This snuff should consist of oil in a case marked by (the concerted actions of the deranged) Kapha and Váyu, while it should consist of Vasá (lard) in a case involving the action of the Vayu alone. Similarly clarified butter should be used as a snuff in a case of a Pittaja disorder, while the snuff should consist of Majjá (marrow) in a case marked by (the concerted actions of the deranged) Váyu and Pitta. The four different modes of using snuff have thus been described in all of which oil may be used as not being hostile in its action as regards the seats of Kapha within the organism. 38.
Now we shall describe the process of using medicinal gargles (Kavala) which may be divided into four kinds, viz.: - The Snehi (oleaginous), Prasádi (soothing), Sodhi (purifying) and the Ropana (healing). The oleaginous (Snehi) gargle should be surcharged with any oleaginous substance and should be prescribed tepid in a case marked by the action of the deranged Váyu, while cold and sweet articles should be employed in preparing a soothing (Prasádi) gargle and should be prescribed in cases of the de-ranged Pitta. The purifying (Sodhana) gargles should be composed of acid, pungent and saline drugs which are parching and heat-making * in their potency and should be employed lukewarm (for corrective purposes) in diseases due to the action of the deranged Kapha. The healing (Ropana) gargles should be composed of bitter, astringent, sweet, pungent heat-making * articles and should be employed in cases of ulceration (of the mouth). The therapeutic virtues and applications of the four different kinds of gargle (Kavala) have thus been described (above). 39-40.
* Vrinda does not include 'parching while Chakradatta does not include 'heat-making' as the conditions of this kind of Kavala in their respective collections.
The neck, cheeks and the forehead of the patient to be treated with gargles should be (first) fomented and softened and he should be made to take (into his mouth) Trikatu, Vacha, mustard-seeds, Haritaki and rock-salt pasted together and dissolved in any of the follow-ing articles, viz: - oil, Sukta, Sura, alkali, (cow's) urine or honey, and made lukewarm (before use as a gargle). 41.
The quantity which can be easily and conveniently rolled out in the mouth is the proper dose in respect of a Kavala, whereas the one which cannot be so (easily and conveniently) rolled out in the mouth is called a Gandusha. 42.
A gargle (Kavala) should be so long held † in the mouth by a patient till the aggravated Dosha ‡ would accumulate in the regions of the cheeks § and would secrete copiously through the nostrils and
* Chakradatta does not include 'pungency' and 'heat-making potency' as conditions of this kind of Kavala.
† Vrinda here reads , i.e., 'and should be rolled out (in the mouth)'.
‡ "Dosha" here means 'Kapha'.
§ Vrinda reads which means till the the eyes, after which the gargle (Kavala) should be every time removed and fresh ones should be taken and kept (similarly) in the mouth. The patient should during the use of a Kavala sit in an erect posture without allowing the mind to be in the least distracted. 43.
Dosha accumulates in the regions of the throat and the cheeks.
Gargles (Kavala) should be similarly prepared with Sneha, milk, honey, curd, urine, meat-juice or Amla (Kánjika) mixed with the decoction (of any drug) or hot water prescribed according to the nature and intensity of the bodily Dosha or Doshas involved in the case. An amelioration of the disease, a sense of lightness and of purity in the mouth, a cheerful frame of mind and an exhilarating vigour in the organs of sense are the features which mark an act of perfect or satisfactory gargling (Kavala), whereas a sense of physical lassitude, salivation and a (consequent) defect in the sense of taste are the traits which mark deficient gargling. Thirst, an aversion to food, dryness of the mouth, a sense of fatigue and an inflammation of the mouth are the symptoms which attend an act of excessive gargling. These symptoms undoubtedly arise in due proportion to the nature and intensity of the corrective drugs used. 44-45.
Sesamum, Nilotpala, clarified butter, sugar, milk and honey * used as a gargle (Gandusha) alleviates the (consequent) burning sensation of a burn inside the mouth. 46.
The process of using medicinal gargles (Kavala) in general have thus been briefly described.
* Commentators, on the authority of Videha, hold that gargles should be used with these articles either collectively or separately in cases of burning in the mouth by an excessive use of an alkali or such other articles,
A Pratisárana remedy may be of four kinds, viz., that prepared with a Kalka (paste), Rasa-kriyá, honey and with powders. Prepared with the appropriate drugs, such a compound should be rubbed gently with the tip of a finger in a case of an affection of the mouth. An intelligent Physician may exercise his discretion in selecting the drugs to be used in the preparation of such a remedy. The symptoms of a satisfactory or unsatisfactory Pratisárana should be respectively identical with those of a Kavala. The ranges of therapeutic applications are also co extensive in both the cases. In other words the diseases of the mouth which yield to the use of medicinal gargles, equally prove amenable to that of Pratisárana remedies. The diet in both the cases should be composed of light and non-phlegmagogic articles of food. 47.
Thus ends the Fortieth Chapter of the Chikitsita Sthánam in the Susruta Samhita which deals with the inhalation of medicinal fumes, snuffs, and gargles.
Here ends the Chikitsita Sthanam.