Swara Bheda Nidanam – 13th Chapter Of Madhav Nidanam
Introduction
Swarabheda is a defining condition mentioned in Ayurveda that is represented by the alteration of the normal quality, tone, clarity, or strength of the voice. Swarabheda means utter alteration or disruption in natural _Swara_, such as hoarseness or roughness, weak voice, or inability to produce speech correctly. Ayurvedic texts relate Swarabheda to the involvement of and interference with the Doshas and their effect on _Svaravaha Srotas_. In _Madhava Nidana_, the Ayurvedic textbook of classical medical wisdom dedicated to the study of diseases and diagnostics, a thorough description of Swara bheda is given, which also describes its Nidana (factors of origin), Samprapti (the process of development), Lakshana (signs and symptoms), types, and prognosis. According to _Madhava Nidana_, there are six types of Swarabheda: Vataja, Pittaja, Kaphaja, Sannipataja, Kshayaja, and Medoja. The classification of Swarabheda proposed by _Madhava Nidana_ is relevant when applied to the Ayurvedic diagnosis of voice disorders.
Swara Bheda Nidana
अत्युच्चभाषणविषाध्ययनाभिघात-
सन्दूषणैः प्रकुपिताः पवनादयस्तु।
स्रोतःसु ते स्वरवहेषु गताः प्रतिष्ठां
हन्युः स्वरं भवति चापि हि षड्विधः सः॥ १॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 3)
The causative factors mentioned include: Atyuccabhāṣaṇa -Speaking very loudly or excessively ,Viṣa- Exposure to or intake of poison , Adhyayana -Excessive recitation or prolonged vocal activity ,Abhighāta – Injury or trauma affecting the throat , Sandūṣaṇa- Factors that cause vitiation or disturbance of the doshas.These factors aggravate Vata, Pitta, and Kapha. The aggravated doshas affect the Svaravaha Srotas (channels associated with voice production), resulting in changes in the voice.
Samprapti (Pathogenesis)
According to Ayurveda, Swarabh bheda develops when causative factors such as excessive speaking, speaking loudly, prolonged recitation, throat injury, and other aggravating factors cause vitiation of Vata, Pitta, and Kapha.The aggravated Doshas affect the Svaravaha Srotas (channels associated with voice production), disturbing the normal function of the voice and resulting in Swarabh eda.
Nidana Sevana (Excessive speaking, loud speech, throat injury)
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Dosha Prakopa (Vata, Pitta and Kapha)
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Svaravaha Srotas Dushti
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Disturbance of Voice Production
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Swarabheda (Alteration of voice)
Types
- Vataja Swarabh Bheda – Caused by Vata dosha.
- Pittaja Swarabh Bheda – Caused by Pitta dosha.
- Kaphaja Swarabh Bheda – Caused by Kapha dosha.
- Sannipataja Swarabh Bheda – Caused by the vitiation of all three Doshas.
- Kshayaja Swarabh Bheda – Associated with Dhatu Kshaya (tissue depletion).
- Medoja Swarabh Bheda – Associated with Meda Dhatu (adipose tissue).
Vataja Swara Bheda Lakshana
वातेन कृष्णनयनाननमूत्रवर्चा
भिन्नं शनैर्वदति गर्दभवत् खरं च ॥ २ ॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 3)
Vataja Swarabh bheda occurs due to the aggravation of Vata Dosha. According to Ayurveda, the patient may exhibit blackish discoloration of the eyes (Krishna Nayana), face (Krishna Anana), urine (Krishna Mutra), and stool (Krishna Varcha). The voice becomes broken or interrupted (Bhinna Swara), and the patient speaks slowly (Shanai Vadati). The voice is characteristically rough, harsh, and hoarse, resembling the braying of a donkey (Gardabhavat Khara Swara). These features are described in Madhava Nidana under Swarabh bheda Nidana.
Pittaja Swara Bheda Lakshana
पित्तेन पीतनयनाननमूत्रवर्चा
ब्रूयाद्गलेन स च दाहसमन्वितेन ॥२॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 4)
Pittaja Swarabh bheda occurs due to the aggravation of Pitta Dosha. According to Madhava Nidana, the patient may exhibit yellowish discoloration of the eyes (Peeta Nayana), face (Peeta Anana), urine (Peeta Mutra), and stool (Peeta Varcha). A burning sensation in the throat (Kantha Daha) is also a characteristic feature. These symptoms are traditionally attributed to the Ushna (hot) and Tikshna (sharp) qualities of aggravated Pitta Dosha, which affect the normal function of the voice and result in Swara bheda.
Kaphaja Swara Bheda Lakshana
ब्रूयात्कफेन सततं कफरुद्धकण्ठः
स्वल्पं शनैर्वदति चापि दिवा विशेषात् ॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 5)
Kaphaja Swara bheda occurs due to the aggravation of Kapha Dosha. According to Madhava Nidana, the patient experiences persistent obstruction in the throat due to Kapha (Kapha-Ruddha Kantha). The patient speaks very little (Svalpam Vadati) and slowly (Shanair Vadati). The voice becomes heavy, muffled, and unclear because of the accumulation of Kapha in the throat. The symptoms are particularly noticeable at night and are relatively relieved during the daytime, as described in the classical context. These features are traditionally attributed to the Guru (heavy), Snigdha (unctuous), and Picchila (slimy) qualities of Kapha Dosha, which interfere with normal voice production.
Kshayaja Swara Bheda Lakshana
धूप्येत वाक् क्षयकृते क्षयमाप्नुयाच्च ।
वागेष चापि हतवाक् परिवर्जनीयः ॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 6)
Kshayaja Swara bheda occurs due to Kshaya (depletion or loss of bodily tissues and strength). According to Madhava Nidana, the patient’s voice becomes weak, faint, and progressively diminished. The voice may feel as though smoke is passing through it (Dhoopyate Vak), and the patient may gradually lose the ability to speak (Hata Vak). This condition is considered serious in the classical Ayurvedic description, particularly when there is marked loss of voice.
Medoja Swara Bheda Lakshana
अन्तर्गतस्वरमलक्ष्यपदं चिरेण
मेदोऽन्वयाद्वदति दिग्धगलस्तृषार्तः ॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 6)
Medoja Swara bheda occurs due to the involvement of Meda Dhatu (adipose tissue). According to Madhava Nidana, the patient’s voice becomes deep, muffled, and unclear (Antargata Swara and Alakshya Pada), making speech difficult to understand. The patient speaks slowly (Chirena Vadati), experiences a coated or sticky sensation in the throat (Digdha Gala), and suffers from thirst (Trishnarta). These features are described in the classical Ayurvedic text as characteristic symptoms of Medoja Swara bheda.
Swara Bheda Asadhyata Lakshana
क्षीणस्य वृद्धस्य कृशस्य चापि चिरोत्थितो यस्य सहोपजातः।
मेदस्विनः सर्वसमुद्भवश्च स्वरामयो यो न स सिद्धिमेति ॥ ५ ॥ (Sushruta Samhita, UttaraTantra,Ch 53 Shloka 7)
According to Madhava Nidana, Swara bheda is considered Asadhya (difficult or incurable in the classical description) when it occurs in a debilitated person (Kshina), an elderly person (Vriddha), or an emaciated person (Krisha). A long-standing condition (Chirotthita), a voice disorder present from birth (Sahopajata), Swarabh eda occurring in an obese person (Medasvi), and the type caused by the aggravation of all three Doshas (Sarvasamudbhava or Sannipataja) are also described as having a poor prognosis. These features are traditionally considered indicators that the disease may not respond successfully to treatment.
Conclusion
As stated in the ancient text Madhava Nidana, Being afflicted with Swara bheda is said to be Asadhya or medically incurable when it occurs in weakened individuals (Kshina), the aged (Vriddha), or in thin people (Krisha). Other forms of this voice defect which are also viewed as having a poor prognosis are chronic conditions (Chirotthita), congenital voice problems (Sahopajata), Swarabh eda appearing in obese individuals (Medasvi), and cases resulting from a simultaneous dosha imbalance (Sarvasamudbhava or Sannipataja).
