Charaka Samhita and Sushruta Samhita

by Nayana Sharma | 2015 | 139,725 words

This page relates ‘Samhitas (Introduction)’ 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.

The Saṃhitās (Introduction)

We begin our study with an overview of our two primary treatises on ancient Indian medicine-the Caraka Saṃhitā and the Suśruta Saṃhitā-which along with Vāgbhaṭa’s Aṣṭāṅgahṛdaya Saṃhitā constitute the Bṛhatrayī or “The Great Triad” of Āyurvedic tradition. The compendium of Caraka is primarily a treatise on kāyācikitsā or internal medicine while Suśruta’s work is concerned essentially with śalyacikitsā or surgery. Nonetheless, both the compendia are encyclopaedic in character for they incorporate knowledge of all the eight branches of Āyurveda. Succeeding generations of practitioners and theorists have depended on these treatises for the knowledge of the fundamental principles of the Āyurvedic system of medicine and applied therapeutics. Other than expounding on all its aspects, the Saṃhitās also explain the philosophy on which this system of medicine is based. It has been commented that their comprehensive character and superior merit probably led, in course, to the extinction of the manuscripts of authors who preceded them. Later writers “confined their labour to making better arranged and more compendious compilations for the use of students, and to explaining or dilating upon the texts of Caraka and Suśruta.”[1]

We have noticed in the Introduction how the beginnings of the interest in ancient Indian medicine can be traced back to the late 18th and the early 19th centuries. Since the texts of Suśruta Saṃhitā and Caraka Saṃhitā first appeared in print in 1835 and 1868 respectively, several editions of the two treatises as also their translations have been published.

In this study for the two treatises we have referred to the following editions of the texts with their translations:

1. R.K. Sharma and Vaidya Bhagwan Dash, Agniveśa’s Caraka Saṃhitā: Text with English Translation and Critical Exposition based on Cakrapāṇi Datta’s Ayurveda Dīpikā, Vols. I-VII, Varanasi: Chowkhamba Sanskrit Series Office, 2008 (Reprint).

2. G.D. Singhal et al., Ancient Indian Surgery based on Suśruta Saṃhitā, Vols. 1-10, Delhi: Chaukhamba Sanskrit Pratisthan, 2006-2007 (Reprint).

3. P.V. Sharma (Edited and translated), Suśruta Saṃhitā with English Translation of text and Ḍalhaṇa’s Commentary along with Critical Notes, Varanasi: Chaukhamba Visvabharati Oriental Publishers and Distributors, 2010 (Reprint).

The popularity of these two treatises is attested to by the vast amount of scholarship they have attracted in the form of commentaries. There are as many as 43 Sanskrit commentaries on the Caraka Saṃhitā though some are only partially available.[2] Among the scholars, Cakrapāṇidatta’s commentary Āyurveda Dīpikā of the 11th century CE is considered the most authoritative. He was also one of the commentators of the Suśruta Saṃhita along with Jejjaṭa, Gayadāsa, Bhaskar, Madhava and Brahmadeva, but the most influential of them all was Ḍalhaṇa (12th century CE). He belonged to an illustrious family of vaidyas. His work Nibandhasaṃgraha is available in complete form.[3]

In this chapter we have made an overview of the contents of the two treatises. We have looked at the issues of the authorship and their time of composition which have vexed Āyurvedic theoreticians and historians of ancient Indian medicine. We have also tried to indicate interpolations and dissimilarities between the two treatises and their basic social orientation.

The Caraka Saṃhitā, consisting of 120 chapters, is composed in both prose and poetry form. Poetry was known to serve as a memory aid and helped students of Āyurveda to memorise the sūtras.[4] It is divided into eight sections or sthānas. The number of sthānas in the Suśruta Saṃhitā[5] is six of which the first five also consist of 120 chapters. The last section or the Uttara-tantra, which is generally regarded as supplementary to the text, is composed of 66 chapters. The subject matter of these sections of the two Saṃhitās is similar with certain differences. The eight sections of Caraka’s treatise are:

1. The Sūtra-sthāna[6] consisting of 30 chapters deals with the fundamental principles of the various aspects of Āyurveda. Hence, it is also known as ślokāsthāna.[7] It is described as the brain of the treatise (śiraḥ).[8] Some of the topics of discourse are the origin and transmission of the science of life, its objective and scope, causation and alleviation of disease, composition of drugs and their usage, dietetics, the four pillars of therapeutics, classification of diseases and various types of therapies. Daily and seasonal regimens for maintenance of good health as well as the principles of social ethics have been discussed.

The chapters of the Sūtra-sthāna barring the 29th and the 30th have been arranged into seven quadrates (sapta catuṣkas) which are as follows:

(i) Chapters 1-4 form the bheṣaja catuṣka dealing with drugs and basic principles of Āyurveda.

(ii) Chapters 5-8 represent the svastha catuṣka that contains instructions for preserving good health.

(iii) Chapters 9-12 constitute the nirdeśa catuṣka containing instructions about various subjects including the four aspects of therapeutics.

(iv) Chapters 13-16 comprise the kalpanā catuṣka that describes the requisite factors essential for initiation of treatment.

(v) Chapters 17-20 form the roga catuṣka that enumerates the various types of diseases.

(vi) Chapters 21-24 constitute the yojanā catuṣka which is a quadrate on therapeutics describing the administration of different therapies.

(vii) Chapters 25-28 represent the annapāna catuṣka which is an exposition on dietetics.

The last two chapters summarise the Sūtra-sthāna as well as the entire treatise.

2. The Nidāna-sthāna[9] comprising 8 chapters is an exposition on the aetiology and diagnosis of eight diseases. It describes their aetiology (nidāna), premonitory symptoms (pūrvarūpa), manifested symptoms (liṅga), exploratory therapy (upaśaya) and pathogenesis (samprāpti).

3. The Vimāna-sthāna[10] consists of 8 chapters. The term “vimāna” implies measure, and therefore, this section deals with science of right measure or proportion. It describes mainly with principles governing the administration of drugs and diet; the etiology of epidemics; means of examining diseases; medical education and debates.

4. The Śārīra-sthāna[11] comprising 8 chapters explains the principles governing the creation of the universe and the human body, embryology, anatomy, pregnancy and childbirth.

5. The Indriya-sthāna[12] is the fifth section of the treatise consisting of 12 chapters. Prognosis of disease on the basis of various signs and symptoms, physiological and non-physiological, is the objective of this section.

6. The Cikitsā-sthāna[13] consisting of 30 chapters is the section on therapeutics wherein rasāyana (rejuvenation) and vājikaraṇa (aphrodisiac) therapies and the treatment of several diseases are described in detail.

7. The Kalpa-sthāna[14] provides various formulations of emetic and purgative drugs in 12 chapters.

8. The Siddhi-sthāna[15] describes the successful administration of pañcakarma or the five elimination therapies in 12 chapters.

The six sections of the Suśruta Saṃhitā and their contents are as follows:

1. The Sūtra-sthāna is of greater length than that of Caraka and comprises 46 chapters. After providing an introduction to Āyurveda, it describes various aspects of surgery, the mode of training, prognostication on the basis of signs and symptoms, treatment of war wounds, pharmacology and dietetics.

2. The Nidāna-sthāna deals with the aetiology, pathogenesis, signs and symptoms of surgical diseases in 16 chapters.

3. The Śārīra-sthāna contains 10 chapters that explain the fundamental concepts of anatomy, physiology and embryology. The procedure of venesection and care of pregnant women are the other topics have also been dealt with here.

4. The Cikitsā-sthāna consisting of 40 chapters is concerned with the management of patients. The treatment of conditions requiring surgical intervention such as ulcers, wounds, fractures and haemorrhoids as well as systemic diseases like skin disorders, urinary ailments, diabetes, etc. have been death with. This section also explains procedures of restorative and rejuvenation therapies.

5. The Kalpa-sthāna is section on toxicology. Poisons of diverse origin, their effects and antidotes have been described in detail in 8 chapters.

6. The Uttara-tantra[16] is the longest section of 66 chapters dealing with four branches of Āyurveda - Kāyacikitsā (Internal Medicine), Kaumārabhṛtya (Paediatrics), Śālākya-tantra (Ophthalmology and Otorhinolaryngology) and Bhūtavidyā (Psychological disorders). The last few chapters deal with miscellaneous topics like rasas (tastes), hygiene, medical terminology and classification of doṣas. It is so called as it is of supreme importance and it is a collection of useful topics placed at the end.[17]

Both the treatises, thus, describe the eight branches of Āyurveda. They are:[18]

Kāya-cikitsā/ Internal Medicine: deals with the management of generalised systemic diseases such as fever, haemorrhagic tendencies, consumption and other wasting diseases, insanity, epilepsy, leprosy, other skin disorders, urinary abnormalities, diarrhoea, dysentery, etc.

Śālākya-tantra /Ophthalmology and Otorhinolaryngology: is concerned with the management of diseases of the body of the regions above the clavicles, i.e., the eyes, the ears, the oral and nasal cavities, etc. The term is derived from the word śalākā which means rod-like blunt instruments used for the application of medicines or sharp instruments for surgical procedures.[19]

Śalya-tantra/ Surgery: which is so named as it deals with the extraction of foreign bodies (śalyas) such as straw, pieces of wood, stones, dust or metal particles, pebbles, bone fragments, hairs, nails, removal of pus or secretions, infected ulcers and obstructed labour by means of blunt and sharp instruments, alkali treatment and cauterisation. Diagnosis and treatment of wounds and surgical conditions fall within its purview.

Agada-tantra/Toxicology: deals with the signs and symptoms as well as the management of poisoning resulting from the bites of snakes, insects, worms, rodents or other poisons.

Bhūta-vidya/Science of seizures or Psychiatry: is concerned with management of disorders resulting from invasion of bhūtas such as Deva, Dānava, Gandharva, Yakṣa, Rākṣasa, Pitṛ, Piśāca, Nāga, etc.

Kaumāra-bhṛtya/Paediatrics: The care of infants and children and management of disorders arising from flawed nursing and presence of evil spirits are the major concerns of this branch.

Rasāyana-tantra/Science of Rejuvenation: is concerned with methods to maintain youth, increase longevity, intellectual capacity and strength as well as to enable the patient to be free from disease.

Vājikaraṇa-tantra/Science of Fertility and Virility: deals with male and female infertility and the administration of aphrodisiacs

Both our compendia discourse on the entire gamut of this science; yet the foci of the two treatises are quite different from each other which is evident from the relative importance given to internal medicine and surgery. In the enumeration of the eight branches, Caraka Saṃhitā[20] begins with kāya-cikitsā and places surgery in the third position while Suśruta Saṃhitā[21] mentions śalya-cikits first.

Caraka’s compendium is generally believed to be anterior to Suśruta’s though there are views to the contrary. The mention of the school of Dhanvantari or the dhānvantarīyāḥ in the context of clinical conditions requiring surgical intervention in the Caraka Saṃhitā[22] has led a scholar like Kunja Lal Bhisagratna to posit an anterior position for Suśruta.[23] Besides, Caraka has cited the opinion of Dhanvantari in the development of the foetus.[24] A similar position is taken by Priyadarshan Ray and others that in the absence of sufficient evidence an earlier date for Caraka Saṃhitā is not tenable.[25]

In support of the anteriority of Caraka, it is argued that the latter is more systematic in its arrangement of its subject matter.[26] P.C. Ray in his work, History of Hindu Chemistry, also argued that the text of Caraka is written in a haphazard and unsystematic manner intermingled with metaphysical disquisitions in sharp contrast to the precise style of works produced in the Buddhist and later periods.[27] We may consider the contents of the Sūtra-sthāna of both the treatises for a comparative discussion. We have noticed the contents of this section above in brief. The first chapter of the Suśruta Saṃhitā gives the definition of Āyurveda, its scope, the eight sub-divisions of medical science, definition of disease and disease typology. The qualifications of the medical teacher and the student, the initiation ceremony and the method of teaching are discussed here in the second chapter itself; whereas in the Caraka Saṃhitā, the topic of medical education and intiation is discussed much later in the text in the third section or Vimāna-sthāna.[28]

The Sūtra-sthāna of Suśruta serves as an excellent introduction to the subject of surgery and to the medical profession itself. Preliminary preparations for surgery (agraharaṇa),[29] the three stages of a surgical procedure,[30] types of surgical instruments,[31] their manufacture, proper use and care,[32] demonstrations of surgical methods and practical experiments (yogya),[33] methods of clinical examination,[34] preparation and application of caustics,[35] thermal cauterization,[36] identification of leeches and their application,[37] the procedure of blood-letting,[38] the fundamentals of physiology,[39] clinical features of abscesses,[40] dressing of wounds by pastes and bandages,[41] nursing of the surgical patient,[42] beneficial and non-beneficial diets for the patient,[43] the eight types of surgical procedures[44] and the extraction of foreign bodies from tissues[45] are some of the topics described here. Besides, professional requirements[46] and ethics[47] have also been dealt with in this section.

The Caraka Saṃhitā, on the other hand, after providing an introduction to the subject by way of a narrative on the origin and transmission of the knowledge of medicine, identification of the pathogenic factors, classification of drugs and enumeration of the useful among them in the first chapter of the Sūtra-sthāna, moves on to enumerating the most efficacious drugs for the elimination therapies in the second chapter. The third and fourth chapters also deal with drugs. The theoretical principles of the functioning of three doṣas are discussed much later. Much importance has been given to philosophical questions such as existence of the soul (ātman) and its characteristics, the concept of the Supreme Soul (paramātman), means to obtain salvation (mokṣa), transmigration, etc, which are discussed in detail in the Śārīra-sthāna. The Suśruta Saṃhitā, on the whole, appears to be more structured.

It is also noteworthy that Suśruta refutes the views of other medical authorities on subjects of clinical examination and seasonal collection of herbs without naming them. According to Suśruta, some prescribe three methods of clinical diagnosis (i.e., inspection, palpation and interrogation);[48] and the collection of particular parts of plants (such as the roots, leaves, bark, etc.) according to the seasons.[49] Both the principles occur in the Caraka Saṃhitā[50] and, hence, we may understand that Suśruta was referring to Ātreya school in these respects. Sharma is of the opinion since Ātreya is not mentioned once by Suśruta, it shows that Divodāsa was anterior to Ātreya.[51] However, this does not indicate that the Suśruta Saṃhitā in its present form is anterior to Caraka’s compendium. It is likely to be posterior in view of the advanced concepts of pathology and physiology observed in Suśruta which have been pointed out by Sharma.[52] Some these developments are:

1. Much importance has been given to blood unlike Caraka. It is regarded as important as the other three doṣas and is termed as the fourth doṣa (śoṇita-caturtaḥ) after vāyu, pitta and śleṣman.[53] It is regarded as an pathogenic factor which we have discussed in chapter 4.

2. The description of five types of pitta[54] and differentiation between pitta and agni[55] is another significant aspect of this work.

3. The system of seeking royal permission for medical practice is noticed in Suśruta’s compendium.[56]

4. The treatise describes a methodical system of training students in practical work through experimental surgery[57] and dissections.[58]

5. The mention of specific drugs for particular diseases, such as bhallātaka for piles,[59] khadira for skin disorders,[60] śilājatu[61] and tuvaraka[62] for glycosuria (madhumeha), etc. is noteworthy.

6. Toxicology in Suśruta Saṃhitā is more advanced to which the entire Kalpa-sthāna is devoted as compared to a single chapter in Caraka Saṃhitā.[63]

7. Suśruta has described methods of purifying turbid water.[64]

8. The use of mercury (pārada/sutāra) in external application[65] and as an antidote[66] is noteworthy. The reference to mercury in Caraka Saṃhitā is controversial.[67] The term rasa appearing in the treatise in the chapter on dvivranīya cikitsā is interpreted as pārada by commentator Cakrapāṇidatta;[68] but the same term occurring in yet another chapter is not identified as the same element.[69]

9. We may point out that the classification of diseases given by Suśruta is more comprehensive and detailed.[70]

Certain cultural indicators also point to a later date for Suśruta Saṃhitā:

1. The karṇavedha saṃskāra or piercing of the ear[71] which was introduced later and is not mentioned in Caraka.

2. Reference to the worship of Kṛṣṇa[72] and Rāma[73] can be understood as evidence of the existence of the Vāsudev sect that is assigned to the 1st -4th centuries CE.[74]

On the basis of the above evidence occurring in Suśruta one may conclude that it is a work later than Caraka in its extant form.

Footnotes and references:

[1]:

U.C. Dutt, The Materia Medica of the Hindus, Calcutta, 1900, pp. xi-xii.

[2]:

R.K. Sharma and Vaidya Bhagwan Dash, Agniveśa’s Caraka Saṃhitā: Text with English Translation and Critical Exposition based on Cakrapāṇi Datta’s Ayurveda Dīpikā, Varanasi, 2008, p. xxxix. Hereafter Caraka Saṃhitā

[3]:

P.V. Sharma (Edited and translated), Suśruta Saṃhitā with English Translation of text and Ḍalhaṇa’s Commentary along with Critical Notes, Varanasi, 2010 (Reprint), p. vi.

[4]:

A.B. Bagde, et al., “Charaka Samhita-A Complete Encyclopedia of Ayurvedic Science”, International Journal of Ayurveda and Alternative Medicine, Vol.1 (1), 2013, pp. 12-20.

[5]:

G.D. Singhal et al., Ancient Indian Surgery based on Suśruta Saṃhitā, Vols. 1-10, Delhi: Chaukhamba Sanskrit Pratisthan, 2007 (Reprint). Hereafter referred to as Suśruta Saṃhitā

[6]:

Abbreviated hereafter as Sūtrasthāna

[7]:

Caraka Saṃhitā Sūtrasthāna 30.46.

[8]:

Caraka Saṃhitā Sūtrasthāna 30.45.

[9]:

Abbreviated hereafter as Nidāna-sthāna

[10]:

Abbreviated hereafter as Vimānasthāna

[11]:

Abbreviated hereafter as Śārīrasthāna

[12]:

Abbreviated hereafter as Indriyasthāna

[13]:

Abbreviated hereafter as Cikitsāsthāna

[14]:

Abbreviated hereafter as Kalpasthāna

[15]:

Abbreviated hereafter as Siddhisthāna

[16]:

Abbreviated hereafter as Uttaratantra

[17]:

Suśruta Saṃhitā Sūtrasthāna 3.43.

[18]:

Caraka Saṃhitā Sūtrasthāna 30.28; Suśruta Saṃhitā Sūtrasthāna 7-8.

[19]:

G.D. Singhal et al., Ancient Indian Surgery based on Suśruta Saṃhitā, Vol. 1, p. 17, fn. 3.

[20]:

Caraka Saṃhitā Sūtrasthāna 30.28.

[21]:

Suśruta Saṃhitā Sūtrasthāna 1.7.

[22]:

Caraka Saṃhitā Ca.5.44, 63.

[23]:

Kaviraj K.L. Bhisagratna (Edited and published), An English Translation of the Sushruta Samhita based on original Sanskrit text with Full and Comprehensive Introduction, Translations of Different Readings, Notes, Comparative Views, Index, Glossary and Plates, Calcutta, 1907, Vol. I, p.xi.

[24]:

K.L. Bhisagratna, An English Translation of the Sushruta Samhita, Vol. I, p.xi; Caraka Saṃhitā Śārīrasthāna 6.21.

[25]:

P. Ray, H.N. Gupta and M. Roy, Suśruta Saṃhita (A Scientific Synopsis), New Delhi, 1993 (Reprint), p. 3.

[26]:

U.C. Dutt, The Materia Medica of the Hindus, p. x.

[27]:

P. Ray and H.N. Gupta, Caraka Saṃhita (A Scientific Synopsis), New Delhi, 1965, p.3.

[28]:

Caraka Saṃhitā Vimānasthāna 8.3-14.

[29]:

Suśruta Saṃhitā Sūtrasthāna 5.6.

[30]:

Suśruta Saṃhitā Sūtrasthāna 7-41.

[31]:

Suśruta Saṃhitā Sūtrasthāna 7-8.

[32]:

Suśruta Saṃhitā Sūtrasthāna 8.

[33]:

Suśruta Saṃhitā Sūtrasthāna 9.

[34]:

Suśruta Saṃhitā Sūtrasthāna 10.4-5.

[35]:

Suśruta Saṃhitā Sūtrasthāna 11.

[36]:

Suśruta Saṃhitā Sūtrasthāna 12.

[37]:

Suśruta Saṃhitā Sūtrasthāna 13.

[38]:

Suśruta Saṃhitā Sūtrasthāna 14.25-45.

[39]:

Suśruta Saṃhitā Sūtrasthāna 15, 21.

[40]:

Suśruta Saṃhitā Sūtrasthāna 17.

[41]:

Suśruta Saṃhitā Sūtrasthāna 18.

[42]:

Suśruta Saṃhitā Sūtrasthāna 19.

[43]:

Suśruta Saṃhitā Sūtrasthāna 20.

[44]:

Suśruta Saṃhitā Sūtrasthāna 25.

[45]:

Suśruta Saṃhitā Sūtrasthāna 26-27.

[46]:

Suśruta Saṃhitā Sūtrasthāna 10.3

[47]:

Suśruta Saṃhitā Sūtrasthāna 2.8;10.8-9; 25.43-44

[48]:

Suśruta Saṃhitā Sūtrasthāna 10.4.

[49]:

Suśruta Saṃhitā Sūtrasthāna 36.5.

[50]:

Caraka Saṃhitā Vimānasthāna 4.7 and Caraka Saṃhitā Kalpasthāna 1.10.

[51]:

P.V.Sharma, Introduction to Acharya Jadavji Trikamji and Acharya Narayanram Kavyatirtha (Eds.), Suśruta-Saṃhitā with the Nibandhasaṃgraha Commentary of Śrī Ḍalhaṇācārya and the Nyāyacandrikā Pañjikā of Śrī Gayadāsacārya on Nidānasthāna, Varanasi, 1980 (4th edition), 1980, p.vii.

[52]:

P.V. Sharma, Introduction to Acharya J.Trikamji and Acharya N. Kavyatirtha (Eds.), Suśruta-Saṃhitā, pp. viii-xiii.

[53]:

Suśruta Saṃhitā Sūtrasthāna 21.3.

[54]:

Suśruta Saṃhitā Sūtrasthāna 21.10.

[55]:

Suśruta Saṃhitā Sūtrasthāna 21.9.

[56]:

Suśruta Saṃhitā Sūtrasthāna 10.3.

[57]:

Suśruta Saṃhitā Sūtrasthāna 9.3-4.

[58]:

Suśruta Saṃhitā Sūtrasthāna 5.47-49.

[59]:

Suśruta Saṃhitā Cikitsāsthāna 6.17-18.

[60]:

Suśruta Saṃhitā Cikitsāsthāna 10.13.

[61]:

Suśruta Saṃhitā Cikitsāsthāna 13.3-17.

[62]:

Suśruta Saṃhitā Cikitsāsthāna 13.24-28.

[63]:

Caraka Saṃhitā Cikitsāsthāna 23.

[64]:

Suśruta Saṃhitā Sūtrasthāna 45.12, 17.

[65]:

Suśruta Saṃhitā Cikitsāsthāna 25.39.

[66]:

Suśruta Saṃhitā Kalpasthāna 3.14.

[67]:

Galib, et al., Therapeutic Potential of Metals in Ancient India: A Review through Charaka Samhita, Journal of Ayurveda and Integrative Medicine, 2011, 2(2), pp.55-63. Doi: 10.4103/0975-9476.82523

[68]:

Caraka Saṃhitā Cikitsāsthāna 25.116.

[69]:

Caraka Saṃhitā Cikitsāsthāna 7.70.

[70]:

Suśruta Saṃhitā Sūtrasthāna 24.4-7.

[71]:

Suśruta Saṃhitā Sūtrasthāna 16.3.

[72]:

Suśruta Saṃhitā Cikitsāsthāna 13.26; 30.27.

[73]:

Suśruta Saṃhitā Cikitsāsthāna 30.27.

[74]:

P.V. Sharma, Introduction to Acharya Jadavji Trikamji and Acharya Narayanram “Kavyatirtha” (Eds.), Suśruta-Saṃhitā, p. viii.

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