Mukha Roga Nidana: Sushruta Samhita's Sixty-Five Diseases of the Mouth in Nidana Sthana 16

📖 25 min read · Classical source: Sushruta Samhita, Nidana Sthana, chapters XV (Bhagna Nidana) and XVI (Mukha Roga Nidana) · pages 153–160 of the Kaviraj Kunja Lal Bhishagratna English edition

Most ancient medical writing begins with a complaint. This chapter begins with a count.

"Sixty-five different forms of mouth disease are known in practice." That is the second line of chapter 16 of the Nidana Sthana, and it is a strange sentence to find in a text from the early centuries of the common era. Not "the mouth is subject to many afflictions". Sixty-five — a number you could be wrong about, a number somebody could check. And then the chapter does something stranger: it tells you how the sixty-five are distributed, eight here and fifteen there and seventeen at the throat, so the arithmetic is open to inspection. Add the seven figures and you get sixty-five exactly. Whoever wrote this expected to be audited.

Nidana Sthana, the second of the Sushruta Samhita's six sections: sixteen chapters on how to tell one disease from another.

This article reads that census in order, along with the chapter immediately before it — chapter 15 on Bhagna, fractures and dislocations — because the two sit next to each other for a reason that becomes clear at the end of chapter 15.

A note on what this is. Everything below describes what an ancient text says. Nothing below is advice, and nothing below claims that anything we sell acts on anything named here. These diseases appear only as the subjects of a very old piece of scholarship. If something is wrong in your mouth, the person to talk to is a dentist.

Mukha Roga: Why Sushruta Gave the Mouth Sixty-Five Names

Mukha is the mouth, roga is disease, and mukha roga in the classical literature is not one condition but a whole department — defined by its territory rather than its symptoms: "diseases which affect the cavity of the mouth in general." Sixty-five names for one small space is a lot; the same compendium gives eleven to the head and twenty-eight to the ear. So why sixty-five?

Part of the answer is that the mouth is the one interior of the body a physician of that era could actually see. No instrument was needed. Open it in daylight and the gums, teeth, tongue, palate and upper throat are all visible at once, and all can be touched. Where the text must guess about a stomach or a joint, here it can look — and when a describer can look, the descriptions multiply, because differences invisible elsewhere become obvious, and each obvious difference earns its own name.

The second part is the method. Sushruta does not file mouth diseases by severity or by how they feel. He files them first by where — which of seven sites — and then within each site by cause: which dosha is deranged, which dhatu is involved, or whether the cause came from outside altogether. Seven sites times several possible causes generates a large grid, and the chapter fills it. You are not reading sixty-five separate discoveries; you are reading a systematic sweep of a small space by someone who decided in advance which questions he would ask of every square inch.

Where Nidana Sthana 16 Sits in the Sushruta Samhita

The Sushruta Samhita is organised into six sthanas, or sections. Nidana Sthana is the second, and it has sixteen chapters. Its subject is nidana — the causes and the distinguishing signs of disease. It is the diagnostic section: not what to do, but how to tell what you are looking at.

Chapter 16 is therefore the last chapter of the section, and it is the mouth; chapter 15, immediately before, is Bhagna. Chapter 13 is Kshudra Roga, the minor ailments, covered separately in our guide to Indralupta, Darunaka and Palita. For the shape of the whole section — all sixteen chapters and what each covers — see our overview of the Nidana Sthana's sixteen-chapter disease classification. This article goes down into 15 and 16 in detail rather than surveying the section again.

Sushruta is conventionally dated to around the sixth century BCE, with the compendium compiled and expanded over the centuries after; the standard commentary is Dalhana's Nibandha Sangraha, from roughly the twelfth century CE. For more, see our background piece on the Sushruta Samhita.

Bhagna Nidana: Sandhi-Mukta and the Six Dislocations

Chapter 15 opens exactly as chapter 16 will: "Now we shall discourse on the Nidanam of Bhagnam" — fractures and dislocations of bones. Its causes are refreshingly ordinary: a fall, pressure, a blow, violent jerking, or the bites of ferocious beasts. Everything after divides in two. Sandhi-Mukta, "joint released", is dislocation — six kinds. Kanda-Bhagna is fracture of a kanda, a segment or shaft — twelve kinds. Eighteen named mechanical failures in all.

What makes the chapter interesting is not the count but the method. Sushruta had no way of seeing inside a limb — two hands, daylight, and a patient who could say where it hurt. So every one of the eighteen is defined by something establishable from outside: which direction the bone has gone, the shape it now makes, whether it grinds under pressure, whether it can be moved, and what the pain does. The signs common to all six dislocations are functional rather than visual. A dislocated limb loses extension, flexion, movement, circumduction and rotation — the natural movements of that particular joint. It becomes extremely painful. And, in a phrase the chapter reuses for fractures, it "cannot bear the least touch." Note what is being tested: not appearance, but range of motion and response to the hand. Those are the two instruments available, and the chapter uses both systematically.

Then the six, each separated by where the bone has gone. Utplishta — the two articular ends rub together; swelling appears on both sides of the joint, with pain at night. Vislishta — simple looseness: a little swelling, constant pain, and a joint that no longer does its job. Vivartita — lateral displacement: pain, and an unevenness you can feel because the connected bones have shifted. Adhah-kshipta — the bone drops or hangs down out of its joint. Ati-kshipta — abnormal projection: the bone carried away from its joint, which becomes extremely painful. Tiryak-kshipta — oblique: displaced to one side, with "a sort of intolerable pain."

Read those six as a set and the axis is obvious. Sushruta asks one question — which way did it go? — and names each answer: rubbing, loose, sideways, downward, outward, oblique. Same discipline as our article on the eleven diseases of the head, where eleven types are separated almost entirely by timing and trigger. Pick one axis, then be exhaustive along it.

Chapter 15, verse 13: cartilage bends, a long bone is severed, a flat bone cracks, a tooth splinters. Four materials, four ways of failing.

Kanda-Bhagna: Twelve Fractures Named by Crab, Horse's Ear and Bristle

The general signs of fracture read as a palpation checklist: violent swelling with throbbing; the limb in an abnormal position; unable to bear the least touch; crepitus under pressure; looseness or dropping of the limb; pain of several kinds; discomfort in every position. That fourth item is the significant one — crepitus, the grating of broken ends felt through the skin, is still part of a clinical examination, and here it is written down as a sign. Then the twelve, and here the chapter's character shows: Sushruta could not draw, and a hand-copied palm-leaf manuscript carries no illustrations, so to make a fracture recognisable to a reader who has never seen one he reaches for objects that reader will certainly have handled.

Karkataka — pressed down at both ends, the bone bulges in the middle into the shape of a knot, a granthi; the name is the crab. Ashva-karna — the fractured end projects upward "like the ear of a horse." Churnita — powdered, shattered into fragments, established by both palpation and crepitation. Pichchita — smashed, usually with a great swelling over it. Asthi-chchalita — the covering of the bone cast or splintered off. Kanda-bhagna — the broken ends project through the skin. Majjagata — a fragment drives into the bone and digs out the marrow. Ati-patita — the bone droops or hangs. Vakra — bent down into the form of an arch. Chhinna — only one articular end severed. Patita — slightly fractured and pierced with a large number of holes, excruciating pain the leading sign. Sphutita — largely cracked and swollen, painful "as if stuffed with the bristles of a Suka insect."

A crab, a horse's ear, flour, an arch, insect bristles. This is the same descriptive economy running through the Kshudra Roga chapter, where surface conditions are calibrated against the contents of a kitchen — a mustard seed, a sesame seed, a lentil, a jujube stone. A manuscript cannot carry a picture. It can, however, assume a farmyard and a pantry.

The chapter then does something easy to underrate: it writes down where its own art fails. Four of the twelve resolve only with extreme difficulty — Churnita, Chhinna, Ati-patita, Majjanugata — and a dislocation is called difficult in particular patients rather than at particular sites: a child, an old or weak patient, one already carrying svasa, kushtha or a kshata-kshina condition. Then come the "memorable verses", the cases set aside as hopeless: the pelvic bone and joints; compound fracture of the thigh or flat bones; the frontal bone in small pieces; the breast-bone, back-bone, temporal and cranial bones. With modern eyes that is a list of the injuries which were, before antisepsis and internal fixation, genuinely unfixable. And then one line that outlives its century: if the dislocations and fractures be improperly set from the outset, or if the union be anyhow disturbed, there is no hope for recovery. The first setting decides the outcome.

Taruna, Nalaka, Kapala, Ruchaka: Four Materials, Four Ways of Failing

Verse 13, the last of chapter 15, is four short clauses and it is the best thing in the chapter. A Taruna bone — gristle or cartilage — does not break; its "fracture" is a bending. A Nalaka bone — long, hollow, reed-like — is "usually found to be severed": it snaps clean across. A Kapala bone — a flat plate, like the vault of the skull — is "found to be cracked": it fissures rather than parting. And a Ruchaka, a tooth, is "found to be splintered off."

Bend, snap, crack, splinter: four bone types, four failure modes, one clause each. Anyone who has handled green cane, a dry stick, a fired clay plate and a shard of hard enamel knows those materials fail in exactly those four ways, and that no force will make cane crack like clay. The verse is not describing anatomy but material behaviour — the recognition that a bone's shape and substance determine the damage it can take. Sushruta's classification and count of bones (300, against Charaka's 360) is a subject of its own, covered in our article on Asthi Sharira and Sushruta's 300 bones.

And the fourth item carries a footnote worth noticing: the particle cha — "and" — is taken by the commentator to bring in valya-asthi as well. A single connective word, and the commentary is prepared to argue about what it lets in. That is the level of attention these texts were read with. The fracture chapter's last word is the tooth; the next chapter opens on the mouth.

The Seven Sites, and an Argument About the Count

Before any disease is described, the mouth is divided. Seven sites, anatomical rather than functional: the lips, the roots of the teeth, the teeth themselves, the tongue, the palate, the throat, and the whole cavity taken together.

Two things repay attention. First, the roots of the teeth are a separate site from the teeth: what we would call the gum, and the text calls danta-mula, gets its own department with fifteen entries — nearly a quarter of the chapter — while the tooth proper gets eight. Sushruta drew a boundary two millimetres wide and put twenty-three named diseases on either side of it. Second, the seventh site is sarva-gata, the whole cavity, with three entries — a category for conditions that refuse to sit in any one place. Any classifier who has actually used a classification ends up needing one, and it is a mark of an honest system that it admits so.

The unevenness is informative. The throat takes the largest share at seventeen — the deepest and most consequential part of the visible field. The gums take fifteen. The tongue, the most mobile structure of all, takes only five. Where the text saw more it named more; where it saw fewer distinctions it left the category small rather than padding it.

Seven sites, sixty-five names: the mouth divided before a single disease is described.

Oshtha Roga: The Eight Diseases of the Lips

The eight lip conditions are the clearest illustration of the chapter's second axis. They are not named after appearances at all, but after causes: Vataja, Pittaja, Kaphaja, Sannipatika (all three doshas together), Raktaja (blood), Mansaja (flesh), Medaja (fat), and Abhighataja — traumatic, from a blow. Five doshic or dhatu categories, one for everything at once, one for injury. The appearance is then derived from the cause, which is the reverse of how a modern description works.

Vataja: dry, rough, numbed, black, extremely painful, the part seeming as if smashed and pulled out, or cracked. Pittaja: blue or yellow, studded with eruptions the size of mustard seeds which suppurate and discharge, with a burning sensation. Kaphaja: small eruptions the colour of the surrounding skin, slimy, heavy, cold and swollen — and then the detail that matters most, pain is absent in this type, with an irresistible urge to scratch. Sannipataja: the lips change colour, black, yellow or ash-white at intervals, with eruptions of several sorts at once. Raktaja: as red as blood, bleeding profusely, with crops of date-coloured eruptions. Mansaja: heavy, thick, gathered into what the text calls a lump of flesh, with krimi — its word for worms or minute creatures — at the angles of the mouth. Medaja: numbed, soft, heavy, itching, the surface glossy "like the surface layer of clarified butter", exuding a thin crystal-clear watery discharge. Abhighataja: red, knotty, itching, seeming "as if pierced into or cut open with an axe", cracked and fissured.

Two of those repay stopping on. The Kaphaja entry defines itself partly by a negative — pain is absent — using the absence of a sign to separate one type from another. And the Medaja entry reaches for ghee: anyone who has watched clarified butter set knows exactly the glossy, faintly wet surface being described. The pantry again, doing an illustration's work.

Mustard seeds for size, a date for colour, clarified butter for a glossy surface: the comparison objects Sushruta's readers were assumed to have handled.

Danta-Mula-Gata Roga: Fifteen at the Roots of the Teeth

Fifteen diseases at the roots of the teeth: ten named individually, plus five varieties of Nadi, sinus, which the chapter handles by cross-reference rather than description.

The ten are Sitada, Danta-pupputaka, Danta-veshtaka, Saushira, Maha-saushira, Paridara, Upakusha, Danta-vaidarbha, Vardhana and Adhimansa. The five Nadi are Vataja, Pittaja, Kaphaja, Sannipataja and Abhighataja, and the chapter says their signs match the corresponding types of nadi-vrana described elsewhere — a pointer instead of a repetition, which is how a well-organised compendium saves a student's memory. Here is the whole set with the cause the text assigns to each, the column this article is really about:

Read down the right-hand column. Six of the ten name rakta — blood — as a cause. A seventh, Maha-saushira, names every dosha at once. Only three step outside that pattern, and each for an obvious reason: one is caused by rubbing, one is a tooth erupting, one is a growth. Hold that observation; it comes back at the end of this article.

Sitada, Paridara, Upakusha: Where the Bleeding Belongs

Three of the fifteen deserve individual attention, because between them they describe a progression the chapter never calls a progression.

Sitada is the mildest-sounding and the most vivid. The gums "suddenly bleed and become putrified, black, slimy and emit a fetid smell. They become soft and gradually slough off." Four observations in one sentence — bleeding, colour, texture, smell — and then a course over time. The 1911 translator attached a modern label in brackets, as he did to many entries; those brackets are his, not Sushruta's, and this article leaves them where he found them.

Paridara is the same territory, harder: the gums "become putrified, wear off and bleed". The distinguishing feature is wearing away — tissue lost rather than merely altered. Its cause is three-fold, rakta with kapha and pitta, which in the classical framework marks it as the more entrenched of the two.

Upakusha shifts the emphasis again. Burning and suppuration in the gums, then the consequence spelled out with a causal connective: the teeth "become loose and shaky in consequence, and bleed at the least shaking." The gum condition is named as the reason the tooth is loose. Slight pain, the whole cavity swollen, the smell fetid. Cause: rakta and pitta.

Put the three side by side and you have a sequence anyone who has looked at a lot of mouths would recognise: bleeding on the slightest provocation, then tissue receding, then teeth loosening because their support has gone. Sushruta files them as three diseases, not three stages — but adjacently, with overlapping causes, and in Upakusha he writes the mechanical consequence explicitly. The observation is there even where the framework has no word for it.

Danta-Vaidarbha and Vardhana: A Blow, and a Tooth Coming Through

Two entries in the gum list have nothing to do with the doshas that dominate the rest, and both are unusually modern in what they identify.

Danta-vaidarbha is described as "consequent upon the friction of the gums", producing a violent swelling at the portion so rubbed, after which the teeth "become loose and can be moved about." The cause is stated flatly as extraneous — "such as a blow etc."

Sit with that. Sushruta has a named, classified disease of the gums whose stated cause is rubbing — not a dosha, not a dhatu, not diet, not season. Mechanical friction, listed in the chapter's own causal ledger alongside the doshic entries and given equal standing. Whatever else the framework got wrong, it had a place in its taxonomy for damage done by handling.

Vardhana is the other: "the disease which is marked by the advent of an additional tooth — the last molar — through the action of the deranged Vayu, with a specific excruciating pain of its own." And then the line that makes it remarkable: the pain subsides with the cutting of the tooth. The last molar coming through is classified as a disease of the gums, given its own name, attributed to vayu — and then explicitly marked as self-limiting, in a chapter otherwise full of conditions that do not resolve on their own. The 1911 translator glossed it with the familiar English name for that tooth; the Sanskrit just says the last one.

Adhimansa, the tenth, is a growth: "a violent and extremely painful tumour about the root of the tooth", at the farthest end of the cheek-bone cavity, with copious saliva, attributed to deranged kapha. Its position — right at the back, behind the last tooth — is stated with real precision.

Danta-Gata Roga: Krimi-Dantaka, Danta-Harsha and the Eight Diseases of the Teeth

Cross the boundary from the tooth-root to the tooth, and the character of the list changes completely.

The eight are Dalana, Krimi-dantaka, Danta-harsha, Bhanjaka, Sarkara, Kapalika, Syava-dantaka and Hanu-moksha. The first four are described in the pages this article works from; the last four are named here and described in the verses immediately following.

Dalana: "the disease in which the teeth seem as if being cleft asunder with a violent pain." Cause: aggravated bodily vayu. The name is from dal, to split. That is a description of a sensation, not an appearance. Bhanjaka, from bhanj, to break: the face is distorted, the teeth break, the pain is severe. Danta-harsha: "the disease in which the teeth cannot bear the heat, cold or touch", cause given as deranged vayu — an entry with no visible sign at all, defined entirely by three provocations and the tooth's failure to tolerate them. Those are still the three things anyone examining a tooth will try.

And then Krimi-dantaka, the one entry in the tooth list that gives visible signs, and the most quietly astonishing entry in either chapter. "The disease in which the teeth are eaten into by worms." The teeth "become loose and perforated by black holes", with copious saliva. Then a detail that reads like a case note: "the appearance of an extremely diffused swelling about the roots of the decayed teeth, with a sudden aggravation of the accompanying pain without any apparent cause, is also one of its specific features."

Two good observations there. Black holes in the tooth substance — perforation, material removed. And pain that flares without provocation, marked explicitly as characteristic rather than incidental: not just that it hurts, but that it hurts unprovoked. Krimi is the word for worms, and more broadly for minute creatures. Sushruta believed something was eating the tooth. On the biology he was wrong — there is no worm. On the shape of the thing he was closer than the framework had any right to be, because something too small to see does remove material from a tooth. He reached for the smallest living things his world had a word for and put them at the site. That is not vindication: a tradition that named a worm knew nothing of micro-organisms, and reading backwards to award credit it did not earn is bad history. What it shows is a describer honest enough to write "without any apparent cause" rather than invent one.

Notice what has disappeared across the whole tooth list. No bleeding, no suppuration, no putrefaction, no fetid smell, no sloughing tissue — the entire vocabulary that dominated the gum list fifteen entries earlier. And no rakta in the causal column. What replaces both is vayu, and what replaces the visible signs is sensation.

Reading the Chapter by Column: Why Rakta Owns the Gums and Vayu Owns the Teeth

Here is what this chapter gives up only if you stop reading it as a list and start reading it as a table.

Take the ten individually named diseases of the tooth-roots and count how many name rakta, blood, among their causes. The answer is six: Sitada, Danta-pupputaka, Danta-veshtaka, Saushira, Paridara, Upakusha. A seventh, Maha-saushira, names all the doshas together. The three that do not name blood are the three with special explanations — friction, an erupting tooth, a growth. Now count the same thing for the teeth. Dalana: vayu. Danta-harsha: vayu. Bhanjaka: vayu. Krimi-dantaka: krimi. Rakta appears in none of them.

Count the signs the same way. The gum entries speak of bleeding, pus, putrefaction, fetid smell, tissue sloughing and wearing away, swelling. The tooth entries speak of splitting sensations, intolerance of hot and cold, pain that flares unprovoked, black perforations, teeth that break. Two adjacent territories a couple of millimetres apart, with two entirely separate causal vocabularies and two entirely separate sign vocabularies — blood and soft-tissue language on one side of the line, wind and sensation and material-loss language on the other.

That is not an accident of drafting. It is a boundary Sushruta drew deliberately when he made danta-mula a separate site from danta, then honoured across twenty-three entries. And it is the same boundary any modern examination of a mouth still draws: the soft tissue surrounding a tooth is assessed by one set of findings, chiefly bleeding and the state of the tissue, and the hard tooth by another, chiefly pain and loss of substance. Two departments, split at the same seam — and Sushruta got there without knowing what blood does, what a tooth is made of, or that micro-organisms exist. What he had was a habit: look, ask the same fixed questions of everything you look at, write the answers down without smoothing them. Do that carefully enough over a small enough space and the structure of the thing starts showing through the framework you are using to describe it, even when the framework is wrong.

That is also, incidentally, why this chapter is still worth reading and the therapeutics of the same era largely are not. Observation ages better than explanation.

Two sites, two vocabularies: rakta and soft-tissue signs at the tooth-root, vayu and sensation at the tooth. The interesting thing is the gap between them.

What This Chapter Is Not

Chapter 16 of the Nidana Sthana is a diagnostic census. It names and distinguishes. It is not a treatment manual — those sit in a different section of the compendium entirely — and it is emphatically not a guide to managing anything in your own mouth. That matters more here than in most chapters we write about, because this one is full of conditions people genuinely have.

The names above are historical. Sitada, Upakusha, Paridara, Krimi-dantaka and the rest are categories inside a two-thousand-year-old framework of doshas and dhatus. They are not diagnoses, they do not map cleanly onto anything in a modern dental chart, and the bracketed English labels the 1911 translator added reflect his era's guesses, not Sushruta's meaning. Reading this chapter will not tell you what is happening in your mouth. And the doshic causes are framework, not mechanism: when the text says a condition arises from vitiated rakta and kapha, that is a statement inside a system of explanation, not a finding. Interesting as intellectual history. Not a reason to do anything.

Daily Care, in the Classical Register

We sell three things for the mouth. None belongs anywhere near the sixty-five names above, and this section keeps the two apart deliberately: what follows is about what these products are made of and when they are used, nothing else.

The honest connection between our shelf and this literature is not a claim about effect, and not really about chapter 16 at all. It is danta dhavana, the classical daily tooth-cleaning routine, which lives in a different part of the tradition — the dinacharya, the description of an ordinary day. Vagbhata sets it out in the Ashtanga Hridaya's Sutrasthana 2, written up in full in our guide to danta dhavana and Vagbhata's nine tooth-cleaning twigs. Daily routine is the register these products sit in.

A churna — a dry powder — is the form the classical daily routine assumes for cleaning the teeth.

All three together are sold as an Oral Care Combo — simply the three in one box. If daily routine as a whole interests you, our guide to the dinacharya morning routine puts tooth-cleaning back where the classical texts put it: one item in an ordinary morning.

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More to Read on This Topic

Between the mouth at sixty-five, the ear at twenty-eight, the nose at thirty-one and the head at eleven, the compendium names well over a hundred conditions in a region you could cover with two hands — the part of the body a physician of that era could examine most directly. The naming density follows the visibility exactly.

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