by Nayana Sharma | 2015 | 139,725 words
This page relates ‘Specialisation of physicians’ 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 eight sub-divisions of Āyurveda offered much scope for specialisation in the medical profession which is very much evident in our medical texts as the ideal of achieving mastery over the entire Āyurveda was one that few could hope to attain. Therefore, when Sūtrasthāna ruta and his fellow students approached Dhanvantari to learn the science of healing, the teacher first enumerated the eight branches of Āyurveda and enquired which branch should be taught and to whom. It appears, therefore, that the student could choose to specialise in one of the eight branches. However, in other textual sources, we also come across with physicians well versed in all the eight branches of Āyurveda. Bāṇa mentions that in the royal household of Prabhākaravardhana, there was a young physician named Rasāyana, who had mastered the entire Āyurveda in all its eight divisions. The name of another erudite physician Pāpaka, the son of a learned Jaina physician, comes from the Arthuna inscription of Vijayarāja (VS 1166). He is described as being well versed in the whole of Āyurveda (sarvvāyurveda). Such physicians who were honoured members of the profession were a rarity and our study of the two medical treatises shows that specialisation in the medical profession was the norm.
Both our compendia discourse on the entire gamut of this science; yet the orientation of the two treatises is not unexpectedly different from each other. In the enumeration of the eight branches of Āyurveda, the Caraka Saṃhitā begins with kāya-cikitsā while the Suśruta Saṃhitā mentions śalya-cikitsā first. The former is essentially a treatise on internal medicine while the compendium of Suśruta is a manual on surgery. Possibly these two branches are very old for the Aśvins, the twin physicians, have both medical and surgical miracles to their credit. Karambelkar suggests the possibility of one of them being a surgeon and the other a physician, thereby representing the schools of medicine and surgery. Suśruta refers to the six treatises of the great sages on medicine (satṣu kāyacikitsāsu). According to Ḍalhaṇa, these are the saṃhitās of Agniveśa, Bhela, Jātukarṇa, Parāśara, Hārīta and Kṣārapāṇi. Here we get an indirect reference to the treatise of Agniveśa as being a composition on kāya-cikitsā.
As a text of primarily internal medicine, the therapeutic focus of the Caraka Saṃhitā is on diseases like fever, diarrhoea, gulma (localized abdominal swellings), diarrhoea, anaemia, jaundice, etc., primarily thorough drugs, diet and non-surgical therapies. Suśruta, on the other hand, gives primacy to surgical conditions than to internal diseases, and systemic diseases are discussed in only in the Uttara-tantra which is a later addition to the text. Keeping in view the importance of anatomical knowledge in surgical procedures, unlike the Caraka Saṃhitā, anatomy has been dealt with in detail in the Śārīra-sthāna by Suśruta.
Consequently, there are only cursory references to surgical procedures in the Caraka Saṃhitā. The diseases for require surgical intervention are indicated but the actual procedure is left to the experts in surgery (śastrakarma manīṣibhiḥ). The procedure of cauterization by application of heat or alkalis also called for expertise in this particular branch of medicine. Caraka says that the physician knowledgeable in the dose, time of administration and the quantity of heat necessary to be applied to the patient of ulcer, should administer kṣāra (alkali preparations), to such patients for whom surgical intervention and cauterization are indicated after considering the strength of the disease and doṣas.
The school of Dhanvantari was known for proficiency in surgical cases. It specialised in the use of blunt and sharp instruments (yantras and śastras), the preparation and the use of caustics, thermal cauterization, the application of leeches, surgical blood-letting, dressing of wounds and application of bandages. There is detailed discussion of each of these procedures in the Suśruta Saṃhitā. Caraka testifies to the competence of the Dhānvantarīyas in these areas who said to be well experienced in the art of puncturing, purification and healing of wounds as well as cauterization. They are described as kṣāra-tantra-vid (proficient in the administration of alkalis). Patients requiring these procedures are in fact referred to the surgeons as in cases of dysuria (mūtra-kṛcchra) caused by calculus (aśmarī) or gravels (śarkarā). If medications fail to have the desired effect, the patient is referred to an expert surgeon who would remove the stones and gravels surgically.
Like the experts in medicine and surgery, other branches of Āyurveda had specialist practitioners. The branch of Śālākya-tantra specialised in the treatment of diseases of the eye, the ear, the head and the neck (Ophthalmology and Otorhinolaryngology). We notice that diseases of the mouth, the eyes and the ear have been dealt with very briefly by Caraka which are left to the practitioners of Śālākya-tantra. Diseases related to this branch has found a place in the Uttara-tantra of the Suśruta Saṃhitā but it acknowledged that they have been drawn from the treatise of the king of Videha.
Suśruta does not mention the source of the discourse on paediatric diseases possibly signifying that it this branch was yet to have its own treatise. It is noteworthy that Caraka devotes only six verses to children’s diseases. Some areas of micro-specialsations may have existed: Suśruta advises that treatment of eye diseases in children should be carried out by physicians who are well versed in children’s diseases and willing to treat eye diseases (bālasya roga-kuśalo(a)kṣigadaṃ jighāṅsu).
Mention of the various categories within the medical profession occurs in other sources. Physicians (bhisakka), surgeons (sallakatta) and exorcists (bhūtavejja) as well as veterinary surgeons for elephants and horses are known in Buddhist texts. Surgery finds a reference in the Rāmāyaṇa when Sitā expresses fear of being dismembered by the vile lord of the rākṣasas with knives just as the surgeon might a foetus in the womb. The word used here for the surgeon is śalyakṛntaḥ which is commented upon as āmbaṣṭhavaidyāḥ. The text also refers to specialists in administering antidotes (viṣavaidyāḥ), paediatrics (bālānāṃ cikitsakāḥ), in removing thorns and spikes (śalākāśalyahartāraḥ) and in surgery (śastrakarmakṛto vaidyāḥ). Cure of snake-bites appears to be a much specialised branch of healing. The Boddhisattva was once born into a family of healers skilled in the cure of snakes-bites according to the Visavanta Jātaka. A snake-doctor (jāṅgulika) by the name of Mayuraka was a childhood companion of Bāṇabhaṭṭa.
A close reading of the two texts reveals a possible undercurrent of rivalry among the various kinds of physicians. Surgeons are evidently condescending of physicians who are incapable of conducting non-surgical (such as oleation, purgation, etc.) and surgical procedures (like excision, etc.), and in fact, goes on to portray them as kuvaidya or bad physicians. Such physicians, according to Suśruta, kill people due their greed and survive only because of the negligence of the government. It is also interesting that Suśruta does not once mention the name of Ātreya or Agniveśa or other authorities of medicine though the name of Dhanvantari (as we have seen) does appear in the compendia of Caraka.
Footnotes and references:
Suśruta Saṃhitā Sūtrasthāna 1.9.
Caraka Saṃhitā Sūtrasthāna 30.28.
Suśruta Saṃhitā Sūtrasthāna 1.7.
P.V. Sharma, Aswins and their Miracles, Nagarjuna, 1964 (December), Vol. VIII, No.4, pp.295-302.
For instance, wounds, lesions, skeletal injuries, piles, urinary stones, fistula, foetal malpresentations, etc.
Caraka Saṃhitā Cikitsāsthāna 25.61/1.
Caraka Saṃhitā Cikitsāsthāna 25.103.
Caraka Saṃhitā Cikitsāsthāna 25.107.
Suśruta Saṃhitā Sūtrasthāna 7.
Suśruta Saṃhitā Sūtrasthāna 8.
Suśruta Saṃhitā Sūtrasthāna 11.
Suśruta Saṃhitā Sūtrasthāna 12.
Suśruta Saṃhitā Sūtrasthāna 13.
Suśruta Saṃhitā Sūtrasthāna 14.25-32.
Suśruta Saṃhitā Sūtrasthāna 18.
Caraka Saṃhitā Cikitsāsthāna 5.44.
Caraka Saṃhitā Cikitsāsthāna 5.63.
Caraka Saṃhitā Cikitsāsthāna 5.64/1.
Caraka Saṃhitā Cikitsāsthāna 26.59-68.
Caraka Saṃhitā Cikitsāsthāna 26.119-123, 127-128, 129-130.
Caraka Saṃhitā Cikitsāsthāna 26.131.
Suśruta Saṃhitā Uttaratantra 1.5.
Caraka Saṃhitā Cikitsāsthāna 30.282-287.
Suśruta Saṃhitā Uttaratantra 19.16.
J. Mitra, A Critical Appraisal of Āyurvedic Material in Buddhist Literature with Special Reference to Tripitaka, Varanasi, 1974, p. 25-26.
R.P. Goldman (Annotated and Translated), The Rāmāyaṇa of Vālmīki, Vol.5, p.427.
The five pre-operative procedures are massage, heat therapy, medication, purgation, stomach wash by vomiting technique and enema.
Suśruta Saṃhitā Sūtrasthāna 3.52.