Sushruta Samhita

Palm leaves of the Sushruta Samhita or Sahottara-Tantra stored at Los Angeles County Museum of Art, from Nepal, the text is dated 12th-13th century while the art is dated 18th-19th century.

The Sushruta Samhita (सुश्रुतसंहिता, IAST: Suśrutasaṃhitā, literally "Suśruta's Compendium") 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 Caraka-Saṃhitā, the Bheḷa-Saṃhitā, and the medical portions of the Bower Manuscript.[1][2] It is one of the two foundational Hindu texts on medical profession that have survived from ancient India.[3][4]

The Suśrutasaṃhitā is of great historical importance because it includes historically unique chapters describing surgical training, instruments and procedures.[2][5]

History

Ancient qualifications of a Nurse

That person alone is fit to nurse or to attend the bedside of a patient, who is cool-headed and pleasant in his demeanor, does not speak ill of any body, is strong and attentive to the requirements of the sick, and strictly and indefatigably follows the instructions of the physician.

Sushruta Samhita Book 1, Chapter XXXIV
Translator: Bhishagratna[6]

Date

The early scholar Rudolf Hoernle proposed that given that the author of Satapatha Brahmana – an ancient Vedic text, was aware of Sushruta doctrines, those Sushruta doctrines should be dated based on the composition date of Satapatha Brahmana.[7] The composition date of the Brahmana is itself unclear, added Hoernle, and he estimated it to be about the sixth century BCE.[7] While Loukas et al. date the Sushruta Samhita to the mid 1st-millennium BCE,[8] Boslaugh dates the currently existing text to the 6th-century CE.[9]

Rao in 1985 suggested that the original layer to the Sushruta Samhita was composed in 1st millennium BCE by "elder Sushruta" consisting of five books and 120 chapters, which was redacted and expanded with Uttara-tantra as the last layer of text in 1st millennium CE, bringing the text size to six books and 184 chapters.[10] Walton et al., in 1994, traced the origins of the text to 1st millennium BCE.[11]

Meulenbeld in his 1999 book states that the Suśruta-saṃhitā 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."[1] It is likely that the Suśruta-saṃhitā was known to the scholar Dṛḍhabala (fl. 300-500 CE, also spelled Dridhabala), which gives the latest date for the version of the work that has survived into the modern era.[1]

Tipton in a 2008 historical perspectives review, states that uncertainty remains on dating the text, how many authors contributed to it and when. Estimates range from 1000 BCE, 800–600 BCE, 600 BCE, 600–200 BCE, 200 BCE, 1–100 CE, and 500 CE.[12] Partial resolution of these uncertainties, states Tipton, has come from comparison of the Sushruta Samhita text with several Vedic hymns particularly the Atharvaveda such as the hymn on the creation of man in its 10th book,[13] the chapters of Atreya Samhita which describe the human skeleton,[14] better dating of ancient texts that mention Sushruta's name, and critical studies on the ancient Bower Manuscript by Hoernle.[12] These information trace the first Sushruta Samhita to likely have been composed by about mid 1st millennium BCE.[12]

Authorship

A statue dedicated to Sushruta at the Patanjali Yogpeeth institute in Haridwar. In the sign next to the statue, Patanjali Yogpeeth attributes the title of Maharishi to Sushruta, claims a floruit of 1500 BC for him, and dubs him the "founding father of surgery", and identifies the Sushrut Samhita as "the best and outstanding commentary on Medical Science of Surgery".

Suśruta (Devanagari सुश्रुत, an adjective meaning "renowned"[15]) is named in the text as the author, who presented the teaching of his guru, Divodāsa.[16] He is said in ancient texts such as the Buddhist Jatakas to have been a physician who taught in a school in Kashi (Varanasi) in parallel to another medical school in Taxila (on Jhelum river),[17][18] sometime between 1200 BC and 600 BC.[19][20] One of the earliest known mentions of the name Sushruta is in the Bower Manuscript (4th or 5th century), where Sushruta is listed as one of the ten sages residing in the Himalayas.[21]

Rao in 1985 suggested that the author of the original "layer" was "elder Sushruta" (Vrddha Sushruta). The text, states Rao, was redacted centuries later "by another Sushruta, then by Nagarjuna, and thereafter Uttara-tantra was added as a supplement.[10] It is generally accepted by scholars that there were several ancient authors called "Suśruta" who contributed to this text.[22]

Affiliation

The text has been called a Hindu text by many scholars.[9][23][24] The text discusses surgery with the same terminology found in more ancient Hindu texts,[25][26] mentions Hindu gods such as Narayana, Hari, Brahma, Rudra, Indra and others in its chapters,[27][28] refers to the scriptures of Hinduism namely the Vedas,[29][30] and in some cases, recommends exercise, walking and "constant study of the Vedas" as part of the patient's treatment and recovery process.[31] The text also uses terminology of Samkhya and other schools of Hindu philosophy.[32][33][34]

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".[34] These ideas include treating the cow as sacred, extensive 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.[34] However, adds Engler, the text also includes another layer of ideas, where empirical rational ideas flourish in competition or cooperation with religious ideas.[34]

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.[22] 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.[35] Similarly, medicinal resins (Laksha) lists vary between Sushruta and the Pali texts, with some sets not mentioned at all.[36] While Sushruta and Caraka are close, many afflictions and their treatments found in these texts are not found in Pali texts.[37]

In general, states Zysk, Buddhist medical texts are closer to Sushruta than to Caraka,[35] 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.[38] 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.[39] 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.[22]

Suśruta is reverentially held in Hindu tradition to be a descendant of Dhanvantari, the mythical god of medicine,[40] or as one who received the knowledge from a discourse from Dhanvantari in Varanasi.[16]

Manuscripts and transmission

A page from the ancient medical text, Susruta samhita.

Our knowledge of the contents of the Suśruta-saṃhitā is based on editions of the text that were published during the nineteenth and early twentieth centuries. Especially noteworthy is the edition by Vaidya Yādavaśarman Trivikramātmaja Ācārya that also includes the commentary of the scholar Dalhaṇa.[41]

The printed editions are based on just a small subset of manuscripts that were available in the major publishing centres 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. These manuscripts exist in the libraries in India and abroad today, perhaps a hundred or more versions of the text exist, and a critical edition of the Suśruta-saṃhitā is yet to be prepared.[42]