यां भुक्त्वा खादेत् कटूनि वा ॥ १६ ॥ यष्टीमधुकपायसम् ॥ १४॥ वा ॥ १५ ॥
Pittaja and Kaphaja Types – Clarified butter should constantly used with milk in the Pittaja type of the disease duly prepared with the admixture of Yasti-madhu and clarified butter, should also be taken. Lambatives composed of the powdered drugs of the Madhura (Kakolyadi) group saturated with honey and clarified butter, or of powders of Satavari or of Bala should be similarly taken. Powders of pungent drugs should be taken with a copious quantity of cow’s urine or licked with oil and honey in a case of the Kaphaja type of Svara-bheda. 14-16.
1. Payasa is a special preparation of rice boiled with milk and sugar.
Medoja – Ksayaja Svarabheda
स्वरोपघाते मेदोजे कफवविधिरिष्यते । सर्वजे क्षयजे चापि प्रत्याख्यायाचरेत् क्रियाम् ॥ १७ ॥ शर्करामधुमिश्राणि शृतानि मधुरैः सह । पिबेत् पयांसि यस्योच्चैर्वदतोऽभिहतः स्वरः ॥ १८ ॥
Medoja, Ksayaja etc., Types – The medical treatment in the case of the Medoja type of Svarabheda should be the same as in the Kaphaja type. The medical treatment of the Tri-Dosaja and Ksayaja types of the disease should be taken in hand without holding out any hope of recovery. Milk¹ duly cooked with the drugs of the Madhura group should be taken in combination with sugar and honey in a case due to the effects of loud speaking. 17-18.
इति सुश्रुत संहितायामुत्तरतन्त्रे स्वरभेदप्रतिषेधव्याख्यानाम त्रिञ्चाशत्तमोऽध्यायः ॥ ५३॥
Thus ends the fifty-third chapter of the Uttara-Tantra in the Susruta Samhita which deals with the (symptoms and) treatment of hoarseness.
1. Milk of a cow or of a she-buffalo, etc. may be used here — Dalhana.