Sushruta Samhita (सुश्रुतसंहिता)

In the field of advance learning in the ancient India like Art , Culture, Religion, Science ,Medicine and Philosophy Amongst Ancient India’s contribution to the world of Science and Medicine  Ayurveda Possibly the best known.

Out of four Vedas Rigveda, Samveda, Yajurveda, Atharveda  Ayurveda (Knowledge of Life) known to be a much prospered evolution of Atharveda is a system of Bharat's medicine originating in Bharat's Subcontinent.

Ayurveda represents eight different branches such as Kaychikitsa (Medicine), Balroga (Paediatric), Graharog (Psychiatry), Shalakya-Tantra (EENT), Shalya-Tantra(Surgery),Danshtra(Toxicology) Rasayana (Rejuvenation), Vajikarana (Reproductive)

Shalya-tantra, the science of Surgery. Shalya tantra found its roots in the war Surgeons of the time, Shalya which means foreign object usually referred to broken arrow heads  embedded in the warriors body so the liberal translation of Shalya tantra is science of removal of foreign objects from the body.  Sushrut Samhita or Sushrut’s Compendium the presently available ancient text of Ayurved represents The School of Surgery.

Sushruta

Sushruta was not only a practitioner of Surgery but also a teacher of Surgery. The hierarchy of school of surgery is as follows, Lord Dhanvantari a Supreme Physician and Surgeon mentioned in almost every classical Bharat's text. This Lord Dhanvantari is amongst 14 Precious stones which are the by-product ocean churning by Deva and Asura i.e. Gods and demons. Lord Dhanvantari brought Amrut Kalash a potion of life into his hands the purpose of appearance of lord Dhanvantari health and longevity of life in the Process of Samudra Manthan , Being a celestial after completion of his purpose lord Vishnu grant his wish to be reincarnated on the earth to serve human being with all his knowledge.

   He reincarnated as Kashiraj Divodas, according to Garud purana  Divodas is a fourth descent of Dhanvantari also named Dhanvantari because of his forefather.

This Kashiraj Divodas established a School of Surgery with his 12 students Sushrut, Aurabhra, Vaitarna , Karveerya, Gopurakshita 1and 2, Aushaneva, Nimi,Gargya, Galav,Paushkalavt. This school predominantly taught Ayurveda- Shalytantra/Surgery to all these students. Amongst all these student Sushrut was brightest student who scripted Sushrut Samhita.

Every compendium has several contributors era by era, there are four remarkable contributor to Sushrut samhita as follows

1.      Kashiraj Divodas/Vrudhha Sushrut -1000-1500 BC 

2.      Sushrut- 2^nd Century

3.      Nagarjun -5^th Century

4.      Chandrat -10^th Century

When it comes to a name Sushrut there are two persons named Sushrut associated with Sushrut samhita first from Upanishad Kaal and a student of Kashiraj Divodas.  He was From the Race of Vishwamitra This Reference also mentioned in – Mahabharat Anushasana Parva. This also coincides with the description given of him in the present recension of Samhita. This Sushruta also considered as Vriddha Sushrut or Old Sushrut. The second Sushruta. He was from Satvahan Kaal ,He was priest of Satvahan Empire also named as Shalihotra Sushrut this era can be established by following points mentioning of community medicine, medicine for emperor, belief on demons and extra-terrestrials, political view similar to Satvahan Empire all these references are mentioned in the compendium. Nagarjun was from the Kapalik community this community belongs to monks who lived in graveyards use heavy metals processing to convert them into the gold and use them in the medicine related to Rasashastra. Chandrat was the last contributor to this classic texthe completely remoulded the compendium by adding extra section to the compendium as Uttartantra.

   Overview of the Samhita- Sushrut was empathetically surgeon, Sushrut samhita is the only book that deal with problems of Practical surgery and midwifery. Almost all the other Samhita written by Sushrut fellow Students are either lost to us or imperfectly preserved. To Sushrut may be elevating the glory of elevating the art of a lancet to forceps to the status of practical science. It may not be out of place  here to give a short history of Ayurveda as it was practice and understood in pre saushrutic times if only to accentuate the improvements which he introduced in every branch of medical science. In Samhita it discusses blood in terms of the fourth doshic principle. This work is the first to enumerate and discuss the pitta sub-doshas and the marmas. With its emphasis on pitta, surgery, and blood, this work best represents the transformational value of life and surgical field.Sir Harold Gillis Pioneer of Modern plastic surgery Quoted Plastic surgery is a race between beauty and Blood supply. The Sushruta Samhita was composed after Charaka Samhita, and except for some topics and their emphasis, both discuss many similar subjects such as General Principles, Pathology, Diagnosis, Anatomy, Sensorial Prognosis, Therapeutics, Pharmaceutics and Toxicology. The Sushruta Samhita, in its extant form, is divided into 186 chapters and contains descriptions of 120 illnesses,700 medicinal plants, 64 preparations from mineral sources and 57 preparations based on animal sources. Crude methods and still cruder implements of incision such as bits of glass, Bamboo skins described in Samhita, Primitive instrumentology  which found favour to ancestor long before humanisation. Sushrut has Knowledge of practical anatomy, Sushrut devoted his whole life to pursuit surgery proper. He was the first to describe and classified different operatives Called as Ashtvidha Shastrakarma. He advised to use models before getting direct into surgery Models-Yogya. Varna –complete chapter dedicated to wound. Also mentioned about Post-operative care of wound. Fractures also mentioned very thoroughly and deeply. The Compendium also mentioned about Fluid evacuation from Hydrocele sac, Ascites. Intestinal perforation , intussusception , volvulus-twisted intestine Discoloured skin after operative regaining natural tone of skin even hairs too are included in 60 treatments, Bandages of wounds.

॥ Shastra Karmas

Basic surgical principals such as,

◦         Chedana -Incision

◦         Bhedana -Excision

◦         Vedhana - Puncturing

◦         Eshana -Probing

◦         Aharana –Extraction of solid bodies

◦         Lekhana -scaring, Dermaplannig

◦         Vistravana -Evacuating fluids

◦         Seevana - Suturing 

Are the classical features of the Samhita which are till date the basic principal of Surgery.

The most popular treatment in ano-rectal diseases Kshar Sutra, it is a medicated thread (seton) coated with herbal Alkaline drugs like Apamarga (Kshar) (Ash of Achyranthus ascera), Snuhi (Euphorbia nerufolia) latex and Haridra (Curcuma longa) powder in a specific order. This combination of medicines on the thread helps in debridement and lysis of tissues, exerts antifungal, anti-bacterial, and anti-inflammatory. Another mechanism proposed for the Kshara Sutrais that it destroys the residual glands in the epithelium.The whole plastic Surgery in Europe took a new flight when these cunning devises of Bharat's workmen become known to us “Transforming an entire skin flap is also an Bharat's method. It is Sushrut who first successfully demonstrated the feasibility of mending a clipped ear lobe with a patch of sensible skin flap or Scrape from the neck of adjoining part. Of the 76 verities of the ophthalmic diseases amongst them 51 are surgical. The mode of operation which is to be performed in each case has been elaborately described in the Samhita. And does not unfavourably compare in most instances with modern methods of ophthalmic surgeries. Sushrut is attributed the glory of discovering the art of cataract crouching which was unknown to the surgeons of ancient Greece and Egypt. Amputations were freely made. Sushrut does not rest content the mere bursting and opening an abscess and the healing of incidental wound but lays down the process of for major operations as well. The removal of the cicatrices until it becomes the same colour with the surrounding skin and the growth of the hair there on are suggestion which we find nowhere else. It is in the region of practical midwifery that one become so much impressed with the greatness of Sushrut. Different turning, flexing, gliding movement. Applications of the forceps in cases of difficult labour and other obstetric operations involving destruction and mutilation of child evolve in samhita such as craniotomy etc. Mentioned about Fumigation and sterilization technics of Sutika agar- labour room. Marma consists of aggregate of Mamsa, Sira, Snayu, Asthi and Sandhi in which particularly Prana by nature stays. That which leads to death or which gives misery to individual similar to death when injured is called Marma. They are that part of the body which exhibits a peculiar sensation or unusual throbbing and causing pain on pressure. Marmas are so called because they cause death when they are injured and they are meeting place of Mamsa, Asthi, Snayu, Dhamani, Sira, Sandhi and life entirely resides in them.

             This was a brief discussion of Sushrut samhita till date this compendium is a mile stone in the field of science of Surgery.

References

Links to Books

Sushruta Samhita English Translation	Kaviraj Kunja Lal Bhishagratna	1911	Calcutta	Volume 1 : Sutra sthanam	https://archive.org/details/dli.bengal.10689.3279/page/n1
		1911	Calcutta	Volume 2 : Nidana-sthana, Sarira sthana, Chikitsa sthana and Kalapa Sthana	https://archive.org/details/englishtranslati00susruoft/page/n4
		1916	Calcutta	Volume 3 : Uttara tantra	https://archive.org/details/AyurvedicTextTheSushrutaSamhitaVol.III/page/n3

Sushruta samhita of Sushruta with Nibandhsangrah Commentary of Dalhancharya Edited by Vaidya Yadavji Trikamji Acharya, Publisher Chaukhmba Surbharati Prakashan. Reprint-2008