Origin Of Sushruta Samhita
The roots of modern Indian Ayurvedic medicine can be traced back to ancient texts that predate the Christian era by an impressive 4000 years. The developmental history of ancient India unfolds across three distinct periods: the Vedic era (circa 1500–500 BCE), the Brahmanic era (600 BCE–1000 CE), and finally, the Mughal era (1000 CE until the 18th century).
Referred to as the ‘science’ of medicine in ancient India, Ayurveda finds its origins in the Atharvaveda and is considered an upanga, or subsidiary, to this ancient Vedic text. The term ‘Ayurveda’ translates to the Veda focused on prolonging life. Furthermore, the medical science associated with it is referred to as ‘Vaidyasastra,’ and individuals practicing it are called ‘vaidya,’ indicating their possession of knowledge (vidya).
The Ayurvedic tradition is deeply rooted in Vedic philosophies, forming the foundational principles of this ancient system of medicine. Compiled during the Vedic period, Ayurveda is recognized as one of the oldest known systems of medicine, reflecting the profound wisdom and knowledge cultivated in ancient India.
As per tradition, Ayurveda, initially consisting of eight parts or “astranga,” covered various aspects including major surgery (salya), minor surgery (sala kya), treatment of bodily diseases (kayaacikitsa), demonology or teachings on diseases caused by demons (bhutavidya), healing of children’s diseases (Kaumarabhrtya), toxicology (agadatantra), elixirs (Rasayana), and aphrodisiacs (vajikarana). At the core of Ayurvedic medicine lie two fundamental texts: the Susruta Samhita and the Charaka Samhita.
Susruta, a renowned physician and surgeon, authored the Susruta Samhita in the 6th century BCE while teaching at the University of Benares (alternatively Kasi or Varanasi) along the Ganga River.His notable achievements include the thorough compilation of surgical knowledge, techniques, and instruments.Notably, Susruta’s work underscores a profound consideration of anatomical structure and function, with a notable advocacy for human dissection. His texts provide a systematic method for the dissection of the human cadaver.
Charaka, affiliated with the northwestern region of India and the ancient university of Taxila, resided during the mid-2nd century. His Charaka Samhita, comprised of 120 chapters in five books, delves into various aspects of medicine. The section on Sharira-sthaka mainly delves into topics of anatomy, embryology, and dissection techniques. Although the exact date of the Charaka Samhita’s origin is uncertain, some estimates suggest it was composed in the early 4th century BCE. Philosophical and ethical considerations permeate the Charaka Samhita, including an Oath of Initiation akin to the Hippocratic Oath.
In ancient India, the conveyance of medical knowledge followed a hereditary model, where wisdom seamlessly transferred from the ‘Guru’ (teacher) to the ‘Sisya’ (disciple).
Who was Sushruta?
Sushruta, considered the father of Indian surgery, hailed from the Eastern part of India near Bihar. He pioneered rhinoplasty in India and is estimated to have flourished around 1000 BCE, as per late Vedic hymns. Although his renowned work, the Susruta Samhita, has not survived, its legacy persists through revisions and copies.
The Samhita focuses on surgical matters, detailing specific instruments and various surgical operations. Susruta’s distinct approach involves revealing human anatomy through surface inspection and human dissection. He emphasized the importance of aspiring surgeons acquiring profound knowledge of the human body’s intricate structure. Intriguingly, neither Sushruta nor Charaka, another influential figure in ancient Indian medicine, indicated practicing animal dissection, suggesting their anatomical knowledge was primarily derived from human dissection.
Their writings reveal a significant grasp of human bone anatomy, demonstrating a sophisticated understanding of ancient Hindu anatomical knowledge. This contributes to the historical foundations of surgical practices in India. The advancement of surgery in ancient Indian medical history is noteworthy, particularly considering the challenges that impeded the study of anatomy. Hindu tenets regard the human body as sacred in death, with Shastras stipulating that nobody should be violated by a knife, and individuals over 2 years old must be cremated in their original condition. Despite these obstacles, Susruta managed to overcome these constraints. He gained remarkable knowledge of human anatomy by employing a brush-type broom to delicately remove skin and flesh without direct contact with the corpse.
Susruta’s description of anatomical specimens encompassed over 300 bones, along with various types of joints, ligaments, and muscles from different body parts. Critics suggest that Susruta’s overestimate of the number of bones in the human body could be attributed to the observation of a significant number of child cadavers. It is plausible that Susruta accounted for individual parts of bones that had not yet fused. Despite potential errors in his skeletal accounts, Susruta provided a comprehensive understanding of bones, muscles, joints, and vessels that surpassed the knowledge of his time.
Sushruta Samhita
The Susruta Samhita stands as arguably the oldest surgical textbook, with its name translating to ‘that which is well heard’ or ‘one who has thoroughly learned by hearing.’ Originally written in Sanskrit, the book underwent its initial translation into Arabic in the late 8th century. Subsequently, it was translated into Latin, German, and English. The most recent English translation, by Kaviraj Bhishagharatan, was published in 1910, with a later edition released in 1963.
The ancient text is split into two sections: the Purva-tantra and the Uttara-tantra. The Purva-tantra further breaks down into five books: the Sutrasthana, Nidana, Sarirasthana, Chikitasathanam, and the Kalpastham, collectively comprising 120 chapters.
During the era of the Susruta Samhita, the healing arts were classified into five categories, including Rogaharas (physicians), Shaylyaharas (surgeons), Vishaharas (poison healers), Krityaharas (demon doctors), and Bhisagatharvans (magic doctors).
The Sutrasthana covers basic medical science and pharmacology, Nidana addresses disease processes, Chikitsasthanam makes up the majority of the text with 34 chapters on surgical procedures and post-operative management, and Kalpasthanam consists of eight chapters on toxicology.
Anatomy in Sushruta Samhita
According to Susruta, being a skilled and erudite surgeon necessitates a deep understanding of anatomy. The Sarirasthana, consisting of 10 chapters, is dedicated to the study of human anatomy. In the Susruta Samhita, it is stated:
“The different parts or members of the body, as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully observe, by dissecting it, and examining its different parts.
This emphasizes the importance Susruta placed on practical experience, specifically the dissection of cadavers, as the means to acquire a comprehensive understanding of the intricacies of human anatomy.
Dissection Procedure Given In Sushruta Samhita
Addressing the conflict with religious laws prohibiting human dissection, Susruta devised a method to navigate within these constraints while utilizing cadavers for a genuine comprehension of human anatomy. The Susruta Samhita outlines this process:
“For dissecting purposes, a cadaver should be selected with all parts present, belonging to a person not poisoned or afflicted by chronic disease, below 100 years old, and devoid of fecal contents in the intestines. This cadaver, wrapped in materials like ‘munja’ (bush or grass), bark, ‘kusa,’ or flax, is placed in a cage, submerged in a slow-flowing river, and left to decompose in an unlit area. After seven nights of proper decomposition, the cadaver should be removed from the cage and dissected slowly using brushes made from ‘usira’ (fragrant roots of a plant), hair, bamboo, or ‘balvaja’ (coarse grass). Following this method, the skin, internal and external parts, along with their subdivisions, are visually examined.”
Notably, the Susruta Samhita acknowledges the role of a student in dissection, stating: “A pupil, otherwise well-read but uninitiated in the practice of medicine or surgery, is not competent to take in hand the medical and surgical treatment of disease.” The text further advocates teaching medical students the art of making cuts in a ‘puspaphala’ (gourd), ‘alavu’ (bottle-gourd), or ‘ervaruka’ (cucumber) before engaging in the dissection of human cadavers.
Procedure On Head And Neck
In the context of ancient Indian practices, where the Hindu Laws of Manu mandated cutting the nose as punishment for adultery, the Susruta Samhita offers insights into reconstructive surgical techniques. Addressing the equivalent of a modern ‘free flap,’ Susruta’s procedure demonstrates a profound understanding of human facial anatomy.
In the portrayal of an otoplastic operation, Susruta is shown conducting the procedure with the patient under the influence of wine. The patient is supported by friends and relatives as the skilled surgeon proceeds to create an artificial ear lobe. For this, a section of the flesh is cut from the patient’s cheek, attached to the stump of the mutilated organ, treated with hemostatic powders, and then carefully bandaged.
The procedure involves first gathering a leaf from a creeper, of sufficient length and breadth to cover the entire severed or clipped part. Subsequently, a patch of living flesh, equal in size to the gathered leaf, is sliced off from the region of the cheek. After scarifying it with a knife, the living flesh is swiftly adhered to the severed nose. The physician, maintaining composure, then ties it up with a bandage suitable for the purpose. To ensure full adhesion of the severed parts, the physician inserts two small pipes into the nostrils for respiration and to prevent the adhered flesh from hanging down. Following this, the adhered part is dusted with hemostatic powders, and the nose is enveloped in Karpasa cotton, with repeated sprinkling of refined oil of pure sesame.
In Case Of Tearing Earlobe
In cases where the tearing of earlobes occurred due to the widespread practice of piercing and enlarging earlobe holes in ancient India, Susruta recommended a pedicle flap reconstructive procedure. This involved taking a graft of skin from an adjacent area while meticulously preserving its vascular supply. Subsequently, the graft was rotated to the site of the defect and reattached, demonstrating Susruta’s advanced understanding of reconstructive surgical techniques.
For the reconstruction of damaged earlobes resulting from practices like earlobe piercing in ancient India, Susruta detailed a surgical procedure. A skilled surgeon, well-versed in surgical knowledge, would extract a patch of living flesh from the cheek, ensuring its ends remained connected to the original site. The designated area for the artificial ear lobe would be lightly scarified, and the blood-rich living flesh, previously sliced off, would be carefully adhered to resemble a natural ear lobe. The flap was then treated with honey and butter, bandaged with cotton and linen, and dusted with baking clay powder. This intricate procedure underscored Susruta’s advanced understanding of facial anatomy, including considerations of blood supply.
Eye Procedures
Susruta dedicated significant attention to ophthalmic studies, particularly addressing prevalent conditions like cataracts in his region. His conceptualization of the eye involved five fundamental elements: earth (Bhu), fire/heat (Agni), air (Vayu), fluid (Jala), and void (Akasa). In this framework, the extraocular muscles represented the solid earth, heat/fire denoted the blood circulating through vessels, air constituted the iris and pupil, the vitreous part corresponded to the fluid element, and the lacrimal ducts originated from the void.
Susruta further divided the eye into five anatomical divisions (Madalas): eyelashes, eyelid, sclera, choroid, and pupil. He detailed a procedure for cataract removal, showcasing his advanced understanding of ocular anatomy and surgical techniques.
The procedure is traditionally conducted during the warm season. Beforehand, the patient’s skin is treated with an oily medicine applied with a cotton pledget, followed by a heated bath. The patient receives a light refreshment, and the treatment room is fumigated with vapors containing white mustard, bdellium, nimva leaves, and resinous gums of shala trees to eliminate insects and potential diseases. Additionally, incense of cannabis and wine are employed for sedation.
During the technique, the patient sits on a high stool, facing the surgeon. The hands are secured, and the patient is instructed to focus on their nose while the surgeon, holding a Yava Vaktra Salaka between the thumb, index, and middle fingers, enters the eye at the junction of the medial and lateral two-thirds of the outer portion of the sclera. The left eye is pierced with the right hand, and vice versa.
Following the correct needle placement, a sound is produced after the gushing of watery fluid. However, if bleeding occurs, indicating needle misplacement, the eye is sprinkled with breast milk. Care is taken to avoid blood vessels. The needle tip is then used to incise the anterior capsule of the lens. While the needle is in place, the patient is instructed to blow down one nostril, closing the opposite one. This action results in the emergence of lens material (Kapha) alongside the needle. Once the patient can perceive objects, the needle is removed.
Postoperatively, indigenous roots, leaves, and ghee are applied with a bandage. The patient lies flat and is advised not to sneeze, cough, or move. The eye is examined every fourth day for ten days, and if whitish material recurs, the procedure is repeated.
Pelvis And Perineum
The Hindu religion’s focus on reproduction and sexual energy is reflected in the Susruta Samhita, which extensively addresses male urogenital issues, while also considering women’s health. Susruta recommended the use of dilators, irrigating syringes, and catheters. The management of a urethral stricture involves the gentle introduction of a lubricated tube made of iron, wood, or shellac into the urethra, gradually increasing the thickness of the tubes through dilation. Emollient food is advised for the patient. Alternatively, an incision into the lower part of the penis, avoiding the sevani (raphe), can be made and treated as an incidental ulcer.
Conclusion1
The enduring influence of Susruta’s groundbreaking work, the Susruta Samhita, continues to shape the Ayurvedic tradition, which persists as a widely practiced system today. Acknowledging the contributions of ancient civilizations, including ancient India, provides valuable insights into the evolution of anatomical knowledge and its impact on our contemporary understanding.
