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Introduction

Good health is considered to be the root of the object of human life like Dharma, Artha, Kama Moksha. Health does not mean merely absence of disease, but it is physical mental, social as spiritual wellbeing of person. Ayurveda is the most ancient, holy and divine science of life which has been preserved, developed and now being globalized. Sanskrit meaning of Ayurveda is Ayu means life and veda means science or knowledge. Ayurveda is person centered medicine which deals with healthy lifestyle, health promotion, disease prevention diagnosis and treatment. Kaumaarbhritya is one of the branches of Ayurved which deals with Bharan(nutrition), poshan, Dhatri, Kshirdosh and its treatment. It deals with pediatric age population. Tundekeri means Shotha(inflammation). In ayurveda it resembles cotton fruit. The symptoms of Tundekeri is more like Tonsillitis. Tonsillitis is a common illness in childhood. It develops in children due to exposure to bacterial and viral infection. Any infection in growing child hampers child’s immune system and gradually growth and development. So, it is important to diagnose any infection early so we can treat it and avoid complications due to the respective disease. Tundekeri shows the symptoms of pain in throat, dysphagia, swelling of tonsils. If these symptoms are treated in time, we can avoid further suppurative tonsillitis and enlargement of tonsils. Enlargement of tonsils results in obstruction to airway and gastrointestinal tract. This obstruction hampers a child’s respiratory function and diet of child. This ultimately hampers the child’s health.

Acute tonsillitis: Tonsillitis has recurrent attacks. If there is enlargement of tonsils to the extent which hampers respiratory and other systems, we have to do surgical excision of tonsils. i.e Tonsillectomy. So, to avoid this operative procedure we should diagnose and treat it carefully early. Acute tonsillitis is one of the most common infections in everyday practice. Tundekeri (Tonsillitis) is a highly prevalent disease in pediatric age from 5 to 15 years. Tonsillitis is an infection of tonsils, which are situated in the lateral wall of oropharynx and superolateral to posterior one third of the tongue. In acute tonsillitis tonsils may be enlarged. Symptoms are soaring throat, difficulty in swallowing, congestion. Tonsils are part of the immune system, which protects and helps the body to fight infections. Tonsils aid the body in fighting diseases and infections in children. Tonsil tissue can become diseased after recurrent infections. After this they lose their effectiveness in helping the immune system. Tonsillitis begins in early childhood and prevalence rate is 9-17% in child aged 3-11 years. If tonsillitis is treated in time, it’s good thing, because recurrent attack of tonsillitis makes the disease chronic and vulnerable. It leads to various health hazards like acute otitis media, rheumatic fever, rheumatic heart disease, quinsy, laryngeal oedema, and systemic complications.

Ayurvedic review: Tundekeri in Ayurveda is included in Mukha Rogas. Acharya Sushrut has described Mukharogas in Nidansthan, in Mukharoganidaan adhyaya. He has told 65 types of mukharogas. Mukhrogas have seven ayatan (sthan) Oshtha,Dantmula, Dant, Jivha, Talu, Kanth, Samagra mukha.

TUNDIKERI:

Derivation: Tundi - this word is derived from the root “Tung” which means “Beak” and then it is suffixed from “Ana” which gives rise to the present word “Tundi”. The meaning of Tundi being Beak, Snout, Bimbi, Cotton herb, swelling of umbilicus.

Meaning: Tundikeri means Vana Karpas Phala (Gossypium herbacium Linn.).

The disease or the Shotha, which resembles like that of cotton fruit.

Tundekeri is disease described under Talugat and Kanthgat rogas.Talu and Kanth are parts of Mukha.Ther is no refrence of specific hetus for Tundekri.So samanya Nidaan of Mukha Rogas can be taken in this context. Samanya Nidaan of Mukha Rogas are as follows.

Aaharaja Nidana: Excessive ingestion of Matsya (fish), Mahisha Mamsa (buffalo's meat), Varaha Mamsa (pig's meat), Amalaka, Mulakam (raw radish), Masha (black gram), Dadhi (curd), Kshira (milk), Shukta, Ikshurasa (sugarcane juice), and Phanita.41 Majority of these food articles have the dominancy of Madhura Rasa or Amla Rasa. So, these cause the vitiation of Kapha and Pitta which results in the vitiation of Rakta and hence the occurrence of the disease.

Viharaja Nidana: Excessive indulgence in Avak Shayya (sleeping in prone position), Dwishato Dantadhavana (improper dental hygiene), Dhuma (improper Dhumapana), Chhardana (improper vomitting), Gandusha (improper gargling), Siravyadha (improper venesection) causes Prakopa of Kaphapradhana Dosha and it results in the occurrence of many disorders of the mouth (Mukha Roga).

Purvaroopa: Purvaroopa of the Tundikeri is not clearly mentioned in Ayurvedic classics. Tundikeri is a disease characterized by Shotha, so premonitory symptoms of Shotha can be considered here i.e. mild pain, mild burning sensation with mild swelling and increase in local temperature.

Lakshanas(Roop): According to Acharya Vagbhata, Tundikeri is located in Hanusandhi Ashrit Kanth(root of the temperomandibular joint).It has the shape of Karpasiphala . It is Pichchhila (Slimy), Manda Ruk (Mild pain) and a firm swelling. According to Acharya Sushruta Tundikeri is the disease caused by the vitiation of Kapha and Rakta and characterized by Shotha (swelling), Toda (pricking type of pain), Daha (burning sensation), Prapaka (Suppuration). Acharya Sushrut included Tundekeri in Talugat rogas. He has described 8 types of Talugat rogas. Tundekeri is caused due to rakt and kaph prakop. Acharya Vagbhat has described Tundekeri as kanthgat roga. He has described lakshanas of Tundekeri as Shotha resembling karpasa phala, Toda, Ragavata, Galoparodha, Asyavairasya.    

Samprapti: Due to intake of excessive Madhura, Amla, Lavana Rasa Ahara, Snigdha, Abhishyandi Ahara, improper oral hygiene, due to improper dental hygiene or on sleeping in prone position leads to cause Agnimandya, Kaphadosha Prakopa, and Rakta Dushti. This leads to Sthana Samshraya of Doshas in Talu or Kantha Pradesha which lead to disease Tundikeri. Excessive consumption of Madhura, Amla, Lavana Rasa dominant Ahara, Snigdha, Abhishyandi Ahara, poor oral hygiene, or sleeping in a prone position all contribute to Agnimandya, Kaphadosha Prakopa, and Rakta Dushti. This leads to the Sthana Sanshraya of Doshas in Talu or Kantha Pradesha, which then leads to the Tundikeri roga.

Tundikeri Sampraptighataka:

Dosha: Kapha Rakta (According to Acharya Sushrut) Kapha (According to Acharya Vagbhat)

Dushya: Rasa, Rakta, Mamsa

Srotasa: Rasavaha, Raktavaha,Mamsavaha

Agni: Jatharagni, Dhatvagni Mandya

Srotodushti: Sanga

Roga Marga: Bahya

Udbhava Sthana: Amashaya

Adhisthana: Mukha, Hanusandhi

Vyaktisthana: Talu or Kantha

Kriyakala:

1. Samchaya: Due to excessive indulgence of Nidana, Kaphadosha gets vitiated. The vitiation is in the form of quantitative increase. Some general symptoms like Alasya, Manda Shotha at the place of Talu may be seen. A wise physician can probably infer the future disease and give appropriate treatment to arrest further vitiation of Doshas.
2. Prakopa: The severity of the disease is increased, and the patient may complaint of irritation and pricking sensation in Mukha Pradesha. He may also have Annadvesha. Quick diagnosis and treatment may prevent the occurrence of Tundikeri.
3. Prasara: Prasara means to spread. There is more pain in Talu region, and the patient may have difficulty in swallowing.
4. Sthana Samshraya: The Doshas which are vitiated now move along the Srotas and there is Srotorodha seen. Prodromal symptoms of the disease are seen here. There is Daha (burning sensation), Toda and Prapaka at the area of Talu or Kantha.
5. Vyakta Avastha: The disease is well established and all the symptoms of Tundikeri are seen. The swelling is Karpasaphala Sannibha, there are Toda, Daha, Pichchhila Srava and difficulty in swallowing. Patients also have complaints of weakness of body, anorexia and may have fever. A proper management at this stage can completely cure the disease.
6. Bheda Avastha: The disease becomes chronic. There is Kathina Shopha (enlarged hardened swelling), unpleasant taste, bad smell in mouth (halitosis), difficulty in swallowing and change in voice may be seen in the patient who has neglected the disease till now.

CHIKITSA: (Treatment of Tundikeri):

According to Acharya Sushrut: Acharya Sushruta, gives the general guideline for the treatment of Tundikeri that Tundikeri should be treated as per the line of treatment of the disease Galashundika. The treatments advocated by Acharya Sushruta are both surgical Bhedana (Incision) and Chhedana (Excision)

According to Acharya Charaka:

1. Dhumapana, Pradhamana, Nasya, Virechana, Vamana, Lekhana are indicated.
2. Snehana, Swedana, Vamana, Virecana, Ghritapana, Dhumapana, Kavalagraha, Abhyanga, Pradhamana Nasya can be administered.
3. Gargling (Kavala or Gandusha) with Triphala, Trikatu, Chitraka, Patha, Nimba, Shukta and Gomutra. Sharangadhara in Uttara Khanda has mentioned Gandusha, Kavala, and Pratisarana as remedial measures for Gala Rogas.
4. Pratisarana with Patha, Haridra, Katuki and Musta. Specific treatment for Tundikeri.
5. Acharya Vagbhata has instructed that Tundikeri has to be treated on the line of Shlesmaja Rohini, which is as follows:

• Raktamokshana
• Nasya with Tikshna Drugs
• Gandusha with Tikshna Drugs
• Kwatha of Bark (Twak) of Daruharidra, Nimba, Rasanjana, Indrayava.

Thus, the Chikitsa of Tundikeri can be done in two ways:

(1) Ashastrakrita (Non-surgical) - Pratisarana, Kavala, Gandusha.

(2) Shastrakrita (Surgical) - Rakta Mokshana, Chhedana, Bhedana.

Sadhyasadhyata:

Acharya Vagbhat- Acharya has said Tundekeri as Sadhya roga.

Acharya Sushrut- Acharya has said Tundekeri as Talugat roga.He have described only Talu Arbud among Talugat rogas as Asadhya.So Tundekeri is Sadhya roga.

None other Acharya have later said that Tundekeri is Asadhya roga.So Tundekeri is Sadhya Roga.

Pathyapathya:

According to Yogaratnakara Pathya-Apathya are as follows:

Pathya:

Ahara: Trinadhanya, Yava, Mudga, Kulattha, Jangala Mamsa Rasa, Karvellaka, Patola, Karpurajala, Ushna Jala, Tambula, Khadira, Ghrita and Katu Tikta Dravya.

Vihara: Swedana, Virecana, Vamana, Gandusha, Pratisarana, Kavala, Raktamokshana, Nasya, Dhumapana, Shashtra and Agnikarama.

Apathya:

Ahara: Amla Rasa Dravyas, Abhishyandi Ahara, Matsya, Dadhi, Kshira, Guda, Masha, Ruksha Kathina Padartha Sevana, Guru Ahara.

Vihara: Diwaswapna, use of Shitala Jala, Adhomukha Shayana, and Snana.

Discussion

The classification of Mukha Rogas has been done either based on involvement of Doshas or based on the site of occurrence of the diseases. Now a days in this changing lifestyle and changing dietary habits the most thing affected badly is the immunity of the child. In this century for survival man is neglecting his own health and well-being. He has to face polluted air, polluted water, pollute environment, low immunity of host factors, use of many antibiotics, ecological consideration, faulty dietary habits which contribute to variety of throat problem where tonsil are common site of infection that give rise to Acute Tonsillitis. Now the available conservative treatment are antimicrobials, analgesic, and anti-inflammatory drugs. This accounts for a large proportion of health care costs. But these drugs have limitations and side effects. Due to recurrent attacks, it causes recently appearing drug resistance bacteria and is major clinical problem. So, it is necessary to find an economical cheap, safe, better effect therapy for tonsillitis.

Usually, it manifests because of respiratory gram-positive cocci e.g. Streptococcus, Pneumococcus etc. and viral infections. Such repeated infections lower the immunity of the patient. Acharya Vagbhat has described the implement of Kawal treatment in kanthgat rogas. According to Bhavprakash Dadimphaltwak kawal has tridoshaghna and kanthgat rogaghna properties. So, it is beneficial in Tonsillitis (tundekeri). Acharya Sushruta advised surgical management in tonsillitis, while Acharya Vagbhata advised conservative treatment on tonsillitis which mainly includes Nasya, Pratisaran, Gandush etc. Recurrent attacks of diseases like tonsillitis affect the normal growth and development of a child and may lead to various health hazards. Tonsillectomy puts a straightforward attack on Respiratory and Gastrointestinal tract. Tonsils are the sentinels of the oral cavity. Antibiotics does not check the recurrence as well as chronicity of the disease.

Conclusion

Tonsillitis is common in children and young adults. Tonsillitis can be correlated with Tundikeri on the basis of classical symptomatology in Ayurvedic texts. Tonsillitis is very common in children and adolescents. Tonsillitis is caused by Kapha prakopa, Agnimandya, and Rakta dushti. In Tonsillitis, avoid all Kapha Rakta pakopaka and Agnimandya karak aahar vihar. Tundikeri can be cured with proper treatment, a healthy diet, and good oral hygiene, which reduces the need for tonsillectomies.

Tonsillitis has a negative impact on growth. Tundikeri can be cured with proper treatment, a healthy diet, and good oral hygiene, reducing the need for tonsillectomies.