Sushruta Samhita

01Dhanvantari at Kashi

The Samhita opens in an ashram at Kashi. Aupadhenava, Vaitarana, Aurabhra, Paushkalavata, Karavirya, Gopurarakshita, Sushruta and others come to Divodasa, king of Kashi, whom the text calls Bhagwan Dhanvantari, foremost of the devas, born again on earth. They tell him their minds are troubled to see people crying out under diseases of the body, the mind and injury, and ask to be taught Ayurveda for the relief of all beings. He welcomes them and teaches. The whole book is set down as his answers, and nearly every chapter opens with the words ‘as Bhagwan Dhanvantari said’.

02Sushruta and his age

The Mahabharata names a Sushruta among the sons of Vishvamitra, and tradition takes him to be the same disciple of Dhanvantari, placing his teaching around the sixth century BCE. The present text grew over time. Dalhana, its great commentator, says a Nagarjuna revised it, and the Uttara Tantra is a later supplement that completes the eight branches. Scholars date the Samhita in its present form to about the third or fourth century CE, since the Bower manuscript of that period already knows Sushruta. The oldest dated manuscript is a palm-leaf copy of 878 CE from Nepal, kept at Kathmandu, whose readings differ in places from the printed text.

03Surgery first

Ayurveda has eight branches, the first chapter says: shalya (surgery), shalakya (diseases above the collarbone: eye, ear, nose, mouth), kayachikitsa (general medicine), bhutavidya (afflictions by spirits), kaumarabhritya (care of children), agadatantra (toxicology), rasayana (rejuvenation) and vajikarana (virility). Dhanvantari calls surgery the first and chief, because it gives quick relief, because it uses instruments, fire and alkali, and because by it the Ashvins rejoined the head of the yajna that Rudra had cut off. The first five sthanas hold 120 chapters, says the text itself, and the Uttara Tantra of 66 chapters follows, covering what the others leave out.

04Training the surgeon

One who knows only the text and has no practice loses his nerve at the bedside like a coward in battle, Sushruta warns, and one who operates boldly without the text wins no respect from the good and deserves the king’s punishment. So the ninth chapter, on yogya, sets drills before any patient is touched. Incision is practised on gourds, watermelons and cucumbers; scraping on a stretched hide with hair; puncturing on the veins of dead animals and the stalks of water lilies; probing on worm-eaten wood and hollow bamboo; extraction on the seeds of jackfruit and bael; suturing on cloth and soft leather; bandaging on full-size dolls; and cautery and alkali on pieces of flesh. Only then does the teacher let him operate.

05The hand and the blade

There are a hundred and one blunt instruments, yantras, says the seventh chapter, and the hand is the chief of them, because without the hand no instrument works. Many are named and shaped after the mouths of animals and birds: the lion-mouth forceps, the crow-mouth, the heron-mouth. The eighth chapter lists twenty sharp instruments, shastras, among them the round-headed knife (mandalagra), the saw (karapatra), the lancet shaped like a lotus petal, the needle and the hook. With them the surgeon performs eight acts: excision, incision, scraping, puncturing, probing, extraction, draining and suturing. Leeches, cautery and caustic alkali complete the kit, and the thirteenth chapter describes twelve kinds of leech and how to apply them.

06Learning the body

No surgeon can work without knowing the body by sight, and the Sharirasthana tells him how to learn it. Take the body of one who died young and not of poison or long illness, clean it, wrap it in grass, place it in a cage in a slow stream in a hidden place, and after seven days rub away the softened layers with a brush of grass roots, observing each part as it is uncovered. Sushruta counts 300 bones, against Charaka’s 360, and 107 marmas, vital points where an injury can kill or cripple, each named and placed, with how far from it a cut must stay. The marma list is still taught in Kerala’s kalaripayattu and marma chikitsa.

07The nose and the ear

The sixteenth chapter of the Sutrasthana gives fifteen ways of joining a torn earlobe, and then the method for a cut-off nose. Take a leaf the size of the lost part, cut a flap of living skin to that measure from the side of the cheek, leaving it attached, turn it over the nose, scarify the edges and stitch it in place. Keep the nostrils open with two small tubes, dust it with powders, cover it with white cotton and oil it. When it has taken, cut the flap free. In 1794 a Madras newspaper and then the Gentleman’s Magazine in London reported the operation done near Pune with a flap from the forehead, and it reached Europe as the Indian method of rhinoplasty.

08Stones, bones and the eye

The Chikitsasthana describes cutting for stone in the bladder, with the patient’s position, the line of the incision and the aftercare, and warns which structures must not be cut. It sets fractures and dislocations with splints of bamboo and bark and bandages of many shapes. For a torn bowel it describes closing the wound with the heads of large black ants, which bite the edges together. The Uttara Tantra opens with the eye, seventy-six diseases of it, and gives the couching of cataract: with the patient seated and looking at his nose, a fine lancet is passed at the edge of the white, and the clouded lens pushed down out of the line of sight.

09Who is healthy

For all its blades, the Samhita’s most quoted verse is about health. One whose doshas are in balance, whose digestive fire is even, whose tissues and excretions work as they should, and whose atman, senses and mind are clear and content, is called svastha, established in himself. The fifteenth chapter, where this verse closes the discussion of increase and decrease of doshas, tissues and wastes, shows how each excess or deficiency appears. Sushruta adds the six tastes and their effects, the qualities of water from different sources, and long lists of foods and their properties. The surgeon is expected to know all of medicine, not only the knife.

10Dalhana, Baghdad and Melbourne

Dalhana’s Nibandhasangraha of the twelfth century, built on the older commentaries of Jejjata and Gayadasa, is the standard reading of the text. In Baghdad, under Harun al-Rashid, the Indian physician Manka put the Samhita into Arabic, and Ibn al-Nadim’s Fihrist lists it as the book of Susrud. Franz Hessler’s Latin translation came out at Erlangen in 1844–50, and Kaviraj Kunja Lal Bhishagratna’s English one at Calcutta in 1907–16. Surgeons abroad now honour Sushruta as a father of plastic surgery: the Royal Australasian College of Surgeons in Melbourne keeps his statue, and the Sushruta Samhita is read in BAMS and MS (Ayurveda) shalya courses across India.

What it contains

1. 1
   Sutrasthana (46 chapters)

   The principles and the making of a surgeon: the descent of Ayurveda, the student’s initiation and drills, instruments and blades, leeches, alkali and cautery. It covers wounds and inflammation, ear and nose repair, doshas, tissues and wastes, and closes with long chapters on water, foods and drinks.

2. 2
   Nidanasthana (16)

   Causes and signs of the diseases surgery treats: disorders of vata, piles, stones, fistula, skin disease, abdominal swellings, tumours, goitre, fractures and diseases of the mouth. It also covers difficult labour and the obstructed foetus.

3. 3
   Sharirasthana (10)

   The making of the body from the elements, conception and the growth of the embryo, and the parts of the body with the method of study by dissection. The marmas, vessels and veins, the care of the pregnant woman and the newborn complete it.

4. 4
   Chikitsasthana (40)

   Treatment: the sixty measures for wounds, fractures, piles, stones, fistula, skin disease, abdominal disorders and the obstructed foetus. Later chapters give rasayana, vajikarana, oiling, sweating, the cleansing therapies and enemas.

5. 5
   Kalpasthana (8)

   Toxicology: guarding the king’s food from poison, poisons of plants and minerals, snakes and their bites, rats, insects and spiders. It ends the 120 chapters of the first five sthanas.

6. 6
   Uttara Tantra (66)

   The later part, covering the branches the first five leave short. It treats diseases of the eye, ear, nose and head, children’s diseases and the grahas that afflict them, and general medicine: fever, diarrhoea, consumption, cough, insanity. It closes with the tantrayuktis and the rules of health.

Famous verses

शल्यं शालाक्यं कायचिकित्सा भूतविद्या कौमारभृत्यमगदतन्त्रं रसायनतन्त्रं वाजीकरणतन्त्रमिति

Surgery, the treatment of diseases above the collarbone, general medicine, the science of spirits, the care of children, toxicology, rejuvenation and virility: these are the eight branches.Sushruta Samhita, Sutrasthana 1.7

यन्त्रशतमेकोत्तरम्, अत्र हस्तमेव प्रधानतमं यन्त्राणामवगच्छ

There are a hundred and one instruments; know that of all instruments the hand is the chief.Sushruta Samhita, Sutrasthana 7.3

समदोषः समाग्निश्च समधातुमलक्रियः। प्रसन्नात्मेन्द्रियमनाः स्वस्थ इत्यभिधीयते॥

One whose doshas and digestive fire are in balance, whose tissues and excretions function rightly, and whose atman, senses and mind are content, is called healthy.Sushruta Samhita, Sutrasthana 15.41 (numbered 15.48 in some editions)

विश्लेषितायास्त्वथ नासिकाया वक्ष्यामि सन्धानविधिं यथावत्। नासाप्रमाणं पृथिवीरुहाणां पत्रं गृहीत्वा त्ववलम्बि तस्य॥

Now I shall describe properly the method of rejoining a severed nose. Take the leaf of a plant of the size of the nose, and hang it against the part.Sushruta Samhita, Sutrasthana 16.27