Unit 32. Karṇa Racanā Śarīra, Nidāna Pañcaka and Samānya Cikitsā of Karṇaroga

Unit 32. Karṇa Racanā Śarīra, Nidāna Pañcaka and Samānya Cikitsā of Karṇaroga

A) Racanā of Karṇa (Anatomy of the Ear)

1) Classical (Āyurvedic) description

• Śrotrendriya (organ of hearing): The ear (Karṇa) is the external seat of Śrotrendriya whose viṣaya (object) is Śabda (sound). Śrotrendriya is said to be Ākāśa–pradhāna (space-dominant) and is nourished by Ākāśa Mahābhūta; its derangement expresses as defects of hearing and equilibrium.
• Karṇa–deśa (ear region) terms used in texts:
  • Karṇapālī — external auricle (pinna).
  • Karṇa–mūla — root of the ear (retro-auricular/tragal region).
  • Karṇa–srotas / Karṇa–nāḍī — external auditory canal leading to the tympanic membrane.
  • Karṇāśrita marmāṇi — important marma in the vicinity (e.g., Vidhura, Śaṅkha, Apāṅga close to ear–eye zone), whose injury leads to ṛjvā–śabda-bādha and hearing loss (traditional prognosis).

Chapter colophon incipit (Karṇaroga–Vijñānīya):
“अथातः कर्णगतरोगविज्ञानं व्याख्यास्यामः।” (Suśruta Saṃhitā, Uttara-tantra 20/1)

(This signals the start of the Karṇaroga section that classifies ear diseases and describes their nidāna–lakṣaṇa.)

2) Modern anatomical correlation

• External ear: Auricle (helix, antihelix, tragus, lobule), external auditory canal (cartilaginous outer 1/3, bony inner 2/3), lined by skin and ceruminous glands (classical karṇa-gutha correlates to impacted cerumen).
• Middle ear: Tympanic membrane, ossicles (malleus, incus, stapes), Eustachian tube (pressure equalization; dysfunction relates to pratināha in classical nosology), mastoid air cells.
• Inner ear: Cochlea (hearing), vestibule & semicircular canals (equilibrium), vestibulocochlear nerve (CN VIII). Vascular and neural proximity to facial nerve (CN VII) is clinically crucial.
• Vascular supply & lymphatics: External carotid branches (superficial temporal, posterior auricular) and deep tympanic arteries; lymphatics to pre- and post-auricular nodes — correlate with śopha (inflammations) in classics.

B) Karṇaroga: Enumeration, Nidāna Pañcaka, Classification, Sādhya–Asādhya, Pathyāpathyā, and Samānya Cikitsā

1) Enumeration / Classification (Suśruta Uttara-tantra, Karṇaroga–Vijñānīya)

Suśruta describes 28 ear diseases. The list, with practical correlations:

1. Karṇaśūla — earache (otalgia)
2. Praṇāda / Karṇanāda — ringing/noise (tinnitus)
3. Badhirya — deafness / significant hearing loss
4. Kṣveda — whistling-type noise
5. Karṇasrāva — otorrhoea (discharge/pus)
6. Karṇakaṇḍū — itching (otitis externa/dermatitis)
7. Karṇagūtha — impacted cerumen
8. Kṛmikarṇa — maggots/vermin in ear (myiasis)
9. Pratināha — block/obstruction (often post-nasal pathway/Eustachian dysfunction)
10. 10–11. Karṇavidradhi — two kinds of abscess (external/internal)

12. Karṇapāka — suppurative disease of ear
13. Puṭikarṇa — fetid ear with thick offensive discharge
14–17. Arśaḥ — four types of polypoid growths
18–24. Arbuda — seven types of tumours
25–28. Śopha — four types of swellings

Chapter colophon close:
“इति सुश्रुतसंहितायामुत्तरतन्त्रे कर्णगतरोगविज्ञानो नाम विंशोऽध्यायः।” (Suśruta Saṃhitā, Uttara-tantra 20 — colophon)

2) Samānya Nidāna (general etiological factors)

• Doṣa-prakopa:
  • Vāta — cold exposure, excessive Vātagena vyāyāma, fasting, dry astringent diet; sudden pressure changes → severe karṇaśūla, nāda, badhirya.
  • Pitta — infections, heat, trauma → karṇapāka, burning pain, reddish-yellow discharge.
  • Kapha — dampness, jalakrīḍā (water entry), day sleep, heavy–unctuous diet → karṇakaṇḍū, karṇagūtha, thick discharge.
• Kṛmi nidāna: poor hygiene → kṛmikarṇa (maggots).
• Nāsā–nāsya sambandha: Eustachian dysfunction following pratiśyāya (rhinitis) and faulty nasya can aggravate ear disorders (classical linkage of śiras–nāsa–karṇa).

Therapeutics incipit (Karṇaroga–Pratiṣedha):
“अथातः कर्णरोगप्रतिषेधं व्याख्यास्यामः।” (Suśruta Saṃhitā, Uttara-tantra 21/1)

3) Samprāpti (pathogenesis) — pattern by doṣa

• Vātaja karṇaśūla: Vāta vitiation (śoṣa–rūkṣa–śīta) in karṇa-srotas → spasmodic, stabbing pain; tinnitus, variable hearing; relief by warmth/uncting.
• Pittaja karṇasrāva/karṇapāka: Pitta with rakta → inflammation, burning pain, fever, red canal, pīta/haridrā discharge.
• Kaphaja: Heaviness, pricking itch, śveta/ghana discharge; wax impaction/edema.
• Saṃnipātaja: Mixed signs; chronicity, deformity, and variable prognosis.
• Complication channels: Pratināha (tube block), vidradhi (abscess), arśa/arbuda (granulation/polyp/tumour), śopha (cellulitis/mastoiditis).

4) Sāmānya Lakṣaṇāḥ

• Karṇaśūla — teevra (colicky) or toda (pricking) pain, worse at night, better with warmth (Vātaja); burning pain & tenderness (Pittaja); dull heavy ache with itching (Kaphaja).
• Śrava — color/consistency points doṣa: pīta-rakta (Pitta), śveta-ghana (Kapha), thin/serous with pain (Vāta).
• Nāda/Kṣveda — ringing/whistling; Badhirya — progressive hypoacusis; Kṛmikarṇa — crawling, foul smell; Arśa/Arbuda — fleshy mass, bleeding touch; Śopha — erythema/heat/pain.

5) Nidāna-Pañcaka application

• Hetu: cold water exposure, faulty pramathana of ear, dust/smoke, trauma, post-nasal infections, day sleep, heavy snigdha-guru āhāra (Kapha).
• Pūrvarūpa: ear fullness, intermittent nāda, mild ache, heaviness, pricking itch, sense of block.
• Rūpa: described above (per doṣa/disease).
• Upaśaya–Anupaśaya: warmth/uncting relieves Vātaja; cooling/antiseptic soothes Pittaja; lekhana–śodhana and dry–light diet relieve Kaphaja.
• Saṃprāpti: doṣa–duṣya–saṃmūrchanā in karṇa-srotas with āvaraṇa (obstruction) or saṅga (stasis), sometimes spreading from nāsa–kaṇṭha.

6) Sādhya–Asādhya (Prognosis)

• Sādhya: recent Vātaja karṇaśūla, simple karṇagūtha, karṇakaṇḍū, non-suppurative catarrhal conditions, early pratināha.
• Kṛcchra-sādhya: karṇasrāva/karṇapāka without bone involvement; small arśa (polyp).
• Yāpya: chronic badhirya, recurrent otorrhoea with Eustachian dysfunction.
• Asādhya: neglected/malignant arbuda, advanced mastoiditis/intracranial spread, gross congenital deafness (classically badhirya with irreversible śrotrendriya–kṣaya).

Pathyāpathyā (Diet–Regimen)

Pathya (doṣa-wise):

• Vātānulomana & snehana: warm ghṛta, warm milk with saindhava, mṛdu svedana, gentle local abhyanga (avoid force).
• Pitta-śamana: cool but not cold fluids, tikta-madhura dravyas; avoid sun/heat; local sterile cooling fomentations in acute inflammation.
• Kapha-hara: laghu, uṣṇa, kaṭu-tikta-kaṣāya āhāra; avoid day sleep; steam inhalation for naso-pharyngeal clearance (indirectly improves Eustachian function).

Apathyā:

• Cold bath/wind exposure, swimming during active disease, forceful ear cleaning, loud sound exposure, night-wakefulness (for Vāta), spicy-sour (for Pitta), heavy, curd, banana, bakery items (for Kapha), and indiscriminate nasya when ear is acutely inflamed.

Samānya Cikitsā of Karṇaroga (Step-wise)

Therapeutics incipit:
“अथातः कर्णरोगप्रतिषेधं व्याख्यास्यामः।” (Suśruta Saṃhitā, Uttara-tantra 21/1)

1) Pūrvakarma

• Doṣa-śamana through śārīra–śiro-upakrama:
  • Vātaja karṇaśūla: gentle uṣṇa snehana (sarvāṅga & periauricular), mṛdu svedana, followed by karṇa-pūraṇa with uṣṇa taila/ghṛta (see below).
  • Pittaja: śīta-upacāra; avoid oil-pouring in presence of acute pus; prefer kaṣāya-pralepa around ear, antiseptic lavage after perforation supervised.
  • Kaphaja: lekhana-upakrama — fumigation, warm dry heat, decongesting dhoomapāna (when no acute suppuration), cautious ear toileting.

2) Pradhāna–kriyā

• Karṇa-pūraṇa / Karṇa-tarpana (instillation/retention):
  • Vātaja: Saindhavādi taila, Bala-taila, warm pūrṇa ghṛta; 5–10 drops lukewarm; 1–2×/day until pain subsides.
  • Pittaja: when discharge reduces and membrane status allows, use yaṣṭimadhu-ghṛta, nimba-patra-svarasa-sahita ghṛta (coolant/ropañīya).
  • Kaphaja: Trikatu-siddha taila, Haridrā-taila after wax/debris removal; pippalī-arka diluted for decongestion.
• Śodhana (when indicated):
  • Karṇagūtha: softening with warm sesame/olive oil or bala-taila, then gentle toileting (avoid pressure).
  • Karṇavidradhi/karṇapāka: surgical drainage when abscess localizes; sterilized wicks; kaṣāya-pralepa (nimba-patra, daruharidrā) around ear; systemic dīpana-pācana.
  • Arśa/Arbuda: evaluation for kṣāra-karma, agnikarma, or modern polypectomy/biopsy as per lesion.

3) Anuśaṅga-cikitsā (adjuvants)

• Nāsya (only after pain, fever, and acute discharge settle): Anu-taila/śadbindu-taila for Eustachian clearance and prevention of pratināha.
• Gandūṣa/Kavala with yaṣṭimadhu-kaṣāya or triphala-kaṣāya to reduce oropharyngeal sepsis (source for tubo-tympanic issues).
• Dhoomapāna (kapha-vāta states without suppuration) with guggulu-haridrā based medicated smokes for decongestion.
• Rasāyana: Bhr̥ṅgarāja, Aśvagandhā, Amalaki in chronic badhirya to strengthen indriya (supportive).

4) Doṣa-wise snapshots

• Vātaja karṇaśūla: uṣṇa snehana + karṇa-pūraṇa; rasna-daśamūla-kaṣāya internal; warm fomentation; strict wind-cold avoidance.
• Pittaja karṇapāka/karṇasrāva: anti-inflammatory nimba-triphala-kaṣāya, gudūcī; local antiseptic care; dīpana-pācana (mustā, parpaṭa); avoid oils until acute phase resolves.
• Kaphaja karṇasrāva/kaṇḍū/gūtha: trikaṭu, pañkolā; steam inhalation; careful wick toileting; later karṇa-pūraṇa with light, uṣṇa taila.
• Saṃnipātaja / chronic suppurative: staged care with culture-sensitive modern antibiotics (institutional), adjuvant Āyurvedic śodhana–śamana, polyp management, and hearing rehab.

Differential diagnosis pointers

• Tinnitus (karṇanāda/pranāda) vs kṣveda: various vs whistling quality; check anemia, thyroid, drugs, and noise exposure.
• Otitis externa vs media: tragal tenderness, canal edema (external) vs tympanic signs, fever, post-URTI (media).
• Red flags (urgent referral): mastoid pain/swelling, facial palsy, vertigo with fever, severe otalgia not settling — suspect śopha/vidradhi spread.

Quick textual anchors

• Opening of classification chapter:
  “अथातः कर्णगतरोगविज्ञानं व्याख्यास्यामः।” (SS Ut. 20/1)
• Opening of therapeutics chapter:
  “अथातः कर्णरोगप्रतिषेधं व्याख्यास्यामः।” (SS Ut. 21/1)
• Colophon tags for answers:
  “…कर्णगतरोगविज्ञानो नाम विंशोऽध्यायः।” (SS Ut. 20, end)
  “…कर्णरोगप्रतिषेधो नाम एकविंशोऽध्यायः।” (SS Ut. 21, end)

(Use these to show textual grounding when writing answers; then present your doṣa-wise analysis.)

Assessment

Long Essay (10 marks)

1. Enumerate the Karṇaroga as per Suśruta and discuss the Nidāna–Pañcaka and Samprāpti of Karṇasrāva.
   Outline: 28 types; general hetu; doṣa-wise samprāpti; lakṣaṇa; upaśaya; prognosis; samānya and viśeṣa cikitsā.
2. Explain the Samānya Cikitsā of Karṇaroga with emphasis on Karṇa-pūraṇa and its indications/contraindications.
   Outline: pūrvakarma; doṣa-wise oil/ghṛta choices; when to avoid oils; role of śodhana; adjuvants (nāsya, dhoomapāna); follow-up and relapse prevention.

Short Essays (5 marks)

1. Describe Vātaja Karṇaśūla — lakṣaṇa, upaśaya and line of management.
2. Write a note on Karṇagūtha (impacted cerumen) — nidāna, lakṣaṇa, and management.
3. Discuss Kaphaja Karṇakaṇḍū — differential diagnosis and pathyāpathyā.
4. Explain Pratināha with clinical correlation to Eustachian tube dysfunction.

Short Answers (2 marks)

1. Define Karṇanāda and Kṣveda.
2. List four red flags in Karṇaroga requiring urgent referral.
3. Mention two kapha-hara kaṣāya for Karṇasrāva.
4. What is Kṛmikarṇa? Give one key sign.
5. Name four Arśa (polyp)–like lesions of the ear in Suśruta.
6. State two apathyā in acute Karṇapāka.

MCQs (1 mark each)

1. Suśruta enumerates Karṇaroga as:
   a) 18 b) 24 c) 28 d) 32
2. Karṇagūtha correlates best with:
   a) Granulation b) Impacted cerumen c) Fungal otitis d) Membrane perforation
3. Vātaja Karṇaśūla is generally relieved by:
   a) Cold applications b) Warm snehana c) Amla-rasa diet d) Day sleep
4. Puṭikarṇa indicates:
   a) Normal ear b) Fetid thick discharge c) Itching only d) Vertigo only
5. Pratināha most closely matches:
   a) Otosclerosis b) Eustachian obstruction c) Otomycosis d) Acoustic neuroma

Model viva points

• Always start with doṣa–doṣya–deśa–kāla when building Nidāna-pañcaka.
• Quote the chapter incipits/colophons to show textual anchoring, then present clinical correlations.
• In management, state when oils are avoided (acute purulent stage), and when karṇa-pūraṇa is re-introduced.