Sushruta Samhita
Encyclopedia
The Sushruta Samhita is a Sanskrit
text, attributed to one Sushruta
, foundational to Ayurvedic medicine (Indian traditional medicine), with innovative chapters on surgery
.
The Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on Anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. It is the main reference book for ayurvedic surgeons. Sushshrutra is considered as a great surgeon of ancient times.
The text as preserved dates to the 3rd or 4th century AD. The earliest surviving copy is known as the Bower Manuscript
.
The text was translated into Arabic in the 8th century.
, pediatrics
, geriatrics
, diseases of the ear, nose, throat and eye, toxicology
, aphrodisiacs and psychiatry
. Thus the whole Samhita, devoted as it is to the science of surgery, does not fail to include the salient portions of other disciplines too. In fact, Sushruta emphasises in his text that unless one possesses enough knowledge of relevant sister branches of learning, one cannot attain proficiency in one's own subject of study. The Samhita is thus an encyclopaedia of medical learning with special emphasis on Salya and Salakya. The Sutra-sthana, Nidana-sthana, Sarira-sthana, Kalpa-sthana and Chikitsa-sthana are the five books of the Purvatantra containing one hundred and twenty chapters. Incidentally, the Agnivesatantra known better as the Charaka Samhita
and the Ashtanga Hridayam
of Vagbhata also contain one hundred and twenty chapters in all. The Nidana-sthana gives the student the knowledge of aetiology, signs and symptoms of important surgical diseases and those ailments, which have a bearing on surgery. The rudiments of embryology and the anatomy of the human body along with instructions for venesection (cutting of veins), the positioning of the patient for each vein, and protection of vital structures (marma) are dealt with in the Sarira-sthana. This also includes the essentials of obstetrics. Principles of management of surgical conditions including obstetrical emergencies are contained in the Chikitsa-sthana, which also includes a few chapters on geriatrics and aphrodisiacs. The Kalpa-sthana is mainly Visa-tantra, dealing with the nature of poisons and their management. Thus the Purva-tantra embraces four branches of Ayurveda. The Uttara-tantra contains the remaining four specialities, namely Salakya, Kaumarabhfefefrtya, Kayacikitsa and Bhutavidya. The entire Uttara-tantra has been called Aupadravika since many of the complications of surgical procedures as well as fever, dysentery, cough, hiccough, krmi-roga, pandu
, kamala
, etc., are briefly described here. The Salakya-tantra portion of the Uttara-tantra contains various diseases of the eye, the ear, the nose and the head. Thus the whole Samhita is a comprehensive treatise on the entire medical discipline.
On the whole, Entire Samhita is a complete work on medicine with special attention to Salya and Salakya tantras. The succinct and serious style and overall superiority of the Sushrutasamhita led to the extinction of other treatises which preceded this compilation or were contemporary. As a text-book, it is unrivalled in respect of composite teaching of the subject of surgery with reference to all allied branches of medical learning required by a surgeon. It is a forerunner of Vagbhata's Astanga-sangraha.
Sushruta has pointed out that haemorrhage can be arrested by apposition of the cut edges with stitches, application of styptic decoctions, by cauterisation with chemicals or heat. That the progress of surgery and its development is closely associated with the great wars of the past is well known. The vrana or injury, says Sushruta, involves breakdown of body-components and may have one or more of the following seats for occurrence, viz., skin, flesh, blood-vessels, sinews, bones, joints, internal organs of chest and abdomen and vital structures. Classically vrana
, the wound, is the ultimate explosion of the underlying pathological structure. It is, in Sushruta's words, the sixth stage of a continuous process, which starts with sotha (inflammation). Sushruta says that in the first stage, the ulcer is unclean and hence called a dusta-vrana. By proper management it becomes a clean wound, a suddha-vrana. Then there is an attempt at healing and is called ruhyamana-vrana and when the ulcer is completely healed, it is a rudha-vrana. Sushruta has advocated the use of wine with incense of cannabis
for anaesthesia. Although the use of henbane
and of Sammohini and Sanjivani
are reported at a later period, Sushruta was the pioneer of anaesthesia.
Sushruta describes eight types of surgical procedures: Excision (chedana) is a procedure whereby a part or whole of the limb is cut off from the parent. Incision (bhedana) is made to achieve effective drainage or exposure of underlying structures to let the content out. Scraping (lekhana) or scooping is carried out to remove a growth or flesh of an ulcer, tartar of teeth, etc. the veins, hydrocele and ascitic fluid in the abdomen are drained by puncturing with special instrument (vyadhana). The sinuses and cavities with foreign bodies are probed (esana) for establishing their size, site, number, shape, position, situation, etc. Sravana
(blood-letting) is to be carried out in skin diseases, vidradhis, localised swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching (svana).
To obtain proficiency and acquiring skill and speed in these different types of surgical manipulations, Sushruta had devised various experimental modules for trying each procedure. For example, incision and excision are to be practised on vegetables and leather bags filled with mud of different densities; scraping on hairy skin of animals; puncturing on the vein of dead animals and lotus stalks; probing on moth-eaten wood or bamboo; scarification on wooden planks smeared with beeswax, etc. On the subject of trauma, Sushruta speaks of six varieties of accidental injuries encompassing almost all parts of the body.
Sushruta also gives classification of the bones and their reaction to injuries. varieties of dislocation of joints (sandhimukta) and fractures of the shaft (kanda-bhagna) are given systematically. He classifies and gives the details of the six types of dislocations and twelve varieties of fractures. He gives the principles of fracture treatment, viz., traction, manipulation, appositions and stabilisation. Sushruta has described the entire orthopaedic surgery, including some measures of rehabilitation, in his work.
As war was a major cause of injury, the name Salya-tantra for this branch of medical learning is derived from Salya, the arrow of the enemy, which in fights used to be lodged in the body of the soldiers. He emphasises that removal of foreign bodies is fraught with certain complications if the seat of the Salya be a marma
.
Sushruta also discusses certain surgical conditions of ano-rectal region, he has given all the methods of management of both haemorrhoids and fistulae. Different types of incision to remove the fistulous tract as langalaka, ardhalangalaka, sarvabhadra, candraadha (curved) and kharjurapatraka (serrated) are described for adoption according to the type of fistula.
Sushruta was well aware of the urinary stones, their varieties; the anatomy of urinary bladder along with its relations is well recorded in the chapter on urinary stones. Varieties of stones, their signs and symptoms, the method of extraction and operative complication are given in detail. Apart from the above, surgery of intestinal obstruction (baddha-gudodara), perforated intestines (chidrodara), accidental injuries to abdomen (assaya-bhinna) in which protrusion of omentum occurs are also described along with their management.
Though the contributions of Sushruta are mainly in the field of Plastic
and Cataract surgery
, a number of his other contributions to medicine are listed below:
Reconstruction of a nose (rhinoplasty) which has been cut-off, using a flap of skin from the cheek has also been described.
Lastly, labioplasty too has received his attention. In short, all the principles of plastic surgery, viz., accuracy, precision, economy and haemostasis find an important place in Sushruta's writings on this subject.
, discovered in Kashgar
in 1890. The manuscript is dated on paleographic grounds to the second half of the 4th century.
The medical works of both Sushruta and Charaka
were translated into Arabic language
during the Abbasid Caliphate (750 AD). These Arabic works made their way into Europe
via intermediaries. In Italy
the Branca family of Sicily
and Gasparo Tagliacozzi
(Bologna
) became familiar with the techniques of Sushruta.
British
physicians traveled to India to see rhinoplasty
using a flap of skin raised from the forehead, being performed by native Indians. Reports on "Indian" rhinoplasty using the forehead skin (not the cheek flap as mentioned in the susrutha samahita) were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue
spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the "Indian" method of nose reconstruction in the western world
by 1815.
Instruments described in the Sushruta Samhita were further modified in the Western World.
Sanskrit
Sanskrit , is a historical Indo-Aryan language and the primary liturgical language of Hinduism, Jainism and Buddhism.Buddhism: besides Pali, see Buddhist Hybrid Sanskrit Today, it is listed as one of the 22 scheduled languages of India and is an official language of the state of Uttarakhand...
text, attributed to one Sushruta
Sushurata
Sushruta was an ancient Indian surgeon and is the author of the book Sushruta Samhita, in which he describes over 300 surgical procedures and 120 surgical instruments and classifies human surgery in eight categories...
, foundational to Ayurvedic medicine (Indian traditional medicine), with innovative chapters on surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
.
The Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on Anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. It is the main reference book for ayurvedic surgeons. Sushshrutra is considered as a great surgeon of ancient times.
The text as preserved dates to the 3rd or 4th century AD. The earliest surviving copy is known as the Bower Manuscript
Bower Manuscript
The Bower Manuscript is a medical manuscript written predominantly in the Sanskrit language,made up of 51 birch-bark leaves, written in an early Indian script.It is today preserved as part of the collections of the Bodleian Library in Oxford...
.
The text was translated into Arabic in the 8th century.
Contents
The Sushruta samhita is in two parts, the Purva-tantra in five sections and the Uttara-tantra. Those two parts together encompass, apart from Salyya and Salakya, the other specialities like medicineMedicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, geriatrics
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
, diseases of the ear, nose, throat and eye, toxicology
Toxicology
Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...
, aphrodisiacs and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
. Thus the whole Samhita, devoted as it is to the science of surgery, does not fail to include the salient portions of other disciplines too. In fact, Sushruta emphasises in his text that unless one possesses enough knowledge of relevant sister branches of learning, one cannot attain proficiency in one's own subject of study. The Samhita is thus an encyclopaedia of medical learning with special emphasis on Salya and Salakya. The Sutra-sthana, Nidana-sthana, Sarira-sthana, Kalpa-sthana and Chikitsa-sthana are the five books of the Purvatantra containing one hundred and twenty chapters. Incidentally, the Agnivesatantra known better as the Charaka Samhita
Charaka Samhita
The ' is an early Ayurvedic text on internal medicine. It is believed to be the oldest of the three ancient treatises of Ayurveda...
and the Ashtanga Hridayam
Ashtanga Hridayam
The Ashtānga Hridayam|Ashtanga Hridayam is a classical book of Ayurveda and is regarded as highly among Ayurvedic physicians as the normative Charaka and Sushruta. The Ashtang Hridayam was compiled by the Vagbhatta-I. The period of the compilation is said to be between 250 and 500 B.C.The...
of Vagbhata also contain one hundred and twenty chapters in all. The Nidana-sthana gives the student the knowledge of aetiology, signs and symptoms of important surgical diseases and those ailments, which have a bearing on surgery. The rudiments of embryology and the anatomy of the human body along with instructions for venesection (cutting of veins), the positioning of the patient for each vein, and protection of vital structures (marma) are dealt with in the Sarira-sthana. This also includes the essentials of obstetrics. Principles of management of surgical conditions including obstetrical emergencies are contained in the Chikitsa-sthana, which also includes a few chapters on geriatrics and aphrodisiacs. The Kalpa-sthana is mainly Visa-tantra, dealing with the nature of poisons and their management. Thus the Purva-tantra embraces four branches of Ayurveda. The Uttara-tantra contains the remaining four specialities, namely Salakya, Kaumarabhfefefrtya, Kayacikitsa and Bhutavidya. The entire Uttara-tantra has been called Aupadravika since many of the complications of surgical procedures as well as fever, dysentery, cough, hiccough, krmi-roga, pandu
Pandu
In the Mahābhārata epic, King Pandu is the son of Ambalika and Rishi Ved Vyasa. He is more popularly known as the father of the Pandavas and ruled Hastinapur.-Birth:...
, kamala
Kamala
Kamala is a common Hindu name, usually meaning Nelumbo nucifera, the lotus. Variants include Kamal and Kamla. It is unrelated to the similar sounding name of Arabic origin meaning perfection or integrity usually spelled Kamal in English but spelled Kemal in Turkish, which appears as the middle name...
, etc., are briefly described here. The Salakya-tantra portion of the Uttara-tantra contains various diseases of the eye, the ear, the nose and the head. Thus the whole Samhita is a comprehensive treatise on the entire medical discipline.
On the whole, Entire Samhita is a complete work on medicine with special attention to Salya and Salakya tantras. The succinct and serious style and overall superiority of the Sushrutasamhita led to the extinction of other treatises which preceded this compilation or were contemporary. As a text-book, it is unrivalled in respect of composite teaching of the subject of surgery with reference to all allied branches of medical learning required by a surgeon. It is a forerunner of Vagbhata's Astanga-sangraha.
Sushruta has pointed out that haemorrhage can be arrested by apposition of the cut edges with stitches, application of styptic decoctions, by cauterisation with chemicals or heat. That the progress of surgery and its development is closely associated with the great wars of the past is well known. The vrana or injury, says Sushruta, involves breakdown of body-components and may have one or more of the following seats for occurrence, viz., skin, flesh, blood-vessels, sinews, bones, joints, internal organs of chest and abdomen and vital structures. Classically vrana
Vrana
Vrana is historic settlement located north of the Vrana Lake, 6 km from Pakoštane, a few kilometers from the Adriatic coast, in Zadar County, Dalmatia, Croatia. Today it is a small rural settlement.-Intro:...
, the wound, is the ultimate explosion of the underlying pathological structure. It is, in Sushruta's words, the sixth stage of a continuous process, which starts with sotha (inflammation). Sushruta says that in the first stage, the ulcer is unclean and hence called a dusta-vrana. By proper management it becomes a clean wound, a suddha-vrana. Then there is an attempt at healing and is called ruhyamana-vrana and when the ulcer is completely healed, it is a rudha-vrana. Sushruta has advocated the use of wine with incense of cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
for anaesthesia. Although the use of henbane
Henbane
Henbane , also known as stinking nightshade or black henbane, is a plant of the family Solanaceae that originated in Eurasia, though it is now globally distributed.-Toxicity and historical usage:...
and of Sammohini and Sanjivani
Sanjivani
Selaginella bryopteris, known commonly as sanjeevani and sanjivini booti , is a lithophytic plant. It is used medicinally in India. The popular name sanjeevani which translates as "One that infuses life" derives from the medicinal properties...
are reported at a later period, Sushruta was the pioneer of anaesthesia.
Sushruta describes eight types of surgical procedures: Excision (chedana) is a procedure whereby a part or whole of the limb is cut off from the parent. Incision (bhedana) is made to achieve effective drainage or exposure of underlying structures to let the content out. Scraping (lekhana) or scooping is carried out to remove a growth or flesh of an ulcer, tartar of teeth, etc. the veins, hydrocele and ascitic fluid in the abdomen are drained by puncturing with special instrument (vyadhana). The sinuses and cavities with foreign bodies are probed (esana) for establishing their size, site, number, shape, position, situation, etc. Sravana
Sravana
Sravana may refer to:* Shravana, a Hindu nakshatra* Shraavana, a month...
(blood-letting) is to be carried out in skin diseases, vidradhis, localised swelling, etc. in case of accidental injuries and in intentional incisions, the lips of the wound are apposed and united by stitching (svana).
To obtain proficiency and acquiring skill and speed in these different types of surgical manipulations, Sushruta had devised various experimental modules for trying each procedure. For example, incision and excision are to be practised on vegetables and leather bags filled with mud of different densities; scraping on hairy skin of animals; puncturing on the vein of dead animals and lotus stalks; probing on moth-eaten wood or bamboo; scarification on wooden planks smeared with beeswax, etc. On the subject of trauma, Sushruta speaks of six varieties of accidental injuries encompassing almost all parts of the body.
Sushruta also gives classification of the bones and their reaction to injuries. varieties of dislocation of joints (sandhimukta) and fractures of the shaft (kanda-bhagna) are given systematically. He classifies and gives the details of the six types of dislocations and twelve varieties of fractures. He gives the principles of fracture treatment, viz., traction, manipulation, appositions and stabilisation. Sushruta has described the entire orthopaedic surgery, including some measures of rehabilitation, in his work.
As war was a major cause of injury, the name Salya-tantra for this branch of medical learning is derived from Salya, the arrow of the enemy, which in fights used to be lodged in the body of the soldiers. He emphasises that removal of foreign bodies is fraught with certain complications if the seat of the Salya be a marma
Marma
The Marma also known as Magh or Mog are Arakanese descendants inhabiting the Chittagong Hill Tracts of Bangladesh since the Arakan kingdom period in the 16th century AD. In the late 20th century, their population stood at over 210,000. Ethnically related to the Myanmar, they are largely followers...
.
Sushruta also discusses certain surgical conditions of ano-rectal region, he has given all the methods of management of both haemorrhoids and fistulae. Different types of incision to remove the fistulous tract as langalaka, ardhalangalaka, sarvabhadra, candraadha (curved) and kharjurapatraka (serrated) are described for adoption according to the type of fistula.
Sushruta was well aware of the urinary stones, their varieties; the anatomy of urinary bladder along with its relations is well recorded in the chapter on urinary stones. Varieties of stones, their signs and symptoms, the method of extraction and operative complication are given in detail. Apart from the above, surgery of intestinal obstruction (baddha-gudodara), perforated intestines (chidrodara), accidental injuries to abdomen (assaya-bhinna) in which protrusion of omentum occurs are also described along with their management.
Though the contributions of Sushruta are mainly in the field of Plastic
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
and Cataract surgery
Cataract surgery
Cataract surgery is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision...
, a number of his other contributions to medicine are listed below:
Plastic Surgery
Sushruta lays down the basic principles of plastic surgery by advocating a proper physiotherapy before the operation and describes various methods or different types of defects, viz., (1) release of the skin for covering small defects, (2) rotation of the flaps to make up for the partial loss and (3) pedicle flaps for covering complete loss of skin from an area. He has mentioned various methods including sliding graft, rotation graft and pedicle graft.Reconstruction of a nose (rhinoplasty) which has been cut-off, using a flap of skin from the cheek has also been described.
Lastly, labioplasty too has received his attention. In short, all the principles of plastic surgery, viz., accuracy, precision, economy and haemostasis find an important place in Sushruta's writings on this subject.
Legacy
The earliest surviving written material which mentions Sushruta's name is the Bower ManuscriptBower Manuscript
The Bower Manuscript is a medical manuscript written predominantly in the Sanskrit language,made up of 51 birch-bark leaves, written in an early Indian script.It is today preserved as part of the collections of the Bodleian Library in Oxford...
, discovered in Kashgar
Kashgar
Kashgar or Kashi is an oasis city with approximately 350,000 residents in the western part of the Xinjiang Uyghur Autonomous Region of the People's Republic of China. Kashgar is the administrative centre of Kashgar Prefecture which has an area of 162,000 km² and a population of approximately...
in 1890. The manuscript is dated on paleographic grounds to the second half of the 4th century.
The medical works of both Sushruta and Charaka
Charaka
Charaka, sometimes spelled Caraka, born c. 300 BC was one of the principal contributors to the ancient art and science of Ayurveda, a system of medicine and lifestyle developed in Ancient India...
were translated into Arabic language
Arabic language
Arabic is a name applied to the descendants of the Classical Arabic language of the 6th century AD, used most prominently in the Quran, the Islamic Holy Book...
during the Abbasid Caliphate (750 AD). These Arabic works made their way into Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
via intermediaries. In Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
the Branca family of Sicily
Sicily
Sicily is a region of Italy, and is the largest island in the Mediterranean Sea. Along with the surrounding minor islands, it constitutes an autonomous region of Italy, the Regione Autonoma Siciliana Sicily has a rich and unique culture, especially with regard to the arts, music, literature,...
and Gasparo Tagliacozzi
Gasparo Tagliacozzi
Gaspare Tagliacozzi was an Italian surgeon.Tagliacozzi was born in Bologna. He studied at the University of Bologna under Gerolamo Cardano and others, and, at the age of twenty-four, earned his degree in philosophy and medicine. First he was appointed professor of surgery and later was appointed...
(Bologna
Bologna
Bologna is the capital city of Emilia-Romagna, in the Po Valley of Northern Italy. The city lies between the Po River and the Apennine Mountains, more specifically, between the Reno River and the Savena River. Bologna is a lively and cosmopolitan Italian college city, with spectacular history,...
) became familiar with the techniques of Sushruta.
British
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
physicians traveled to India to see rhinoplasty
Rhinoplasty
Rhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
using a flap of skin raised from the forehead, being performed by native Indians. Reports on "Indian" rhinoplasty using the forehead skin (not the cheek flap as mentioned in the susrutha samahita) were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue
Joseph Constantine Carpue
Joseph Constantine Carpue was an English surgeon who was born in London. He was associated with St. George's Hospital and Duke of York Hospital in Chelsea. He was a skilled surgeon and popular lecturer of anatomy....
spent 20 years in India studying local plastic surgery methods. Carpue was able to perform the "Indian" method of nose reconstruction in the western world
Western world
The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...
by 1815.
Instruments described in the Sushruta Samhita were further modified in the Western World.