Kantha Roga, Talu Roga and Jihva Roga: Sushruta Samhita's Throat, Palate and Tongue Diseases (Nidana Sthana 16)

📖 24 min read · Classical source: Sushruta Samhita, Nidana Sthana, Chapter XVI, verses 26–72 · Kaviraj Kunjalal Bhishagratna's English translation, Volume II, Calcutta, 1911

Where this half of Nidana Sthana 16 begins

The Nidana Sthana is the diagnostic section of the Sushruta Samhita — sixteen chapters that describe how disorders arise, what they look like, and how they are told apart. It is the section that classifies rather than the section that operates. Its sixteenth and final chapter, Mukha Roga Nidana, is given over entirely to the mouth, and it is the longest single catalogue in the whole division.

Sushruta divides the mouth by site rather than by cause. Seven regions are counted: the lips (oshtha), the roots of the teeth (danta-mula), the teeth themselves (danta), the tongue (jihva), the palate (talu), the throat (kantha), and the whole cavity taken together (sarvasara). Add the sub-totals and you get sixty-five disorders. That census, along with the lips, the gums and the first of the dental entries, belongs to the earlier part of the chapter and is read in detail in our companion article on mukha roga and the sixty-five diseases of the mouth.

This article picks the chapter up mid-sentence, at verse 26, where the dental list is still running. From there it goes inward and downward: the last four dental entries, then the tongue at verse 34, the palate at verse 38, the throat at verse 48, and the whole cavity at verse 68. The chapter — and with it the entire Nidana Sthana — closes at verse 72.

It is worth saying plainly what kind of writing this is. There is no therapy here. Nidana means the determination of a disorder: its origin, its site, its appearance, and whether it can be dealt with at all. What is in front of us is a naming system, and it is being read here as intellectual history — the way one would read a mediaeval herbal.

The chapter counts by merging, not by listing

Read the second half of the chapter with a pencil and you will find yourself disagreeing with it three separate times. Each disagreement resolves the same way, and the pattern is worth stating before the details arrive, because it explains almost everything strange about the chapter's arithmetic.

First. Verse 48 announces that the disorders of the throat and larynx "are seventeen in number" and then names them. Count the names as they are printed and you get eighteen, because Eka-Vrinda and Vrinda are given separately. The translator noticed, and put the problem in a footnote rather than quietly fixing the count.

Second. Verse 38 announces the disorders of the palate and gives eight names. But the descriptions that follow, in verses 39 to 47, describe nine — Talu-Pupputa is fully described and is not in the announcement list.

Third. Verse 68 says the disorders of the whole cavity may be Vataja, Pittaja, Kaphaja or Raktaja — four. Then verse 72 says the Raktaja variety "is nothing but a modification of the Pittaja one." Four names, three entries.

This is not sloppiness, and it is not a scribal accident, because it happens three times in seven pages and each time the text says out loud what it is doing. It is a deliberate distinction between a name and a countable entity — and it is a distinction that any working classification system eventually has to make.

Three heaps, one rule: a variant is a state, not a new entry.

Sharkara and Kapalika: a deposit tracked through stages

The dental list is still running when this half of the chapter opens, and its last entries are the most mechanically described in the whole mouth. Two of them are worth slowing down over.

Sharkara. The text describes sordes forming on the teeth and then hardening, under the influence of aggravated Vayu, until they "lie in a crystallised form at the roots of the teeth." The English translation glosses the term as tartar. Sushruta adds that such deposits "tend to destroy the healthy growth and functions of the teeth" — the deposit is not merely present, it is doing something over time.

Kapalika. This is the entry that repays attention. Sushruta does not describe a new lesion; he describes what happens next to the previous one. "The preceding crystallised deposits get cemented together and afterwards separate from the teeth taking away a part of their coating," which the translator glosses as enamel. The deposit consolidates, detaches, and takes surface with it as it goes.

The nidana assigned to Sharkara is aggravated Vayu; the mechanism of Kapalika follows from it directly. Neither entry carries a therapy, and neither is presented as common or rare. They are simply two adjacent squares in a grid that Sushruta is filling in region by region.

Sharkara hardens; Kapalika is what happens next.

Shyava-Dantaka and Hanu-Moksha: where danta roga closes

Shyava-Dantaka closes the colour entries. The teeth, "variously scorched by the action of the deranged Pittam," take on a blackish or blue colour. The Sanskrit shyava covers a dark, dusky, blue-brown range, and the causal assignment to Pitta is consistent with how the text handles discolouration everywhere else — heat-natured change is Pitta's department throughout the Samhita.

Hanu-Moksha is the odd one out, and the last dental entry in the chapter. It is a dislocation of the jawbones, and what makes it memorable is its list of causes. Not a constitutional derangement arriving from nowhere, but three perfectly ordinary acts: "loud talking, chewing of hard substances, or immoderate yawning." Vayu is aggravated by these, and the jaw gives way.

Then the text does something it will do repeatedly over the next few pages. Rather than describe the presentation, it says Hanu-Moksha "is identical with Ardditam as regards its symptoms" — and stops. Ardita is a disorder of Vata handled elsewhere in the classical corpus, and readers who want that description are expected to go and find it. The nature of Vata itself is set out in our article on Vatakalakaliya, Charaka Samhita Sutrasthana 12.

Jihva roga: the five diseases of the tongue

Verse 34 opens a new region and does so with a count: "The five kinds of diseases which affect the organ of taste." Note the phrasing — the tongue is introduced not as an anatomical part but by its function. Sushruta names it as the organ of taste and then proceeds to describe things that happen to it.

The five are: three Kantakas, one for each dosha; Alasa; and Upajihvika. This is the shortest of the regional lists in the chapter and the only one whose count is not disputed anywhere on the page — five announced, five described, no footnote required.

It is also the only region where a single name is subdivided by dosha rather than being given three separate names. Elsewhere in this chapter each disorder gets its own label; here, Kantaka is one label wearing three faces. The section on Rohini later does the same thing with five faces, and those two are the only places in the second half of the chapter where the doshic subdivision is made explicit in the naming.

The three Kantakas: one name, three doshas

Kantaka means a thorn or a prickle, and the name is doing descriptive work in all three variants — the tongue's surface is altered in a way the text keeps reaching for sharp, rough comparisons to convey.

The Vataja description is the one that stays with you, because it names a functional loss alongside the appearance: the tongue "loses the sense of taste." Sushruta has just introduced this organ as the organ of taste, so the Vataja variant is the one in which the region stops doing the job the region was defined by. That connection is not spelled out in the text. It is available to anyone reading the two verses in order.

The teak leaf and the Shalmali thorn are both outdoor comparisons — a broad rough-surfaced leaf, and the conical thorns that stud the trunk of the silk-cotton tree. Neither requires any specialist knowledge. Both would have been within sight of most readers.

Vataja Kantaka: rough like a teak leaf.

Alasa and Upajihvika — and the other Alasa

Alasa is described as a severe inflammatory swelling on the under surface of the tongue, arising from deranged blood and Kapha. Sushruta adds a trajectory: if allowed to grow unchecked it "gives rise to numbness and immobility of the organ" and tends toward rapid suppuration at its base. Again the entry carries a direction of travel rather than a static picture.

Upajihvika — the name means roughly "the little one near the tongue" — is a swelling shaped like the tip of the tongue, appearing on the under-surface and raising it slightly. The translator glosses it as ranula. The accompanying features are salivation with burning and itching, and the causes given are deranged Kapha and the blood of the locality.

Talu roga: nine disorders of the palate

The palate section runs from verse 38 to verse 47 and is the most simile-dense stretch of the chapter. Almost every entry is identified by comparison to something you could pick up.

Two entries in this table deserve a second look. Mamsa-Sanghata and Talu-Pupputa are both marked painless, and Talu-Pupputa is additionally marked permanent. In a chapter where most entries come with burning, piercing or fever, Sushruta is taking the trouble to record the absence of pain as a distinguishing feature. Absence of a feature is harder to notice than its presence, and recording it is a mark of a catalogue built by comparison rather than by anecdote.

Arvuda is the other. Sushruta describes its shape and its origin in one line and then declines to go further: it "is identical with the Rakta-Arvuda described before." That earlier description sits in Nidana Sthana chapter 11, alongside Granthi, Apachi and Galaganda, and we have covered it in the article on granthi, apachi, arbuda and galaganda.

The palate list that names eight and describes nine

Verse 38 gives the roll-call: "Gala-Shundika, Tundikeri, Adhrusha, Mansa-kachchapa, Arvuda, Mansa-sanghata, Talu-Shosha and Talu-Paka." That is eight names. The descriptions that follow cover nine, because Talu-Pupputa is described in full, between Mamsa-Sanghata and Talu-Shosha, without ever having been announced.

The standard classical enumeration of talu roga is nine, which is what the sub-totals of the sixty-five require. So the announcement line in this edition is one short, and the description block is right. Whether that is a slip in this particular printing, in the manuscript behind it, or something older is not something the page itself can settle — and the honest thing is to record the discrepancy rather than tidy it away.

Kantha roga: the seventeen diseases of the throat

The throat is the largest region in the chapter and the most consequential. Verse 48 states the count as seventeen and names them: the five types of Rohini, Kantha-Shaluka, Adhijihva, Valaya, Valasa, Eka-Vrinda, Vrinda, Shataghni, Gilayu, Gala-Vidradhi, Galaugha, Svaraghna, Mamsatana and Vidari.

The throat is where the chapter's tone changes. In the lips, the teeth and the palate, entries are largely descriptive. Here, more than half carry an explicit statement about what can and cannot be done — and several of them say, in plain terms, that nothing can.

Rohini: five types, and the gravest entry in the chapter

Rohini is given a general description before its subdivisions, which is unusual in this chapter. The aggravated Vayu, Pitta and Kapha — "either severally or in combination" — or the blood may affect the mucous lining of the throat and give rise to growths of fleshy papillae "which gradually obstruct the channel of the throat and bring on death." The translator's parenthetical gloss is diphtheria, a nineteenth-century identification that says as much about 1911 nosology as about the Sanskrit.

The five types are then set out:

• Vataja Rohini — extremely painful fleshy nodules (ankuras) cropping up over the tongue and obstructing the passage of the throat.
• Pittaja Rohini — nodules marked by rapid growth and suppuration, with burning and high fever.
• Kaphaja Rohini — nodules that are heavy and hard, with slow suppuration, gradually obstructing the passage.
• Sannipatika Rohini — suppuration in the deeper strata of the membrane with all the dangerous features of the three preceding types. "Rarely amenable to treatment."
• Raktaja Rohini — the Pittaja picture, with the fleshy outgrowth covered in small vesicles. Marked incurable.

There is a scholarly footnote attached to the Raktaja entry that is worth recording. The translator observes that several printed editions of Madhava's Nidana read sadhya (curable) where this text reads asadhya, and states flatly that in his view the curable reading "is not to our mind correct." An editor arguing about a single syllable, in a footnote, on a question of prognosis — this is textual scholarship in the ordinary sense, and it is happening in the middle of a mediaeval medical catalogue.

Kantha-Shaluka, Gilayu and Adhijihva: growths named by size

Three throat entries are identified almost entirely by dimension and hardness, and all three are handed to the surgeon rather than described further.

Kantha-Shaluka is a hard, rough nodular growth — a granthi — "in the shape of a plum-stone." Sushruta adds a sensation for the sufferer that is remarkably specific: the throat seems "as if it has been stuffed with the bristle of a Shuka insect or been pricked by thorns." It is attributed to deranged Kapha, and the verdict is unambiguous: amenable to surgical treatment only.

Gilayu is a hard, glandular swelling in the throat "to the size of the stone of the Amalaka fruit," from aggravated Kapha and blood, with the sensation of a morsel or bolus of food stuck in the throat. The text records a variant reading here too — one manuscript tradition has it extremely painful rather than slightly painful. Its verdict: "by its very nature a surgical case."

Adhijihva is a small swelling like the tip of the tongue, over the root of the tongue, from deranged blood and Kapha. Sushruta's instruction is to abandon it once suppuration begins — a judgement about timing rather than about the lesion.

Note what Sushruta uses as his ruler in two of these three: a plum-stone and an Amalaka stone. Not a unit of measure — a familiar object of known size. The Amalaka in particular does double duty across the Ayurvedic corpus as both a material and a measure.

The reference library was the room he stood in.

Eka-Vrinda and Vrinda: the footnote that argues with the text

This is the clearest instance of the chapter's counting rule, and it is clear because the editor makes it explicit at the bottom of the page.

Eka-Vrinda is a circular, raised, heavy and slightly soft swelling in the throat, with itching, slight burning and slight suppuration, from vitiated blood and Kapha. Vrinda is a round elevated swelling with high fever and slight burning, from aggravated blood and Pitta. Sushruta then adds a differentiator that applies to neither cleanly: "A piercing pain in the swelling points to its Vataja origin."

The footnote reads: "The diseases of the throat are 17 in number. Taking Vrinda as a separate disease they amount to 18; but Vrinda, affecting similar place and being similar in appearance with but a slight distinction of symptoms, is only a particular state of Eka-Vrinda, and not a separate disease."

Valaya, named for its outline alone.

Shataghni, Galaugha, Svaraghna and Mamsatana

Four entries in the throat carry the chapter's heaviest descriptions, and three of them are named for what they do rather than what they look like.

Shataghni is named after a weapon. The text describes a hard, obstructing formation along the inner lining of the throat, jagged and "densely beset with fleshy excrescences," and adds a footnote explaining that a shataghni "is a kind of weapon used in ancient warfare" — a spiked or studded implement. Various pains characteristic of each of the three deranged doshas are present. It is to be "necessarily considered as irremediable."

Galaugha — the name carries the sense of a flood or an overwhelming — is a large swelling that completely obstructs the passage of solid and liquid food and of Udana-vayu, attended with high fever, from deranged blood and Kapha. This is the only entry in the second half of the chapter that names one of the five vayus specifically. Udana is the upward-moving vayu associated with speech and with the throat; naming it here connects the local obstruction to a functional system described elsewhere in the Samhita.

Svaraghna means, literally, the destroyer of voice. The description is of stertorous breathing, hoarseness, dryness and loss of function in the throat, with fainting from the choking of the larynx by deranged Kapha — and then, in the same entry, the origin is ascribed to deranged Vayu. Kapha does the choking; Vayu is named as the origin. The two statements sit side by side without reconciliation.

Mamsatana is a pendent, spreading and extremely painful swelling that gradually obstructs the passage, from all three deranged doshas. Sushruta's verdict is the bluntest in the chapter: it "invariably proves fatal."

Gala-Vidradhi belongs with this group by gravity, though the text refuses to describe it separately: an extensive swelling along the whole inner lining of the throat, from the concerted action of all three doshas, which "exhibits all the features present in a Vidradhi of the Sannipatika type." Vidradhi has its own chapter in the Nidana Sthana, and we have covered its six types in the article on vidradhi and the six classical types.

Vidari: the side you sleep on

The last of the seventeen is the one that reads least like a catalogue entry and most like an observation.

Vidari is described as a copper-coloured swelling in the throat with pricking and burning, in which the flesh putrefies and sloughs off with a fetid smell. Its origin is Pittaja. And then Sushruta adds a line that has nothing to do with doshas at all: it "is found to attack that side of the throat on which the patient is in the habit of lying."

Sarvasara and Mukha-Paka: the whole cavity

The chapter's final section covers cases "found to invade the entire cavity of the mouth without being restricted to any particular part thereof." These are given the general name Sarvasara, and four types are announced: Vataja, Pittaja, Kaphaja and Raktaja.

• Vataja — the entire cavity studded with vesicles, with a pricking sensation inside them.
• Pittaja — a large number of small yellow or red vesicles over the entire lining, with burning.
• Kaphaja — a similar crop of slightly painful, itching vesicles the same colour as the skin.
• Raktaja — "nothing but a modification of the Pittaja one," producing similar features. Also called Mukha-Paka by others.

Two things are happening in that last line. First, the merge: four named, three counted, by the same rule that folded Vrinda into Eka-Vrinda. Second, and easy to miss, an attribution of a name to other authorities — "it is also by others called Mukha-Paka." Sushruta is recording that a different school uses a different label for the same thing. In a chapter otherwise presented as settled fact, that is a small acknowledgement that the naming was contested.

With verse 72 the chapter ends, and with it the Nidana Sthana. The section that began with vata vyadhi closes on the inside of the mouth.

Diagnosis by simile: Sushruta's household reference set

Gather every comparison in these seven pages and a pattern appears that no single entry reveals. Sushruta has no photographs, no diagrams and no measuring instruments for what he is describing. What he has is a shared world of ordinary objects — and he uses it as a reference library.

Look at where those objects come from. The kitchen, the orchard, the yard, the pond, the tree line, the household store, and once — memorably — the armoury. There is not a single specialist instrument in the list. Sushruta's entire comparative vocabulary is drawn from the room he was standing in and the ground immediately outside it.

That is a deliberate choice, and a practical one. A simile only transmits if both people have handled the thing. A comparison to a plum-stone works on a student who has eaten a plum, which is everyone; a comparison to a calibrated instrument works on nobody who does not own one. Building a diagnostic vocabulary out of domestic objects is what makes a text teachable across a subcontinent and across centuries.

The most cross-referential chapter in the Nidana Sthana

Five times in seven pages, this chapter declines to describe something and points elsewhere instead. Once you notice the habit, the chapter stops looking like a flat list and starts looking like an index.

• Hanu-Moksha → "identical with Ardditam as regards its symptoms." Points to the vata vyadhi material.
• Palate Arvuda → "identical with the Rakta-Arvuda described before." Points back to Nidana Sthana 11.
• Gala-Vidradhi → "exhibits all the features present in a Vidradhi of the Sannipatika type." Points to the Vidradhi chapter.
• Vrinda → "only a particular state of Eka-Vrinda." Points sideways, within the same list.
• Raktaja Sarvasara → "nothing but a modification of the Pittaja one." Points sideways again.

Two of these point outward to other chapters, two point sideways within the list, and one points to a disorder handled in a different division of the Samhita entirely. In every case the text could have repeated the description and chose not to.

The three sibling chapters on the head — karna roga on the ear, nasa roga on the nose and shiro roga on the head — sit in the Uttara Tantra rather than here, and are organised on the same regional principle.

Five times the chapter points elsewhere rather than repeat itself.

When nidana turns into triage

The Nidana Sthana is nominally about identification. But in the throat section, identification and verdict arrive in the same breath, and the verdicts are unusually direct.

Counting the explicit statements in the throat list: Rohini in general "brings on death"; Sannipatika Rohini is "rarely amenable to treatment"; Raktaja Rohini is marked incurable; Valaya "should be given up"; Adhijihva should be given up once suppuration sets in; Shataghni is "necessarily irremediable"; Mamsatana "invariably proves fatal"; Valasa is "very difficult"; Kantha-Shaluka is surgical only; Gilayu is "by its very nature a surgical case."

That is ten verdicts across seventeen entries — and only two of them are routes forward. The rest are refusals.

What this chapter is not

A few things need saying plainly, because a page listing named disorders can easily be read as something it is not.

This is not a diagnostic tool. Nothing above is a checklist for identifying anything in yourself or anyone else. The named disorders in this chapter belong to qualified medical care, and the descriptions are being read here as historical text — the way one reads a mediaeval herbal — not as guidance.

This is not a treatment article. The Nidana Sthana contains no therapy at all. Sushruta's procedures live in the Chikitsa Sthana and the Uttara Tantra. Where this chapter records verdicts, those verdicts belong to a surgical tradition of the first millennium and have no bearing on what is available or advisable now.

The translator's glosses are of their time. Bhishagratna's parenthetical identifications — diphtheria for Rohini, tonsilitis for Gala-Shundika, ranula for Upajihvika, tartar for Sharkara — are a scholar of around 1911 mapping Sanskrit terms onto the medical vocabulary he had. They are useful for orientation and should not be treated as equivalences.

We do not sell anything named in this chapter. Ayurveda Hub makes everyday personal care goods. Nothing on our shelf addresses any disorder described above, and nothing in this article should be read as suggesting otherwise.

On ordinary household materials

There is one honest thread running from this chapter to a shelf, and it is not a medical one. It is about materials.

Every comparison Sushruta reaches for comes out of an ordinary house and the ground around it: a plum stone, a kola fruit, a lotus petal, a teak leaf, the back of a tortoise in the yard, a ring, a slack bladder. Nothing from a workshop, nothing from a library, nothing anyone would have to be taught. He wrote for readers who already knew these things by handling them, and that shared familiarity with ordinary stuff is what made the writing usable.

Our shelf is made of that same kind of ordinary material, and we describe it that way.

More to read on this topic

Short visual reads and companion articles from our classical text series:

• 3 Signs Your Skin Barrier Is Damaged — a short visual story on everyday skin care.
• Spring Allergies? Your Gut Is the Real Problem — a short visual story on seasonal routine.
• The sixteen chapters of the Nidana Sthana — the parent survey of the whole diagnostic division.
• Danta dhavana in the Ashtanga Hridaya — Vagbhata's daily tooth-cleaning procedure and its nine twigs.

Frequently asked questions

Shop All Ayurveda Hub Products →