Charaka Samhita and Sushruta Samhita

by Nayana Sharma | 2015 | 139,725 words

This page relates ‘Multiplicity of Textual Strata’ of the study on the Charaka Samhita and the Sushruta Samhita, both important and authentic Sanskrit texts belonging to Ayurveda: the ancient Indian science of medicine and nature. The text anaylsis its medical and social aspects, and various topics such as diseases and health-care, the physician, their training and specialisation, interaction with society, educational training, etc.

Multiplicity of Textual Strata

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It is evident, therefore, from the evidence we have considered, the Saṃhitās were written over a long stretch of time and additions were made as medical knowledge progressed. The layers within the texts are not distinguishable at present. The multiplicity of textual strata can be seen as a response to enhancement of knowledge which is a continuous process. We have Dṛḍhabala’s affirmation that he compiled and restored aforementioned chapters of Caraka’s compendium by culling material from several important treatises. It is noteworthy that although Ātreya is a teacher of kāyā-cikitsā or internal medicine, the present Caraka Saṃhitā takes cognizance of surgical procedures in the treatment of particular conditions. The procedures that find mention are blood-letting by means of horn (śṛṅga), gourd (alābu), leech (jalauka) or sharp instrument (tikṣna śastra);^[1] cauterisation by application of alkalis (kṣāra-karma)^[2] or heat (agni-karma)^[3] and use of surgical instruments.

Blood-letting (rakta-mocana), for instance, is recommended in the following conditions: in certain types of fever (jvara);^[4] phantom tumour (gulma);^[5] skin disorders (kuṣṭha); psychological disorders (unmāda);^[6] āpasmāra (epilepsy);^[7] goitre (galagaṇḍa) and gaṇḍamālā (cervical adenitis);^[8] painful eruptions and swellings known as alaji, carmanakhāntara śotha (whitlow) and vidārikā;^[9] jālakagardabha (suppuration with fever),^[10] plīhodara (enlargement of the spleen) and yakṛdudara (liver enlargement);^[11] piles;^[12] ulcers (vraṇa);^[13] gout (vāta-rakta)^[14] and sciatica (gṛdhrasī).^[15] There is also an explanation of why becomes necessary in certain conditions and the precautions to be exercised.^[16] Caraka affirms that it is only after the elimination of blood impurities through blood-letting as well as elimination of vitiated doṣas from the gastro-intestinal tract that the ointments for kuṣṭha become efficacious.^[17] This acknowledgment must have come from the observation of the efficacy of blood-letting practised by the school of Dhanvantari.

The application of leeches is specified in piles if blood does not come out on its own.^[18] There is reference to use of sharp instruments (śastra) and cauterisation by alkali and heat in the management of skin disorders,^[19] piles^[20] and in various types of swellings (śotha).^[21] Thermal cauterisation is prescribed in ulcers with excessive bleeding, post-excision of protruding flesh, muscular over-growth, enlarged glands (caused by kapha), goitre, in stiffness and other ailments brought on by aggravated vāyu.^[22]

Incision of fistula with kṣāra sūtra (thread smeared with alkaline preparation) is also referred to by Caraka.^[23] Besides, the management of granthi (hard tumour) follows that prescribed by Suśruta: fomentation of the tumour, excision followed by cauterization.^[24] Surgical removal of abscesses^[25] and urinary stones and gravels^[26] are also mentioned.

The change in the position of practitioners of kāyā-cikitsā or internal medicine vis-à-vis surgical intervention is perhaps best illustrated by the following two statements of Caraka occurring in the Sūtra-sthāna and Cikitsā-sthāna respectively:

(a) One the factors that indicates negative prognosis of a disease is one in which treatment surgery, application of alkalis and cauterization is involved^[27] for they are difficult to cure (kṛcchrasādhya [kṛcchrasādhyam]).^[28]

(b) If the patient is kṛcchra (physically and mentally strong), then incision of the suppurated abscess is an excellent remedial measure (paramucyate).^[29]

The polarity of the two statements reflects the change in attitude towards another line of treatment which is accepted as efficacious in certain clinical conditions. Blood-letting and scarification as we have seen above are incorporated in the treatment of skin disorders.^[30] The use of kūrca (surgical brush with hard fibres) and sharp edged scalpel (śastra) are specifically mentioned in the chapter dealing with treatment of kuṣṭha.^[31] It is therefore not surprising that students of the Ātreya school had to be apprised of the six types of surgical procedures of pāṭana (incision), vyādhana (puncturing), chedana (excision), lepana or lekhana (scraping), pracchana (scarification) and sīvana (suturing) and their specific conditions of application.^[32] All these procedures as well as probing (eṣaṇa), application of alkalis and leeches are included in surgical therapy (śastrapraṇidhāna) as opposed to internal cleansing (antaḥparimārjana) and external cleansing (bahiḥparimārjana).^[33]

The processes involving surgical processes have generally been only a cursory treatment in Caraka’s treatise. Cakrapāṇidatta explains that since Caraka deals with medicine and surgical procedures fall in the domain of surgery, detailed explanation of the procedures is absent.^[34] Post-operative measures are not mentioned by in the treatise.

It is also interesting to point out that the recognition of blood-letting as a therapeutic measure necessitated acquaintance with the functions and properties of blood. The Ātreya school recognises the three doṣas (often translated as humours) of vāyu, pitta and kapha as the pathogenic factors in the body.^[35] Nevertheless, in the twenty-fourth chapter of the Sūtra-sthāna there is notice of blood as an independent vitiating factor with as many as forty clinical disorders are attributed to it.^[36] Two diseases mentioned among them are conjunctivitis (akṣirāga) and skin disorders. In the Cikitsā-sthāna, however, aetiologically both are attributed to the perturbation of the three doṣas or all the three together. Blood is not seen as a vitiating factor in eye diseases;^[37] while vitiation of blood is recognised in the pathogenesis of kuṣṭha, it is said to be caused by the perturbation of the three doṣas and not independently.^[38] One may, therefore, construe that this portion relating to blood in the Sūtra-sthāna^[39] is an interpolation in the compendium.

A few interpolations in the Suśruta Saṃhitā too may be indicated. Both the texts have described the seasonal regimen (ṛtucaryā) in the sixth chapter of their respective Sutra-sthāna.^[40] In fact one could argue that this chapter appears to be in the nature of an interpolation in the Suśruta’s compendium between the fifth chapter on “Preoperative Arrangements” (agropaharaṇīya-adhyāya) and the seventh chapter on “The Varieties of Blunt Instruments” (yantravidhiradhyāya). The chapter on “Ear Puncture and Plastic Surgery”^[41] describing fifteen patterns of repair of the ear lobule (karṇabandha) and rhinoplasty also appears to be a later insertion as the management of other ear and nose diseases are discussed in the Uttara-tantra.^[42] We would also argue that the 24^th chapter of the Sūtra-sthāna enumerating the classification of diseases is probably an interpolation.

The nature of management of children’s diseases is seems to be at variance with the treatment of other afflictions for they are all ascribed to malevolent beings (grahas) and not to the imbalance of doṣas.^[43] The text recommends various offerings of food substances including cooked and uncooked meat for the appeasement of the grahas-a feature not noticed in other sections of the work. Finally the discussion of internal diseases like fever, diarrhoea, consumption, etc. in last section of the compendium is also a later addition for they are not present in the eight major diseases enumerated in the Nidāna-sthāna. We may conjecture that this was necessitated by the complications arising from surgical procedures and their understanding became fundamental for the surgeon.

The presence of several textual layers makes the task of determination of time of composition of the treatises rather complex. The term Saṃhitā itself indicates that the treatises are compilations. It is necessary to take up a critical study of the extant manuscripts as has been accomplished by V.S. Sukhthankar for the Mahābhārata which unfortunately we have not been able to take up.