Acharya Sushruta (आचार्य सुश्रुतः)

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Everyone around the world who practices surgery remembers the pioneering contributions of Acharya Sushruta for introducing surgical methods of treatment approach and establishing the fundamentals of surgery, now referring to him as the “Father of Surgery”. Acharya Sushruta laid down the roadmap of various surgeries in his work now known as “Sushruta Samhita” which is one of the largest and oldest written treatises on surgery, anatomy, and various other procedures which is also called Shalya Tantra(techniques of surgery). Sushruta Samhita is also a part of “bhrihat trayee” which literally means three great trios. The other treatises are, “Charaka Samhita” and “Ashtanga Sangraha/Hriday.

Time period and history

Ayurvedic knowledge is the oldest Indian traditional system of medicine that antedates other systems of medicine by not less than four centuries. Acharya Sushruta was the disciple of “Deivodasa” who was the King of Kashi. (Kashi is considered one of the oldest cities, known to humans since 1500 BCE, which is now known as Varanasi) he hailed from the Dhanwantari () school of thought. Medicine was taught in ancient India through Guru- Shishya parampara which is a method of imparting knowledge from a guru or teacher to his shishya or student/disciple in the form of shruti (verbal verses) which is solely in Sanskrit.

According to some references mentioned in Ramayana, Acharya Sushruta was the son of Sage Vishwamitra (he was the Guru of Lord Rama and Lakshmana).  

Even though many aspects of Sushruta Samhita are well-researched these days, there is not much written about Acharya Sushruta, who wrote the treatise. Son of Sage Vishwamitra, Acharya Sushruta practiced in the northern city of India, Kashi (now Varanasi) by the banks of river Ganga around 1000-1500 BCE. This interacts with the period of Acharya Charaka, drawing a loose conclusion that these two Acharyas could be contemporaries.

According to certain historians, Sushruta is the term used to denote “renowned”, thus the birth name could be different.

According to “panini” in the 7^th cent BCE, refers the meaning of the word “Sushruta” is a person who is skilled in surgery.

According to certain historians, Divodasa is also considered as an incarnation of Lord Dhanwantari.

Sushruta Samhita

Originally written by Acharya Sushruta, this treatise was later redacted by Acharya Nagarjuna.

The original treatises written by Acharya Sushruta are yet untraceable, but a copy of this original treatise was found in Chinese Turkestan, in 1890. This was later sold to a man named Hamilton Bower. Now, this copy is named Bower’s manuscript since it was purchased by him. This Bower’s manuscript is now placed in Oxford, Bodlean Library. A man named Horlean later edited this copy and since Sushruta’s name was found in the treatise, he traced its origins around the 5^th cent BCE.  This is approx. 150 years before Hippocrates.

https://www.ijsr.net/archive/v5i3/NOV153097.pdf

Acharya Sushruta’s disciples were known as Sushrutas, and they were trained for 6 years in theory and later practical knowledge and the hands-on training was provided for them following Standard procedure.  The incision and suture techniques were practiced on Vegetables, and leather bags filled with different densities of mud. Puncturing on veins of dead animals, lotus stalks, scraping techniques on the skin of hairy animals, scarring on the wooden plank smeared with beeswax. The skills of incision and cuts were taught on the skin of Alavu(bottle gourd), Pushpaphala(another type of gourd), and cucumber. These methods merely suggest the excellent skill set and training methods during those times as well.

https://www.ijsr.net/archive/v5i3/NOV153097.pdf

The original treatise consists of 120 chapters which are divided into 5 sections or “sthana”,

Sthana / Section	Number
Sutrasthana	46
Shareerasthana	10
Nidanasthana	16
Chikitsasthana	40
KalpaSthana	08
Uttara tantra	66

Dissection

A deeper understanding of the human body is impossible without dissecting it, thus, Acharya Sushruta during his era did dissect the human body with the help of certain plants like roots of ushira(Vetiver) used as a brush, bamboo, and many more. His dissection methods were skillful and study of shareera (human body) layer by layer.

Embryology

Acharya Sushruta in Shareera Sthana mentioned verses describing the layers of development in the embryo. He later described the diseases affecting those layers and treatment and preventive aspects for mothers during pregnancy.

Thus, there is a description of congenital as well as genetic factors as well.

Anatomy

There are mentions of the anatomical positions of each named organ and its function, dosha, dhatu, and many other aspects of Ayurvedic anatomy in a separate section of Sushruta Samhita by Acharya Sushruta in Shareera Sthana.

Detailed mentions of the number of bones and their classification, muscles, various channels (strotas), organs, etc.

Ophthalmology

Ophthalmology and E.N.T (ear, nose, and throat) have been described in detail under the Shalakya Tantra.

There are steps mentioned by Acharya Sushruta in the form of verses, on how to remove the opacity of the cataractous lens. Several such surgical methods were practiced during that time following the steps mentioned in Sushruta Samhita.

Explanation of yantras and shastras

There is a description of over 120 surgical instruments (yantra-101 and shastra - 20) and more than 300 surgical procedures. And anushastras () where shastras cannot be used.

Apart from these, suture and bandaging techniques have also been mentioned in reference to fractures as well.

Unique techniques such as jalauka avacharana(extraction of a minimum quantity of blood from a particular area of shareera through Jalauka or certain kind of leeches), and siravedhana(venipuncture) specific to Shalya Tantra have gained popularity in recent times.

Reconstructive surgeries, skin grafts and plastic surgeries

Acharya Sushruta mentioned reconstruction of the earlobe in fifteen ways along with pre and post-operative procedures.

In 1792, Tipu Sultan’s soldiers captured a Maratha Cart driver and cut off his nose and arm. A year later, a Vaidya (named Kawasji) in Poona (now Pune) reconstructed his nose and two British surgeons from the Bombay Presidency observed and witnessed this skillful procedure and noted its details. This, in 1794 was later published in “The Gentlemen’s Magazine” describing it as an operation not uncommon in India. This procedure was similar to that mentioned in Sushruta Samhita.

These techniques suggest that acharya Sushruta considered Surgery as the best possible treatment for many disorders and has mentioned Standard protocol for skillful surgical procedures and many other unique methods including “jalauka avarachana” during medieval India and took surgery to commendable heights.