Mouth

Part of: Eyes, ears, nose and mouth

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कोरोना के समय स्वाद चला जाये तो क्या करें? By BK Dr. Diwakar Shukla

Self treatment

Mouth Shukla

From The Fire and the Ash

The tongue and the curd

Lines and a coating on the tongue; milk vomited as milk or as curd

THE METHOD, STEP BY STEP

The tongue test

The saying to keep in mind: the face is the reflection of the mind; the tongue is the mirror of the intestines.

Position. Seated The patient faces a window or a lamp so the light falls into the mouth. Ask her to put the tongue right out and hold it out — not to say aah, which curls the back of it out of sight.

1. Look for lines — small or large scratches or lines on the tongue: some fine and running across, some a single deep furrow down the middle, some a cracked pattern over the whole surface.

2. What it means. Lines on the tongue indicate that inside the intestines too there will be such scratches — on account of which they cannot absorb nutrients properly. A level two finding: absorption, not acid.

3. Look also for a coating — a white layer-like coating, clearest first thing in the morning, clearest of all in a child about to run a fever, coming together with hunger not being felt. Look before anything is eaten or drunk, and before tooth-cleaning, if you can arrange it.

4. Write what you see, not what you conclude. Tongue — deep central line, white coating is a record; poor absorption is an opinion, and next month you will want to know which of the two you had.

THE METHOD, STEP BY STEP

The curd test — for a small child

You do not perform this one. You ask it — of the mother, in these words.

The question: "When the child vomits after drinking milk, does the milk come out as milk — or as curd?"

The reading:

If it comes out having become curd — दही — the milk reached a stomach that was making its acid. That is what acid does to milk.

If the milk comes out as milk, then it means hydrochloric acid is not being made in the child's stomach — otherwise the milk would not have come out as milk; it would have come out having become curd. This means the child has UDF.

And what follows. For acid to be made properly, histamine, acetylcholine and gastrin are required. So a milk-as-milk answer means one of those three, or all of them, are not working properly.

▲ Take care Ask the question; never ask a mother to produce the observation — no over-feeding, no laying a baby down after a feed. And a baby who vomits forcefully and repeatedly, who is not gaining weight, who brings up anything green or blood-stained, or who has become floppy or hard to rouse, is a doctor's problem the same day.

From Seated II — Face, Jaw, Ear, Sinus

Teeth Points — दांतों के दर्द के लिए पॉइंट्स

This treatment is to be taught to the patient, and tell them to press and release at the points shown in the figure.

For the upper teeth, press at the points above the ear and below the eyes. To find the point above the ear, tell the patient to clench their teeth; at that moment, placing the hand above the temple, the muscles will be felt moving at one place. Wherever pain is felt there, press at that place and do clockwise.

For the lower teeth, at the points below the chin and below the jaws, wherever pain is felt, stroke in the direction of the clock's hand at that place.

Treat on the same side as the side on which the teeth hurt.

Doing it on and off through the day, rather than continuously, will bring relief sooner.

Patient's position	Seated; the treatment is taught to the patient to do themselves Seated
Where the hands are placed	Upper teeth: the point above the ear — found by asking the patient to clench the teeth and feeling where the muscles move — and the point below the eyes. Lower teeth: below the chin and below the jaws. Wherever pain is felt
Duration and repetitions	Press and release, then clockwise; no count is given. Doing it on and off through the day, rather than continuously, will bring relief sooner
What it is for	Pain of the teeth — upper and lower separately, on the same side as the side on which the teeth hurt Left Right

This is a point you give away, so the teaching of it is the treatment.

What lies beneath. The bunch that rises when the jaw clenches is the fan-shaped muscle of the temple; below the cheekbone is the thick slab doing the same work from the other direction. Both are run by the lower division of the great nerve of the face — the same division that carries sensation from the lower teeth — while the upper teeth are served by the division above it. Hence something a therapist meets constantly: pain from a clenching jaw muscle is very commonly reported as toothache.

From Cranial Nerve and Brain Formulas

The face and the mouth

Eight doors into one list: what the face feels, and what the face does

The longest table in the formulary runs across four pages. It is set out here in eight groups, so that a therapist can find a row in the time a patient takes to describe a complaint. Nothing has been left out and nothing has been combined; the groups are only doors into one list.

Table 9 — Swallowing Seated × 3

Point or condition	Treatment
For swallowing — to take the bolus, the mouthful, backwards	(5) Medulla
For swallowing — to open and close the epiglottis, by way of the cricothyroid and arytenoid muscles	(10) Medulla
For swallowing — for the muscles of the tongue	(12) Medulla
To close the epiglottis	(9) Medulla
To remove a problem in swallowing — in swallowing food	(9) Medulla
To remove difficulty in swallowing — because of narrowing of the food pipe	(10) Medulla * Left
To open the oesophagus — the food pipe — if it has contracted	(10) Medulla * Left

Two instructions decide between the two commonest rows of that group, and they are worth learning as a pair, because they are a diagnosis made from one extra question:

Key teaching

Which nerve, when swallowing is hard

If, with difficulty in swallowing, taste does not come — that will be put right by (9) Medulla.

But if, with difficulty in swallowing, the voice is heavy — that will be put right by (10) Medulla.

One complaint, two answers, and the question that separates them takes four seconds: and how is your taste? and how is your voice?

Behind it: cranial nerves 5, 9, 10, 11 and 12 together look after the work of swallowing, and the motor impulses that cause swallowing are transmitted by the 5th, 9th, 10th and 12th. The larynx and the pharynx are both controlled by cranial nerves 10 and 11, while the pharynx is also controlled by cranial 9. Both of those organs are necessary for swallowing food and for the voice to come out correctly.

Table 10 — The voice and the larynx

Point or condition	Treatment
To bring back a voice that has gone	(12) Medulla
To correct a heavy voice — thick speech	(12) Medulla
To bring sweetness into the voice	(10) Medulla
To remove hoarseness — roughness — in the voice	(10) Medulla
To remove difficulty in speaking — to widen the larynx, the voice-box, by way of the left vagus	(10) Medulla * Left
The muscles of the larynx	(10) Medulla
The mucous membrane of the larynx	(10) Medulla
Contraction of the muscles of the pharynx and larynx	(10), (11) Medulla
It contracts the smooth muscles of the trachea and bronchi — for bronchitis	(10) Medulla

Table 11 — The face

Point or condition	Treatment
Paralysis of one side of the face	(7) Medulla
The expressions of the face, by which a person's face contracts or lights up according to the emotions	(7) Medulla — and this should be used in Parkinson's disease
The mouth turning towards the good side — as happens in Bell's palsy	(7) Medulla
The mouth becoming crooked, in which all the muscles of one side are paralysed	(7) Medulla
Not being able to whistle	(7) Medulla
Silhouette or wrinkles not appearing on the forehead or the eyebrow	(7) Medulla
Pain on the face, or the sensation or absence of sensation	(5) Medulla
Pain on the temple, or the sensation or absence of sensation	(5) Medulla
Pain in the eyebrow, or no sensation there	(5) Medulla
Trigeminal neuralgia	(5) Medulla
Problem in the cheekbone	(5) Medulla
The skin and mucous membrane of the cheeks	(5) Medulla

Notice what that table does with one face. Everything that the face feels is the fifth. Everything the face does is the seventh. Sensation and movement, two nerves, side by side over the same cheek. When a patient's face droops but she can still feel your finger on it, you are looking at the seventh; when she feels nothing but the face moves normally, you are looking at the fifth.

Table 12 — The jaw, the teeth and the gums

Point or condition	Treatment
Problems of the muscles of chewing	(5) Medulla
For every problem of the teeth	(5) Medulla
Problems of the gums	(5) Medulla
Problems of the lips	(5) Medulla
The soft part inside the jaw	(5) Medulla
Problems of the muscles of the jaw — from the motor root not working	(5) Medulla
The jaw turning towards the paralysed side, and the patient not being able to chew properly	(5) Medulla
Problem of the upper or lower part of the jaw	(7) Medulla

Table 13 — The tongue, the mouth and taste

Point or condition	Treatment
The mucous membrane of the front two-thirds of the tongue	(5) Medulla
Not experiencing sensation in the tongue	(5) Medulla
Not experiencing pain or touch sensation on the mouth	(5) Medulla
Movement of the muscles of the tongue	(12) Medulla
Paralysis of one side of the tongue — the tongue repeatedly going to one side	(12) Medulla #
Problems of the palate inside the mouth	(5), (9) Medulla
Contraction of the muscles of the palate	(10) Medulla
Taste — the posterior third of the tongue	(9) Medulla
The experience of taste — the chorda tympani	(7) Medulla
The experience of taste — from the front two-thirds of the tongue	(7) Medulla

Table 14 — Saliva

Point or condition	Treatment
If the mouth has gone dry — to bring saliva	(7), (9) Medulla
To increase saliva — from the parotid glands	(9) Medulla
To increase saliva — from the sublingual and submaxillary glands	(7) Medulla
The salivary glands — the visceral motor nerve	(7) Medulla

Ptyalin is found in greater quantity in the saliva of the parotid glands. And it is the 9th cranial nerve that stimulates the parotid glands, not the seventh. That sentence is printed as a footnote, and it is a correction — the kind of small, exact self-correction that tells you somebody checked.

Table 15 — The pharynx and the tonsils

Point or condition	Treatment
Control of the muscles of the pharynx	(9) Medulla
The mucous membrane of the pharynx	(9) Medulla
Sensation from the pharynx	(7), (9) Medulla
To stimulate the nerves of the tonsils	(9) Medulla

Table 16 — The blood pressure and the carotid sensors

Point or condition	Treatment
Control of BP by the nerves of Hering	(9) Medulla
Control of BP — by way of the carotid sinus	(9) Medulla
Problems of the carotid arteries and the carotid bodies	(9) Medulla

Two marks travel with the face-and-mouth list and must be carried wherever a row from it is copied onto a card:

DID YOU KNOW?

The swallow: five nerves, one second, and a lid

Swallowing is the most finely timed thing the body does without being asked. The first part is voluntary — the tongue gathers the food into a ball and pushes it to the back of the mouth. The moment it touches the back of the throat, control is handed over completely and cannot be taken back.

What happens next takes less than a second. The soft palate lifts to seal the nose. The vocal cords shut. Breathing stops. The voice-box is pulled up and forward so that the epiglottis, a leaf of cartilage, tips back over the airway like a lid. The gullet's top ring relaxes. The throat squeezes the ball down past the sealed airway, and breathing resumes.

Five cranial nerves are involved, and the index above assigns each step to the nerve that performs it: the ball going backward to the fifth, the tongue muscles to the twelfth, the throat muscles and the closing lid to the ninth, the lid's opening and closing by the voice-box muscles to the tenth. It is not a loose list. It is a reflex taken apart.

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