JIHVA ARSHAS (TONGUE NODULES)

🔺 CASE STUDY: JIHVA ARSHAS (TONGUE NODULES)

🔺 NIDANAM (CAUSES)

(References: Suśruta Saṃhitā Uttara Tantra 21, Ashtanga Hṛdaya)

• Ati guru, ati rukṣa, kaṣāya ahāra

• Viruddha ahāra (incompatible food combinations)

• Adhyaśana (eating before previous food is digested)

• Kapha-Pitta vitiating ahāra-vihāra

• Overuse of speech (excessive talking, shouting)

• Smoking, chewing irritants or spicy substances

🔺 PURVAROOPAM (PRODROMAL SYMPTOMS)

• Soreness or burning sensation in tongue

• Mild swelling or stiffness of the tongue

• Loss of taste (Rasanā hāni)

• Increased salivation or mucous coating

🔺 LAKSHANA (SYMPTOMS)
(Ref: Suśruta Saṃhitā Uttara Tantra 21)

• Granthi (nodule-like swelling) on tongue

• Vedanā (pain) while talking or eating

• Sometimes Raktasrāva (bleeding)

• Difficulty in chewing and swallowing

• Varied color of the lesion — reddish, bluish or whitish

• May resemble Arbuda or Granthi if large or chronic

🔺 GENERAL AND SYSTEMIC EXAMINATION

• Vitals: Pulse, BP, respiratory rate, temperature

• Nutrition: Check for signs of malnutrition or anemia

• Hydration: Dry tongue suggests dehydration

• Oral Hygiene: Halitosis, plaques, coating

• Head & Neck:

  • Lymph node palpation (submandibular/cervical)

  • Salivary gland palpation

• ENT Exam:

  • Inspection of oral cavity with tongue depressor

  • Mobility of tongue, ulcer, pain on movement

• GIT Evaluation:

  • Rule out chronic constipation or systemic cause

  • Liver pathology correlation (as per Ayurvedic association of Arśas)

🔺 LABORATORY INVESTIGATIONS

• CBC: Anemia or infection

• ESR/CRP: Inflammation marker

• Blood Sugar: To rule out diabetes mellitus

• Oral Swab/Culture: To rule out bacterial/fungal cause

• Biopsy: If lesion appears suspicious of malignancy

• Serology: HIV/Syphilis if chronic, non-healing ulcer

• Liver & Renal Function Tests: If systemic disease suspected

🔺 DIFFERENTIAL DIAGNOSIS (DD)

• Oral squamous cell carcinoma

• Leukoplakia

• Aphthous ulcer

• Oral lichen planus

• Oral candidiasis

• Traumatic fibroma

• Tuberculous ulcer

• Syphilitic ulcer

• Pyogenic granuloma

• Hemangioma

🔺 SAMPRAPTI (PATHOGENESIS)

• Nidana leads to vitiation of Kapha and Rakta

• Localized dushti in Jihvā leads to Granthi/Arśas formation

• In chronic cases, can resemble Arbuda (tumor)

• Associated with Māṃsa vriddhi and Raktadushti

• Dosha Involved: Kapha + Rakta + sometimes Pitta

Samprapti Ghataka:

• Dosha: Kapha, Rakta, Pitta (if burning/bleeding)

• Dushya: Rasa, Rakta, Māṃsa

• Adhisthāna: Jihvā (tongue)

• Srotas: Rasavaha, Raktavaha

• Roga Mārga: Bāhya

🔺 SAMANYA CIKITSA (GENERAL LINE OF TREATMENT)

• Kapha-Pitta hara chikitsa

• Langhana (light diet) to reduce dosha load

• Deepana – Pachana drugs: Trikatu, Chitraka, Panchakola

• Kaphahara dravyas: Vacha, Haridra, Shunthi

• Raktaprasadana and Raktashodhana:

  • Manjishtha, Sariva, Guduchi, Usheera

🔺 UPASHAYA (PALLIATIVE FACTORS)

• Use of Tikta and Katu rasa herbs

• Mild lepa with Haridra, Triphala, Gairika

• Warm, soothing herbal gargles (Kavala, Gandusha)

• Avoid irritants and rest to voice

🔺 ANUPASHAYA (AGGRAVATING FACTORS)

• Guru, snigdha, madhura ahāra

• Cold food and beverages

• Excessive talking or shouting

• Use of tobacco, smoking

• Viruddha āhāra

🔺 VISESA CIKITSĀ (SPECIFIC MANAGEMENT)
(References: Suśruta Uttara Tantra 21, Chikitsa Sthāna)

Local Therapies (Lepa / Pratisarana):

• Haridra + Triphala + Madhu

• Yashtimadhu + Gairika chūrṇa

• Lodhra + Daru Haridra paste

Kavaladhāraṇa (Holding Medicated Liquids):

• Triphala kaṣāya

• Arimedādi taila

• Madhuyashti siddha jala

Oral Internal Medicines:

• Kaishora Guggulu – granthi, Rakta-Pitta shamaka

• Gandhaka Rasāyana – chronic ulcers/granthis

• Punarnavādi Kaṣāya – if inflammation/shotha present

Surgical / Para-surgical Measures (if large growth):

• Excision of the Granthi (as per Suśruta)

• Agni Karma or Kṣāra Karma in chronic nodular cases