Sushruta Samhita

Ancient Sanskrit medical compendium

The Sushruta Samhita (, ) is an ancient Sanskrit text on medicine and surgery, and one of the most important such treatises on this subject to survive from the ancient world. The Compendium of Suśruta is one of the foundational texts of Ayurveda (Indian traditional medicine), alongside the Charaka Saṃhitā, the Bhela Saṃhitā, and the medical portions of the Bower Manuscript. It is one of the two foundational Hindu texts on the medical profession that have survived from ancient India. The Suśrutasaṃhitā is of great historical importance because it includes historically unique chapters describing surgical training, instruments and procedures which is still followed by modern science of surgery. One of the oldest Sushruta Samhita palm leaf manuscripts is preserved at the Kaiser Library, Nepal.

The most detailed and extensive consideration of the date of the Suśrutasaṃhitā is that published by Meulenbeld in his History of Indian Medical Literature (1999 2002). Meulenbeld stated that the Suśrutasaṃhitā is likely a work that includes several historical layers, whose composition may have begun in the last centuries BCE and was completed in its presently surviving form by another author who redacted its first five sections and added the long, final section, the "Uttaratantra." It is likely that the Suśruta saṃhitā was known to the scholar display=true (fl. 300 500 CE), which gives the latest date for the version of the work that has survived into the modern era. In Suśrutasaṃhitā A Scientific Synopsis, the historians of Indian science Ray, Gupta and Roy noted the following view, which is broadly the same as Meulenbeld's:"The Chronology Committee of the National Institute of Sciences of India (Proceedings, 1952), was of the opinion that third to fourth centuries A. D. may be accepted as the date of the recension of the Suśruta Saṃhitā by Nāgārjuna, which formed the basis of Dallaṇa's commentary. "The above view remains the consensus amongst university scholars of the history of Indian medicine and Sanskrit literature.

Regrettably, given its subsequent influence, a century ago, the scholar Rudolf Hoernle (1841 – 1918) proposed that because the author of Satapatha Brahmana, a Vedic text from the mid first millennium BCE, was aware of Sushruta's doctrines, Sushruta's doctrines should be dated based on the composition date of Satapatha Brahmana. The composition date of the Brahmana was itself unclear, added Hoernle, but he estimated it to be about the sixth century BCE. Unfortunately, Hoernle's date of 600 BCE for the Suśrutasaṃhitā continues to be widely and uncritically cited in spite of much intervening scholarship over the last century. Yet because of further research, scores of scholars have subsequently published more considered opinions on the date of the work, and these many views have been summarized by Meulenbeld in his History of Indian Medical Literature. Central to the problem of chronology is the fact that the Suśrutasaṃhitā is the work of several hands. The internal tradition recorded in manuscript colophons and by medieval commentators makes clear that an old version of the Suśrutasaṃhitā consisted of sections 1 5, with the sixth part having been added by a later author. However, the oldest manuscripts we have of the work already include the sixth section, called the Uttara tantra. Manuscript colophons routinely call the whole work "The Suśrutasaṃhitā together with the Uttara tantra," reinforcing the idea that this was perceived as a five+one composition.

As mentioned above, scores of scholars have proposed hypotheses on the formation and dating of the Suśrutasaṃhitā. an adjective meaning "renowned") is named in the text as the author, who is presented in later manuscripts and printed editions a narrating the teaching of his guru, Divodāsa. A person of this name is said in early texts such as the Buddhist Jatakas to have been a physician who taught in a school in Kashi (Varanasi) and lived in Varanasi too, sometime between 1200 BCE and 600 BCE. The earliest known mentions of the name Sushruta firmly associated with the tradition of the Suśrutasaṃhitā is in the Bower Manuscript (4th or 5th century CE), where Sushruta is listed as one of the ten sages residing in the Himalayas. Rao in 1985 suggested that the author of the original "layer" was "elder Sushruta" (Vrddha Sushruta), although this name appears nowhere in the early Sanskrit literature. The text, states Rao, was redacted centuries later "by another Sushruta, then by Nagarjuna, and thereafter Uttara tantra was added as a supplement". mentions Hindu gods such as Narayana, Hari, Brahma, Rudra, Indra and others in its chapters, refers to the scriptures of Hinduism namely the Vedas, and in some cases, recommends exercise, walking and "constant study of the Vedas" as part of the patient's treatment and recovery process. The text also uses terminology of Samkhya and other schools of Hindu philosophy. The Sushruta Samhita and Caraka Samhita have religious ideas throughout, states Steven Engler, who then concludes "Vedic elements are too central to be discounted as marginal". These ideas include the use of terms and same metaphors that are pervasive in the Hindu scriptures – the Vedas, and the inclusion of theory of Karma, self (Atman) and Brahman (metaphysical reality) along the lines of those found in ancient Hindu texts. However, adds Engler, the text also includes another layer of ideas, where empirical rational ideas flourish in competition or cooperation with religious ideas. Following Engler's study, contemporary scholars have abandoned the distinction "religious" vs. "empirico rational" as no longer being a useful analytical distinction. The text may have Buddhist influences, since a redactor named Nagarjuna has raised many historical questions, whether he was the same person of Mahayana Buddhism fame. Zysk states that the ancient Buddhist medical texts are significantly different from both Sushruta and Caraka Samhita. For example, both Caraka and Sushruta recommend Dhupana (fumigation) in some cases, the use of cauterization with fire and alkali in a class of treatments, and the letting out of blood as the first step in treatment of wounds. Nowhere in the Buddhist Pali texts, states Zysk, are these types of medical procedures mentioned. Similarly, medicinal resins (Laksha) lists vary between Sushruta and the Pali texts, with some sets not mentioned at all. While Sushruta and Caraka are close, many afflictions and their treatments found in these texts are not found in Pali texts. In general, states Zysk, Buddhist medical texts are closer to Sushruta than to Caraka, and in his study suggests that the Sushruta Samhita probably underwent a "Hinduization process" around the end of 1st millennium BCE and the early centuries of the common era after the Hindu orthodox identity had formed. Clifford states that the influence was probably mutual, with Buddhist medical practice in its ancient tradition prohibited outside of the Buddhist monastic order by a precedent set by Buddha, and Buddhist text praise Buddha instead of Hindu gods in their prelude. The mutual influence between the medical traditions between the various Indian religions, the history of the layers of the Suśruta saṃhitā remains unclear, a large and difficult research problem. Sushruta is reverentially held in Hindu tradition to be a descendant of Dhanvantari, the mythical god of medicine, or as one who received the knowledge from a discourse from Dhanvantari in Varanasi. The printed editions are based on the small subset of surviving manuscripts that was available in the major publishing centers of Bombay, Calcutta and elsewhere when the editions were being prepared — sometimes as few as three or four manuscripts. But these do not adequately represent the large number of manuscript versions of the Suśruta saṃhitā that have survived into the modern era. Taken together, all printed versions of the Suśrutasaṃhitā are based on no more than ten percent of the more than 230 manuscripts of the work that exist today. These manuscripts exist in the libraries in India and abroad today. More than two hundred manuscripts of the work exist, and a critical edition of the Suśruta saṃhitā is yet to be prepared.

The Sushruta Samhita is among the most important ancient medical treatises.

Sushruta, states Tipton, asserts that a physician should invest the effort to prevent diseases as much as curative remedial procedures. An important means for prevention, states Sushruta, is physical exercise and hygienic practices. The text adds that excessive strenuous exercise can be injurious and make one more susceptible to diseases, cautioning against such excess. Regular moderate exercise, suggests Sushruta, improves resistance to disease and physical decay. Sushruta has written Shlokas on the prevention of diseases.

The Sushruta Samhita states, per Hoernle's translation, that "the professors of Ayurveda speak of three hundred and sixty bones, but books on Shalya Shastra (surgical science) know of only three hundred". The text then lists the total of 300 as follows: 120 in the extremities (e. g. hands, legs), 117 in the pelvic area, sides, back, abdomen and breast, and 63 in the neck and upwards. The text then explains how these subtotals were empirically verified. The discussion shows that the Indian tradition nurtured diversity of thought, with Sushruta school reaching its own conclusions and differing from the Atreya Caraka tradition. The osteological system of Sushruta, states Hoernle, follows the principle of homology, where the body and organs are viewed as self mirroring and corresponding across various axes of symmetry. The differences in the count of bones in the two schools is partly because Charaka Samhita includes thirty two teeth sockets in its count, and their difference of opinions on how and when to count a cartilage as bone (both count cartilages as bones, unlike current medical practice).

The Sushruta Samhita is best known in non specialist sources on medical history for its approach and discussions of surgery. A student should practice, states the text, on objects resembling the diseased or body part. Incision studies, for example, are recommended on Pushpaphala (squash, Cucurbita maxima), Alabu (bottle gourd, Lagenaria vulgaris), Trapusha (cucumber, Cucumis pubescens), leather bags filled with fluids and bladders of dead animals. The ancient text, state Menon and Haberman, describes haemorrhoidectomy, amputations, plastic, rhinoplastic, ophthalmic, lithotomic and obstetrical procedures. Reconstruction of a nose (rhinoplasty) which has been cut off, using a flap of skin from the cheek is also described. Labioplasty too has received attention in the samahita.

The Sushruta Samhita, along with the Sanskrit medicine related classics Atharvaveda and Charak Samhita, together describe more than 700 medicinal herbs.