AIAPGET POINTS
– Acharya Sushruta has described Swarabheda and its treatment in Chapter 53 of Uttara Tantra.
– Ati Uchcha Bhashana, Visha, Adhyayana, Gita, Shitadi – are the Nidanas of Swarabheda.
– In the Samprapti of Swarabheda, SWARAVAHA SROTAS are damaged by aggravated Vatadi doshas.
– There are six types of Swarabheda – Vataja, Pittaja, Kaphaja, Sannipataja, Kshayaja and Medoja Swarabheda.
– Gadgadavat Swara – is a feature of Vataja Swarabheda.
– Digdha Gala Oshta Talu are the special features of Medoja Swarabheda.
– Shvasa-Kasa-Vidhi has been mentioned amongst treatment principles of Swarabheda.
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The 53rd chapter of Uttaratantra of Sushruta Samhita is named as Svarabheda Pratiședha. This chapter deals with Treatment of Hoarseness.
अथातः स्वरभेदप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||
We will now expound Svarabhedapratisedha – treatment of hoarseness of voice; as revealed by the venerable Dhanvantari.
Nidāna- samprāpti – causes and pathogenesis
अत्युच्चभाषणविषाध्ययनातिगीतशीतादिभिः [१] प्रकुपिताः पवनादयस्तु |
स्रोतःसु ते स्वरवहेषु गताः प्रतिष्ठां हन्युः स्वरं भवति चापि हि षड्विधः सः ||३||
Causes –
– Talking in high pitch, for prolonged periods of time,
– Affliction by poisons,
– Studying in loud voice
– Singing in loud voice
– Excessive use of cold things
Pathogenesis –
Due to the above said causes, Vata and other doshas get aggravated. These aggravated doshas get lodged and localized in the svaravaha srotas i.e. channels of voice and destroy the voice of the person. This is called Svarabheda.
Types – Swarabheda is of six types.
Lakşana – clinical features
वातेन कृष्णनयनाननमूत्रवर्चा भिन्नं शनैर्वदति गद्गदवत् स्वरं च |
पित्तेन पीतवदनाक्षिपुरीषमूत्रो ब्रूयाद्गलेन परिदाहसमन्वितेन ||४||
कृच्छ्रात् कफेन सततं कफरुद्धकण्ठो मन्दं शनैर्वदति चापि दिवा विशेषः |
सर्वात्मके भवति सर्वविकारसम्पदव्यक्तता च वचसस्तमसाध्यमाहुः ||५||
धूप्येत वाक् क्षयकृते क्षयमाप्नुयाच्च वागेष चा(वा)पि हतवाक् परिवर्जनीयः |
अन्तर्गलं स्वरमलक्ष्यपदं चिरेण मेदश्चयाद्वदति दिग्धगलौष्ठतालुः ||६||
| Type of Svarabheda | Symptoms |
| Vataja Svarabheda – hoarseness of voice produced by vata | Blackish discolouration of the eye, face, urine and faeces of the patient
Speaks with broken voice, slowly Speech associated with stammering |
| Pittaja Svarabheda – hoarseness of voice produced by pitta | Yellowish discolouration of the face, eyes, faeces and urine of the patient
Speech comes from deep inside the throat i.e. the person speaks from the throat Speech associated with burning sensation |
| Kaphaja Svarabheda – hoarseness of voice produced by kapha | Person speaks with difficulty, continuously, slowly and during the day
Obstruction of throat by kapha at night |
| Sannipataja Svarabheda – hoarseness of voice produced by simultaneous aggravation of all the three doshas | Symptoms of all the doshas will be present
Voice of the person will not be manifested, not audible It is incurable |
| Kshayaja Svarabheda – hoarseness of voice caused by Kshaya – consumption or pthisis | Voice is decrease or
Voice is completely lost It is incurable |
| Medoja Svarabheda – hoarseness of voice caused by accumulation of medas – fat | Sound of the voice lurks in the throat of the patient,
Words do not come clearly, Voice of the patient comes out slowly The person’s throat, lips and palate are coated with fat |
क्षीणस्य वृद्धस्य कृशस्य चापि चिरोत्थितो यश्च सहोपजातः |
मेदस्विनः सर्वसमुद्भवश्च स्वरामयो यो न स सिद्धिमेति ||७||
Treatment done for hoarseness of voice do not succeed in the below mentioned conditions (i.e. it would become incurable) –
– In persons who are weak
– Aged people
– Emaciated persons
– That which has become chronic
– That which is congenital
– That occurring in obese individuals
– That produced by all the doshas together
Samāñya cikitsā – general treatment
स्निग्धान् स्वरातुरनरानपकृष्टदोषान् न्यायेन तान् वमनरेचनबस्तिभिश्च |
नस्यावपीडमुखधावनधूमलेहैः सम्पादयेच्च विविधैः कवलग्रहैश्च ||८||
यः श्वासकासविधिरादित एव चोक्तस्तं चाप्यशेषमवतारयितुं यतेत |९|
वैशेषिकं च विधिमूर्ध्वमतो वदामि तं वै स्वरातुरहितं निखिलं निबोध ||९||
Below mentioned are the treatment principles for Svarabheda –
Snehana – firstly, the patient suffering from voice disorders or hoarseness of voice should be administered with oleation therapy.
Swedana – After oleation, sudation therapy should be administered.
Shodhana – After oleation and sudation, purificatory therapies should be administered in the form of vamana – emesis, virechana – purgation and vasti – enema.
Nasya etc – Other therapies should be done according to the usual procedure should be done, including
– nasya – errhines and avapida – type of nasal drops,
– mukha dhavana – mouthwashes,
– dhuma – inhalation of medicated smoke,
– leha – electuaries and
– kavala – various types of gargles
Shvasa Kasa Vidhi – Therapies mentioned in the treatment of dyspnoea and cough can also be administered to treat svarabheda.
After this, special treatments beneficial for patients suffering from different types of disorders of voice / hoarseness of voice will be described.
Vātaja svarabheda cikitsa
स्वरोपघातेऽनिलजे भुक्तोपरि घृतं पिबेत् |
कासमर्दकवार्ताकमार्कवस्वरसे शृतम् ||१०||
पीतं घृतं हन्त्यनिलं सिद्धमार्तगले रसे |
यवक्षाराजमोदाभ्यां चित्रकामलकेषु वा ||११||
देवदार्वग्निकाभ्यां वा सिद्धमाजं समाक्षिकम् |
सुखोदकानुपानो वा ससर्पिष्को गुडौदनः ||१२||
In vataja svarabheda
Ghee prepared with the below mentioned ingredients should be given to the patient to drink –
– kasamarda
– vartaka and
– juice of markava
Alternatively, ghee prepared with juice of artagala should be given. This cures vataja svarabheda.
Also, goat’s ghee boiled with below mentioned herbs added with honey should be given –
– yavakshara
– ajamoda
Goat’s ghee boiled and prepared with the below mentioned herbs should be given mixed with honey –
– amalaka
– devadaru
– agnika
Gudodana is boiled rice added with jaggery. This should be served with ghee for consumption. Comfortably warm water should be given as an after-drink.
Pittaja svarabheda cikitsa
क्षीरानुपानं पित्ते तु पिबेत् सर्पिरतन्द्रितः |
अश्नीयाच्च ससर्पिष्कं यष्टीमधुकपायसम् ||१३||
लिह्यान्मधुरकाणां वा चूर्णं मधुघृताप्लुतम् |
शतावरीचूर्णयोगं बलाचूर्णमथापि वा ||१४||
In pittaja svarabheda
Ghee should be given for consumption followed by milk for drinking.
Yashtimadhu Payasa – milk pudding prepared with licorice should be given to drink added with ghee.
Powder of herbs of sweet taste i.e. Kakolyadi Gana group of herbs should be given to lick mixed with honey and ghee.
Alternatively, powder of Satavari or Bala shall be given mixed with honey and ghee to lick.
Kaphaja svarabheda cikitsā
पिबेत् कटूनि मूत्रेण कफजे स्वरसङ्क्षये |
लिह्याद्वा मधुतैलाभ्यां भुक्त्वा खादेत् कटूनि वा ||१५||
In kaphaja svarabheda
Powder of herbs tasting pungent like Trikatu etc should be given, mixed with cow urine.
The same powder of pungent herbs shall be given to lick after mixing it with honey and oil.
It can also be consumed after taking food.
Medaja svarabheda cikitsa
स्वरोपघाते मेदोजे कफवद्विधिरिष्यते |
सर्वजे क्षयजे चापि प्रत्याख्यायाचरेत् क्रियाम् ||१६||
In medoja svarabheda
Treatment should be done on the same lines of kaphaja svarabheda treatment explained above.
In trioshaja and ksayaja svarabheda
Treatment should be done after intimating the patient and his family about the incurability of these conditions.
शर्करामधुमिश्राणि शृतानि मधुरैः सह |
पिबेत् पयांसि यस्योच्चैर्वदतोऽभिहतः स्वरः ||१७||
Milk boiled with sweet tasting herbs added with sugar and honey should be given for consumption to the patients suffering from hoarseness caused by speaking or studying loudly.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे छर्दिप्रतिषेधो नाम (पञ्चदशोऽध्यायः, आदितः) त्रिपञ्चाशत्तमोऽध्यायः ||५३||
Thus ends the fifty-third chapter by name Svarabheda pratişedha in Uttara sthana of Suśruta Samhita.
