Sushruta Samhita, volume 1: Sutrasthana

by Kaviraj Kunja Lal Bhishagratna | 1907 | 148,756 words

This current book, the Sutra-sthana (english translation), is the first part of this voluminous medical work. It contains a large summary of the knowledge envelopig the medical aspects of Ayurveda. Descriptions of diseases, various diets and drugs, the duties of a surgeon, surgical procedures, medical training; these are only some of the numerous s...

Chapter XIV - Description of blood

Now we shall discuss the Chapter which treats of blood (Shonita-Varnaniya-adhyaya).

The food of a human being, which is usually composed of the five fundamental material principles, admits of being classified under four different heads [as, drinks and edibles, etc.]. It has six different tastes or is of two [cooling or heat-making] potencies, or consists of eightfold properties, [ viz. hot, cool, dry, expansive, slimy, mild, sharp, etc.] and of a variety of other active or efficacious virtues. The food is fully digested with the help of the internal heat and ultimately assimilated in the system, giving rise to lymph chyle (Rasa) which is extremely thin or attenuated in its consistency and which forms the essence of the assimilated food.[1]

The lymph chyle (Rasa), though running through the whole organism, has its primary seat in the heart, whence it flows through the twenty-four vessels which branch off from the latter (heart) to the remotest parts and extremities of the body. Of the aforesaid twenty-four vessels, ten are up-coursing, ten are down-coursing, and four have a lateral direction. The Rasa or the lymph chyle, thus flowing out of the heart, constantly soothes, maintains, and irrigates by transudation the body, and further contributes to its growth, and supports life owing to the dynamical effects of causes which lie beyond the ken of human understanding. The nature and course of this lymph chyle, which runs through the whole system, can be inferred from the growth, attenuation, or other modified conditions of the body.

Now it may be asked, whether the Rasa, which permeates the entire body and limbs, and which by flowing through different chambers (visceras) of the body is thus in constant contact with the excreta and other morbid humours, is of a cooling (Saumya) or heat-making (agneya) potency?

The question may be answered by stating that, since the Rasa or lymph chyle is a fluid, and possessed of lubricating, vitalising, moistening, and nutritive (lit:—supporting) properties, it must be included within the class of Saumya (cooling) substances. The Rasa, though a Saumya fluid, obtains its characteristic pigment (Ragam) in its passage through the spleen and liver.

Authoritative verses on the subject:—

The Rasa or the lymph chyle, coloured through the effect of the healthy normal dyeing heat of the body, obtains the name of blood. The Rasa is transformed into the catamenial flow in women which commences at the age of twelve and ceases at fifty.

Catamenial blood, though originating from Rasa which is of a cooling potency, is fiery or heat-making (agneya) in its character; and the fecundated or impregnated ovum (Garbha) is both cooling and heatmaking in its properties on account of its partaking of the nature of both the menstrual blood (ovum) and semen which are respectively possessed of the two preceding virtues. Hence several authorities hold the blood to be identical with the life blood or with the vital principle of a living organism, and being such, to be the product of the five fundamental material principles (Pancabhautika).

Metrical texts:—

In blood the properties such as, a raw or fleshy smell, fluidity, redness, lightness and mobility, which respectively characterise the fundamental principles (of earth, water, fire, air, and sky) are to be found thus representing those specific elements in its composition.

The chyle produces blood. From blood is formed flesh. From flesh originates fat which gives rise to bones. From bones originate marrow, which, in its turn, germinates semen.

The Rasa which is originated from the digested or assimilated food and drink pre-eminently strengthens all the fundamental principles of the body.

The Purusha or self-conscious personality is Chyle-born in its origin, and hence an intelligent person should carefully preserve his bodily Rasa (lymph chyle) by adopting a proper regimen of diet and conduct.

The term Rasa is derived from the root “Ras”, to go, and the substance is so called from the fact of its continually flowing through and permeating every vital principle of an animated organism.

The Rasa is successively transformed into each of the six remaining fundamental principles of the body, and continues in the shape of each for the period of three thousand and fifteen kalas (five days according to our modern computation). Thus the Rasa is converted into semen, or into the menstrual blood (ovum) in women, in the course of a month.[2]

Authoritative verse on its computation:—

In the present work, as well as in other works of recognised authority, a month is calculated to consist of eighteen thousand and ninety Kalas.

The said Rasa courses through the whole body in invisible currents of zigzag shape, like the waves of sound, or in (an upward direction) like flames of fire, or (in a downward direction) like rivulets of water.

Now it may be asked, since the Rasa is naturally transformed into semen in.the course of a month, what is the use of administering medicine which has a stimulating effect upon the organs of generation (Vajikarana.) The answer is, that such medicines out of their own specific potencies and virtue help the speedy conversion of Rasa into semen and its profuse emission [on the desired occasion] like purgatives aiding the drastic evacuation of the bowels.

Again it may be asked, how is it, that semen is not found in an infant? Since perfume in a flower-bud is imperceptible to the organ of smell you may as well ask whether there is any perfume in it or not. But what does not exist in a thing can not be evoked in the subsequent course of its development. As the perfume in a flower-bud lies latent in its early stage of growth but becomes patent only with the growth of its seed organs, so semen or catamenial blood lies in a potential state in a male or a female child, and appears with the growth of beards and mustaches, or with the enlargement of the breasts, uterus and vaginal canal and the appearance of pubic hair.

The same Rasa, originated from the assimilated food, serves only to maintain the vitality in the old and spontaneously decayed subjects owing to an exhausted state of the inner vitalising principle, natural to old age. The abovesaid principles (of Rasa, blood etc.) are called the root principles (Dhatus), inasmuch as they maintain the integrity of the human organism and guard against its speedy dissolution)., And since the strength or weakness of the abovesaid bodily principles absolutely depends upon the richness or poverty of blood, we shall discourse on the latter condition of the blood.

The blood, vitiated by the deranged bodily wind (Vayu), becomes thin, frothy, transparent, quick-coursing, and expansive, assumes a vermilion or black hue, and is divested of its slimy character; whereas vitiated through a deranged condition of the bile (Pitta), it assumes a blue, yellow, green, or brown colour, emits a fishy smell, becomes thin in its consistency and is shun by flies and ants. Similarly, blood, vitiated by the deranged phlegm (Kapha), becomes cold, glossy and thick, assumes a colour like that of the washings of Gairika or that of a flesh tendon, takes time in secreting or in running down, and is marked by an increase of its slimy character. The blood, vitiated through a concerted derangement of the three bodily humours, is marked by features peculiar to each of them, and assumes a colour like that of Kanjika (sour gruel), and emits a fetid smell. Similarly, the blood, vitiated through the joint action of any two of the (beforesaid) bodily humours, is characterised by features peculiar to each of them.

The blood in its healthy and natural state is possessed of a vivid red colour like that of an Indragopa (Cochineal) insect, and is neither too thin nor too transparent.[3]

Cases where blood-letting is prohibited:—

A person afflicted with an edematous swelling extending all over the body should be deemed unfit for bleeding. An intumescence occurring in a weak and enfeebled patient owing to an excessive use of acid food or in a person suffering from jaundice or laid up with hemorrhoids or abdominal dropsy, as well as in an enceinte, or in a person suffering from Pulmonary consumption (Shosha), should not be bled.

Blood-letting, with the help of a surgical instrument, may be grouped under two distinct heads, according as scarification (Pracchana) or venesection (Sira-Vyadhana) is resorted to for the purpose. In such a case the knife or the instrument (Shastram) should be driven straight and speedily so as to make the incision straight, narrow, unextended, and of equal and slight depth throughout, (so as to reach only the surface layer of the flesh and blood), and not to injure in any way the local veins, nerves, joints, and other vital parts.

Bleeding performed on a cloudy day or done with a wrong incision, or with full exposure to cold and wind, or performed on a patient not previously diaphorised, or on a patient with an empty stomach, is attended with little or no outflow of blood owing to the thickened condition of the blood.

Authoritative verse on the subject:—

Blood-letting surgically performed on a fatigued or exhausted subject, or on a person in a swoon, or anyway poisoned or intoxicated, or on a person suffering from extreme constipation of the bowels accompanied by suppression of the flatus (Vayu) and urine, or on a person of timid disposition, or on one overcome with sleep, is marked by the absence of any outflow of blood.

The vitiated blood, failing to find out an outlet, gives rise to itching, swelling, redness, burning, suppuration and pain in the part (to which it is confined). On the contrary, blood-letting performed on the body of a person excessively diaphorised or heated, or by an ignorant or inexperienced surgeon, or with an injudiciously deep incision, is attended with Hemorrhage, which may be followed by such dreadful results as Shirobhitapa or violent headache, blindness or loss of sight (Timria), Adhimantha (ophthalmia), loss of vital principles of the body (Dhatu-Kshaya), convulsions, paralysis (Ekanga Vikara), Hemiplegia (Pakshaghata), thirst, a burning sensation, hic-cough, cough, asthma, jaundice and even death.

Authoritative verses on the subject:—

Therefore blood-jetting should be performed on a patient not in an extremly hot or cold season, neither on one who is too much heated or improperly diaphorised (before the act). The patient should be given gruel (Yavagu) before the operation. A spontaneous cessation of red flow would indicate that there has been a free discharge of blood.

An act of complete and successful blood-letting is followed by a feeling of lightness and alleviation of pain in the affected part, by an abatement of the disease, and a general sense of cheerfulness.

A person, accustomed to blood letting, enjoys a kind of immunity from all types of skin diseases, sarcomata, aneurism, oedema, and diseases brought about by a vitiated condition of the blood such as, Ovarian tumour, Carbuncle, Erysipelas, etc.

A plaster composed of Ela, Shitashiva, Kustha, Tagara, Patha, Agaradhuma, Bhadradaru, Vidanga, Citraka, Trikatus, Ankura, Haridra, Arka, and Nakta-mala, or three, or four, or as many of them as are available, pasted together and soaked in mustard oil saturated with common salt, should be rubbed over the mouth of the incision. By this means the blood will fully come out. In a case of excessive flow or Hemor rhage, the mouth of the incision should be gently rubbed with a composition consisting of the powders of Lodhra, Priyangu, Madhuka, Pattanga, Gairika, Sarjarasa, Rasanjana, Shalmali flowers, Shankha, Shukti, Masha, Yava and Godhuma, and firmly pressed with the tips of the fingers. As an alternative, the mouth of the incision should be gently rubbed with the powdered barks of Sala, Sarja, Arjuna, Arimeda, Mesha-shringi, and Dhanvana, or the edges of the wound should be lightly dusted with the burnt ashes of a silk cord (a piece of silk rolled up in the form of a cord), and firmly pressed with the tips of the fingers; or the mouth of the wound should be lightly touched with the powders of Laksha and Samudra-phena, and its edges should be similarly pressed together as above. Then the wound should be firmly tied up (with a piece of silk or linen) plastered over with a paste of the substances mentioned in connection with the bandaging of ulcers (Vrana). The patient should be kept in a cool room, covered over with a wet sheet and constantly soothed with sprays of cold water. A medicinal plaster of a cooling virtue and a course of cooling diet should be prescribed for him. The wound should be cauterised with fire or an alkali, or the vein should be again opened at a point a little below the seat of the first incision in case where the abovesaid measures should have failed to check the flow of blood. The patient should be made to drink a decoction compound of drugs of the Kakolyadi group, sweetened with sugar or honey; and his ordinary drink should consist of the blood of the Ena or common deer, or of a sheep, hare, or buffalo. A diet composed of boiled rice, soaked in or saturated with clarified butter, should be prescribed, and the complications should be subdued according to the nature of the deranged bodily humours respectively involved therein.

Authoritative verses on the subject:—

Excessive blood-letting is followed by impaired appetite and an agitated condition of the vital Vayu owing to the loss of the fundamental principles of the body, and, accordingly, to recoup the health of the the patient a course of diet should be prescribed which is light and not excessively heat-making, and which contains a fair amount of emollient and blood-making matter, and is marked by little or no acid taste.

The four measures indicated for the stoppage of bleeding are known; as the Sandhana (process by contracting the affected part), the Skandana (thickening or congealing the local blood), the Pacana (process of setting up suppuration in the wound) and the Dahana (process of cauterisation).

Drugs of astringent tastes are possessed of the property of bringing about an adhesion (contraction) of the wound. Cooling measures such as, applications of ice etc, tend to thicken the local blood; alkalis and alkaline preparations produce suppuration in such a wound or ulcer, whereas cauterisation has the property of.contracting a vein.

Remedies and appliances possessed of the virtue of bringing about an adhesion of such a wound should be used where applications for thickening or congealing the local blood would fail; whereas the suppurating measures should be adopted in the event of the former (Sandhana) proving ineffectual. With any of the three of these preceding measures a physician should try to check the outflow of blood incidental to an operation of bleeding, and lastly the process of cauterisation should be resorted to in the event of the preceding ones having proved unavailing, as it is pre-eminently the best means of checking the bleeding.

The least residue of the vitiated blood continuing in the affected part may not aggravate the disease but prevent its perfect healing. In such a case bleeding should not be again resorted to, but the deranged residue should be subdued by means of pacifying or absorbing remedies.

Blood is the origin of the body. It is blood that maintains vitality. Blood is life. Hence it should be preserved with the greatest care.

The Vayu of a person who has been bled, and which has been aggravated by constant cold applications may give rise to a swelling of the incised part characterised by a piercing pain, which should be treated with an unguent of tepid clarified butter.


Thus ends the fourteenth Chapter of the Sutrasthana in the Sushruta Samhita which treats of Blood.

Footnotes and references:


It is free from all sorts of impurities such as fecal matter, etc., and permeates the minutest vessels and capillaries.


The successive development of the fundamental or root principles of the body follows a distinct order. The essence of the assimilated food-matter under the heat of digestion goes towards the formation of chyle, and is ultimately transformed into it, its excreted and effete residue being passed out of the organism in the shape of stool, etc. The chyle thus produced is called the immature Rasa, or the Rasa in its nascent stage. Subsequently it enters into the bodily principle of Rasa, becomes matured by the native heat of the latter, and is resolved into three factors, or in other words, its excreted matter is transformed into phlegm, its thick or condensed portion is transformed into and assimilated in the matured Rasa of the body, whereas its subtile essence is metamorphosed into blood. The blood, thus newly generated, is merged into the fundamental organic principle of blood; and there by the heat of the latter it is again resolved into three factors, viz., its excreted portion is transformed into bile, its thick or condensed portion is transformed or assimilated into the fundamental organic principle of blood, and its subtile essence is metamorphosed into flesh. The flesh, thus newly formed, is merged into the fundamental organic principle of flesh, and there, by the native heat of the latter, it is resolved into three factors, vis, its excreted portion goes towards the formation of such excreta as are found to be deposited in the corners of the eyes and inside the integuments of the prepuce, or about the region of the glans penis, its thick or condensed portion is transformed into the organic principle of flesh and its subtile essence is metamorphosed into fat. The fat, thus newly generated, enters into the organic principle of that name, and there, by the native heat of the latter, is resolved into three factors, viz, its excreted portion is discharged through the pores of the skin in drops of perspiration, its condensed portion is assimilated in the organic principle of fat, and its subtile portion is metamorphosed into bone. Again the bone, in its nascent stage, enters into the organic principle of bone, and there, by the inherent heat of that principle, is resolved into three factors, viz, its excreted portion goes towards the formation of hairs, mustaches, etc, its thick or condensed portion is assimilated into the organic principle of bone, and its subtile portion is metamorphosed into marrow. The marrow, in its nascent state, enters into the organic principle of that name; and there matured under the native heat of that principle, it is resolved into three factors, viz, its excreted portion contributes towards the formation of gelatinous matter deposited in the corners of the eyes, and the oily secretions of the skin, its condensed portion is assimilated into the organic principle of marrow, and its subtile portion is metamorphosed into semen. The semen again, in its nascent stage, enters into the organic principle of that name and there matured under its native heat is resolved into two factors, viz. thick and thin. The thick portion is assimilated into the organic principle of semen, the thin one being metamorphosed into (albumen). Semen, like gold a thousand times purified, casts off no dregs. Hence certain authorities hold albumen (protoplasmic matter) to be the eighth or the culminating principle of the body.


Additional texts:—Later on we shall have occasion to speak of the principles known as the life-blood (essential conditions of vitality—Sk. Jiva-Shonita) and of the process of blood-letting.

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