The 21st chapter of Uttara Sthanam of Ashtanga Hridayam is named as Mukharoga Vijnaniya. This chapter deals with the explanation of ‘Knowledge of diseases of the mouth’.

The topics covered in this chapter include

• Nidana – Causes
• Oshta Rogah – diseases of the lips
• Khandoshta
• Oshtakopa
• Jalarbuda
• Gandalaji
• Shitadanta or Dalana
• Dantaharsha
• Dantabheda
• Dantachala
• Karala Danta
• Adhidanta
• Danta Sharkara, Kapalika
• Shyavadanta
• Dantamamsa Roga – diseases of the gums
• Krmidanta
• Shitada
• Upakusha
• Danta Pupputa
• Danta Vidradhi
• Sushira – Mahasushira
• Adhimamsaka
• Vidarbha
• Dantanadi
• Jihva Roga – diseases of the tongue
• Doshadusta Jihva
• Alasa
• Adijihva
• Upajihva
• Talu Roga – diseases of the palate
• Talupitika
• Galashundika
• Talusamhati
• Talu Arbuda
• Kacchapa
• Talu Pupputa
• Talu Paka
• Talu Shosha
• Kantha Roga – diseases of the throat
• Kantha Rohini
• Kantha Shaluka
• Vinda
• Tundikerika
• Galaugha
• Valaya
• Gilayuka
• Shataghni
• Galavidradhi
• Galarbuda
• Galaganda
• Svaraha
• Mukhapaka
• Urdvaguda
• Mukhapaka due to pitta, rakta and kapha
• Putiasyata

Pledge by the author(s)

अथातो मुखरोगविज्ञानीयं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘Diseases of diseases of the mouth’.
Thus, say (pledge) Atreya and other sages.

Nidana : Causes

मात्स्यमाहिषवाराहपिशितामकमूलकम् ।
माषसूपदधिक्षीरशुक्तेक्षुरसफाणितम् ॥ १ ॥
अवाक्शय्यां च भजतो द्विषतो दन्तधावनम् ।
धूमच्छर्दनगण्डूषानुचितं च सिराव्यधम् ॥ २ ॥
क्रुद्धाः श्लेष्मोल्बणा दोषाः कुर्वन्त्यन्तर्मुखं गदान् ।
Partaking meat of fish,alo and boar, uncooked Raphanus sativus (greater indulgence) in soup of Vigna mungo, curds, milk, fermented gruel, juice of Saccharum officinarum and half cooked molasses, sleeping with the face down, not cleaning the teeth daily, improper administration of therapies like inhalation of medicated smoke, emesis, mouth gargles and venesection etc.; by these causes the doshas with the predominance of Kapha get aggravated and produce diseases inside the mouth.

Oshta Rogah: Diseases of the lips Khandoshta

तत्र खण्डौष्ठ इत्युक्तो वातेनौष्ठो द्विधा कृतः ॥३॥
Among those, Is splitting of the lips into two parts and is caused by Vata.

Oshtakopa

ओष्ठकोपे तु पवनात्स्तब्धावोष्ठौ महारुजौ ।
दाल्येते परिपाट्येते परुषासितकर्कशौ ॥ ४ ॥
पित्तात्तीक्ष्णासहौ पीतौ सर्षपाकृतिभिश्चितौ ।
पिटिकाभिर्बहुक्लेदावाशुपाकौ कफात्पुनः ॥ ५ ॥
शीतासहौ गुरू शूनौ सवर्णपिटिकाचितौ ।
सन्निपातादनेकाभौ दुर्गन्धास्रावपिच्छिलौ ॥ ६ ॥
अकस्मान्म्लानसंशूनरुजौ विषमपाकिनौ ।
In Oshtakopa caused by Vata, the lips are rigid, very painful, as though splitting and bursting, are rough, black and dry / harsh. In that caused by Pitta, the lips are angry red, intolerant of touch, studded with eruption which are yellow, resembling mustard seeds, full of fluid and suppurating / ulcerating quickly. In that, due to Kapha, the lips do not tolerate cold, heavy, swollen and studded with eruptions of the same color (as of the lips). In that caused by Sannipata, the eruptions are of many kinds, discharging fluid of foul smell and slimy, sometimes these are lusterless, swollen, painful and ulcerating irregularly (ulcerating in some places and not so in some others).

रक्तोपसृष्टौ रुधिरं स्रवतः शोणितप्रभौ ॥ ७ ॥
खर्जूरसदृशं चात्र क्षीणे रक्तेऽर्बुदं भवेत् ।
In that caused by association of blood, the lips have bleeding, resembling blood (in color) appearing like the kharjura (date fruit) after the blood is shed and gives rise to Arbuda (tumor).

मांसपिण्डोपमौ मांसात्स्यातां मूर्च्छत्कृमी क्रमात् ॥ ८ ॥
Oshtakopa affecting mamsa dhatu, leads to growths similar to mamsa pinda (bolus) and gradually leads to worm infestation.

तैलाभश्वयथुक्लेदौ सकण्ड्वौ मेदसा मृदू ।
In that caused by association of fat tissue, the lips develop swelling which is oily (in appearance), moist, itching and soft.

क्षतजाववदीर्येते पाट्येते चासकृत्पुनः ॥ ९ ॥
ग्रथितौ च पुनः स्यातां कण्डूलौ दशनच्छदौ ।
In that caused by Kshata (injury) the lips are split, torn, cracked repeatedly knotted, swollen and having itching.

Jalarbuda

जलबुद्बुदवद्वातकफादोष्ठे जलार्बुदम् ॥ १० ॥
From Vata and Kapha arises Jalarbuda in the lips
which resembles a bubble of water.

Gandalaji

गण्डालजी स्थिरः शोफो गण्डे दाहज्वरान्वितः ।
Gandalaji is a static (immovable) swelling in the cheek,
accompanied with a burning sensation and fever.

Shitadanta or Dalana

वातादुष्णसहा दन्ताः शीतस्पर्शेऽधिकव्यथाः ॥ ११ ॥
दाल्यन्त इव शूलेन शीताख्यो दालनश्च सः ।
From Vata, disease produced is known as Shitadanta or Dalana, in which the teeth tolerate only hot things, causing severe pain by the touch of cold things, the pain appearing as though splitting the teeth.

Dantaharsha

दन्तहर्षे प्रवाताम्लशीतभक्षाक्षमा द्विजाः ॥ १२ ॥
भवन्त्यम्लाशनेनेव सरुजाश्चलिता इव ।
In Dantaharsha, the teeth become intolerant (cool) to breeze, sour and cold eatables, painful and feel to be loose caused by eating of (too much of) sour thing only.

Dantabheda

दन्तभेदे द्विजास्तोदभेदरुक्स्फुटनान्विताः ॥ १३ ॥
In Dantabheda, the teeth are having pricking, cutting and bursting like pain.

Dantachala

चालश्चलद्भिर्दशनैर्भक्षणादधिकव्यथैः ।
Dantachala is shaking of the teeth, causing severe pain during eating.

Karala Danta

करालस्तु करालानां दशनानां समुद्गमः ॥ १४ ॥
Karala Danta is an eruption of teeth in ugly or improper way.

Adhidanta

दन्तोऽधिकोऽधिदन्ताख्यः स चोक्तः खलु वर्धनः ।
जायमानेऽतिरुग्दन्ते जाते तत्र तु शाम्यति ॥ १५ ॥
Adhidanta also known as Vardhana, is eruption of extra teeth, during eruption of teeth there will be severe pain, after eruption pain will subside.

Danta Sharkara, Kapalika

अधावनान्मलो दन्ते कफो वा वातशोषितः ।
पूतिगन्धिः स्थिरीभूतः शर्करा साप्युपेक्षिता ॥ १६ ॥
शातयत्यणुशो दन्तात्कपालानि कपालिका ।
Accumulation of dirt on the teeth, not cleaning them (daily); or of Kapha dehydrated by Vata, adhering to the teeth, becoming hard and emitting bad odor, this is known as (Danta) Sharkara. This neglected, makes the crown of the teeth fall off little.This disease is Kapalika.

Shyavadanta

श्यावः श्यावत्वमायातो रक्तपित्तानिलैर्द्विजः ॥ १७ ॥
In Shyavadanta, caused by Rakta, Pitta and Vata,
the teeth assume a brown color.

Dantamamsa Roga: Diseases of the gums

Krimidanta

समूलं दन्तमाश्रित्य दोषैरुल्बणमारुतैः ।
शोषिते मज्ज्ञि सुषिरे दन्तेऽन्नमलपूरिते ॥ १८ ॥
पूतित्वात्कृमयः सूक्ष्मा जायन्ते जायते ततः ।
अहेतुतीव्रार्तिशमः ससंरम्भोऽसितश्चलः ॥ १९ ॥
प्रलूनः पूयरक्तस्रुत्स चोक्तः कृमिदन्तकः ।
The doshas with the predominance of Vata undergoing increase, invade the teeth along with its root dries up the marrow, creates cavity in teeth; which the waste products of the food fill up because of the putrefaction, minute (invisible) worms develop inside; then severe pain appears and disappears without any reason.There is swelling, black coloration, shaking of the teeth, and discharge of pus and blood on shaking. This disease is Krimidantaka.

Shitada

श्लेष्मरक्तेन पूतीनि वहन्त्यस्रमहेतुकम् ॥ २० ॥
शीर्यन्ते दन्तमांसानि मृदुक्लिन्नासितानि च ।
शीतादोऽसौ
By aggravation of Kapha and Rakta, the gums discharge blood, foul smelling, without any reason become torn, soft, spongy and black, this is known as Shitada.

Upakusha

उपकुशः पाकः पित्तासृगुद्भवः ॥ २१ ॥
दन्तमांसानि दह्यन्ते रक्तान्युत्सेधवन्त्यतः ।
कण्डूमन्ति स्रवन्त्यस्रमाध्मायन्तेऽसृजि स्थिते ॥ २२ ॥
चला मन्दरुजो दन्ताः पूति वक्त्रं च जायते ।
Upakusha is ulceration arising from (aggravation of) Pitta and Asrik (blood), the gums have burning sensation, are red, swollen, itching, exude blood, gets discharged after the bleeding stops, teeth are shaky, slightly painful and the mouth emits bad odor.

Danta Pupputa

दन्तयोस्त्रिषु वा शोफो बदरास्थिनिभो घनः ॥ २३ ॥
कफास्रात्तीव्ररुक् शीघ्रं पच्यते दन्तपुप्पुटः ।
Thick swelling, like the stone of a badara fruit – Ziziphus jujuba, hard round of two or three teeth, with severe pain and quick ripening are the features of the disease
Dantapupputa, caused by aggravated Kapha and asra (blood).

Danta Vidradhi

दन्तमांसे मलैः सास्रैर्बाह्यान्तः श्वयथुर्गुरुः ॥ २४ ॥
सरुग्दाहः स्रवेद्भिन्नः पूयास्रं दन्तविद्रधिः ।
Big swelling either outside or inside the gums, caused by all the doshas together with blood, accompanied with pain, burning sensation and discharge pus and blood after bursting.This is Danta Vidardhi.

Sushira, Mahasushira

श्वयथुर्दन्तमूलेषु रुजावान् पित्तरक्तजः ॥ २५ ॥
लालास्रावी स सुषिरो दन्तमांसप्रशातनः ।
स सन्निपाताज्ज्वरवान् सपूयरुधिरस्रुतिः ॥ २६ ॥
महासुषिर इत्युक्तो विशीर्णद्विजबन्धनः ।
Painful swelling at the root of the teeth caused by aggravated Pitta and Rakta, associated with too much of saliva and falling off of the gums, this disease is Sushira, the same caused by Sannipata (aggravation of all the doshas simultaneously) accompanied with fever, discharge of pus and blood and causing loosening of the joint of the teeth is called as Mahasushira.

Adhimamsaka

दन्तान्ते कीलवच्छोफो हनुकर्णरुजाकरः ॥ २७ ॥
प्रतिहन्त्यभ्यवहृतिं श्लेष्मणा सोऽधिमांसकः ।
Swelling resembling a nail at the end of the (row of) teeth causing pain in the lower jaw, and ears and obstructing the food (during swallowing) is known as Adhimamsaka and is caused by Kapha.

Vidarbha

घृष्टेषु दन्तमांसेषु संरम्भो जायते महान् ॥ २८ ॥
यस्मिंश्चलन्ति दन्ताश्च स विदर्भोऽभिघातजः ।
The gums if scratched (during brushing of the teeth) giving rise to profound swelling and shaking of the teeth, this disease known as Vidarbha is due to trauma.

Dantanadi

दन्तमांसाश्रितान् रोगान् यः साध्यानप्युपेक्षते ॥२९॥
अन्तस्तस्यास्रवन् दोषः सूक्ष्मां सञ्जनयेद्गतिम् ।
पूयं मुहुः सा स्रवति त्वङ्मांसास्थिप्रभेदिनी ॥ ३० ॥
ताः पुनः पञ्च विज्ञेया लक्षणैः स्वैर्यथोदितैः ।
He (the patient) who neglects even the curable diseases of the gums, in such a patient the doshas remaining inside, not coming out, create minute fissures, pus comes out of these often, the skin, muscles and bones get destroyed.these nadi (fissures) are five kinds having the features of the doshas respectively.

Jihva Roga: diseases of the tongue

Doshadusta Jihva

शाकपत्रखरा सुप्ता स्फुटिता वातदूषिता ॥ ३१ ॥
जिह्वा पित्तात्सदाहोषा रक्तैर्मांसाङ्कुरैश्चिता ।
शाल्मलीकण्टकाभैस्तु कफेन बहला गुरुः ॥ ३२ ॥
The tongue becoming rough like the leaf of leafy vegetable, having loss of sensation (of taste) and cracked/fissured
is vitiated by Vata, that vitiated by Pitta has burning sensation, feeling of heat and studded with red muscular eruptions that vitiated by Kapha, has elevations like the thorns of a śālmalī – Salmalia malabarica tree, bahalā -becomes thick and heavy.

Alasa

कफपित्तादधः शोफो जिह्वास्तम्भकृदुन्नतः ।
मत्स्यगन्धिर्भवेत्पक्वः सोऽलसो मांसशातनः ॥ ३३ ॥
A raised swelling underneath of the tongue, caused by Kapha and Pitta, causing rigidity (loss of movement) of the tongue, emitting fishy smell, ripening and causing denudation of the muscle this disease is Alasa.

Adhijihva

प्रबन्धनेऽधो जिह्वायाः शोफो जिह्वाग्रसन्निभः ।
साङ्कुरः कफपित्तास्रैर्लालोषास्तम्भवान् खरः ॥ ३४ ॥
अधिजिह्वः सरुक्कण्डुर्वाक्याहारविघातकृत् ।
A swelling resembling the tip of the tongue, developing under the root of the (binding septum) tongue studded with sprouts, leading to more of salivation, feeling of heat, loss of movement, rough on touch, painful, itching and obstructing speaking and swallowing of food. This disease called Adhijihva, and it is caused by Kapha, Pitta and Asra (blood).

Upajihva

तादृगेवोपजिह्वस्तु जिह्वाया उपरि स्थितः ॥ ३५ ॥
A similar one developing over the tongue is known as Upajihva.

Talu Roga: Diseases of the palate

Talupitika

तालुमांसेऽनिलाद्दुष्टे पिटिकाः सरुजः खराः ।
बह्व्यो घनाः स्रावयुतास्तास्तालुपिटिकाः स्मृताः ॥ ३६ ॥
Eruptions on the muscle of the palate, painful, rough, multiple, exuding thick fluid are known as Talupitika and caused by aggravated Vata.

Galashundika

तालुमूले कफात्सास्रान्मत्स्यवस्तिनिभो मृदुः ।
प्रलम्बः पिच्छिलः शोफो नासयाऽऽहारमीरयन् ॥३७॥
कण्ठोपरोधतृट्कासवमिकृत्गलशुण्डिका ।
A swelling caused by Kapha, developing in the root of the palate, associated with blood resembling the urinary bladder of the fish, soft, elongated, slimy, making particles of food to come out through the nose, causing obstruction to the throat, producing thirst, cough and vomiting, this disease is Galashundika.

Talusamhati

तालुमध्ये निरुङ्मांसं संहतं तालुसंहतिः ॥ ३८ ॥
Painless growth of muscle tissue in the middle of the palate is Talusamhati.

Talu Arbuda

पद्माकृतिस्तालुमध्ये रक्ताच्छ्वयथुरर्बुदम् ।
A swelling by vitiated blood in the middle of the palate, resembling a lotus flower, is Arbuda.

Kacchapa

कच्छपः कच्छपाकारश्चिरवृद्धिः कफादरुक् ॥ ३९ ॥
Kacchapa is a swelling resembling the tortoise shell developing slowly and painlessly, it is caused by Kapha.

Talu Pupputa

कोलाभः श्लेष्ममेदोभ्यां पुप्पुटो नीरुजः स्थिरः ।
From Kapha and Medas (fat) arises Talupupputa, a swelling resembling Kola fruit, painless and static.

Talu Paka

पित्तेन पाकः पाकाख्यः पूयास्रावी महारुजः ॥ ४० ॥
From Pitta arises the disease known as Talupaka, which is an ulcer discharging pus and is very painful.

Talu Shosha

वातपित्तज्वरायासैस्तालुशोषस्तदाह्वयः ।
Talushosha arises from Vata and Pitta, with fever and exertion.

Kantha Roga : Diseases of the throat

Kantha Rohini

जिह्वाप्रबन्धजाः कण्ठे दारुणा मार्गरोधिनः ॥ ४१ ॥
मांसाङ्कुराः शीघ्रचया रोहिणी शीघ्रकारिणी ।
Sprouts of muscles, at the root of the tongue, in the throat, unbearable, obstructing the passage of the throat, developing (and progressing) fast and killing the patient quickly is called Rohini.

कण्ठास्यशोषकृद्वातात्सा हनुश्रोत्ररुक्करी ॥ ४२ ॥
पित्ताज्ज्वरोषातृण्मोहकण्ठधूमायनान्विता ।
क्षिप्रजा क्षिप्रपाकातिरागिणी स्पर्शनासहा ॥ ४३ ॥
कफेन पिच्छिला पाण्डुरसृजा स्फोटकाचिता ।
तप्ताङ्गारनिभा कर्णरुक्करी पित्तजाकृतिः ॥ ४४ ॥
गम्भीरपाका निचयात्सर्वलिङ्गसमन्विता ।
If Vata is predominant, it (rohini) causes dryness of the throat and mouth and causes pain in the lower jaw and ears. If Pitta is predominant, there is fever, feeling of a heat, thirst, delusion, feeling of hot fumes coming out of the throat, developing fast, very red in appearance and does not tolerate touch (tenderness). If Kapha is predominant, it is slimy, and pale; when arisen from blood, it is studded with eruptions/bleeds, resembling burning coal, produces pain in the ears and has other features of that type caused by Pitta. That arising from all the doshas, undergoes ripening deep inside and presents the features of all the doshas simultaneously.

Kantha Shaluka

दोषैः कफोल्बणैः शोफः कोलवद्ग्रथितोन्नतः ॥ ४५ ॥
शूककण्टकवत्कण्ठे शालूको मार्गरोधनः ।
Arising from all the doshas with the predominance of Kapha, a swelling in the throat resembling a Ziziphus mauritiana fruit, tumor like, elevated, creating a feeling of presence of spikes and thorns in the throat and obstructing the passage; this disease is called Shaluka.

Vrinda

वृन्दो वृत्तोन्नतो दाहज्वरकृद्गलपार्श्वगः ॥ ४६
Vrinda is round, elevated mass, at the sides of the throat giving rise to burning sensation and fever.

Tundikerika

हनुसन्ध्याश्रितः कण्ठे कार्पासीफलसन्निभः ।
पिच्छिलो मन्दरुक् शोफः कठिनस्तुण्डिकेरिका ॥ ४७
A swelling in the throat, located at the meeting place of the lower jaw, resembling the fruit of kārpāsī – Gossypium herbaceum, slimy, with mild pain and hard to touch, this is known as Tundikerika.

Galaugha

बाह्यान्तः श्वयथुर्घोरो गलमार्गार्गलोपमः ।
गलौघो मूर्धगुरुतातन्द्रालालाज्वरप्रदः ॥४८॥
Profound swelling, both outside and inside the throat, remains like a bolt in the passage of the throat, producing heaviness of the head, stupor, more of salivation and fever. This disease is Galaugha.

Valaya

वलयं नातिरुक् शोफस्तद्वदेवायतोन्नतः ।
Valaya is a similar kind of swelling, of the same shape (of valaya or ring) not very painful, and of similar width and elevation.

Gilayuka

मांसकीलो गले दोषैरेकोऽनेकोऽथवाऽल्परुक् ॥ ४९ ॥
कृच्छ्रोच्छ्वासाभ्यवहृतिः पृथुमूलो गिलायुकः ।
Sprouts of muscle,one or more in the throat, with mild pain,causing difficulty in breathing and swallowing and with thick root, is known as Gilayuka and caused by all the doshas.

Shataghni

भूरिमांसाङ्कुरवृता तीव्रतृड्ज्वरमूर्धरुक् ॥ ५० ॥
शतघ्नी निचिता वर्तिः शतघ्नीवातिरुक्करी ।
An accumulation (elevation) like a wick (thick roll of cloth), studded with multiple sprouts of muscle tissue, accompanied with severe thirst, fever and headache and causing very severe pain like the Shataghni (a weapon used in war, a club with plenty of sharp spikes), this disease is called as Shataghni.

Galavidradhi

व्याप्तसर्वगलः शीघ्रजन्मपाको महारुजः ॥ ५१ ॥
पूतिपूयनिभस्रावी श्वयथुर्गलविद्रधिः ।
A swelling occupying the entire throat, developing and ripening quickly, having severe pain, discharge of fluid of bad smell resembling pus, is Galavidradhi.

Galarbuda

जिह्वावसाने कण्ठादावपाकं श्वयथुं मलाः ॥ ५२ ॥
जनयन्ति स्थिरं रक्तं नीरुजं तद्गलार्बुदम् |
All the doshas together produce a swelling at the root of the tongue and beginning of the throat, which does not ripen (suppurate), is static, red in color and painless.This is Galarbuda.

Galaganda

पवनश्लेष्ममेदोभिर्गलगण्डो भवेद्बहिः |
वर्धमानः स कालेन मुष्कवल्लम्बतेऽतिरुक् ॥ ५३ ॥
Galaganda arises from Vata, Kapha and Medas, outside the throat (on the sides of the neck), growing in size in course of time, it hangs like the scrotum and causes severe pain.

Galaganda

कृष्णोऽरुणो वा तोदाढ्यः स वातात्कृष्णराजिमान् ।
वृद्धस्तालुगले शोषं कुर्याच्च विरसास्यताम् ॥ ५४ ॥
If in its production Vata is predominant, the tumor is blackish or light red, has severe pricking pain and black lines on it when full grown it causes dryness of the palate and throat and bad taste in the mouth.

Galaganda

स्थिरः सवर्णः कण्डूमान् शीतस्पर्शो गुरुः कफात् ।
वृद्धस्तालुगले लेपं कुर्याच्च मधुरास्यताम् ॥ ५५ ॥
If Kapha is predominant, the tumor is static, of the same color of the skin, has itching, cold to touch, heaviness, when full grown it causes coating of the palate and the throat and sweet taste in the mouth.

Galaganda

मेदसः श्लेष्मवद्धानिवृद्ध्योः सोऽनुविधीयते ।
देहं वृद्धश्च कुरुते गले शब्दं स्वरेऽल्पताम् ॥ ५६ ॥
If medas (fat) is predominant, the tumor has features similar to that of Kapha origin, so imitates the body in its regression and development; when it grows fully gives rise to abnormal sound in the throat and less sound of the voice.

Svaraha

श्लेष्मरुद्धानिलगतिः शुष्ककण्ठो हतस्वरः ।
ताम्यन् प्रसक्तं श्वसिति येन स स्वरहाऽनिलात्॥५७॥
Movement of Vata hindered by Kapha, dryness of the throat, loss of voice, loss of consciousness and obstruction to breathing are the features of the disease Svaraha, which is caused by Vata.

Mukhapaka

करोति वदनस्यान्तर्व्रणान् सर्वसरोऽनिलः ।
सञ्चारिणोऽरुणान् रूक्षान् ओष्ठौ ताम्रौ चलत्वचौ ॥ ५८ ॥
जिह्वा शीतासहा गुर्वी स्फुटिता कण्टकाचिता ।
विवृणोति च कृच्छ्रेण मुखं पाको मुखस्य सः ॥ ५९ ॥
Vata moving throughout the interior of the mouth gives rise to ulcer which shifts from place to place, dry, make the lips coppery red and loosens the skin, the tongue, becomes intolerant to cold, feels heavy, cracked and feels as though full of thorns there is difficulty in opening the mouth this is Mukhapaka.

Urdvaguda

अधः प्रतिहतो वायुरर्शोगुल्मकफादिभिः ।
यात्यूर्ध्वं वक्त्रदौर्गन्ध्यं कुर्वन्नूर्ध्वगुदस्तु सः ॥ ६०
Vata getting obstructed in its downwards movement in the rectum by piles, abnormal tumors, Kapha etc. begins to move upwardsproducing bad smell (fecal smell) in the mouth.This is called as Urdhvaguda.

Mukhapaka due to Pitta, Rakta and Kapha

मुखस्य पित्तजे पाके दाहोषे तिक्तवक्त्रता ।
क्षारोक्षितक्षतसमा व्रणास्तद्वच्च रक्तजे ॥ ६१ ॥
कफजे मधुरास्यत्वं कण्डूमत्पिच्छिला व्रणाः ।
In Mukhapaka, caused by Pitta, there is burning sensation, feeling of heat, bitter taste in the mouth and the ulcers resembles those caused by application of caustic alkalies; that caused by Rakta (blood) is also similar in its features; in that born from Kapha, there is sweet taste in the mouth, itching and sliminess of the ulcers.

Mukhapaka due to Pitta, Rakta and Kapha

अन्तःकपोलमाश्रित्य श्यावपाण्डु कफोऽर्बुदम् ॥६२॥
कुर्यात्तद्घट्टितं छिन्नं मृदितं च विवर्धते ।
Kapha aggravated and getting localized inside the cheeks, gives rise to Arbuda (big tumor) which is blue and pale yellow in color, growing again even beating, cutting or squeezing it.

Mukhapaka due to all the doshas

मुखपाको भवेत्सास्रैः सर्वैः सर्वाकृतिर्मलैः ॥ ६३ ॥
Mukhapaka caused by all the doshas, associated with blood will have all the features together.

Putiasyata

पूत्यास्यता च तैरेव दन्तकाष्ठादिविद्विषः ।
Bad smell in the mouth is caused by doshas, due to hatred towards toothbrushes.

Enumeration of diseases

ओष्ठे गण्डे द्विजे मूले जिह्वायां तालुके गले ॥६४॥
वक्त्रे सर्वत्र चेत्युक्ताः पञ्चसप्ततिरामयाः ।
एकादशैको दश च त्रयोदश तथा च षट् ॥ ६५ ॥
अष्टावष्टादशाष्टौ च क्रमात्
Thus, were described seventy-five diseases, pertaining to the lips, cheeks, teeth, gums, tongue, palate, throat and mouth and everywhere eleven, one, ten, thirteen, six, eight, eighteen and eight respectively, in that order.

Putiasyata

तेष्वनुपक्रमाः ।
करालो मांसरक्तौष्ठावर्बुदानि जलाद्विना ॥ ६६ ॥
कच्छपस्तालुपिटिका गलौघः सुषिरो महान् ।
स्वरघ्नोर्ध्वगुदश्यावशतघ्नीवलयालसाः ॥ ६७ ॥
नाड्योष्ठकोपौ निचयाद्रक्तात्सर्वैश्च रोहिणी ।
दशने स्फुटिते दन्तभेदः पक्वोपजिह्विका ॥ ६८ ॥
गलगण्डः स्वरभ्रंशी कृच्छ्रोच्छ्वासोऽतिवत्सरः ।
Among these the following are incurable Karala (dantaroga), Mamsa-ostha, Raktaosta and Arbuda except Jalarbuda (ostha roga), Kacchapa, Talupitika (taluroga), Galaugha, Mahasushira (danta roga), Svaranghna (Gala roga), Urdhva Guda (Mukha roga), Shyava (dantaroga), Shataghni and Valaya (Kantha Roga), Alasa (Jihvaroga), Nadi (Danta Mula Roga), Oshtakopa caused by all the doshas together (Ohstharoga), Rohini caused by Rakta and by all the doshas (Kantha roga), Dantabheda (danta roga) in which the tooth has been chipped off/ cracked, Upajihvaka (Jihvaroga) which has ripened (suppurated/ulcerated) Galaganda (tumor in the sides of the neck) which has caused hoarseness, difficulty in breathing and which has persisted for many years.

Putiasyata

याप्यस्तु हर्षो भेदश्च शेषाञ्छस्त्रौषधैर्जयेत् ॥ ६९ ॥
Danta Harsa and Bheda (Dantaroga) are controllable but persist for longtime the remaining should be cured/treated by surgical and medicinal treatments.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां षष्ठे उत्तरस्थाने मुखरोगविज्ञानीयो नामैकविंशोऽध्याय: ॥१॥
Thus, ends the chapter – Mukharoga Vijnaniya – the twenty-first in Uttarasthana of Astanga Hridaya Samhita composed by Srimad Vagbhata, son of sri Vaidyapati Simhagupta.