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AN ENGLISH TRANSLATION
OF
THE SUSHRUTA SAMHITA.
Vol. l.—SUTRASTHANAM.
AN ENGLISH TRANSLATION ,
OF
THE' SUSHRUTA SAMHITA
BASED ON ORIGINAL SANSKRIT TEXT.
Wt
EDITED AND PUBLISHED BY
KAVIRAJ KUNJA LAL BHISHAGRATNA
WITH A FULL AND COMPREHENSIVE INTRODUCTION, TRANSLATION
OF DIFFERENT READINGS, NOTES, COMPARATIVE
VIEWS, INDEX, GLOSSARY
&.
PLATES. ( IN THREE VOL UMES. )
Vol. I.-SUTRASTHANAM.
CALCUTTA : ^
No. lO, KASHI GHOSE'S LANE. '
1907. * -•
. f'
srf3
Printed by J. N. Bose. ' '^ / College Square, Calcutta.
MW Riqhtx Rexd'ved)
•
WAHAMAIlUPAbHVAYA KAVIRAJ DVARKANAIH SEN, KAVIKATNA. ( In Durbar dress )
II w^ff^ II
PREFACE.
--^^B'
Xo special ^polcfgy is necessary for the publication of an English translation of the Sushruta Samhita. The vast medical literature of ancient India practically remains as yet unexplored, and any undertaking, which „has the obiect of making that terra incognita, known to thescientific world, is bound to be welcomedby the public. Spasmodic attempts have been made by several scholars and erudite bodies to bring out an English translation of the Sushruta Samhita, as the most representative work of the Ayurveda, but we regret to say that such efforts have hitherto proved abortive. In spite of incomplete infor- mation on the subject many drugs of the Ayurvedic ?vlateria Medica have been adopted by different foreign systems of medicine, and this has afforded us a fresh impetus to issue an English translation of the book, which not only deals with the essentials of Indian Therapeutics but embraces the whole range of the science of A3airveda, as it was understood and practised by the Vedic sages.
We sincerely hope that the English rendering of Sushruta, which we have undertaken, will, when completed, supply a long-felt want and help to start a fuller inquiry into the properties of the indige- nous drugs of India. Many institutions have been already started both in England and Germany with the sole object of studying the reti(^logy of tropical diseases, and of formulating an empirical system of their prevention and cure, and we, hope an I4nglish translation of the Sushruta Samhita, embracing as it
^11
does the results of researches made by our ancient Rishis ill the land of their origin(^ may contribute no small amount of useful information to those bodies. "We have many things to learn" observes Lt. Col. C. P. Lukis, M.b., F.R.C.S., I. M.S., Principal, Medical College, Calcutta, "from the people of this country in respect of medicine and medical science," and five doubt not that an accurate knowledge of the contents of this splendid monument of the Ayurveda in quarters where it has every chance of being utilised and improved upon will make the Inmian race better equipped too combat the ills of life.
A few remarks on the method we have adopted in editing this work are necessarv by way of explana- tion. We have carefully collated all the available texts of the Sushruta Samhita, whether printed or otherwise, expunging from the body of our work all texts, which, though not proved to be wholly spurious, are of questionable authority, and putting them in foot-notes as "Different Readings" or "Additional Texts." In cases of doubt or discrepancy of opinion we have thought fit to abide by the decision of our revered preceptor, Mahamahopadhyaya Kaviraj Dvarkanath Sen, Kaviratna, and inserted within brackets explanatory clauses, where a strictly literal translation of texts would not convey their true meaning. In many instances it is impossible to find in the English language equivalent words for the technical terms of the A3'urveda. In such cases we have put approximate English words within brackets, after the original Sanskrit terms. For exapiple we have translated the term Ojah as albumen. Sut the Ojah of the Ayurveda is a disputed thing, t It may mean something like but not exactl)' albumen; glycogen, which contributes largely to
Ill "^ ,
the reproductive activity of tlfe body in certaiR)*instances. would appear to be the more correct description. In cases like this we h'ave not put before our readers, any suggestions of our own, but left them free to draw their own inference. And for this purpose we further intend to Append to the last volume of this work an index a,nd a glossary illustrating the possible meanings of the Ayurvedic terms with English and Latin synonyms, wherever possible. The true meaning of the Ayurveda can be better explained or understood only with the light of moder.n science, and we leave it to our European colleagues to carry on the research on the lines we have suggested with regard to this ancient S3'stem of medicine, which a better knowledge of its principles and methods will enable them to do.
By a lamentable oversight, the terms Vayu, Pittani, Kaphah and Dosha have been translated as wind, bile, phlegm and humour in the first few chapters.
For the sake of convenience we have divided the entire work into three volumes, the first containing only the Sutrasthanam, the second Xidanam, Sharira and Chikitsa, and the third Kalpa and Uttara Tantram.
We have adopted the diagrams of surgical instruments from that most valuable work of the Thakore Saheb of Gondal, called the History of the Aryan Medical Science, for which I am particularly indebted to His Highness.
In conclusion, we beg to conve\' our sincerest thanks to our preceptor's son Kaviraj Jogendranath Sen Vidya- bhusana M. A., Dr. U. D. Banerji L. R. C. P., M. R. C. S. (Lond), and Lt. Col. K. P. Gupta M. A., M. D., I. ^l. S., Professor Janakinath Bhattacharya M.A. B?L., P.R.S. for having kindly examined the different portions of the manuscript. I am grateful to Dr. Surendranath
<■ IV
t
f #
(josvaini B^A., L. M. S. teo, for the kind interest he has all 'along taken in the publicittion of this work and />i"or various intelhgent suggestions, which haxc been of consfderable help to me.
My thanks are also due to numerous learned authors, ancient and modern 'from whose writings, I ha\e found it necessary to make frequent quotcition^.
10, Kashi Ghose's Laxe. ] KUNJA LAL BIIISHAGKATNA.
i.-^t TJeceiiiher, igoy. \
CALCUTTA. J Kaviraj.
TNTRODTK^TION.
^^
Sushruta :— His age and personality :— A few
preliminary observations regarding the technique of the Ayurvedic system of medicine are necessary at the outset to correctly understand thp aim and scope of the Sushruta Samhita. Who was Sushruta ? When and where did he live and flourish ? These are questions that would naturally suggest themselves to the readers of the following pages ; but the}^ can only be imperfectly answered like all similar questions respecting the lives of our ancient worthies. In a country like India where life itself was simply regarded as an illusion, the lives of kings or commoners were deemed matters of little moment to the vital economy of the race ; and all histories and biographies were looked upon as the embodiment of thLe flimsy vanities of life. Lives of saints and canonised kings had been made use of in certain instances as themes of national epics. But they were intended more to elucidate or enunciate the doctrines of certain schools of Ethics or Metaphysics than to record any historical fact or event. Authentic history we have none beyond chronicles of state events and royal names in some instances ; and those which are usually found in the Sanskrit Puranas are strange com- binations of myths and legends, which often contradict each other. Hence the utter futility of attempts to explain a historical fact by the light of a votive npdal or tablet unearthed perhaps frorri the ruins of one of sur ancient cities. Such an endeavour serves, in most cases, only to make the " darkness visible, " • and the confusion more confounded.
ii 'iNTROniTCTIOX.
Identity of Sushruta and Divodasa :— It is only safe to assert that Sushruta was of tl>e raceof Vishvamitra. The Mahabharatam f i) represents him as a son of that roval sage. This coincides with the description given of him in the present recension of the Samhita. The Garuda Puranam (2) places Divodasa as fourth in descent from Dhanvantari, the first propounder of medical science on earti}, whereas the Sushruta Samhita describes the two as identical persons. But this apparent anomaly in the Samhita can be accounted for, if we consider that in some parts of India the custom still prevails of appending, for the purposes of better identi- fication, the name of one's father, or of a glorious ancestor to one's name, and it is therefore not surprising that Divodasa (the preceptor of Sushruta), who was a firm believer in the doctrine of psychic transmigration, should represent himself as an incarnation of Dhanvantari, and a=.sume his name and style in the usual wav. Revond this meagre genealogy we possess no trustworthy information regarding the life and personalitv of Sushruta, the father of Indian Surgery.
Age of the Sushruta Samhita:— We have no means of ascertaining what the Samhita was like as originally written hv Sushruta, the present being only a recension, or rather a
Mahahhiralam — Anushasan Parva, Ch. W
(2} f^-^rf*T^TC^T<T Tnf^E^T^?i: %<^v. 1
^T5?I^T3I»??T'Pr*T^r: f^Tr??T^»^^3: II
Garuda PuranAm, Chap. 139, \'s. 8- 11,
INTRODUCTION* lil
>■>
recension of recensions, made oy N^garjuna (i)? All opinions concur in identifying hifn ^with the celebrated founder of the Madhyamika school of Buddhistic philosophy — a fac| which materially assists us in fixing the age of the present Samhita. A few quotations from the Vriddha (old) Sushruta are all that are preserved of the oViginal Sainhitu. But their genuineness is ot a problematic character, and we are not sure whether the}- are the productions of lesser lights, or of ancient though less renowned commentators, attri- buted to the master to invest thciU with a greater sanctity ;ind authority— a practice which was quite common amongst the bibliographers of Ancient India.
Date of Nagarjuna :— At all events Nagarjuna who redacted the Sushruta Samhita lived about the latter part of the fourth century before the__Chris£ian era ;(2) and the
Dallanas Commentary, Sulrasth^nam, Ch. I. i.
Dallana mentions the names of Jejjada, Gayadasa etc., as the redactors of the original Samhita, and rejects as spurious or of questionable authority the texts which cannot be found in their editions of the work. Must probably the authoritative verses are quotations from the Vriddha Sushruta.
Recension or Pratisamsk^ra consists in curtaiUng statements that have been made inordinately elaborate, and in dilating upon truths lliat have been very succinctly dealt with in the original book. A Redactor or Pralisamaskarta makes an old book new again.
A Samhita, on the other hand, deals with aphorisms coniained in the
Vedas. ^
t^T^f^lfST?! #f%m'TTT: H^lf^cTT: I
(2) rT^T VUT^Jf!: SIT^nFff^ qif*!/^: !
Rijatarangini I. Taranga. Vs. 172-173.
IV wtroAj
CTION.
original or V^rtddha Sus|jruta 'must have been wriUen at least two centuries earlier in order 'to acquire that hoary aythority and prescription of age,* which alone could have given its right to a recension at the time. Several scholars on the authority of a very vague and general statement concerning* the recension of the Samhita in Dallana's commentary, ascribe th'e authorship of the Uttaratantram (latter portion of '.the Sushruta Samhita) to Nagarjuna. We, on the other hand, hold the Uttaratantram to be neither an interpolation, nor a subsequent addition,
• but that it forms an integral portion of the book as it was originally written, though not planned by the Rishi. In the first Chapter of Sutrasthanani Divodasa formally divides the Science of Ayurveda into eight subdivisions, such as, the Shalya (surgery), Sh^iakya (portion treating of diseases restricted to super-clavicular regions such as the eyes, etc.), Kaya-Chikitsa (general diseases such as, fever, etc.), but does not speak anything about them in the first five Sthcinas or subdivisions of the book. It is only once in the 25th chapter of the Sutrasthanani that he mentions the name of Netravartma (diseases of the eyelids) in con- nection with the classification of surgical operations. It is inxpossible that Divodasa would fall short of his duties by omitting to give instructions on all the subdivisions of the Ayurveda as he promises at the outset, or that Sushruta would leave his Samhita, which is pre-eminently a work on surgery, incomplete by banishiiTg_^ophthalmic ^surgery,
\ laryngotomy or fever-therapeutics from his work. From I the general plan of the book we can safely assert that Sushruta dealt with easier or more elementary topics in the first five subdivisions of his Samhita in the manner of our modern progressive readers, reserving the discussion of those re^uirmg a more advanced knowledge and skill for the Uttaratantram. The Uttara*^^antram has not been incluued within the five original subdivisions of the Samhita inasmuch as it embraces and more elaborately discusses
INTRODUCl'ION. J V
>■>
lupics which legitimately beloi^g to, ^or are but»incidentairy mentioned in those subdivisions. Hence it is more ot the nature of an appendix or supplement, arising out of the^ exigencies of the original subdivisions. It is probable that Nagarjuna might have redacted this part of the Samhita in common with its other portions. (i}
Western opipions* on the subject :— The consensus of western opinions is to place Nagarjuna in the first quarter of the third Century B. C. (2), and for fixing Sushruta as a contemporary of Sakya Sinha Buddha. It i^ contended that the age immediately preceding Sakya Muni was a period of decadence in Hindu thought ; and the Sushruta Samhita must have been the fruit of a revived intellectual activity which usually follows the advent of a new creed^an assumption which is in favour of the hypothesis of Greek influence on the Hindu system of medicine. But great men there had been in India before Buddha. The age which immediately preceded the age of Buddha was by no means an age of decadence properly speaking, the age which followed the downfall of Buddliisin shows, on the contrar}', signs of true decadence. India had had eminent philosophers and scientists almost contempo- raneously with the great Buddha. The chronological facts collected above from the Mahabharatam, and the Garuda Puranam could have been construed to prove that the age of Sushruta was prior to that of the Mahabharatam but for the internal evidence furnished by the Samhitn itself as to the probable date of its composition which we shall have occasion to deal with later on. ♦>
Extraneous Evidence :— Sushruta is mentioned in the
(i) MaMmahopadhyaya Kaviraj Dvaiaka N^lh .^en Kaviialna of Calcutta subscribes to this opinion — Tr. ■,
(2) Bael's Buddhistic Records of the Western World. \'ol. II. P. 212. Stein's Rdjatarant^uai. >
(3) Lalita-Vistarain — Raja R. L. Mitter's Edition, Chaptef I.
VI * INTRODUCTION. ^-
V^rtikas oP'(i) Katyayana ^4 Century B. C.) and we have
no hesitation in saying thatP'^Iie* original Sarnhita was
^vritten at least two centuries before the birth of Buddha.
'■f We are equally ready to admit, on the other hand, that
the tinal recension of the Sarnhita by Nagarjuna, at least the
form in which we have it, was made about the second
Century B. C. ' ^
Two Nagarjunas :— Several scholars, on the authority of Dallana (the celebrated commentator of the Sushruta Samhita) endeavour to establish the identity of Nagarjuna (the redactor of this Samhita) with his namesake, the celebrated alchemist of the tenth Century (2). But their contentions fall to the ground when we know that many verses of the Sushruta Samhita occur in the works of Bagbhat (Ashtangahridayam) and Madhava (Nidanam), which are two of the works which were translated by the order of the Kaliph (3) in the eighth century. The internal evidences of the book do not supply us with any authentic material to compose anything like a biography of this father of Hindu Surgery. •
Internal Evidence :— The line in the Samhita, which has formed the veritable bone of contention amongst scholars of all shades of opinion as throwing a light upon the probable date of its composition, occurs ni the Sharira — Sthanam, in connection with the development of the foetal body and reads as "Subhuti Gautama said that it is the trunk that tirst developed."
Conflicting testimonies and the uncertain indication of materiaSs at our disposal : — It is a matter of historic
(l) f^^ffll^^^tf"
K;5 lyayana'si V^rlikas lo Panini's Grammar.
"' Chakra Dutta — Rash^yandhikara. (3) P. C. Roy— Hindu Chcmislry p. X\'1II. (1902),
INTRODtTrTIOX. ' VU
■>•)
certainty that Subhuti was o^e of, the personal disciples of Sakya Sinha Buddha, and that it was customary amongst the contemporaVy Buddliists to append the appela- , tion of their (i) lord fGautama or Rodhisattva) to the "name of a proselyte to accentuate his wisdom and sanctity in the world. A certain section of scholars is'never tired of setting up this line as a conclusive evidence of the fact that the Samhita was, at best, a contemporary production of early Buddhism. But they shut their eyes to opinions of Shaunaka and others on the subject quoted exactl)' in the same portion of the book, which places the date of its composition at least several centuries earlier. Shaunaka, who was the si.vth in remove from the immortal Vyasa in direct line of discipleship, was the author of the renowned Shaunaka Samhita of the Atharvan. These facts lend a very plausible colour to our hypothesis that the original Sushruta Samhita which, was first composed perhaps con- temporaneously with the latter portions of the Atharvan, naturally discussed the opinions of Shaunaka and other Vedic embryologists, while Nagarjuna, at the time of redacting that book, quoted the opinion of his contemporar}' Subhuti for the purpose of giving him an equal status with the Vedic Rishis, if for nothing else.
Greek Influence : — As regards Hellenic influence on the Hindu system of medicine and on the Sushruta Samhita in special, we must disabuse our mind of all sentiments of racial vanity and proceed to investigate the case in a scientific and unprejudiced spirit before giving a more detailed account of the contents of the SushrutaiSamhita.
(i) Nagarjuna Bodhisattva was well practised in the art of compound- ing medicine. N^gSrjuna Bodhisattva by moistening all the great stones with a divine and superior decoction changed them into gold. — Bael's Buddhistic Records of the western world Vol. II.
AnuvSk 19, 45. 46. 5.
iNTRonurrioN.
Su^hrufa and Hippocrates -.—From the very apparent similarity which exists between jhe contents of this Samhita •and tjie aphorisms of Hippocrates, many western scholars are apt ,to conclude too hastily that the ancient Indians drew their inspiration in the healing art from the medical works of the Greeks. But the reverse may be said of the Greeks as well with the greater confidence because such an assertion is supported by historic facts, and confirmed by the researches of the scholars of the west (i). According to all accounts Pythagoras was the founder of the healing art amongst the Greeks and the Hellenic peoples in general (2). This great philosopher imbibed his mysteries and metaphysics from the Brahmanas of India. Mr. Pocock in his Jnt^ia in Greece identifies him with Buddhagurus or Buddha, and it is but an easy inference to suppose that he carried many recipes and aphorisms of his master's Ayurveda with him. The sacred bean of Pythagoras is thought to have been the (3) Indian Nelumbium (Utpalam). We know thai simnllaneously with the birth of Buddhism, Buddhist Sramanas were sent out to Greece, Asia minor. Egypt and ether distant countries to preach their new religion. They were known to the Greeks and there is good reason to believe that the Greek Simnoi (venerable) were no other than the Buddhist Sramanas (4). Now a missionary usually teaches the sciences of his country in addition to the preaching of his gospel. The distant mission stations or monasteries of Buddhism were
(1) There*1s no ground whatever to suppose that Sushruta borrowed his system of medicine from the Greeks. On the contrary, there is much to tell against such an idea— Weber's History of Indian Literature.
(2) The Origin and Growth of the Healing Art — Bedroe P. 162.
(3) Pratt's FloNiering Plants. Vol. I P. 57.
(4) These *Simoi (venerable) whom Clemeni of Alexandria has narraleil to have rendered worship to a pjTamid originally dedicated to tiie relics of a god, were the Buddhi!»t Arhals (venerables) Sramanas.
Lalita-Vistaram— T\:iia R^jendra I.ala Milter's Edition. Ch. I.
INTRODUGTION. , IX
the principal centres for disseaiinating Brahm^»nic culture in distant lands, and Hippocrates, though he did his' utmost to liberate medical sciertce iVom the thraldom of speculative philosophy, yet might have thought it necessary tG>tetain only those truths of the Ayurveda which Pythagoras and the Buddhistic brotherhood might have imported into his country, and which do not exactly appertain to the domain of pure metaphysics. Of course, it is quite possible for men of different nationalities to arrive at the same truth cr conclusion independently. There are coincidences i'l science as in art and philosophy, (i) Gravitation and circulation of blood (2) were known ta tfite Indians long before the births of Newton and Harvey in Europe. The cele- brated atomic theory was preached in the Gangetic valley some five hundred years before the birth of Christ (3). But well may we ask those, who still adhere to this Hellenic hobby, to look at the reverse side of the picture as well. It may be stated without the least fear of contradiction that the Charaka and Sushruta, through the Channel of Arabic, Persian and Latin translations still form the
Siddhanla Shiromani (Bhaskaracharyaya) GolodhyAya.
iT^^TR ^R ^fq II ???Tg lifqcT' ^^ %-^^ ^^^i t%Tr:, cI^t^ f^q^r
^JTT T\\^^ T.w^^m: I VTT^fl^TaiiT | (BhavaprakasUa).
The Hdrita Samhitd, which according to certain scholars, is older than the Sushruta SamhitS, refers to the circulation of blood in describing I'induroga (Anemia). The disease, he observes, is caused by eating clay which thus blocks the lumen of veins and obstructs the circulation of blood, Bhcivamisra, the celebrated author of Bh^vaprakdsham, and who is a century older than Harvey, has the above couplets bearing on the sufcject.
(3) Vaiseshika Darshana by Kandda.
X Introduction.
»«•
basis of all sj-stems of s^ienti^c medicines in the world (i). Of these, the Sushruta Samhit^ is the most representative ;vork of the Hindu system of medicine. It embraces all that can possibly appertain to the science of medicine (2).
Sushruta prior to Charaka :— The general consensus of expert opinion is to place Charaka prior to Sushruta in respect of time. But the Puninas unat^mously describe Sushruta as a disciple of Dhanvantari, the first-propounder of medical science. The long compounds (samasas) used by him, the prose and metrical portions of the Sushruta after the models of Jaimini, Patanjali, and other philosophi,r cal writers who had adopted prose or metre according to the e.xegetic or rationalistic tenor of the subjects in their works, have all been cited to prove Sushruta a contemporary of the Darshanas, or of Buddha. But these may serve, at least, to fix the date of the recension by Nagarjuna, i.e., the Sushruta Samhita as we have it, but can never help to determine the chronology of Sushruta, the disciple of Dhan- vantari "who was churned out of the primordial ocean in the golden age (Satya Yuga) (3). On the other hand, if
(l) A, "The great works of Charaka and Sushruta were translated into
Arabic, under the patronage of Kaliph Almansur, in the seventh century.
The Arabic version of Sushruta is known by the name of " Kelale- Shawshoore-al-Hindi." These translations in their turn were rendered into Latin. The Latin versions formed the basis of European medicine, which remained indebted to the Eastern science of medicine down to the seventeenth century."— History of the Aryan Medical science (Th^kore Saheb of Gondal) P. 196.
B, For tljc indebtedness of Arabic school of Medicine to the works of Indian masters, see Puschmann P. 162.
C. BednVe. Book IV. Ch. IL 286—299. (2) Dr. Wise (Hindu system of medicine).
f^>?fT ^?5^^' ^'n?T^T 5B5f5TfT: II
Garuda PurSnam. Chip. 142, Vs. 5-6.
INTROniTC?ION. , xi
the testimonies of the Puninas -♦have anj- histor^6al worth, we ca!i safely place him somewhere in the Satya Yuga, (age) at least in those dim centuries which immediate})' succeeded the composition of the Atharvan. Charaka, too. in coi^nec- tion with his discourse on the development of the foetal body has cited the opinion of Dhanvantaii (ij on the subject (tiie same as promulgated in the Sushruta S'amhita) & referred his disciples to the Dhanvantari school of surgeons (meaning Sushruta and his school) in cases where surgical aid and knowledge are necessary ; this proves that Sushruta was before Charaka.
Sushruta as a Surgeon : — Stishr'uta was emphatically a '•'igeon, and the Sushruta Samhiti is the only complete 'ok we have which deals with the problems of practi- )cal surgery and midwifer}'. Almost all the other Samhitas written by Sushruta's fellow students are either lost to us, lor are but imperfectly preserved. To Sushruta may be attri- buted the glory of elevating the art of handling a lancet or forceps to the status of a practical science, and it maj' not be out of place here to give a short history of the Ayurveda as it was practised and understood in Pre-^uhsrutic times if only to accentuate the improvements which he introduced in every branch of medical science.
Commentators of the Sushruta Samhita : — We would be guilty of ingratitude if we closed this portion of our dissertation without expressing a deep sense of our obliga- tion to Jejjada Achiirya, Gayadasa, Bhaskara, Madhava, Brahmadeva, Dallana and Chakrapani Datta, the celebrated commentators and scholiasts of the Samhitd, 'ji'lio have laboured much to make the book a repository of priceless
(i) ^^i'f*T?fTiaTqKfH ^^^f^: I
Charaka, .Shariraslhiinam. Chap. \'.
I^Tt EfTcT^T^Tt ssit^'^^'I^^ II ' ">
Charaka, ChikitshSsth^nam. Chap. V.
xn • INTRODUCTION.
wisdom ancf experienge. D'allana has made use of all the commentaries in revising and collating the texts of .Sushruta Samhita.
Origin and History of the A yurveda : —In the science of medicine, as in all other branches of study, the ancient Aryans claim to have derived their knowledge from the gods through direct revelation. Su*shruta in his Samhita has described the Ayurveda as a subdivision (Upanga) of the Atharvan (i), while according to others the science of the Ayurveda has its origin in the verses of the Rik Samhita (2). Indeed the origin of the science is lost in dim anti- quity. Death and disease there had been in the world since the advent of man ; it was by following the examples of lower animals in disease, that our primitive ancestors acquired by chance the knowledge about the properties of many valuable medicinal drugs. There is a verse in the Rigveda which shows that the lower animals were the preceptors of man in matters of selecting food stuffs and medicinal simples (3K Individual experiences in the realms of cure and hygiene were collected, and codified, and thus formed the bases of the present Ayurveda. The verses in the Vedas clearly mark each step in the progress of medical knowledge. The properties of a new drug were always hymned in a Vedic verse with a regularity which enables us to put our finger upon the very time when a particular drug of our Materia Medica first came to be of service of man (4).
(i) Sushruta Samhita, Sutrasthanam. Ch. I. 3.
(2) ^jrC^^T^^i? ^qt?:
Charana ^^•uha by \^y5sa.
(3) jitfwT^* ^w(f[ I ^?^^ «i» I ^^ I ^a.
(4) A. ipc: wii: ^gfi'?Tt^5Tifn It^r'^q^rd'T^ 1
0
Atharvan SamhitS U. Sec also Ibid I 2 II. 4. 7. 9. 25, 27 and 36.
INTRODUCTION. , Xlil
Discrepancies accounted' for : — Verses q\i medicine, hygiene, and surgery, etc. lie scattered throughout the four Vedas. Those having bearing on Medicine proper occur most in the Rigveda, and perhaps it was for this reasoT^i that Agnivesha, who was a physician, has ascribed the^origin of the Ayurveda to revelations in the Rik Samhitd. Precepts" relating to the art anu practice of surgery are found most in the Atharvan (i), which amply accounts for the fact of Sushruta's opinion of holding the Ayurveda as a subdivision of the Atharvan, as he was pre-eminentl}' a surgeon himself. Different kinds of physicians :— Vedic India, like Ancient Egypt, recognised the principle of the division of labour among the followers of the healing art. There were Shalya Vaidyas (surgeons), Bhisaks (physicians) and Bhisag- atharvans (magic doctors), and we find that at the time of
{ the Mahabharatam, which nearly approaches the age of our author, the number of the sects had increased to five which
J were named as Rogaharas (physicians^ Shalyaharas (sur- geons), Vishaharas (poison curers), . Krityaharas (demon- doctors) and Bhisag-Atharvans (2).
In the Vedic age (before the age of Sushruta) physicians had to go out into the open streets, calling out for patients (3^ They lived in houses surrounded by gardens of medicinal herbs. The Rigveda mentions the names of a thousand and one medicinal drugs (4). Verses eulogising the virtues of water as an all-healer, and of certain trees and herbs as purifiers of the atmosphere are not uncommon in the Vedas. Indeed the rudiments of Embryology, Midwifery, child management (pediatrics) and sanitation were foimu-
(i) ciwT?^Tre5nf^=^=^ '^]'^T\^ ?^Tf*ni5iTW^M 1
Rik Samhitfi I M. 1 16-16. (2) MahAbhdratam. Shantiparva. Rajadharmanu^hashan Parv5dhydya.
(3) ^cT' f^^^^ I
Rigveda. IX M» 112. ■>
(4) sifT* % ^m^ fm^ ^^'^g^f^TT. Rik.
XIV INTROgDUCTION.
lated in thecage of the Vedas i^nd Brahmanas, and we shall present^' see how from* these scanty- and confused materials Sushruta created a science and a Sanjhita which inv'ice the ddmirs^.ion of the world even after thousands of years of human prc*gress.
Origin of A'yurvedic Surgery : — In India, as in all other countries, curative spells and hewing mantras preceded medicine (i) ; and the first man of medicirte in India was a priest, a Bhisag Atharvan, who held a superior position to a surgeon in society. The first Aryan setLlements in the Punjab were often assailed by the dark aborigines of the country, and in the wars .that ensued surgeons had fre-' quently to attend to the Aryaa chiefs and soldiery. So in the Rigveda (2) we find that legs were amputated and replaced by iron substitutes, injured eyes were plucked out, and arrow shafts were extracted from the limbs of the Aryan warriors. Nay we have reasons to believe that many difficult surgical operations were successfully per- formed, thougli some of them sound almost incredible. But although the aid of surgery was constantly sought for, surgeons were not often allowed to mix in the Brahmanic society of Vedic India. This is hinted at by our author when he says that it was during the wars be tween the gods and demons that the Ashvins, the surgeons of heaven, did not become entitled to any sacrificial oblation till they had made themselves eligible for it by uniting the head of the god of sacrifice to his decapitated body. The story of the progress of Ayurvedic surgery is long and inter- esting, but it must suffice here to mention that with the
(1) Bedroe"s Origin of the Healing Art, and Sir John Lubbock's Prehistoric times,
(2) ^^ 5igi^i^?5l f^aj^i^^ait V% f|fIWfT% flsi^"*f' II
t
• « » * »
Rik Samhita I A. 8 Ad. 186 S. 116. 5.
INTRODUCTION. ' XV
' ' > '
return of peace, the small Aiynn settlements grew in number and prosperit}-. And the rich Ar3'an nobles now travelled in stately carriages, and as there were constant accidents ihere ■ arose a class of surgeons who exclusively devoted tlfemselves to the treatment of injured animals. The surgeons, now no longer required in camps and on battle fields, had to attend on the rich ladies at baronial castles during parturition, the magic doctor (Bhisag Atharvan) who could assuage fever and concoct lo\e potions (i) being held as the greatest of them all. But the Vedic Aryans had a regular armoury against pain and suffering, which is in no way inferior to our present day Materia Medica. But of that we shall speak later on in connection with the therapeutics of Sushruta.
The scope and nature of Sushruta's Surgery :- So
rnuch for the history of Vedic Surgery. It is in the Su-
(shruta Samhita that we first come across a systematic method of arranging the surgical experiences of the older surgeons, and of collecting the scattered facts of the science ^fom the vast range of Vedic literature. Sushruta had no desire of abandoning the Vedas in the darkness and pushing en an independent voyage of discovery. The crude methods and the still cruder implements of incision such as, bits of glass, bamboo skins etc., laid down and described in the Samhita, may bj the relics of a primitive instrumentalogy which tiiund favour vviih our ancestors long before the hymnisation of any Rik verse. Practical surgery requires a good knowledge of practical anatomy. The quartered animals at the Vedic sacriiices afforded excellent materials for the framing of a comparative anatomy (2)'. Sushruta devoted his whole life to the pursuit of surgery proper, to
Rik Samhit5. X M. 145 S. i. (2) Vide .^itareya Br^hmana I, 2. II, i±. Ill, 37,
XVI • INTRODUCTION.
which he b/'ought a niyid stored with luminous analogies from the lower animals. It was he who first classified all ♦.surgical operations into five differe'nt kinds, and grouped them under heads such as Aharya (extractions of solid bodies), Bhedya (excising), Chhedya (incising), Eshya (prob- ing), Lekhya (scarifying), Sivya (suturing), Vedhya (punc- turing) and Visravaniya (evacuating fluids). The surgery of Sushruta recognises a hundred and twenty-five different instruments, constructed after the shape of beasts and birds, and authorises the surgeon to devise new instruments according to the exigencies of each case. The qualifications and equipments of a surgeon are practically the sam*^ as are recommended at the present time. A light refresh- ment is enjoined to be given to the patient before a surgical operation, while abdominal operations, and operations m the mouth are advised to be performed while the patient is fasting. Sushruta enjoins the sick room to be fumigated with the vapours of white mustard, bdellium, Nimva ' leaves, and resinous gums of Shala trees, etc., which fore- shadows the antiseptic ^bacilli) theory of modern times. The number of surgical implements described in the Samhita is decidedly small in comparison with the almost inexhaustible resources of western surgery, and one may be naturally led to suspect the au' henticity of the glorious achievements claimed to have been performed by the surgeons of yore ; but then their kno vledge of the properties and virtues of drugs were so great that cases, which are reckoned as surgical nowadays, were cured with the help of medicines internally^pplied. "Surgery," says Tantram, is mutilation not doctoring (i). It should only be employed when the
(l) Aif^s^qfq* f^5n tf^ si«3f^^ ifT<qi^T I
].\TKOI)lf?TIO.\,, xvii
alTected vital energy is not strcnig enough to al^lie effect the cure that the surgeon is justified to handle his kniYe. We find in the Samhita that ophthalmic, obstetric and other operations were performed with the utmost skill and caution. '
Plastic and Rhinoplastic Operations :- Doctor Hirschberg of Berlin ^ys — "the whole plastic surgery in Europe took a new flight when these cunning devices of Indian workmen became known to us." The transplan- ting of sensible skin-flaps is also an entirely. Indian method (Sushruta, Sutrasthanam, Ch. XV'I). It is Sushruta who first successfully demonstrated tlie feasibility of mending a dipt earlobe with a patch of sensible skin-flap scraped from the neck or the adjoining part.
To Sushruta is attributed the glory of discovering the art of cataract-crouching which was unknown to the sur- ' geons of ancient Greece and Egypt. Limbs were amputated, abdominal sections were performed, fractures were set, dislocations, hernia and ruptures were reduced, hcemorrhoids rind fistula were removed, and we take pride in saying that the methods recommended in the Sushruta Samhita some- times prove more successful than those adopted by the surgeons of modern Europe, as we shall have occasion to observe later on. In tho case where the intestines are injured, Sushruta advises that "the protruded part should be gently replaced by following with the fingevP A surgeon should enlarge the wound in it, if necessary, by means of a knife.
"m^^ ^ffT fTf%T^^ fm^-^ f^^ftg^ II
Mahanilatanlram, Patola X. \'~.. 72-74.
B. See the Article on "Ileredily and some of its Surgical Aspects," By F. C. Til/ell, m. d. The ^fediL»al Advance Vd. LXIV. June iqo6. Page 357.
\
X
xviii j\TkMfnnrT[o\,
•• In the cas% where the intestine is severed, the severed parts s'hoLild be held together by applying living black ants to • their ends. Then their bodies should be cut off Teaviifg only the heads to serve the same purpose which in moderrt improved European surgery an animal tissue like catgut is expected to 4'ulfill. After this the intestine should be fairly replaced in the abdominal Ct^-ity and the external opening stitched and properly dressed. We abstain here from a lengthy description of the different methods recom- mended by the Sushruta in cases of abdominal and peritoneal wounds. We only ask our readers to compare this Chapter (II Chikitsa^thaTiam) of the Sushruta Samhita with the Chapter in anv work on European chirurgery whicli deals with the same subject. Certain medicinal plasters were used to be applied to localise the shafts of arrows embedded in the limbs of wounded soldiers and their exact locations were ascertained from the inflammation caused bv the application of such a plaster with a precision which would be sometimes welcome even in these days of Rontgen rays.
Lithotomic Operations : -In these cases, elaborate instructions have been given for making the perineal incision, as well as about the care and general management of the patient after the operation. In a case of Shukra- shmari (seminal or spermatic concretion) the forma- tion and existence of which have been verv recentlv discovered bv English pathologists, Sushruta enjoins that the stone, if in the urethra, should be removed with the help of Anyvdsanam and urethral enematas, failing which the penis should be cut open and the concretion extracted with the help of a hook. Kavinij I'mesii Chandra (Jupla in the introduction to his Vaidyaka Shavda-Sindhu remarks, that he and !>, Durgddasa Gupta M. B. translated the Chapters on lithotomic operations and instrumental parturi- tion «f the Susbrufa Samhita for the perusal of Dr Charles, the then Principal of the Medical College, Calcutta.
rNTRODUCTlON. XIX
t >
■-»
''Dr. Charles highly praised the pvocess ot clelivt^ry in difficult ca^es and even coijfessed I hat with all his great experience in midwifery and surgery he never hdi} any idea of the like heing found in all the medical \\;orks that came under his observation."
Amputation : — Amputation^ were freely made and medicated wines, were given to the patients as anccsthe- tics (i). These conclusivelv show thai the surgery of Sushruta does not rest content with the mere bursting or opening of an abscess, and the healing of the incidental wound, but lays down processes for major operations as well. The removal of the cicatrix until it becomes of the same colour with the surrounding skin and the growth of hair thereon are suggestions which we find nowhere else.
Ophthalmic Surgery : — Of the seventy six varieties of ophthalmic diseases. Sushruta holds that fifty-one are surgical OP*-" Tra Tantram Ch. Vlllu The mode of operation which is tV' be performed in each case has been elaborately de- scribed in the Samhita, and does not unfavourably compare in most instances with modern methods of ophthalmic surgery. Sushruta was aware of the fact that the angle of veHection is equal to the angle of incidence, and that the same ray which impinges upon the retina serves the double purpose of illumining the eye and the external world, and is in itself converted into the sensation of light.
Midwifery : — It is in the region of practical midwifery
that one becomes so much impressed with the greatness of
Sushruta. The different turning, flexing, gliding movements,
the application of the forceps in cases of difficult la1:)our and
other obstetric operations in\uiving the deslructioJi and
mutilation of the child, such as craniotomy, were iirsl
systematically described in the Subhiuta Sauihitd lung
before fillets and forceps were dreamt of in Europe, and
thousands of years before the birth uf Christ. Sushruta, who
< }
(i) For llie use of .Sanmohinis (an,Teslheiics) for surgical purposes, sec
Hhoia Prabandlia \>v I'.allAla T'andil.
XX » INTKOnUCTION.
advocates Clesarean se^nion iri hopeless cases of obslruclion, lays down that the instrument should be employed only in ♦those cases where the proportion between the child and the maternal passage is so defective that medicated plasters, fumigations, etc.. are not sufficient to effect a natural delivery. His directions regarding the management of the puerperal state, lactation and management of the chijd and the choice of a wet-nurse are substantial!}- the same as are found in modern scientific works of European authors. A feeling of pride and joy moves our heart when we contrast these glorious achievements of our ancestors with the meanness of results which modern Europe has gained in this department of midwifer}-. In those old days perhaps there were no hospitals to huddle patients together in the same room and therebv to create artificiallv septicemic poisons which are now so common and so fatal in lying-in rooms. A ne^-'^' built Iving-in room in an open space abunduntly suf^s-ea J with the rays of the sun and heat of the burning f^ie for each individual case, the recommendation of a fresh bamboo-chip for the section of the cord are suggestions the value of which the west has yet to learn from the east.
Dissection :--Sushruta, himself a practical surgeon, was the first to advocate dissection of dead bodies as indispen- sable for a successful student of Surgery. The Paritschittas of ancient Egypt perhaps learnt their art from the Purusachettas (Dissector) of ancient India. With a candour less common among western scholars Dr. Wise observes that, ''the Hindu philosophers undoubtedly deserve the credit of having, though opposed bv strong preiudire, entertained sound and philosophical views respecting the uses of the dead to the living, and were the first scientific and successful cultivator? of the most important and essential of all the departments of medical knowledge, practical anatomy". A bungling burgeon is a public danger and Sushiuta savs iliat, "theorv without practice is like a onc-wingetl bird that is incapable of flight".
lNTK01)UCT!(ON. XXI
■»
> >
Study of Practical Surgery :— To give effii-iency in surgical operations, the pupils of Dhan^antari(Sushruta etc.) were asked to try their knives repeatedly first on natural and artificial objects resembling the diseased parts ofv> the body before undertaking an actual operation. Incision, for example, was practised on Pushpafala /cucerbeta maxima), Alavu (Longenaris Vulgaris) or Trapusha (cucmis pubescuas), evacuating on leatfier bags full of water and on the urinary bladders of dead animals, scarification on the hides of animals on which the hair was allowed to remain. Venesec- tion was practised on the vessels of dead animals and on the stalks of the water-lily : the art .of stuffing and probing on bamboo reeds etc. : extraction of solid bodies on Panasa (Artocarpus Integrifolia) and such like fruit, scraping on wax spread on a Shalmali (Bombox Malabaricum) plank, and suturing on pieces of cloth, skin or hide. Ligaturing and bandaging were practised on dummies, cauterisation (both actual and potential ) on pieces of flesh, and cathe- terisation on unbaked earthen vessels filled with water. It is almost with a feeling of wonder we hear him talk of extirpation of uterine excrescences and discourse on the necessity of observing caution in surgically operating upon uterine tumours (Raktarvudai. These facts should be borne in mind as thev would help us a good deal in account- ing for the numerous anomalies that are to be found in the anatomical portions of the Samhita.
Study of Practical Anatomy :— We have stated be- fore that tb.e quartered sacrificial animals afforded excellent materials for the framing of comparative anatomy. The Aitareya Brahmana contains special injunction for the quartering of such animals (i) and we are told that the preceptors availed themselves of the religious meetings to
(i) The Ailaicya Firaliniana describes a )iaitirular wav of tlividini; the orgaas and viscera of the sirriticjjil animals 'wliich was kepi 'secret among the priesls. Aitareya Brahmana VIII. i.
XXII INIROniJCTIOX.
<
deinonslrjiLe the lessons ou^ practical anatomy. We come
I. acrosj; such terms as the heart, stomach, brain, intestines,
anus, liver, spleen, uterus etc', iv the Rigveda, and the *' Aitaj-e3'a Brdhmana (i). There is an entire h\inn (Rik) devoted* to the subject and treatment of Phthisis ( Knja Yakshma) which becomes utterly unintelligible in the absence of an accurate knowledge about the structure of lungs, and mechanism of the human heart. The Vtdic Arya fully understood the resultant nature of the human organism. The Rik Mantra, which to this day is recited on the occasion of a funeral ceremony, ampl}' testifies to the fact that he used to look upon his mortal frame as the product of the combination of the five physical elements (2). He understood the effects of different drugs upon diges- tion and the office which the tendons, muscles, flesh and nerves, etc. respectively serve in the economy. It is in the Sushruta Samhita that we find a systematic attempt at arranging together the facts of anatomical observation. The age of Sushruta, the Acharyic age of the Ayurveda, was a period of scientific investigation. The sturd}- Aryan colonists exchanged their simple mode of living for luxuiy and ease. The number of general diseases was great. Jn
( 1 ) A. fT^T ^^^ f ?gjnri:«3 f^fsffTTiRii
Rik Samhita \'. \'II, I, -'3, 538.
H. \ide also .Ailareya BrShmana I 2. II 12. Ill 37.
(2) The iialuie of the huiiiaii body as tile resulting efi'ect of tlie C(im- hinatidii dftlu' live elementals havcheen clearly described in the verse.
^Tqt'TTiI^ qf? era n f%rT?ft^y'l«I^ wfaf^VTTSlf 1»: I
* Rik Samhita X M. 16 S. 3.
Which l)eing translated reads :— Let his eye go t(j the sun, let his breath- wind nVx with the wind'of the atmosphere, and to the sky. earth and the cereals the parts which ha\e spriint; out of them. Cvc.
ixTR'onurTioN. » XX 111
vain did the holy Narada (i) ^reacl] the gospd of plain living and high thinking, and exhort them, like Cato, to return to their simpl'e mode of life. The long peace brought opulence in its train and wealth begot indolence and disease. Men like Bharadvaja, Angira, Yamadagni, Atreya, Gautama, Agastya, Vdmadeva', Kapisthala, Asa- marthya, Bhargava, Kusliika, Kdpya, Kashyapa, Sharkara- ksha, Shaunaka, Manmathayani, Agnivesha, Charaka, Sushruta, Narada, Pulastya, Asita, Chyavana, Paingi and Dhaumya etc. began to write Samhitas. Each hermitage was a College of Ayurveda, and the empirical method of investi- gation was introduced into each department of the science of cure.
Anatomical Anomalies in the Samhita :— Having got so far in our analysis, before passing on to the study of the Anatomical portion of the Sushruta Samhita, we must try to account for the many anomalies and discrepancies that have crept into or have been suffered to remain in the present recension of the book. Take, for example, the line in which Dhanvantari is made to speak of three hundred bones in the human organism. It is impossible that the human frame, in so short a time, has got rid of so many of of its skeletal accessories simply through disuse, or because of their becoming superfluous in the altered condition of its environments. More absurd is it to think that Sushruta, who discards all authority except the testimony of positive knowledge, would write a thing which none but the blind would believe in a dissecting room. The spirit of the a^re ill which he flouri:>lied piecliided the possibility oT^ such an crrnr.
Anomalies accounted for : -In ancient India, subjects chosen for the demonstration of practical anatomy were always children (2), and naturally those bones, which are (i) Vide Aitann'a Br5hmana VII. 13.
(2) The injunction of ihe Hindu Sllasiras is ihat '-corpse of persons more than 2 years old should he burned." Cremation of dead bodies bein"
xxi\- f (\'^Roi)rc~Ti().\.
fused or''«'inaslon"iised inlo'one whole durine: adult life, have been' separately enumerated — a circumstance which may, to some extent, account for th'e excess in the number of bon'es described in this Samhita (i). Likewise the theory that Sushrula might have included the teeth and the cartilages within the list of s'iveletal bones comes very near the truth, but It does not reflect the whole trtith either. The fact is that the orignial Sushruta Samhita has passed through several recensions ; and we have reasons to believe that the present one by Nagarjuna is neither the only nor the last one made. The redactors, according to their own light, have made man\- in'terpbLitions in the text, and when Brahmanas, thev have tried to come to a sort of compromise at points of disagieement with the teachings of the Vedas 12). Therefore it is that we come across such statements in the Samhita as ''there are 360 bones in the human body, ;-|0 it is in the Vedas, but the science of surgery recognises three hundred skeletal bones." What lends a greater colour to the hypothesis is that Sushruta, who, in the Chapter on Marma Shariram, has so accurately described the unions of bones and ligaments, anastomoses of nerves, veins and arteries etc.,
obligatory on Government, ;is well as on private individuals, it was almost impossible to secure a full-grown anatomical subject in I'auranic India, the more so when we consider that the Hindus look upon the non-crema- tion and mutilation oi a corpse vvilii a peculiar horror as it prevents the spirit from purging off its uncleanness in the funeral fire, and bars ilf access to a higher spiritual life. Naturally in later and more cere- moniil times the interred corpses of infants, less than 2 \ears old, had to be unearthed and dissected for anatomical purposes ; and these portions of the Sushruta SamliitS might have been modified by the subsequent commentators in order to conform them to occular proofs.— T. R.
(i) See Tiray's Anatomy {1897) p. 2S8 and 301 Figs. 248 and 262.
(2) "'?f^T*fgtw; vi?i': ^^rfij^: ^T^?nf" 1"
\ishnu Smriti. Ch, 96. 55. (,'haraka. Shfiriraslli^nani.
INTRODUCMON. , XXV
must have described their courszs and locations, a,L? otherwise it would have been quite impossible for practical suigeons, for whom it was intended, to conform to the directions of the Samhita in surgically operating on their patients' limbs^, and to avoid those vulnerable unions or anastomoses as"'enjo'ned therein. These Marmas have been 'divided into three classes such as, the Sadya-prana-hara : Kala-pnina-hara, and Vaikalya-kara, according as an injur}' to any of them proves instantaneously fatal, or fatal in course of time, or is followed b}-^ a maimed condition of the limb concerned. The fact is that the study of practical Anatomy was in a manner forbidden in the reig>n of Ashoka Pij-adarshi inasmuch as ail religious sacrifices were prohibited by a royal edict (i), and the subsequent commentators (who were also redactors on a small scale) of the Sushruta ■jSamhita, in the absence of any positive knowledge on the subject, had to grope their way out in darkness as best they could ; hence, this wanton mutilation of texts and hopeless confusion of verses in the Sharira Sthanam of the present day Sushruta Samhita, which should be re-arranged and restored to their proper chapters before any definite opinion can be pronounced on the anatomical knowledge of the holy Sushruta.
Sushruta as a Biologist •. — h^ the tirst chapter of his Sh.irira Sthanani, Sushruta discusses the question. what is man, wherein lies his individualit v, why does he come into being, why does he die at all ? Like all Indian philosophers, Sushruta argues the question down from the universe to man. The factors or laws, that govern the evolution of the universe in its phy- sical aspect, are extended to cover the evolution of the physical aspect of man (organic evolution). There is but one law and one force which run through -the three plains of mind, matter and spirit. Physiology, that fails to loc^k
(l) fournal of ihe .\siiiUc Society i.f CulciUla \'n\. \'U. P. 26f.
XXvi INTRODUCTION.
<•
into the iKiLure of life and iU background and tries to ex- plain t-.iway thib intelligent, living force as the product of chemiQal action of the organ'ic cells, is no Physiology at all. '.Cell is not life, but there is life in a cell. Cells may be called the true bearers of li-fe. Dr. Weismann insists that it is more correct to sppak of the continuity of the general protoplasm than of "the germ ceils." Professors Geddes and Thomson observe that, "the bodies are but the torches which burn out, while the living flame has passed through- out the organic series unextinguished. The bodies are the leaves which fall in dying from the continuously growing branch. Thus although deafh take inexorable grasp of the individual, the continuance of the life is still in a deep sense unaffected ; the reproductive elements (cells) have already claimed their protozoan immortality, are already recreating a new body.'" But to invest these reproductive cells with immortality, and to deny the same to the individual self, which directs and controls these protoplasms, and is before and behind them, is like the statement of Prof. Huxlev when he admits the chance of the physical transmigration of the organic constituents of the human body, and yet denies the possibility of an individual self continuing in any other form. "It is sensibility," observes Sushruta, "that precedes the senses ; and self, the sensibility proceeds from the self to which all such conditions are referred as mine."
Sushruta's Theory of Cosmogony is based on the
old S;inkhya Duality of Prakriti (Objective) and Purusha (Subjective). The two are coeval and co-extensive realities. Out of the Avyakta (unmanifest) or Prakriti has evolved the Mahai, the (inimatcd cosmic matter. Out of this cosmic matter has evolved Ahamk;ira (the sense of indivi- dualit\- or more correctly egoism) which is divided into thrt-e kinjs such as the Vaikarika (phenomenal, ihought-fornii, Taijasa (kinetic), and Bhut;idi (pertaining In il^e first form of matter). This \'"aik;irika Ahamkara in combination with the Taijasa Ahamkara has fathered
iNTRonurfioN. > xxvii
1.1
the eleven sense organs, whith. in combinatiqii with the Bnutadi, have produced the five Tanmatras or {iroper sensibles of touch, sight, ^ hearing, etc. The material principles of sound, light, taste, smell, etc., are biJ't the modifications of these five Tanmatras, of which'* Akisha (ethereon), Vayu (ether), light, and soui-^d, etc. are the grosser forms. In other wordfl, these Tanmatras may he defined as the atomic essences of the material principles of sound, light, ether, etc. In addition to these, Sushruta, Hke Kapila, admits the existence of a kind of atom-like units of consciousness, which he calls Purusha. The combination of' the sixteen aforesaid categories and the Purusha is for the expansion and liberation of the latter. A human being (individual), who is the fit subject for medical treatment, is the product of the combination of Purusha with the five primordial material principles (iMahabhutas). The Purushas, real selves of beings, the sources of their vital energy, and the controllers and directors of all organic or mental actions, are extremely subtile in their essence, and manifest themselves onlv through the combination of the seed (paternal element) or ovum (maternal element). It is the Karma (dynamics of acts done by a person in a prior existence) which deterinines the nature of the body it will be clothed with, as wcii cts che nat'Te of the womb it shall be conceived in, in its next incarnation.
Nature of Self : — v^; elf is a simple substance, and, as such, is immaterial. Force is substance and substance, is force. It is endued with constructive intelligepce, and, like gravitation or cohesion, can permeate a material body, without, in any way, disturbing h. It is adaptative or elective, or, in other words, elects that kind of selves for its parents as are best suited to the purposes* of its being. Man is the outcome of an influx of a se.f, a force, a dynamis with its path determined by the dynamics of the d^jeds of its prior existence. To think that vitality starts from
xxviii , iNTifoniTCTioN.
•• protoplastfv is insanity. Cimemically examined protoplasm is but', C, O, H, N anci S. But no amount of C, O, H, N afid S put together will constit<ite life. The idea that life 'iias nothing prior to it, that the force which controls the co-ordination of man's economy perished with the death of his organism, is'quite puerile. Life is expansion and not creation, and, as such, is linked to those unseen realities which constitute its prior and future selves. We see only the middle link in the chain of existence which we call life, but take no notice of the preceding or succeeding ones which are invisible (i). The grosser material body is linked to a finer, imma<;erial one, in as much as nothing can exist vvithout being attached to its antecedent. So at each conception there is the influx of a new self, for the lifeless constituents of a human body can not create a man, no matter how many chemical or physiological actions may be postulated to run to their rescue.
Ayurvedic Embryology : — Before entering into the discussion of Sushruta's tiieory of conception, we shall take a little more trouble to enunciate fully the Vedic theories on the subject. "The child is the fruit of the combination of sperm and ovum" (2'. It lies with its head downward inside the uterus, a fact which facilitates its passage out of, and protects its form from the effects of anv injur}' done to that viscus. (3) The eyes of the child a-y ..n^finrtltTi'',
Bhagavat Gita II. 28.
(2) ^f ^wic^t ^ra: ';^»j]3R^5i'^^f^: 1
Astanga llridayam (Vagbhat) c ShArira SthSnam. Ch, I. i.
« * * ^ r\^Tf[ ^'^^Vh ?clT 1
' * Aiteriya Brahmana \'I. ic g(^
introduct?oa. i xxix
1.1
as the cephalic portion of the feJal body is tirst ,».1eveloped. The factors, which are essential to the developme'nt of the fetal hody, from the time of fecundation to the 'ippearance of the characteristic sense-organs, have '^een described in a verse of the Rig Veda (i). In thfe Vedic mythology each organic function is 'consecrated to the tutelage of a presiding^' deity, and a Vedic Aryan loves to call a thing oftener by the name of its divine custodian than by that of its own. Rightly translated, the verse would read as follows : — "May Vishnu (the presiding deity of ether and nerve force) expand thy uterus, may Tvashta (the presiding deity 'of heat and metabolism) bring about the full differentiation of the limbs and the sex of the foetus, may Prajapati (the presiding deity of the ovum) sprinkle thy uterus, and mayst thou conceive through the blessing of the lortl of human destiny. May Snrasvati (goddess of intellect) and the Ashvins, the surgeons f>1' the gods (the |iresiding deity of fission, etc.) help thee in taking the seed." Now, the development of the fetal body takes place after the pattern of its father's species, and this conformity to the pattern of its species represents an act of intellection. Hence, the aid of the goddess of intellect has been invoked with that of the celestial surgeons, who preside over the process of cell-division, so essential to the formation of the fetal limbs. Divested of its allegory, the verse would mean
(i) f^^?itf^ ^^?tg, ^^T^qTt% f^sig I
JTwf ^f% f^5?t^T#, w ^f? T?:«^frr I
rf Tf 5fIW ^WlH'i ^^fT *?Tffl fl^f?^ II
' Rik Samhila X, M. 184, S.
XXX t INTfionUCTION.
that the •§perm led into a healthy and well-developed uteru5 through the agency of the Vayu (increased activity of the-^ local nerves) meets the 'maternal element (ovum) in tViat viscus. Then the impregnated matter undergoes a process of fission, and takes shape after the pattern of its father's species. • When we think of so many idle speculations as regards the proces% of fertilisation, which obtained credence so late as the beginning of the i8th century in Europe, and the controversies that arose between the Ovists, Performists and Animalculists (i), we cannot help regretting that the Ayurvedic Embryology, which started under such h'appy auspices, could not fully solve the problem of fertilisation even before the advent of the Tantrik age. The fundamental principles with which the Embryology of the Acharyayas (Sushruta, Dhanvantari, etc.) was started are substaritially the same as have now been discovered by the researches of the Western workers. Sushruta in his dissertation on the subject showed the illegitimacy which lay at the root of his predecessor's theory ( Sharirasthanam Chap. II. ) and took up research exactlv where the Vedic Rishis had left off. He clearly demonstrated the fact thai "by a physiological process known as Rasapika (metabolism) the hmph chyle is metamorphosed into sperm in men, or into ovum in women, in the course of a month. The catamenial fluid is carried down into the uterus through its proper ducts. The sperm or ovum is thus the quintessence of a man's or a woman's body. The sperm meets the ovum (Artavam) in the ute;-us, which resembles a lotus-bud in shape, and whose aperture is shut up with a mucous deposit as soon as fecundation takes place. The most favourable time for fecundation is between the fourth and twelfth day after the af)pearance of the flow (Garbhakala)" as has
(») For a short history of tlie Theories of Fertilisation, Vide Evolution of Sex (Prof. P. Geddes and J. A. Thompson) Chap. XII. pp. 169— 171.
JNTRODUCT?0\. > XXXI
I' I
been lately demonstrated by 'the researches ''of Prof. Von Ott. (I).
Sexual Diamorphism :— Some light is thrown on the relative preponderance of the sperm and ovum in the Birth of a female child. "When the maternal element prepon- derates the child is female ; when the 'fraternal element is stronger the child is malfe. When both the elements are equal, the child is of no sex.'" In theory at least Sushruta admits the possibility of the birth of many children at a single conception. "When the seed is divided into two by its inherent force (Vayu), twins are born in the womb" — a statement which points to the 'irresistible conclusion that multiplicity of birth is the outcome of the multifarious fission of the seed in the womb under certain abnormal conditions. Sushruta gives a reason for believing that, in exceptional circumstances, and without sexual union, the unfertilised ovum may give rise to perfect oflTspring, thus giving a prevision of the modern theory of parthenogenesis. Pathological parthenogenesis has occasionally been noticed in higher animals. Oellacher has noted this in respect of hen's eggs, and Janosik has observed it in the ovarian ova of many mammals such as the guinea-pig, etc. (2) Sushruta extends the probability to the human ova under certain conditions. He admits the possibility of conception without the admixture of the male germinal element, though he observes that like all asexual genesis" the development dots not proceed far in the case." From such a hypothesis it is but one step to the theory which enunciates the possibility of conception withou? proper sexual union.
But to understand his theory of sexual diamorphism, it
(1) Vide ihe chari of menstrual wave prepared by V*n Ou given in ilan and Woman '(Havelock and Ellis) Chap. XL
(2) The Evolution of Sc.k Ch. XIII. P. 1S5. ,
rn>/. p. r,eihlclfn,(} J. A, Thnmps.m.
XXxii «- INI^RODUCTION.
t •
is necessary thai on^shouFd fully compreliend the meaning of such Ayuryedic terms on the subject as Ichchha Shakli (will-force). Shukra-Vahulyam (\) (preponderance of the male reproductive element) and Shonita-Vahulyam (prepon- derance of the female reproductive element) etc. Sushruta, in common with 'the Brahmanic philosophers of Ind, believed that distinction of sex h'as evolved from a pri- mordial hermaijhroditism. Manu in his Institutes has emphasised the fact (2), though in a highly poetic style. He observes that "the Purusha (Logos), by a stroke of Will, divided its body (animated cosmic matter) into two, one of which was male, and the other female." The Tantra says that, ''the male part was endued with an energy (force) of its own, which is called Pitrika Shaktl ; and the corresponding female part, with the one, which is called Matrika Shakti. Pitrika Shakti is a disruptive force ; •Matrika Shakti is a constructive energy. Though the conception of force in Sanskrit sciences is but partially physical, the nearest approach to the connotations of the Pitrika and Matrika Shakti is made by the terms Ana- bolism and KatabolisiU of the Western physiologists. Sanskrit physiology recognises the two opposite poles of vital force in a living organism, and has not taken inconsiderate pains to determine their exact locations in mau and woman. Matrika Shakti, it observes, predominates in the left half of a woman's organism, which is negative as regards vital magnetism. {3) Now, Sushruta says that, in cases where female offspring is desired, the enceinte should
(l) Shdiiia-sth^iiani Ch. II.
(2) f^ifi^n«r*^ ^^»TiT 3«i«iT5«^fT '^i^ sfrff r\f^i ^ f^?;T5w^5TrT nij- 11
Manu .Samhili Ch. I. J2. (■2.) ^f^^irtar; *JI fi: ijt^ sfmwnflf^S'T'RT; 1
SfiradS Tilak Tanlrani.
INTRODbCTVJN. XXXIU
snufF through her left nostril (thq expressed juice Qf certain herbals), while the same should be administered through her right nostril where njale* issue would be the object. In other words, the anabolic (Mairika) or katabolic (Piti;}ka) forces of a mother's organism can be so adjusted with the help of drug-dynamics, as to determine, the sex of the child in the womb. The b',rth of a male child is usually pre- saged by the appearance of the milk (which according to Sushruta is metamorphised menstraal blood) in the right breast of the enceinte ; and where that has been effected with the help of suitable medicines, it must be presumed that the Katabolic pole of her glife-force has been acted upon, as desired.
The original hermaphroditism, which forms the anterior condition of all subsequent sex distinctions, and the character of the two opposite poles of vital energy, have been very clearly set forth in the Pauranik allegory of Ardha- Narishvara(i). The figure, observes the Pauranik rhapsodist, is half male, half female ; half life, half death (since, death, in fact, is the father of Hfe) (2) ; half anabolism, half katabolism ; with the crescent moon, the premise, the s3'mbol of progressive evolution on its brow, is made to sit on the eternal bull, the representative of the inmiutable law of the universe (lit : — the four-footed order). The Rishis and Rasasiddhas of ancient India were fully aware of the fact that, conception is effected only at an enormous sacrifice on the part of the mother ; that the Matrika Shakti is the real manufacturer of life, and that the Pitrika Shakti (paternal element) evokes, or calls it into play only through its disintegrating or disruptive effect by separating the two opposite life-poles, that lie neutralised through contact. It is love that governs these two complementary (i) Vishnu PurSnam Ch. 7. Vs. lo-ii. *
(2) mm: F?^n ^^^^^ ^t^ «TTJrfff ^^v. 1
Mahdbhaialam.
xxxiv INTRODUCTION.
forces of .life and death (i), (though in' fact they represent the two different aspects of the same energy) and controls its evolutionary rhythms through the desire of seeing itself many though one in reality. Does not modern biology endorse the same view when it says that the reproductive cells, as protozoons,.are immortal, and that bodies are the natural appendages which blossom.forth and fall off round these cells for the fructification of their innate purposes of being (2)?
A little more investigation into the biological thesis of the Rishis would be necessary for the clear comprehen- sion of "Shukra-Vahulyani" and '"Shonita-Vahulyam" ' of Sushruta and other Tantras (3). iMan is both animal and spirit ; and the Ayurvedic physiology recognises two distinct sets of apparatus in his organism answering to the different phases of his existence. The one helps him in performing the organic functions, which are so essential to his animal existence, and keeps intact the co-ordination of those inter- nal functions with the incidents of his environments. The other is attuned to the finer forces of nature, and responds
(I) The Evolution of Sex. Ch. XVIII.
Prof. P. Gedde/i and J, A. Thomson. (2) "The body or soma'\ Weismann says, "thus appears to a certain extent as a subsidiary appendage of the true bearers of the life,— the repro- ductive cells". Ray Lankester has again well expressed this :— "Among the multicellular animals, certain cells are separated from the rest of the consti- tuent units of the body, as egg-cells and sperm-cells ; these conjugate and continue to live, whilst the remaining cells, the mere carriers as it were of the immortal reproductive cells, die and disintegrate. The bodies of the higher aniivals which die, may from this point of view be regarded as something temporary and non-essential, destined merely to carry for a time, to nurse, and to nourish the mure important and deathless fission -products of the unicellular egg."— Quoted in the Evelution of Sex (P. Geddes and J, A. Thompton) 1901. Chap. XVIII.
(3) (a) ^liTf^^T wtwrf^ ^f<f^ry^: HiTi^ 1
Sarada Tilak Tantram. (15) Sushrula SamhilA (ShSrira Sthdnam Ch. Ill )
INTRODUCTION. ' XXXV
to the call of his higher or psychiq self. Tli'e one is organic, the other is psyC^ic The one chains him down to the phenomenal, and is" governed by the laws of growth and decay ; the other opens on the region of absolute realities where growth and decay have no room to be. Growth is not the only condition of life. Man may exist without food (i)or respiration, only if he can manage to dive deep into the realities within himself. Between these two sets of apparatus there is the Jivatma, which, by its own peculiar energy (the will-force), can operate in phenomenal or organic pl?,in, or recede from thence into the psychic one, thus being in contact with the world of the senses' and the one that is beyond the darkness of death. Death, in fact, is the grand usherer to life, which is only the rise of the curtain over the life's drama, all equipments for which are made in the green room of death.
A man can not propagate at will. No amount of willing on the part of the parent-animal can help him in creating progeny. The self of the child, who is about to come into life, chooses its own parents, according to the dynamics of its own acts or Karma, from the region of the lunar Pitris or quiescent life, if it be warrantable to use such an expres- sion (2). The self of the would-be child mixes with the self of its human father, and hovers over the reproductive cells of the latter's organism, and regulates the intensity of its father's sexual desire, according to the nature of the sex, determined necessary for the fruition of the purposes of its advent into the world. A greater intensity of its father's desires ensures the preponderance of tile Pitrika Shakti (katabolism) in the impregnated ovum, which
Skanda PurSnam quoted by Shridhara SvSmi in his commentaries on the Vishnu Purdnam. Ch. VI. V. i6. ,
(2) ^^^m ^7m\^m 1
Shruti.
XXXVl ' INTRODUCTION.
determiiies the male^sex of the child, while such a thing, on the part of the mother at the time, is followed by the relative preponderance of the Afatrika Shakti (anabolism) which accounts for the femininity of the issue. Equal in- tensity of sexual desires in both the parents, creating an absence of the relative preponderance of the Pitrika and Matrika Shaktis in the impregnated ovum, leaves the sex of the child practically undetermined. The relative prepon- derance of the Pitrikd or Matrika Shakti, as evidenced by the greater or less intensity of the sexual desire of either of the parents, which results in the speedier emission of the paternal or maternal element (sperm or ovum) during an act of successful fecundation, is contemplated by the term ''Shukra-Vahulyam," or "Shonita-Vahulyam," by the framer of the Samhita, as ma}- be fully substantiated by a couplet by the venerable Daruvahi (i).
So far Sushruta is at one with the modern Western theory of preponderant katabolism or anabolism in the ovum as the determining factor of the sexual diamorphism to the extent that seeds or reproductive cells are the bearers and not the manufacturers of life, only containing those categories which foster life, and help its evolution into an organic being. To deny this would be to admit the chemi- cal, or physiological basis of life, which, as a theory, was never acceptable to the biologists of ancient India. The number of reproductive cells may be increased bv suitable dietary, and to say that the immortal reproductive cells, as the creators of life, come out of the mortal, organic food stufll* is to say that darkness is the father of light. The question of the immortality of the seed (germ plasm) has
(I) ^a«g^: q^q^ft qgr?^ Uw^r[ ^^T^_^ \
fl^^qif^flT ^'qi'Sn?!^ l^fl^cTT II D5rub5hi (Quoted by Arunadatla in his commentaries on Viigbhat).
INTRODUCTION. XXXVii
been elaborately discussed in the Gommentaries on the Sankhya Darshanam(i). The, Pjah Vindus (germ cells) pulsate with the vibrations (rhythmic movements), which are^the relics of the primordial ethereal vibrations, which ,ushered in the birth-throes of the universe. ^ As such, they are essential to the evolution of life ; and man, as an offspring of the universe, still retains them in his reproductive cells as the best condition for calling out the life in his offspring, when its seK enters into the impregnated ovum in the mother's womb. Life is the essence of self, and not the prjoduct of any chemical or physiological process. It is an influx ; and microscopes and spectroscopes mav not expose to view the hinterlands of birth and genesis. Perhaps it was this theorv of will-force and intensity of parental desire as determining the sex in the child, together with the facts of parthenogenesis observed in lower animals, from which Sushruta was disposed to extend the analogy to the human species, and believed that conception without sexual union is possible in women.
^j. The conception of the nature of these Matrika and J '.rika Shaktis is more clearly set forth in the Pauranika n jth regarding the origin (etiology) of fever ; Sushruta relates the story as follows : — Daksha, the father of the universal mother, (or constructive metabolism in man) insulted the divine father, her consort (destructive meta- bolism), by witholding his quota of sacrificial oblations. The wrath of the insulted deity broke out in the shape of a morbific heat (hyperpyrexia) which is fever. The process of digestion in man has been often compared 'to an act
(l) (a) qRHTSTtftS'C^I^T ^"Wl,^^ I
Sankhya Sutra Ch. I. 122.
(b) fT^5TT<T ^^fh '
Ibid. Ch. III. 3.
(c) *r% f% ^^^^^m^^mfn^]^'^^wf^^Tff x?m^i ^^i*
Sankhya Prabachana Vashya (Vijn^n Bhikshu) Ch. I. S. I.
XXXVni INTRODUCTION.
< f
• <
of Homa sacrifice (i) in the Ayurveda. Stripped of its allegory the myth may be exp^iined quite in a pathological lin^ It means that when the t*itrika Shakti, the process of destructive metabolism (Pita, father or Shiva in Hindu mythology being the god of destruction or disintegration) of the body is not properly served by the factors, which noun'sh its constructive metabolism (Father of the Matrika Shakti), the excrements and excretory process of the body are arrested (b^r the wrathful deity), and the heat generated in consequence is fever. Fever, then, is a disease of defective digestion and excretion. Whenever this Pit rika Shakti,. is disturbed or not properly served there is fever, and heat is one of its essential effects.
With a precision and love of details, which mark the best days of Brahmanic literature, Sushruta lays down rules of diet and conduct to be observed by the enceinte, from month to month, during the whole period of gestation, and gives medicinal recipes for the development of a partiall}^ atrophied child in the womb.
A perusal of the Chapter on Marma Shiriram world leave no doubt for the conclusion that anatomical kt\psP/, ledge was cultivated by surgeons and soldiers alike, la jr.. knowledge about the locations of the vulnerable joints, iir nerves, or vein anastomoses where a blow or a little pressure may enable him to make short work of his man could not but be dearly prized by the soldiery at a time when the fate of a war was often decided by the success of a single champion, and we have reasons to belieVe that a scientific system of wrestling was formulated in the light of the Sushruta Samhita, and practised by the gentry of ancient India much like
c
( I) ^ffcTTTT «?r q'5fi'q=?T^^flfcT ^: I
Charaka SamhitS.
INTRODUCTION. XXXIX
• >
the Jiujitsu (Skr. Yuyutsu, t,he intending fighter) of modern Japan, (i). '
Sushnita's Physiolo^ ."— But if Sushruta is ad- mired so much for his practical and scientific jt!ast of mind, it is his writings on Physiologv, ''which is practicalh- the same as the one adopted by all schools of the Ayurveda) which , have appeared as a stumbling block to the intelligence of many a Western and and Eastern scholar. European Sanskritists have thought fit to translate "Vayu," "Pittam'' and "Kapham" (the three main physiological functions) as air, bile and phlegm. B\l\ nothing could be more misleading, or erroneous than that. A right understanding of the science of the Ayur- vedic medicine, in all its branches, hinges on a right concep- tion of the Vayu. Pittam and Kapham, so we should like to clear up the nature of these three physiological factors before proceeding farther in our enquiry.
Antiquity of the division:— A reference to these
three physiological factors of Vayu, Pittam and Kapham,
under the name of Tridhatu. is first met with in the
Rikveda, (3). Sayana explains the term as a synonvm for
Vayu, Pittam and Kapham. The Vedic physicians possessed
at least a considerable knowledge of the process of diges-
tionf4), the circulation of gas in the human organism, and of
(i) It is anions that the phonetic and etymological resemblance between Sanskrit "Juyutsu" and Japanese ''Jiujitsu" (would be fighter) should be so close. Perhaps it was the Buddhist missionaries (and they were not always peaceful hermits) who had carried with them a system of scientific wrestling from India, which was subsequently developed in Japan. Compare with the complete Kano, Jiu-jitsu (Jeudo) by H. Irving Hancock and Katsukuma Higashi. Chart I and III.
(3) * * * f^^rg vm w^ct' :crw^^ 11
Rik. Samhita. I. 3, 6. Sayana explains it as
(4) ^rm: if!?n^^T f^^ 1 tmrr w. wf^^v^r^'^j^ w^Ict. 5|1»ni5^ 'fiWtf^fT, ^sfT^: ^: unu: 1 ^^sc. ^^ ! w^^'.-^m ^sf^Ti
Chhandagya Brihmana.
Xl ^ INTCiODUCTlON.
the properties and functioiv> of flesh, fat, muscles, tendons, ligaments and cartilages. But to the Acharyas of the Ayurveda belongs the glor\' of "nrs^. formulating a systematic physiological science, to which end Sushruta as a surgeon did con<;ribute no mean a quo'.a. In the light of Western science the actionsr of living matter, varied as they are, may be reduced to three categorief, viz. (a) Sustentative, {d) Generative, and (c) Correlative functions. The second is not co-extensive with the entire existence of a living organism, Sushruta observes some such distinction among the functions of a living organism when he denominates the living body as the "three supported one" (Tristhunam), and describes the normal Vayu, Pittam and Kapham as its three supports. We wonder how the term Vayu, meaning nerve force, can be confounded with the same term meaning air, since Sushruta derives the former from the root "Va," to move, to spread. Vayu, according to Sushruta, is so called from the fact of its sensory and motor functions such as, smelling, &c. But the Vayu in the Ayurveda is not wholly a physical or organic force, it has its spiritual aspect as well which does not legitimately fall within the scope of our enquiry. It is safe to aver however, that the Ayurvedic physiology, like its sister science in modern Europe, is concerned more with the invisible molecular components of the human organism, than with the workings of its gross members. The holy Agnivesha warns the students of physiology against the danger of regarding the human system as some- thing other than the aggregate of molecules (i).
* Charaka Saniliit^ ShArirasthAnam, Chap. VII.
INTRODUCTI9N. xli
The three fundamental principles of Vayu,,Pittam and Kaphah: — The actions of living matter vary and so may be reduced to^ three categories. They are either— (i), functions which affect the material conipositJDn of the body and determine its mass, which is the baUnce of the processes of waste on one hand and t^hose of assimilation on the other. Or (2), they are functions which subserve the process of reproduction which is essentially the detach- ment of a part endowed with the powers of developing into an independent whole, or (3), they are functions in virtues of which one part of the body is able to exert a direct influence on another, and^ the body, by its parts as a whole, becomes a source of molar motion. The first may be termed Sustentative, the second Generative, and the third Correlative functions. The above is the sum and substance of the works which a living matter has to perform. But setting apart the processes of reproduction as a subject for future discussion, we shall now try to examine what the other two functions are as understood by Oriental thinkers. In the Mahfibhiratam the Prdna vayu is described as a force, akin to electricity. It is some- what like a flash of lightning (1). This fact aHonce shows the errors of confounding Prana vdyzi with an effete material — with gases generated during the processes of digestion. Shushruta describes it as a force, (2) which sets the whole organism into motion. Self-evolved, it acts as the principal
(i) HTOSIT^^^ JJcTRt Mm ?sifvf^?j^ I
MahSbMratam. ShAnti Pa^va S. 39.
(2) Fo'ce may be defined as ihat which tends to produce motion in a body at lesi, or to produce change of motion in a body which is movjng. — Daschanel,
6
xlii INJRODUCTION.
factor that deLerinines the genesis, continuance and disin- tegration of the livir-g body. It is the primary cause — an all-in-all that governs our organic as well as our cognitive faQulties. Its special feature is that the vibration, that is produqed in it, instead of travelling like light in a transverse direction, takes a course as the controller of the correlative functions of the system. It maintains an equilibrium between the Pittam and Shleshma which are said to be inert, (i) But for this adjustment the living body would stand in imminent danger of being consumed like fuel by its internal heat or fire. Taking into consideration the various functions the living body has to perform, Sushruta attempts a classif.ca-
tion of Vdyu into Prana, Udana, Samana, Vyana and
Apana, which, in detail, correspond to the divisions of functions performed by the Cerebro-spinal and Sympathe- tic nerves of the Western physiology. Tintric literature abounds in the descriptions of the Nadichakras (nerve plexuses) and contains a more detailed account of the motor, sensory, and mixed nerves according to their differences in their functions and relations. In short, the term Vayu may not only be rightly interpreted to mean the nerve force, but is often extended to include any kind of electro-motor or molecular force (as when we speak of the V^yu of the soil), though the term is loosely applied now to signify gas or air. The Rishis of yore gave the name of V;iyu to the bodily force in the absence of any suitable nomenclature, little suspecting that it might be confounded with the atmospheric air by the foreign translators of their works.
Charaka, Sutraslh4nam. Chap. XII.
Inert i.s Pittam, inert is Kaphah, inert are the Malas & 'Jh^lus Like clouds, they go wherever they arc!- carried by the V5yu,
INTRODUCTION. xliii
Pittam : — The function of the »Pittam consists in metamorphosing the chyle, .through a graduated series of organic principles, to a protoplasmic substance like sperm in men, and the ovum in women. Thus we see that the Pittam of the Ayurveda corresponds to metabolism of Western physiology. But b}? a confounding carelessness of terms the excreted portion of Rasa and blood though ultimately connected with those normal physiological processes has been respectively styled as the Doshas or defiling principles of Kaphah and Pittam. Again, as in the case, of soil, the terms V^yu, Pittam and Kaphah are extend- ed to denote magnetism, kinetic energy and humidity of its molecules. The circulation of blood is connected with the Pittam, while the circulation of lymph chyle fRasa) is related to Shleshmi the two combinedly forming what is called the sustentative function of the Western Physiology.
The term Pittam, which, by its etymology, signifies the agent of metabolism, has been loosely used by our Ayurvedic physiolgists to denote two different organic principles from an observed similarity in their nature and functions. Pittam in Sanskrit means both bile and meta- bolism of tissues as well as the bodily heat which is the product of the latter.
Hence a few commentators lean towards the view that Pittam is the heat incarcerated in the bile, and the principal agent in performing digestion (i). The real import of the term may be gathered from the five sub-divisions of the Pittam, made by our ' Rishis according to their functions and locations, and which are
called the Pachaka, Ranjaka, Sadhaka, A'lochaka and
(l) 5^^: ^g^Rim^^lfq fqfl^ ^^WT^Sf'af?;f?I '*
Madhukosha.
Xliv ' INTRODUCTION.
Bhr^jaka. All metabolic processes in the organism, whether constructive or dj^structive, are called Pittam, wljich is said to be in the products of those processes whether serum, bile, blood, albumen, etc., which are either essential to the substance of the body, or to the proper performance of any organic function. Hence we learn that Pittam is latent in Lasika (Serum), blood, lymph chyle, albumen etc., and in the organs of touch and sight. In other words, metabolism goes on in those principles and regions of the human organism (i) either as a sustentative or as a cognetic physiological process. First, we have ,,the Pachakagni or the heat of digestion, which is situated in the region between the stomach and the intestines ; (2) and being a liquid fire or fluid heat incarcerated in the secre- tions of the liver (bile), it is primarily concerned in digesting the four kinds of food (as they meet it in the abdomen). Thus we see that the Pachakagni of our Ayurveda is the same as the bile of Western physiology, its other function being to differentiate (precipitate) the nutritive essence of the food from its unutilisable portion, and to act as an excrementitious matter. It is this Pittam, which makes metabolism in other parts of the bodv possible, (3) b)' helping the organism in acquiring fresh energy.
(1) iTfv(?:i9f?j: ^^ft^^t^T^'PfT' Tw. I
l^rsjafil" ^ fqtrw TlfHT^ f^^r\ II
Bdgbhat (Sutra Sihinam ch. XII.) (2) The bile assists in emulsifying the fats of the foods, and thus rendering them capable of passing into the lacteals by absorption *. The bile has b*een considered as a natural purgative * * * The bile appears to have the power of precipitating the gastric proteoses and peptones, together with the pepsin, which is mixed up with them. * * * As an excrementitious substance, the bile may serve as a medicine for the separa- tion of certain highly carbonaceous substances from the blood.
Kirk's Physiology Ch. XIII. pp 377-378.
^ (3) tT«f^iR^fqrTrr^t ^EfjiiTfitgg^T^'T 1
^i'lfh ^sT?T%ii ^\'^'^ siTfl rTfTnr.fTfl; 11
Bagbhat Sutra ch. XII.
INTRODUCTION. ' xlv
»
The second kind of Pittam i^'called RanjakaoV pigment Pittam from the circumstance of its imparting the characteristic colour to th'e lymph chyle as it is transformed into blood by coursing through the liver and spleen, u^here it is located (i).
The third kind r.f Pittair. (Sadhak'a) is situated in the heart, and indirectly a5s*\sts in the performance of cognitive functions in man by keeping up the rhythmic cardiac contractions (2). Perhaps it is this view of the heart's contraction that predisposed many of our ancient physio-
* (l) A. The colouring matter of the Ijilc is derived from and is closely related to that of blood, since the qualities of the bile pigment secreted are markedly increased by the injection of substances into the veins which are capable of setting free haemoglobin
Kirk's Physiology — (Metabolism in the liver.) Ch. XII. p. 505.
B. There seems to be a close relationship between the colouring matters of the blood and of the bile, and ' ' between these and that of urine (urobilin) and of the feces— Ibid Ch. \ III. p. 376.
c. It seems probable that the spleen, like the lymphatic glands, is engaged in the formation of blood corpuscles. For it is quite certain, tl at the blood of the splenic vein contains an unusually large number of white corpuscles, t t i" In Kottikor's opinion, the development of colour- less and .also coloured corpuscles of the l)lood, is one of the essential functions of the spleen, into the veins of which the new formed corpuscles pass, and are conveved into the general current of the circulations.
Ibid. Ch. XII.
(2) A. The contraction (of the heart) can not be long maintained without a due supply of blood or of a similar nutritive fluid. * * * The view that is at present taken of the action of the heart is * * that in heart muscle, as in protoplasm generally, the metabolic processes are those of anabolism or building up. which takes place during diastole of the heart * * * and the katabolism or discharge which is manifested in the contrac- tion of the heart. Kirk's Physiology (metabolism of the heart). Ch. VI.
*1T^ f ??t" ffTffl II , •»
BSgbhat Sutra. Ch. XII. 13.
xlvi ' INTRODUCTION.
logists to hold it ^ as iWe seat of cognition ( Viiddhi Sthanam). (l)
The- fourth, which is the Albchaka or the Pittam of sight; indicates the metabolic process in the substance of the retina (Drishti) which gives rise to visual sensation. (2;
The fifth is the Bhrajakagni or the Pittam in the skin which produces perspiration or hefps exudations from the skin by evaporation. In short it is the Pittam which keeps active, under certain circumstances, the secretions from the sweat and sebaceous glands of the human skin.
Kaphah :— Sushruta is oie in holding with Foster thgj "the animal body dies daily, in the sense that at every moment some part of its substance is suffering decay, is undergoing combustion."' The etymological significance of the term Shariam vSkr. Shri, to wither up) testifies to his knowledge of the combustion that goes on within the human system. Three kinds of fire are detected in the bod}', which are sure to feed upon its constituent principles in the absence of proper fuel in the shape of food and air. It is food and the fundamental brdily principle of Shleshma, which is cooling or watery in its essence, that fly to the rescue of the organism, the latter (Sleshma) surcharging ii with its own essential humidity and keeping intact the integration of its component molecules.
The Rasa, or lymph chyle which is formed out of the ingested food, prevents the internal bodily fire- from
(i) The seat of the moon is at the root of the palate ami thai of the sun is at the root of the navel ; the place of the air (or breath) is above the sun, and mind dwells above the moon, Chittam (or the passage between the mind and the spiritual soul) dwells above the sun. and life dwells above the moon.
Jn4na Sankallni Tantrani, International Journal of Tdntrik order (New York) Vol. V'. No. 5 p. 109.
(2) It is supposed that the change effected by the light, which falls upon the retina, is in fact a chemical alteration in the protoplasm, and that this stimulates the optic nerve-endings. Kirk's Physiology Ch, XVII,
INTRODUCT.PN. xlvii
preying upon the vitals by coursing freely th;'Ough the whole organism. The Rasa, thus g^enerated, undergoes a sort of purification, the » purified portion being called Prasddabhuta, and the excreted portion Malabhttta, suc^>9 as are found as effete products deposited in certain pores of the body. Kaphah or Sleshmd is that pprtion of Rasa which fills all the intercellular^ spaces of the body, thus holding them together in a kind of cooling embrace (Skr. Slish to embrace) and prevents (il the dreadful combustion which would otherwise have been caused by organic heat. Our Acharjas have classified the Kaphah into five diflFerent kinds such as the Kledaka, Avalanwaka, Vodhaka and Shlcsmaka according to their different functions and locations in the economy.
Dosha : — The lymph chyle, born of the digested food, and which courses through the body, potentially contains the elements which build the diflferent tissues of the human organism. Under the influence of metabolic heat it is progressively transformed into blood, flesh, fat, bone, marrow, semen and OJah. In other words, under the process of physiological metamorphosis, the lymph chyle sets free that part of its constituents (2) which possess blood-
(i) A ^wftl*lK*!: — Bagbhat.
Charaka Chikitshasth,<.nam. Chap. 15. (2) A. %^Ttg ?}^Tli^T: TJ^f^rf f^f^«(*ft; I
fi^^^n: ^Tg^^ ^f^T*i ^t^^ K^: II
Bh^va Mishra.
Chakra Datta's commentary on the Charaka Samhit^. SutrasthSrjani. Cr. XXVIIl.
xlviii int;roduction.
making properties, and are ultimately transformed into blood — (its unuiilised^or excreted portion being eliminated through the natural apertures of the body), and so on, thrqugh the progressive series of metabolism to Oj'a/i Dhd.iu.> Thus with ihc derangement f)f the bodily Vayu which causes the fr^e coursing oi the lymph ch3'le through its vessels, the Pittam imetabolismj,of tissues), in any parti- cular part of the body, is also affected by reason of its incarceration, and thus causes an increase or diminu- tion in the excreted portion of the Rasa, which is another name for Kapham during the progressive metabolism. Thus we see that Vayu, Pitta^i, and Kaphah, which, in their normal state, are the three supporting principles of the body are transformed into morbific diathesis by increasing or diminishing the bodily heat, secretions, or excretions. t
Thus congestion and inanition (atony) are the two main forms of disease recognised by the Ayurvedic Patholo- gists, the former being held amenable to resolution or elimination, and the latter to local feeding or nourishment.
Agni and Dh^tvagnis : — We can not better conclude this portion of our dissertation than by speaking a word or two about Agni. Sushruta raises the question whether there is any kind of fire in the human organism other than the Pittam ; or are they identical ? Sushruta holds that the Pittam is the only fire present in the system, in as much as all acts from the digestion of food to the disintegration of tissues are performed with the help of the Pittam, which includes within its signification what is connoted by Anabolism and Katabolism of Western Physiologists. But Agnivesha and certain sections of the Ayurvedic Acharyayas hold that there
^fTf^=5WWri^ «?^ ftqi 5f?T «I,?TI: II
Bh^vaprakeisha Part I.
Charaka Sutrasthinam Chap. I.
/'
,/ /
rxTRODrcTfoN. , xlix
are five Anjali-fuls of Agni (i)' in the human t)rganism. This discrepancy is best explained away by including one Yava measure of Agni - (enzymes, ferment) in the five Anjali-measures of Pittam. •'
The A'yurvedic Physiology recognises the exist'ence of another kind of Agni, which is called Dhatvagni (proto- plasm) and which it cL\ssifies into seven different kinds, Arunadatta, the celebrated commentator of the Ashtanga- hridayam, holds that there are as many Dhatvagnis as the constituents of the body. (2)
'(i) q'g fiiTT^— Charaka Samhita. (2) A q^ qT^vftffi^i '5Bra?f:— v^ ^^^ift?:. ^'^tt^^^I ^rg<fl[inr
flfq qigi?rfcT^(9rn fT(?Tfq qTf?f^T3I^r«Io|: 1 ^g qif^^Till'flirw 3»r: qi^: I Arundatta.
q^g ?Tt€q3?^ 5I?Tq -^ q'^rfusrcrr^ffT II Ibid.
r. ^ T^TTf ■^^^^\ ^ig^TTit 'g^=^% 1
fqrnWl!; ^ \W^ '^m T^R^^^f^^ffT II fm'^'e^ HM *Tf« ^TfT ^"^^1 q^^^fl?T II
l^a T?^f|c5J^ 5fT?r^Sf^ f^^t?^T*T I ^frf?T fT^ ^Tf^^T^j TW ^kli: II
ii^ffTOifir 1^55^ #^ f\-n\ riff: w,?t: i cHJiTri f{'^m, f\\ #f 5[r^' fr5iTg?T fT?f: 11
^iaT^T9?lf^fvwiq : 9^fq^' ^qHsf^g I
Charaka SamhiiS, ChikitsSsthSnam^ Chapter X\'.
I). ^f«f¥ mJTTft >^?Tfr f^f^^ ^: I
q^T»^*Tf^f«: qi^ gif'Tf ff ? q^l^rf: I! "
Vid lljid Chap. XX.
1 intr6duction.
The tommeniator of the Chhandagya Bhasyani has emphasised the identity of the Pittani and the solar heat. In fact it was a doctrine of faith among the Rishis that the solar heat pent up in the solids is transformed into organic heat (Bhutagni) which, becoming liberated in the stomach, produces the heat of digestion, (i) All these are but different forms of solar "^ heat. The Dhatvagni and Udaragni lie inert in the organism. It is the Vayu that sets them free and makes them operative.
The Dhatvagnis (protoplasm) of the muscle are not of
the same kind as that of the arteries. We cannot resist'
<■
the temptation of quoting a few lines from Foster's physiology on the subject.*
(I) A. flra: ^«< ^^\ M^m-^^ ^%^^\ « ^f ^* ^q?")^r?T ^.^
ChhAndogya Upanisliad.
Chh^ndogya Bh^syam.
" These facts and other considenitions, which might be brought forward, lead to tl\e tentative conception of protoplasm as being a substance (if we may use the word in somewhat loose sense) not only unstable in nature but subject to incessant change, existing indeed as the expression of incessant molecular, i. i. chemical and physical cliange, ver3' much as a fountain is the expression of incessant replacement of water. We may picture to ourselves the total <:'hange. which we denote by the term "metabolism," as consisting on the one hand, of a downward series of i,Katabolic changes) a stair of many steps in which the more complex bodies are broken down with the setting free of energy into simpler waste bodies, and, on the other hand, of an upward series of changes (anabolic changes) also a stair of _ many steps, by which ihe dead food of varying simplicity or complexity is with further assumption of energ}- built up into more and more complex bodies. The summit of the do'uble stair we call ''protoplosm" whether we have right to speak of it as a single hodv .'in the chemical sense of that word or as a
INTRODUCTION. , ll
From whal has now been sUted regarding ihe func- tions and significations of the Vayu, l*ittam and Kaphah, it will appear that the Achai*yayas of the Ayurveda contem- plated three different sets of principles in the domains of Biology and Pathology. Vayu, Pittam, and Kaphah are
mixture in some way of several bodies. Whether we should regard it as tlie very summit of the double stair, or as embracing as well as the topmost steps in either side, we can not at present tell. Even if this be a simple substance forming the topmost summit, its existence is absolutely temporary, at one instance it is made, at the next it is unmade matter, which is passing through the phase of life, rolls up the ascending step t«5 the top and forthwith rolls down on the other side * o o
Further the dead food itself fairly, but far from being wholly stable in character, becomes more and more complex living material. It becomes more and more explosive and when it reaches the sum- mit its equilibrium is over-thrown and it actually explodes. The whole downward stair of events seems in fact to be a series of explosives by means of which the energy latent in the dead food and augmented by the touches through which the dead food becomes living protoplasm, is set free. Some of those freed energy is used up again by the material itself, in order to carry on tliis same vivification of dead food, the rest leaves the body as heat or motion.
If this be admitted it almost inevitably follows, that what we have called protoplasm, can not be alwnys the sumo thing : that tliere must be many varieties of protoplasm witli dilVcrcnt qualities and with corresponding different molecular strncturL' and composition. Using the word '"protoplasm'' in this sense, it is oi'vious that the varieties of protoplasm are numerous indeed, almost innumerable. The molecular protoplasm, whicli brings forth a contractile kata- state must difEer in nature, in composition, that is in construction from glandular protoplasm wliere kata-state is a mother of ferment. Fur* her the protoplaspi of a swiftly contracting striped muscular fibre must differ from that of the torpid, smooth, unstriatcd fibre, the protoplasm of a human muscle must differ from that of a sheep or a frog, the protoplasm of one muscle must differ from that of another muscle, in the aaine kind of animal, and the pro- toplasm of Smith's biceps must differ from that of Jone's— Foster.
Hi ,, INTRODUCTION.
Called D/iaius or fundaraental principles of the economy, when in virtue of their correlative and sustentative func- tions, or with the help of their subservient processes of metabolism and lymphatic circulation, they ensure an equi- poise among the diflferent vital and physiological processes in the u'hole economy which is essential to its perfect health. Biologically considered they are but the primary subtle djniamics of organic life, or as Sayana expresses it, the three fundamental principles of the body.* But when this healthy equilibrium is disturbed either through the agency of any extrinsic or idiopathic factor, when any one of them is abnormally augmented or dominates the other two, thus altering their mutual relation in the economy, naturally certain pathological conditions arise which form the esse of a disease ; t or in the parlance of the Ayurveda they are said to have been transformed into Doshas or morbific diathesis. Even blood, which, according to our Acharyayas, forms one of the fundamental principles (Dhatu) of the organism, may be designated as a Dosha (morbific diathesis), when owing to its congestion in any particular organ or member of the body, it brings about a disturbance in its general vascular system and produces pathological conditions which are offshoots of its own deficient or disturbed circulation. They are denominated as MalaS, \ when observed still in grosser or superficial principles of the organism producing those excretions, or organic lesions which appertain to the sphere of morbid Anatomy. Thus we see that the Ayurvedic principles of Vayu, Pittam and Kaphah embrace both the biological and pathologi-
.Sayanas Commentary Rig ^^ 1 A. Chanika.
INTRODUCTION. . Hli
»
cal principles of the organism ;» or in other wOrds, the Ayurvedic physiology elucidates and investigates the causes through which the 'same principles, which sustain life and the organism, are transformed into the dynari\*ics of disease, lastly pointing out the grosser excretory changes and organic lesions in the external or "superficial plane of existence, which form thi subject of morbid anatomy and are sometimes confounded with the disease itself. In the Vayu, Pittam and Kaphah of the Acharyayas we have at once a complete picture of the finer sustentative forces of the human economy as well as their antithesis, the construc- tive as well as the expulsive forces* of the inner man, to- gether with an exhaustive analysis of their grosser products which legitimately fall within the sphere of morbid ana- tomy. A real knowledge of the nature and functions of the Vayu, Pittam and Kaphah may be useful in giving a deeper and clearer insight into the principles of true biology or pathology. It is incorrect to translate Vayu, Pittam and Kaphah as air, bile and phlegm, except under certain cir- cumstances. Viyu, Pittam and Kaphah are air, bile and phlegm only when they are transformed into Malas or grosser organic excretions which are supposed to be so very intimately connected with factors, pathogenetic or pathological, but they are not air, bile and phlegm in those planes of their functions which determine the genesis, growth and continuance of the organism, as w-ell as its death, decay and disinteg ation. -The knowledge of a region without that of its antipodes is but a half knowledge, and the principle of Vayu, Pittam and Kaphah is the only one of its kind that tries to embrace the whole sphere of organic existence.
Ojah-Dh^tU : — From what has been stated before it will appear that during the process of tissu'e-formation, the Ivmph or chyle, under the influence of Pittam, or metabolic heat, is transformed in^o the same, the refuse or un-utilisable portion of it being passed off through the
liv . IN*rRODUCTION.
f
apertures of ihe body, is excretions. The Ojah-Dhatu is present in the reproductive energy that lies latent in every organic principle, viz. lymph, blood, muscles, bone (synovia), ma"Vro\v, and in the *male & female reproductive elements. Hence it is not a matter of si.irprise when we find in Ayur- vedic works this Sbma, or Ojah-Dhatu mentioned as lying diffused in the human organism aiVd described as the essence of the lymph chyle, blood, &c. (i). The terms Rasagata Ojah, Raktagata Ojah are therefore used perhaps in the sense of modern serum-albumen, blood-albumen, &c. The male & female reproductive elements, according to this view, form the essence of 'the body as a whole, and the Ojah, which is abundantly found in these protoplasmic cells, is the quintessence of a quintessence. The muscle of the heart alone, according to Charaka, is chiefly associated with this energetic substance, which is of a bloody yellowish colour &. possesses both cooling & heat-making virtues. (2)
In diseases caused by defective assimilation it is said to be ejected through the kidne\'s and to pass off with the urine (as in certain types of Prameha) (3), whereby the patient gradually loses strength, flesh, and healthy glow of complex- ion inasmuch as these are but the accompaniments of its
(l) ^T\^ ^Wt^Tfprt ^^JflTlt RT'^^fW I
Vagbhal .
=^3f: aift? ^wm' tT^mrar ftfjpfw n
Charaka (Sutra StMnam) Ch. XVII. (3) A. ^?:mfJ?ll7T^ft^ ^I^T?I JI^ff?f I
^] -^fm' tT^ §f^ ^^^%: ffWn II •^ Charaka (Sutra Sthinam) Ch, XVII.
Charaka (ShSrira SthSnam) Ch. IV.
INTRODUCTieN. , Iv
healthy continuance in the humi^n organism. "Health and strength," observes our Rishi," reside latent in the Ojah- dhatu, as butter (Ghritam)4ies latent in milk, (i)
Dallana Mishra, the celebrated commentator of the Sushruta Samhita, has defined Ojah as a fatty su6stance completely combustible in its character. Thus in the course of tissue combustion its excess quantity is deposited especially in the female body as f.it which produces that peculiar softness and elegance. (2) The presence of Ojah in urine is said to induce Madhumeha (3). Taking this fact alone into consideration one is inclined to the belief that Ojah must be something "of the nature of sugar. As a consequence of these diflFerent interpretations of Ojah the question arises whether there is present in the human organism any such common element that produces either of these two important oxidising materials, viz. fat and sugar.
It is a demonstrated fact in modern Physiology that glycogen is found in other tissues and organs besides in the liver. Tissues of embryos and of young animals as well as newly formed pathological growths may be said to contain glycogen. The activity of the heart, as well as the development of the fetal body (4) is largely dependent
(i) A. '^]w. 'FT^at^T'??' %^ aftct* f^T f^ciH I
Bh^VaprakSsha. Part I. BhSvaprakSsha.
Dallana Mishra. (3) See Note 3 (B) Page iiv. »
(4) ^r\ ^TTmfl "wsf ^Tr^'Tff^m?^: 1
^TFr^TT-ffT'T' ^?^' ?1HlTr^^rrf m ^X\ II
Charaka SutrasthSnam, Chap. XXX.
Ivi , IN-TRODUCTION.
upon this Ojah-dhatu which may be best translated as glycogen in- the parlance of Western physiology. In fact, our Acharyayas have used tke term ''ojah" to denote that xitzl principle in the organism which is essential to the maintenance of a healthy combustion in its tissues and to the due performance of their normal functions and activities, no matter whether that principle is patent in the form of proto- plasm, protoplasmic albumen, glycogen or mucosin (Prakrita shleshma)* in accordance with the difference of their func- tions, geneses, and conditions of protoplasmic metabolism. In short, the}- were cognisant of the fact that fat and sugar are evolved out of a common basic principle in the organism as has been very eruditely demonstrated by Dr. S. N. Goswami, B. A., L. M. S. in his treatise on Pumsavanam t It is far from our intention to thrust this opinion on an^' one ; we have simply stated our conclusion in the matter and will welcome the result of fresh enquiries on this subject.
Charaka SamhitS Sutrasth^nain, Chap. XVII.
Chakiadattas Commentary S. Samhit^, Sutrasthanam Chap. XV.
1^ "From these extracts ii appears to us still more vividly that our countrymen did also discover, like Dr. Pavy, the importance of fat and sugar in the animal economy, as well as the mode in which they can be elaborated from one common principle. (76-78). A comparative study of the two systems of medical science, Indian and European, has led us to arrive at this conclusion ; if we, therefore are not inclined to identify Ojah with albumen, as it has been done by some modern Indian commentators, we have reasons to believe that the aforesaid extracts have not as yet received sufficient consideration from them, as forming the nutri'ive basis of the procreative elements ; in short the subject has hitherto been neglected or, at least, been placed in the back-ground, rom want of attention on the part of those whose business it was to investi- gate into the truths of Science. To hold that Ojah is kept in deposit in the heart, as a reserved food material, for the maintenance of its own work
INTRODUCTld^'. » Ivii
Space does not permit us to giVe here even something like a satisfactory synopsis of the physiology of Sushruta. It is enough for our purpose if we can create for our readers an interest in the various physiological problems discuss'ed by our author in this part of his work, or in his description of the various physiological processes, which are essential to the healthy continuance of human economy. But if Hindu physiology is startling in its demonstration of the
as well as for the production of germinal seed, is to admit that efficiency of reproduction depends entirely upon the efficiency of this important sub- stantt in the body."J
(76) ^?5%7>JT^SigTUT'?rf?T*TT^' Tfl^tTmj
(77) ?fT' 21^ fifW€tT#^:
(78) ^??tSt2IT^?l' '^^W. q^TRTTRTW
—Ibid.
76. Those who partake of heavy and cooling food abounding in acids and salts, of new rice, and beverages, or constantly enjoy sleep and luxuries, or neglect the exercise of body and mind, or who hal)itually abstain from the use of corrective medicines, help to accumulate in their bodiej phlegm, bile, fat and flesh ; and these interfere with the functions of the \'Ay\i, which causes the Ojah to be displaced from its proper place down in the bladder and produces glycosuria,
77. As Ghee pervades the whole of milk, so Teja (f^yah) permeates all the tissues of the body.
78. Teja (Ojah) too is combustible : in course of tissue-combustion, the excess quantity of it gets deposited especially in the female body as fat which produces softness and elegance.
Iviii ifiTRonucTioN.
c
fact tha'L growth is not the only condition of Ufe, that vitali- ty is somewhat independent of the physiological processes, that the inner man, with the he4p of Yoga, can long survive even without food and respiration,* and that death and decay" may be arrested to a considerable degree by com- pletely stopping nfany of those physiological processes in the body,t which are considered ^j very essential to living by the savants of the West, then Hindu pathology is unique in its conception of the nature of disease.
Sushruta's Pathology : — What is it in a man, asks Sush- ruta, that falls sick ? What is that that we treat medicinally ? The body or the mind ? 'Sushruta says that, "anything that afflicts the nmer man (self or Purusha) is disease! and that disease has its primary seat in the inner spring of vitality from which it flows out to the surface, the external body". In man, as in everything else in the universe, the direction of the inherent force is from the centre to the circumference. The shock is felt first at the centre of vitality, whence it is transmitted outwards and thus affects the energy which holds the molecules together, Dvyanuks and Tryanuks (Binary and teriiary atoms) of which the gross body is composed, and further opposes the dissolution of those molecules into their elemental constituents in the living organism. Even in cases of external injuries such as snake- bite, etc. the potency of the virus is carried at once to that centre from whence it is almost instantaneously transmitted through the external channels of the body to its surface,
ff^TTUr *^^« 1
Palanjala Uarshanani X^ibhudpAda 29 — 30 A.
Pcitanjala Daishanam. Vibhutipada. 21. A.
Sushruta samhitA. Sulra. Chap. 1.
INTRODUCTION. , lix'
>
Otherwise what purpose does the \iyu (nerve force),5erve in the human economy ? What do those myriads of Chaitanya- vahini Nadis (sensory ne,ivt^s) exist for in the human system ? In all diseases the subjective sensations are I'he first to be experienced. "I am ill," "I feel hot," etc. are the voices of sensations, which form the "esse" of the disease. Disease then is a force ar^d not matter.*
Pathology of Tridosha :— Sushmta, though adopting the Vedic pathological dictum of Tridhatu, has expressed a very clear opinion on the subject. He observes that the relation between a disease and the deranged Vayu (nerve force), Pittam (metabolism) and Kapham (unutilised product of the system), and the pathogenic factors which lie at the root of that disease, is not real but contingent. These morbific principles may permeate the whole organism without creating any discomfort, and it is only when they find a distinct lodgment, and are centred in some distinct part or tissue of the body, that they become the exciting factors of disease.
Drug Potency :— The next question which naturally arises in connection with such a theory of pathogeny, is what is medicine, or in other words, what is it in the drug that cures ! Sushruta, after closely investigating all the theories on the subject, inclines towards the opinion that it is the potency of the drug that is curative, though he observes that inasmuch as potency cannot exist independently of a drug, a drug is of primary interest for p11 practical purposes in therapy.
Drug-Dynamisation :-"It is the potency of a drug that cures a disease". The potency is administered best
* That Hahnemann's theory of disea.se was long before fore- .shadowed by Sushruta, will appear from the above extracts from his works. Hahnemann observes that, when a person falls ill, it is only this spiritual self-acting vital force, everywhere present in the organism, that is primarily deranged by the dynamic influence of a morbific agent inimical to life — Orgenon.
Ix INiTRODUCTIOK.
c
when the physical or chqjmical properties of a drug are annihilated. This "is best performed by subjecting it to heat or pressure. In the n^edicated Ghritas or oils of ouv.pharmacopoea, which are prepared by successively boiling or cocking them with drug-decoctions, we cannot even detect the trace of /Miy of its component drugs, but still we know how potent and efficacious they prove in the hands of our Vaidyas. When Sushruta formulated the process of preparing mediciual oils and Ghritas, and laid down the use of Shatadhautam Ghritam (clarified butter, a hundred times washed with water in succession), Sahasrapak Tailam (medicinal oil, successively codked a thousand times), or Kumbha-Ghritam (clarified butter, a hundred years old) it may be fairly said that he was in sight of the principle of drug-dynamisation.
Principles of A yurvedic Treatment:— Ayurvedic phy- sicians piacticallv recognise two dififerent sets of principles in the domain of practical therapeutics, which may be stated in the terms of ::heir western colleagues as Laws of Similars and Contraries.* This apparent contradiction has been fully accounted for and explained in the writings of the latter day commentators, but it does not fall within our province to enter into these disquisitions. In addition to those, Sushruta, in common with the Acharyayas of his time, never fails to emphasise the value of psycopathy in
* Similar in ch.iracter to the exciting factors of a disease — Similar in character to the £sse of a disease — Similar in character both to the exciting actors and £i>\se of a disease.
Contrary in character to the exciting factors of a disease.
Contrary in character to the £sse of a disease.
Contrary in character both to the exciting factors and Esse of a disease.
M^dhava NidSnam Ch I. V, 8.
INTRODUCTION. ^ 1X1
those forms of mental or nerv;ous distempers fgr which Mesmer rightly now receives so n\uch honor. Since the creation of man, the tput'h of the "Saintly" has been credited with the virtue of curing the sick ; and Av^feha (auto-hypnotism) and Samadhi (higher phases of ciairvoy- ance) have achieved many miracles in . the art of healing in India, which was the, first country where it was first successfully practised for the welfare of man.
Samshodhanam and Samshamanam :— All kinds of treatment may be grouped under two heads such as Sam- shodhanam and Samshamanam, i.e. either the body should be cleansed (Samshodhitam) of the morbific diathesis with the help of emetics or purgatives, or steps should be taken to restore the deranged Vayu, Pittam and Kapham to their normal condition with the help of proper medicinal drugs without resorting to any eliminating process. But in cases of inflammation, Sushruta enjoins that, instead of any Sam- shamanam remedies, diaphoresis should be first resorted to. In cases where counter-irritants are indicated and in parts which are directly accessible, leeching and cauterisation should be practised with a due regard to the season of the year and the requirements of the case. We find in his Samhita a detailed account of the several species of leeches with their habits and habitats.
Forms of medicine: — Powders, lambatives, decoctions as well as medicated oils, Ghritas, confection and wines are the forms in "-hich, according to Sushruta, medicines should be given. The different di ugs such as roots, leaves, etc. should be culled in the seasons proper to each. Reclassified the soil into five different kinds for the purpose of growing drugs of different therapeutic properties. Even the virtues of different flavours and colours were ascertained with regard to their respective actions on the deranged morbific principles of the body.
Rasayanam : — The Ayurveda being the science of life and health, the holy Agnivesha, at the very commencement
Ixii , INTRODUCTION.
ot the th-erapeutical porticMi of his work, * has described several medicinal compounds, which improve general health and arrest the ravages of time. ' Theoretically speaking the sciehrce of the A3'urveda recognises no preordained limit to human fexistence. Life can be prolonged with the help of suitable medicines. By dint of observation and patient researches our Rishis devised maay such adjuncts which can rejuvenate an old man, and supply those vital elements to an old and exhausted human body, which ebb away with the progress of years. Hence, we find many rejuvenating medicines to have been prescribed for men in health which would arrest decay and guard against the approach of senility b}' increasing the fundamental vital principles of the body and preventing Vayu, Pittam and Kapham from being transformed into morbific diatheses.
Diet — "A good and proper diet in disease is worth a hundred medicines and no amount of medication can do good to a patient who does not observe a strict regimen of diet.'' Our A'jairveda, instead of being content with specify- ing the nature of diet in diseases in general, mentions the names of articles, which should, or should not be taken in ■^J any specific malady, judged by the light of their properties of aggravating Vayu, Pittam or Kapham. The dietic or therapeutic properties of a large number of articles of human consumption, as well as the chemical changes they undergo in the digestive apparatus of diflferent mammals, have been studied and analysed, and so we find in our physique, medical Samhitas, such injunctions that barley- corns passed undigested with _ the fceces of a cow or
flwi^ii' J?^t[z^^^' ^^^n ^^' ^x w
Chaiaka Sanihit^t Chikitsrt Slli4nam Ch I,
)NTKuDUC'?ioN. > Ixiii
>
horse, should foiiu the diet of 'a Prameha patielit * that the milk of a she-camel should be given to a patient suffering from a cutaneous aflFection, and that the flesh of any carnivorous beast or bird should be given to 'one suffering from pulmonary consumption and so ' on. It was a cardinal doctrine with Ayurvedic dietisls that the longing of a patieni for any particular kind of food in a certain disease, emphatically shows that his organism is in want of those elements which enter into the composition of the article offered. Hence elaborate dietetics were formulated, which cannot but be acceptable to the most fastidious patient. '
Therapeutics:— The exclusiont of salt and water from the food of an ascites or anasarca patient as laid down in our Samhitas shows that our Rishi possessed a higher chemical knowledge regarding the effects of organic matter on the human system than many of us are ready to accord to these pioneers in medical science.
Medical Botany;— After therapeutics comes the subject of Medical Botany. Sushruta divides the whole vegetable
Charaka Samhiti, Chikiisa Sthanam, Ch. \'I. 23. t The efficacy of such exclusion has been lately demonsU-ated by the researches of Dr. Benjamin Horniman (Lectures, Sanitarium, Park si. London.)
Charaka Chikitsha Sthanam Ch, XIIL ^bid Chap. 13.
Charaka Chikitsha Sthanam Chap, 1 2.
Ixiv ■ f INTRODUCTION.
kingdom into Vriksha, Gultlia, Vanaspati and Virudha. This classification has been minutely worked out in works on Hindu Botany where we find si!ich nice subdivisions as r Agravija (whose toplings are only planted), Mulaja (whose roots only are planted), Parnayoni, Skandaja, Vijaruha (ger- minated from seeds) ^nd Sannurudhaja. But the botany of / Sushrnta is more of the nature of a" Materia Medica than
/ a work on Botany proper, though sometimes he mentions the habitat and describes the foliage of certain plants so that they may be distinguished from others of a cognate species. , ^ The uses of metals and 'minerals for therapeutical pur- poses in India are as old as the Rigveda * itself. Sush- ruta describes the methods of preparing oxides, sulphates or chlorides of the six metals as the case may be. Mercury has been only once mentioned in the Samhita and then very vaguely too. Processes for the preparation of alkalis and the lixiviation of ashes are very elaborately described. Beyond these the chemical knowledge of Sushruta scarcely extends.
Hygiene and Public Health:— A? a writer of Hygiene and public health, Sushruta emphasises the importance of cleanliness of both sririt and body. Water whose disinfecting virtues have so often been hymnised in the Vedas t forms the subject of discussion of an entire chapter of the Samhita. Outbreaks of epidemic have been attributed to contrary seasons, to the floating of minute
^/\ particles of poisonous flower pollen in the air, and to the sin or unrighteous conduct of the community. Earthquakes, famines, and physical phenomena, which are at present attri- buted to magnetic disturbances of the earth, have been
* Lead crystal (including diamond) gold and mineral poisons arc men- tioned in the I. i6. I. 29. I 55. and IV 10. of the Atharva SamhitA.
Rik Samhiti I. 23 s. 19,
INTRODUCTION. ' IxV
described by Sushi ut a as the usual precursors of devastating epidemics sucli as jilague etc. Mortality among birds and an unusual death among rats and other burrowing rodents hav^ been iricluded aiuo.ig other presaging indications of a visi- tation by Providence. Interrogated as to the cause of such outbreaks, Dhanvautari observes that, the Viyu (molecular energy) of the soi' is disturoed or affected by earthquakes, and seasons of unnatural drought or deluge, deranging their Pittam (kinetic energy) and Shleshma (humidity) which produce morbific factors that affect a whole community. Sushyuta, as a true physician, has elaborately dealt with the regimen of diet and conduct during the different seasons of the year (Ch. 24 -U. T. 64) which, strictly followed, should act as a good prophylaxis against attacks of many epidemic diseases, being framed with a most careful regard to the conditions of life which obtain in it, and ward off those sad breakdowns in health, which are, in many instances, the result of an unsuitable mode of living in this country.
Twofold division of Time &C :— It is a fundamental dictum of Sushruta that in a case of medical treatment the then prevailing season of the year should be taken into account. In his Samhita we find two distinct classifications of seasons, one based on the peculiar physical pheno- mena which distinguish the different seasons of the year, a fact which emphaticall}' proves that Sushruta was an inhabitant of the sub-Himalayan Gangetic Doab, the other is for the purpose of showing the respective accumulation, aggrava- tion and subsidence of morbific diatheses (Doshas). In the same manner the different quarters of the day and night have been minutely charted or set down to show the spontaneous aggravation and subsidence of the deranged Vayu, Pittam and Kaphah during the 24 l^ours. The! , influence of planets as to the production of certain diseases such as small-pox, measles, scarlet fever, &c. is almost a proved fact. As it governs the' prevalence and non- prevalence of certain maladies, the aggravation and
9
Ixvi INTRODUCTION.
non-aggravation of certain existing disorders as well owe much of tb.eir origin to this potent factor. The vegetable kingdom from which we glean our daily food is also subject to thi? influence, and hence the discrimination we exercise in selecting our food on certain davs of the lunar month.
Countries have been divided into Jangala or A'nr.pa ac- cording as their physical features partake of the character of a dry plateau or of a swamp or marsh, a Sadharana one possessing features, which are common to both. Diseases, which are natural or are spontaneously relieved in each of these kinds of countr}- have been treated with that scienti- fic insight which marks modern medical works on sea-side or spring sanitariums. The virtues of the waters of different rivers of India were ascertained for the purposes of practical therapeutics. The therapeutic properties of the milk of a she-goat, she-buflFalo, mare, cow-elephant, or woman, as well as of any of their modifications such as curd, whey &c. together with the properties of the flesh and urine of the several groups of she-animals, which are indigenous to the land, were studied and analysed, thus placing at the disposal of a practical physician a list of dietarv in different diseases to soothe the taste of the most fastidious patient, and which is at the same time potent enough to cure the distemper he is suffering from without the help of anj?^ special medicine. Thus it is that we find our Vaid\'as prescribing" the flesh of many carnivorous animals as a diet in consumption, goat's meat in phthisis, goat's milk in colitis and Tittira's flesh in fever &c.
Diseases of the Kidneys and Bladder: — In treating of the diseases of the kidneys, blatlder and the urethra, Sushruta has described the symptoms and the colour of the urine irii each specific variety without laying down any mode of testing the urine. But we know that Sn^hruta has enjoined his readers at the ver}- outset of his work to refer to other allied branches of the science for information which is not contained in his book. In the same manrier
INTRODUCTION'. Ixvii
we can account for the absence of.^ any instiuctions as regards the feeling of the p'j'>se as an important auxiliary in making a correct diagnosis. We need but repeat -.the statement that the readers of this Samhita must look for this information in the Kanada's Nadi Vijnanam, which has made our Vaidyas such expert sphygmologists.
Kalpa: — In the Kalpasth:inam of his Samhita, Sushruta has described the symptoms of hydrophobia and snake bites, etc as well as those developed in cases of vegetable poisoning, together with their therapeutical treatment and remedies, wkich, if rightly studied and investigated, may yet throw a new liglit upon the subject.
Sushruta as an Observer :— It has been lately dis- covered by a German physiologist that tubercular bacilli do not thrive in goat's blood. The importance of goat's milk in colitis as an efficient agent in checking ferment in the intestines, or of the close contact of a goat as a powerful auxiliary in curing tuberculous phthisis was first demonstrated by Sushruta. Not onl}' this — but the inhalation of the air of a cattle-shed and especially the fact that exhalations of goats, bodies tend to destroy the phthisis germs did not fail to attract the attention of the Indian Rishis ; the fumigation of tlie sick-room with antiseptic preparations such as isT^T^wq (Asthanga dhupas) is purely Indian in its origin and in no way inferior to the modern introduction of Cogghill's respirators. The microscopic germs that are said to propagate septic fever otherwise called ^^^crrfvf q^'lsj f^^^j^ are found very often to disappear under this Indian device where no medicines produce any impression. Thus many a wonderful discovery like the above hails from the dimness of a bygone age. Manj' truths lie embedded in the vast medical literature of the Brajimanas which claimed close attention and devout study, even by the western savants. We have not laboured in vain if these pages can help a little to reviVe the old genius of the Ayurveda, or help the progress of human Science one step onward towards the attainment of its goal.
PLATE No. I,
1. An^uli yantra.
i '^ 3 . Ashmaryaharna yantra
S-Bhrin^amuklia yantra.
Z.Arsho yantra.
M^HP^^PKf^^P^^H^
4. Basti yantra.
6 . Darvyakritislialaka.
7. Garbhashanlcu yantra.
8. Jalodar yantra.
9 . Kakamuklia yantra.
10 . Kankamukha yantra.
ILMuclititi yantra.
^
12. Nadi yantra.
13 . Riksliaraukha- yantra.
14-. Sadansha yantra.
SEE CHAPTER VII.
PLATE No. II.
15 . Shamipatra yautra.
16. Shalaka vanira.
17. Sliarapunka ixmkha.
19. Shvanaraukha y antra.
18. Sinliainiiklia yantra.
20. Shanku yantra.
21. Snuhi yantra.
22. Tila yantra.
23 .Tarakshumukha.
24.Vrikaiimkha yantra.
25 . Vrinapraksii.alana yantra, 26 . Yya^hramukha yantra
27. Yugmaslianku yantra. - %k ,,^M Yofljaveksliana yantra.
SEE CHAPTER VII.
PLATE No. III.
l.Ardhadhara shastra.
S.Ara sliastra.
Z.Atimukha shastra. 4. Badisha. shastra.
^
S.Dantaslianku shastra.
7. Karapatra shastra.
^ '
<!>-
6. Eshani shastra.
8. Antarmukha kartarika.
J^aSKrJsniKU
SEE CHAPTER VIII.
I
PLATE No. IV.
9.Kritharika sTiastra.
1E^&£
lO.Kushapatra shastra.
ll.Manda.la^ra shastra. ♦
12.Mudrika shastra.
13.Na.kiia shastra.
. <5' -^
14. Sliaianmuklia shastra.
15. Suchi shastra.
'^— J=
iS.Trikurchaka shastra.
17. Utpalapatra shastra. J'j|
18. Vetaspatra shastra.
19 . Yrihimukha shastra.
ZO.Vndhipatra shaslra.
SEE CHAPTER VIII.
CONTENTS.
CHAPTER I.
Origin of the Ayurveda : — The eight divisions of the Ayurveda and the characteristic features of each of them — History of Surgery and its primary importance — Gradual exteiisi(jn of the Ayurveda — Definition of Purusha — Classification of the mobile and the im- mobile— Definition and classification of disease — Classification of Oshadhis — ^The four factors to be employed in successfully coping with 'a disease — The four stages of a disease ... ... 1 — 15
CHAPTER n.
Initiation of a student of the Ayurveda :— Qualifications of a student of medicine — ]\Iode of Initiation — Compact between the preceptor and his disciple — Proliibited periods of the study of the Ayurveda ... ... ... ... ... 16 — 20
CHAPTER III.
Classification of the Ayurveda &c. :— The distribution of its hundred and twenty chapters among the five subdivisions of .this Samhita — A synopsis of the contents of the cliapters allotted to each of its subdivisions — Skilful and unskilful phj^sicians — The mode of studying the Ayurveda — Duties of a pupil after having finished the study of the Ayurveda ... ... 21 — .^2
CHAPTER. IV.
General explanations : — Necessity of a clear exposition of tlie Ayurveda — Defects which flow from nonexposition of the same — Duties of a student of the Ayurveda ... ... 33 — 35
ii ' ( ONTRNTS.
CHAPTER V.
Preliminary surgical measures : — Classification of surgical ope^-ations — Accessories which are to be collected at the outset — Qualifications of a surgeon — Modes of incision, etc. at the different parts of the body — Measures to be adopted after surgical operations — The prophylactic Mantra — Directions for dressing wounds and removing bandages according to tlie nature of the prevailing season of the year — Acts and articles proliibited to a patient with a granuliiting wound — Measures for removing the pain in a surgical wound ... ... ... ... ... 30 — 44
CHAPTER VI.
Characteristic features of the different seasons of the year and their influence on health and drugs : — Time and its traits- Etymology of the term Kala (time) — Divisions of time and classifica- tion of the seasons of the year, witli Iheir respective features. Classification of the seasons of the year for the purposes of the Ayurveda — Inception, aggravation or subsidence of the deranged Vayu, Pittam and Kapham according to the nature of the prevailing season of the year — Aggravation or subsidence of the same in the dilferent qiuirters of the day and night — Causes of epidemics — Pro- phylactic measures — Features of natural or unnatural seasons 45 — 55
CHAPTER YII.
Surgical appliances, their use and construction : — Number of surgical instruments — Names, dimensions^ use and functions of surgical appliances with points of their respective excellence or defect — Minor siu'S'ical accessories — Excellence of Kankaraukha ... 56 — 03
CHAPTER VIII.
Surgical instruments, and their names, use and construc- tion : — Mode of handling th^ different surgical instruments. — Their commendable features — Sharpening, edging and tempering, etc.. of
CONTENTS. ' 111
surgical instruments and enumeration of cases where they »should be employed ... ... ... ... ... 64 — 70
CHAPTER IX.
Practice of surgery : — Ti'iichiiig oi' siir^^ery on (iiiiniiiies ami suitable fruits, etc. ... , ... ... ... 71—73
CHAPTER X.
Essential qualifications of a physician before he formally cntirs his profession: — Means of diagnosis — Things to be observed in making a diagnosis — Cure, palliation and incurability of diseases — Prohibited conduct of a physician ... ... 74 — 77
CHAPTER XI.
Mode of preparing alkalis, and their comparative excellence as incising, excising or scraping agents :— Alkalis for external application or internal use — Cases where alkalis prove injurious — The three potencies of alkalis for external application — Commendable or defective features in an alkali — IMode of its application, and after- measures— Symptoms of satisfactory cauterisation— Persons who should not be treated with alkalis — Dangers which attend its abuse ... ... ... ... ■•• 78—87
CHAPTER XII.
Actual cauteries : — Accessories to an act of cauterisation — Pre- liminary measures— Symptoms which manifest themselves as the skin, or flesh, or a vein, or joint is cauterised — Seats of caifterisation in different diseases— Different modes of cauterisation— Characteristic symptoms of burns and scalds, etc.— Rationale of treating a burn or a scald with heat— Medical treatment of burns and scalds, etc.— Symptoms which appear when the nostrils, etc. of a person is choked with smoke— Its treatment— Medical treatment of sun strikes, and scorchings by hot Avind, etc. ... ... 88 — 97
IV , UONTENTS.
CHAPTER XIII.
Leeches and their use : — Persons who may be leeched — Mode of extracting the vitiated blood in' such cases — Mode of apply- ing the leeches — Classification, and mode of collecting and keep- ing the leeches — Bad leeches and their characteristics — After- measures ... ,,.. ... ... ... 98 — 105
CHAPTER XIV.
Origin and characteristic features of lymph chyle .-—Its location, course and metamorphosis into blood — Menstrual blood and its nature — Successive .metamorphosis of the fundamental principles of the body — Etymology of the terra Dhatu — Blood — Swellings which should not be bled — Two kinds of blood letting— \'enesectioii, its mode and different aspects — ]\Iischief created by the vitiated blood not extracted from the system — Causes of excessive bleeding and its effect upon the system — Symptoms of satisfactory l)leeding and its benertcial results — Measures to be adopted in cases of excessive or scanty bleeding — Medical treatment of excessive bleeding — Various instructions ... ... ... 106 — 110
CHAPTER XV.
Development or non-development of the excrements and constituent principles of thebody:— Nature, locations and functions of the Normal Vayu, Pittam and Kapham, as well as of the lymph chyle, blood, fat, marrow, semen, and ojah (albumen), and the symp- toms which mark their increase, decrease, or disiodgment in the human system — Etiologies of obesity and thinness ... 120 — 140
CHAPTER XVI.
Piercing and bandaging of the lobules of ears t — Evils wliich attend the acc\dental hurting of a local vein — Medical unguents and lints — Different processes of bringing about the adhesion of a bifurcated ear-lobe — plastic and rhinuplastic operations ... 141 — 154
CONTENTS.' « V
CHAPTER XVII.
Distinction between suppurat\ng and non-suppurating swell- ings : — Different types of intiammatory swellings produced by the deranged Vayu, Pittani, etc , and the symptoms which mark their respective actions in each type — Characteristic symptoms of a suppurating, suppurated, or non-suppurated !5welling — Hints on in cising suppurated swellings-r-Evils of opening an abscess at its inflammatory stage — Feeding and anftsthetising of a patient before lancing otf an abscess — Classification of surgical operations in connection with an abscess ... ... ... 155 — 161
CHAPTER XVIII.
Dressings and bandages of ulcers : — Classification of medicinal plasters according to their thickness, application and function — Use of the different types of plasters — Articles of bandaging — Bandages and their names and applications — Tow — Mode of introducing a lint — Renewals of bandages according to the nature of the ulcer and the prevailing season of the year — Evils of non-bandaging — Benefits of bandaging — Cases where bandaging is prohibited — Hints on the proper lubrication of the lint — Incidental remarks on the bandaging of fractured or dislocated bones ... ... 162 — 175
CHAPTER XIX.
Nursing and management of an Ulcer-patient : — Nature ot his bed and chamber— Articles prohibited to an ulcer patient — Prophylaxis against monsters and demons — Diet and conduct of an ulcer- patient ... ... ... ... ... 176—182
CHAPTER XX.
Salutary and Non-salutary effects of regimen, etc. : — Classi- fication (if all articles of fare according as they are wholesome or unwholeseme to the human system, or are relatively wholesome or otherwise — Foodstuff' — Incompatibility through combination — Injuriousness through combination- Incompatibility through pre-
VI . "CONTENTS.
paration,' quantity or Havour-rEffect of winds on the human system as they blow from the'ditierent quarters of the heaven ... 183—193
CHAPTER XXI.
The deranged Vaf/u, Pittam, etc., as the exciting causes of ulcers : — Seats of Vayu, Pittam, etc. in, the human body, and their functions— Different kinds of Vayii, Pittam and Shleshma, and their functions and locations in the economy of nature — Factors which aggravate the deranged Vayu, Pittam and Kapham, and their periodicity — Symptoms of the deranged Pittam, Kapham and blood — Expansion of the deranged Vayu, Pittam, etc.. and diseases dye to their incarceration in the difterent parts of the body — Disease — its development and occasions which necessitate the calling in of medical aid — The nature of medical treatment in the case where two or all of the Vayu, Pittam and Kapham are involved ... ... 194 — 211
CHAPTER XXII.
Secretions from boils and ulcers : — Shapes and seats of boils etc. — Symptoms of bad ulcers — Secretions from ulcers — Presumption as to the derangement of Vayu, etc. from the nature of the secretion — Different kinds of pain wliich mark the different types of ulcers — Colours of Ulcers ... ... ... ... 212—219
CHAPTER XXIII.
Prognosis in ulcer cases -.—Easy curability of an ulcer— Symp- toms of an ulcer which readily granulates— Symptoms of difficult or incurable types, as well as of those which admit only of palliation — Symptoms of a purified, granulating or healed ulcer — Factors which lead to the reopening of a healed ulcer ... 220—227
CHAPTER XXIV.
Classification of diseases according as they are medical or surgical :— Further classitica'tioii uf diseases according as they arc congenital, etc.— Diseases due to mental, physical or providential
CONTENTS. »
causes — Diseases due to the derangeinent of lymph chj-'je, etc. — Relation between fever and the deranged ' Vaj'u, Pittam and Kapham ... ... ..., ... ... 228—237
CHAPTER XXV.
Eight different forms of surgical operation : — Cases where incision, excision, scarification, aspiration, extraction, etc., should be respectively resorted to — Mode and conditions of suturing — Defec- tive surgical operations — Symptoms wliich mark tiie injudicious hurting of a vein, artery, lig.'iment, joint or lione, as well as those which are manifested when any of tlie other Alarmas is accidentally hurt ' ... ... ... ... ... 238—246
CHAPTER XXVI.
Exploration of splinters, deep-seated in the organism : — Defi- nition of a Shalyam — Clpssification of the shafts of arrows — Flights of arrows — Characteristic symptoms of arrow-wounds— Localisation of a shaft of arrow lying imbedded in the body — Symptoms which show that the shaft or the splinter does not lie imbedded in the wound — Evils cf not extracting the shaft of an arrow from such a wound ... ... ... ... ... 247— 2.o5
CHAPTER XXVII.
Extraction of splinters : — Fifteen different processes of extrac- '1— Two recognised modes of extracting splinters from all types of mds— Measures to be adopted after the extraction — Mode of acting splinters from veins, etc.— Dangers of not extracting 'inter from a wound ... ... ... 2^6 — 265
CHAPTER XXVIII.
vourable or unfavourable prognosis of an julcer: — Fatal avourable symptoms — Advisability of abandoning ihe patient hese unfavouraole symptoms appear ... ... 266 — 269
VIU , •"CONTENTS.
CHAPTER XXIX.
Favourable or unfavourable prognosis in diseases as known from messengers, omens, birds of happy or evil augury : — The same predicted from dreams, etc. — Remedies for inauspicious dreams under the circumstance— Description of auspicious dreams 270 — 283
CHAPTER XXX.
Prognosis that can be obtained from the perverted functions of the five sense organs : — Arislitas or unfavourable mental symp- toms— Unfavourable symptoms in connection with the faculties of hearing, touch, taste, smell or. sight ... ... 284—287
CHAPTER XXXI.
Prognosis to be gathered from the altered condition of features : — Other Aristha symptoms in connection with Asthma, Cough, and (Edema. &c. ... ... ... 288—292
CHAPTER XXXII.
Prognosis based on the perversion of the external appearances of the body and other Arishta symptoms ... ... 293 — 297
CHAPTER XXXIIf.
Incurable diseases, and Incurable symptoms developed in con- nection with diseases of the nervous systems, morbid urethral discharges, Leprosy, Haamorrhoids : — Fistula in ano — Urinarj' concretions, DitKcult labour, Ascites, Fever, Dysentery, Phthisis, abdominal glands, Abscess, Chlorosis, Ha?moptysis, Insanity and Epilepsy ... ... ... ... ... 298—302
CHAPTER XXXIV.
Mode of preserving the Ii<e of a king whose soldiers are on
the march : — The four factors of medical treatment — Good which
CONTENTb.
lebiiUs from a butitifuolory coiiibinaliun oi all tlieso lour facloib — Commendable features in a physician, yatient, medicine and nurse ... ... ... ... ... 303 — 307
CHAPTER XXXV.
Clinical Observations : — Cliracteristic features of a long lived or short lived man, or of one with an average duration of life — Physical temperaments and dimensions of the limbs and members of the body — Curable, incurable or suppressible diseases — Sym- pathetic and Primary diseases — Different kinds of digestive capacity — Three stages of man — Relative preponderance of Vayu, Pittam and Kapham during different stages of life — Classification of countries according to their physical features ... 308 — 328
CHAPTER XXXVI.
Miscellaneous remedies for swellings : — Piasters for establish- ing suppuration in swellings — Plasters for bursting, pressing out the pus from, or asepsising swellings — Aseptic pastes — Fumigating com- pounds—Healing pastes — Compounds which favour granulation in, or destroy the supergrowths around an ulcer ... ... 329 — 335
CHAPTER XXXVn.
Destructive traits of the different kinds of soil commended for the growth or culture of medicinal herbs : — Examination of the soil from which medicinal drugs are to be gathered — Examination of drugs — IMode of collecting drugs — Commendable traits in a room to be used as a drug-store ... ... ... 336 — 341
CHAPTER XXXVni.
A General Classification o^rdf^?'^- according to tl^eir therapeu-
umer^^ II ^ yU'irty seven different groups of
"?yametc.-Pix)^"«- - ^^^-f^^
.ption of the Vel'uoi. ^ lesh group
tical properties; — Enumerh^^jl^.^^ rhirty seven different groups of medicinal drugs— Their US' y^jygj. Pro^"'' ••• ••• ^^^ — ^^^
X CONTKNTS.
CHAPTER XXXIX.
Drugs possessed of cathartic or soothing effects : — Emetics- Purgatives — Drugs possessed of lirith emetic and purgutive properties — ^.Errliines — Drugs whicli respectively soothe the der inged Vayu, Pittaiu and Kaphaui — Mode of administering medicines.,. 358 — 363
CHAPTER XL,
Drugs and their flavours, virtues, potencies, and chemical actions : — Disquisitions as regards the primary importance of drugs, or their flavours, potency', or chemical reaction in respect of curing diseases — Causes of different kinds of digestion — Conclusion as regards the primary importance of drugs in curing a disease ... ... ... • ... ... 364 — 374
CHAPTER XLI.
Specific properties of drugs : — Classification of drugs according to the preponderance of the virtues of elemental matter in them — Characteristic features of drugs of dominant earth matter, etc. — Periodicity of drug action — Reasons why purgative drugs move the bowels — Factors which lead to the aggravation or subsidence of the deranged Vayu, Pittam and Kapham— Potency of drugs... 375 — 381
CHAPTER XLII.
Specific properties of flavours :— Reasons for the classification of ff a voms— Relation of the elemental earth matter with the flavours —Reasons for the primary derangement of Vayu, Pittam, etc— Symptoms and aggravating factors of the deranged Vayu, Pittam and Kapham— Virtues of the different kinds of ^iavour, such as sweet, etc.— Enumeration of groups of ~ * drugs, etc.— Sixty-three different combinations of fiavoi^rj? XXXI ••• ••• 3^2 393
Moae >.. , life of a king w.>
the march j — Tnc . ^actors of medical treatuicnt — Good whw
COMLMS. XI
CHAPTER XLIII.
Mode of administering emetics : — Compounds of Madana fruits Gompounds of Jimutaka ••» ... ... 394 — 399
CHAPTER XLIV. > Choice of purgatives : — Most efficient purgatives— Purgative compounds — Purgative soups — Asavas, wines, Sauviras, and Tusho- dakas, etc. — Instructions as to the way of administering purgative compounds of Danti, etc., in the manner of Trivrit compounds — Trivrit Ashtakam — Mode of using purgative fruits and milky exudations of trees— Administration of purgative medicines through the media of wine, etc. ... ... ... 400—417
CHAPTER XLV.
Rules to be observed in respect of liquid substances : — Water group — Modes of purifying different kinds of water and their virtues etc. — Milk group — Virtues of the different kinds of milk — Curd group — Virtues of the different kinds of curd — Takra group — Modes of preparing different kinds of Takra, and their attributes — Properties of butter, Kilat, etc. — Different kinds of Ghritas (clarified butter), and their properties — Oil group and the properties of different kinds of oil— Properties of the fat obtained from aquatic or domestic animals — Honey group — Classification of the different kinds of honey and their properties — Sugar-cane group, and the properties of the different preparations of sugar-cane juice, such as treacle, sugar, etc., — Wine group — Properties of the different kinds of animal urine... 418 — 468
CHAPTER XL VI.
Different kinds of for and drink :— Descripti^^ns of Sliali Dlianyam, Shasht'' "Ah . udhanyam, Vaidal, Mudga, Sesamum, Barley, Wheat, Sp , ' ..nanyametc. — Properties of Dlianyas according to their jnatui'ity — Description of the Vei'udha Dhanyas— Flesh group
Xll ■ CONTENTS.
— Classiticutiou of tlesh— The Vishkira group — General properties of the flesh' of Vishkira, animal^ — Etymology of the term Pratuda — Enumeration of the animals of the Pratuda group— Cave dwelling, and hole dwelling animals— The Prasalia group of animals — Beneficial use of flesh of the Prasaha group in, Phthisis — Detailed classification of animals with the etymology of their generic names, and proper- ties of their flesh — Frvit group, and the properties of different fruits — Group of pot herbs, and their properties — Flower groups — The group o£ edible leaves of plants, and their properties — The group of bulbous plants — The group of salts — General properties of nitrate of potash, etc. — Properties of gold, iron, silver and other metals — Deter- mination of the properties of drugs other than those herein mentioned — Drinks and beverages — Rules of diet — Rules of serving out the meal — General causes of indigestion— Symptoms of the different types of indigestion — Medical treatment of the same — Symptoms which mark acts of over or insufticient eating, or an act of eating a meal before a previous one is digested — Reason of one's feeling hungi'y even when suffering from indigestion ... 469 — 571
^ •
THE SUSHRUTA SAMHUA
SUTRASTHANAM.
CHAP T E R I.
Well, we* shall now describe the origin of the Science of Medicine, as disclosed by the holy Dhanvantari to his
disciple Sushruta. (Vedotpattimadhyaryam).
Once upon a time, when the holy Dhanvantari, the greatest of the mighty celestials, incarnated in the form of Divodasa, the king of Kasi, was blissfulh^ seated, in his hermitage, surrounded bv a concourse of holy Rishis ; Aupadhenava, Vaitarana, Aurabhra, Paush- kalavata, Karavirya, Gopura-rakshita, Sushruta and others addressed him as follows : — "O Sire, it grieves us much to find men, though otherwise well befriended
" The present work which originally formed the subject of a discourse by the holy sage Dhanvantari to his disciple Sushruta, has been compiled in its present form by the venerable Nagarj una, and is accordingly designated as the Sushruta Samhila.
2 THE SUSHRUTA SAMHITA. [ Chap I.
b)' the'ir kin and relations, falling a prey to diseases, mental, physical, traumatic, or natural, and piteously wailing in agony like utterly friendless creatures on earth ; and we supplicate thee, O Lord, to illumine our minds with the truths of the Eternal Ayurveda (Medical Science) so that we may faithfully discharge the duties allotted to us in life, and alleviate the sufferings of humanit)" at large. Bliss in this life and hereafter, is in the gift of this eternal Ayurveda, and for this, O Lord, we have made bold to approach thee as thy humble disciples." To them, thus replied the hoi}' Dhanvantari : — "Welcome to all of you to this blissful hermitage. All of you are worthy of the honour of true pupilship or tutelage."
The A'yui'veda (which forms the subject of our present discourse), originally formed one of the sub- sections of the Athar\'a A'eda ; and even before the creation of mankind, the self-begotten Brahma strung it together into a hundred thousand couplets (Shlokas), divided into a thousand chapters. But then he thought of the small duration of human life on earth, and the failing character of human memory, and found it prudent to divide the whole of the Ayurveda into eight different branches such as, the Salya- Tantram, the Salakya-Tantram, the Kaya-Chikitsa, the Bhuta-Vidy.i, the KauniHr-Bhrityci, the Agada-Tantram, the Rusa\"ana-Tantram and the \'ajeekarana-Tantram.
Chap. I. ] SUTRASTHAN'AM. ^
Xow about the characteristi'c features of each of these branches of the Science of the Ayurveda : —
The Salya-Tantram*— The scope of this branch of Medical Science is to remote from an ulcer) any extraneous substanx:e such as, iTagments of hay, particles of stone, dust, iron or bone ; splinters, nails, hair, clotted blood, or condensed pus (as the case may be , or to draw out of the uterus a dead foetus, or to bring about safe parturitions in cases of false presentation, and to deal with the principle and mode of using and handling surgical instruments in general, and with the application of fire (cautery) and alkaline (caustic) substances, together with the diagno- sis and treatment of ulcers.
The Sha'Ia'kya-Tantramt— embraces as its
object the treatment of those diseases which are restricted to the upward (lit: — region above the clavicles) fissures or cavities of the body, such as the ears, the eyes, the cavity of the mouth, the nostrils, etc.
The Ka'ya-Chikitsar (General diseases! — treats of diseases, which, instead of being simply
* Any foreign mailer, lodged in a human organism and proving painful 10 it, is called a Shalya.
t The name is derived from the Sanskrit term Slialak^, a probe or a rod, the use and application of the instrument being primarily jincluded within the scope of this branch of the Ayurveda.
J The term K^ya literally signifies the vital heat or fire which runs through the entire system, and hence the II5ya-chikits6 deals with diseases which may gradually invade the root-principles of a living human organism.
4 THE SUSHRUTA SAATHITA' [ Cliap. I.
restricted to an}^ specific organ, or to any particular part of the body, affect the entire system, as Fever, Dysentery, Haemoptysis, Insanity, Hysteria, Leprosy, unnatural discharges from the urethra, etc.
The Bhuta-Vidya' 'Demoniacal diseases) — lays down incantations and modes of exorcising evil spirits and making offerings to the gods, demons, Gandharvas, Yakshas, Rakshas, etc. for cures of diseases originating from their malignant influences.
The Kauma'ra-Bhritya Management of children) — deals with the nursing and healthy bringing up of infants, with purification and bettering of mothers' milk, found deficient in any of its characteristic traits, and also with cures for diseases peculiar to infant life and due to the use of vitiated mother's milk or to the influences of malignant stars and spirits.
The Agada-Tantram ■Toxicology— deals with bites from snakes, spiders and venomous worms, and their characteristic symptoms and antidotes. It hai also for its object the elimination of poison whether animal, vegetable, or chemical (resulting from incompatible combinations) from the system of a man, overwhelmed with its effects.
The Rasa'yana-Tantram Science of Rejuvenation , — has for its specific object the
Chap. I. ] SUa^RASTHA'NAM. 5
prolongation of human life, and tl^e invigoration of memory and the vital organs of man. It deals with recipes which enable a man to retain his manhood or youthful vigour up to a good old age, and which generally serve to make the human system invuhierable to disease and deca}'.
The Varjcckarana-Tantram (Science of Aplarodisiacs, — treats of measures b}' which the semen of a man naturally scanty or deficient in quality becomes shorn of its defects ; or is purified, if deranged by the ^•itiated humours of the body (such as wind, etc. ; or is invigorated and increased in quantit}' (if pure and healthy) ; or acquires its health}' and normal consistence ' if thinned and enfeebled by indiscretions of youth\ [In short, it deals with things which increase the pleasures of youth and make a man doubly endearing to a woman].
Thus the entire science of the Ayurveda is classified into the eight preceding branches. Xow tell me, which of them is to be taught and to which of you ? Said the disciples : — "Instruct us all, O Lord, in the science of surgery ( Shalya ) and let that be the chief subject of our study." To which replied the holy Dhan- vantari : — "Be it so." Then the disciples again said : — "We are all of one mind in the matter, O Lord, that Sushruta shall be our spokesman aiid .ask
6 THE SUSHRUTA SAMHITA' [ Chap. I
you questions conformably to the general trend of our purpose. All of us will attentively hear what you will be pleased to discourse to Sushruta, [and that will save you the trouble of teaching us individuall)']". To which replied the venerable sage — ",Be it so. Now listen, Sushruta, m}- dear child. The object or utility of the science which forms the subject of our present discus- sion, ma}' be gi^ouped under two distinct sub-heads such as (i) the cure of diseased persons, and (2) the presetva- tion of health in those who are not afflicted with any sort of bodily distempers."
The etymological meaning of the term "Ayur- veda" may be interpreted to denote either a science in the knowledge of which life exists, or which helps a man to enjoy a longer duration of life.
The primary position of surgery:—
[As regards time and importance among the other allied branches of the Science of Medicine]. Hear me discourse on the Science of Surgery { Shalya-Tantram) which is the oldest of all the other branches of the Science of Medicme (Ayurveda) and is fuither corroborated by the four classes of testimonies, viz., Perception, Inference, Analogv and Scriptural Truths (Agamas). The primary position of this branch of the Ayurveda, (as regards its time or origin), may be inferred from the fact that Surgerv lends her aid materiallv towards the
Chap. I. ] SUTRASTHANAM. 7
«
healing up of traumatic mlcers.* The 'second
reason for such an intWence may be deduced
from the replacement of the severed head of Yajna.
It is told that the god Rudra, severed the head of
the God of Sacrifice (Yajna). Whereupon the gods
approached the celestial Ashvins, and addressed
them as follows : — "You twins, O lords, who are
to be the greatest of us all, connect the head of
\''aj?ia with his decapitated trunk." To them, replied
the divine Ashvins : — " We shall do, O lords, as you
command us to do." Then the celestials propitiated
the god Indra in order that a portion of the oblations
offered in the course of a sacrifice, might be allotted
to those heavenly twins. The Ashvins reunited the
severed head of Yajna to his body as prayed for.
[Hence this branch of the Ayurveda (Shalyanga) is the
oldest of all its subdivisions].
The primary importance of the
Shalyam : — All hold this Tantram to be the
most imnortant of all the other branches of the Mi^o See/' 'f ' "^^^ ^^ suc^w
^^ ^receptacle ofheauff iustantaueous actious can be
r/VPQ ' ^ ^^ ^^^^^^ appliances as,
^ 3 Jb|*/£^getable world belongs t Ve|*Op , T o^ locomotion, belong to
^Jnav be areued here, since nd sword-cuts had to be dressed and
^ ^^^ tllQ to iuindamental material the gods and the denwns, long before
ff dQ^f]^ 'ippearance Oir) ], it is not ct' idiopathic maladies such-^ as, fever, etc. ;
ad Smgery contruvofold attril/ was demanded of her towards the healint;
"-• up of those u'cers. li>. But s' branch of the Ayurveda is the oldest of all
IP the allied brawhes of thu-se in.ng art.
8 THE SUSHRUTA SAMHITA [ Chap. I.
surgical operatioi|s, external applications of alkalis, cauterisation, etc., and -.secondly inasmuch as it contains all that can be found in the other branches of the science of medicine as well, with the superior advantage of producing instantaneous effects by means of surgical instruments and appliances. Hence it is the highest in value of all the medical Tantras. It is eternal and a source of infinite piety, imparts fame and opens the gates of Heaven to its votavies, prolongs the duration of human existence on earth, and helps men in successfully fulfilling their missions, and earning a decent competence, in life.
Gradual extension of the Ayur- vedic Knowledge :—Bramha was the first to inculcate the principles of the holy Ayurveda. Prajapati learned the science from him. The Ashvins learned it from Prajapati and imparted the knowledge to Indra, who has favoured me ( Dhanvantari ) with an entire knowledge thereof. I, for the good of mankind, am ready to impart it to those ^;-}-i^antram)-M^i^ earth.
anches of the Sci
The King of Kar?^,ther corroborate'^^ ac- count Of himself i._^ pe,ception, Inft'^^ '^^ supreme and original god i^^^^j^^ (Agam?' *^"^^ ^^ Dhanvantifri. It is I who warde , f tl disease and decay fi-on\ the celestials, ^o - Kg j,-,^ was an inmate of the region of heaven, now I a . ^ .carnated on earth
Chap. I.] SUTRASTHA'NAM. 9
with the view to teach the Science of SurgeiV with all its allied branches of study to men.
In the present science (Ayurveda), the Piirusha (self- conscious oro:anic individual) is described as the resultant of the combination of the soul and the five primar>- material principles. All medical acts such as, surgical operations, administration of medicinal remedies and applications of alkaline substances, or cauterisation, etc.), are restricted to the Piirusha alone.*
Why is it so ? The answer is, simply because the created world is composed of two distinct classes, such as the mobile and the immobile. f These two classes, in their turn, are further sub-divided for the purposes of the science of medicine into the two orders, Agneya hot and Saumya (cool. Hence the world is composed of fi^'e material principles, though characterised by the twofold virtues, Agneya (hot) and Saumya (cool).i
* It may be questioned why they should be confined to the Puiusha ? Such a query may be successfully met by the statement that the Purusha alone is the receptacle of health and disease in contradistinction to the Self or Ego.
t The vegetable world belongs to the latter category, while 'animals, possessed of locomotion, belong to the former.
X It may be argued here, since everything in the universe is composed of the five fundamental material principles [ of earth, water, fire (heat), air and sky (ether) ], it is not competent to assert that the universe is possessed of the twofold attributes Agneya (heated or fiery) and Saumya (cool or watery), alone. But since fire (heat) or water (cold) predominates in all things in the universe in juxtaposition with ihe primary virtues of the
10 THE SUSWRUTA SAMHITA. [Chap. I.
Further cliassification of the mobile and the immobile :- The animated world may be divided into four subdivisions, such as the Svedaja (born of sweat or heat and moisture ?'. e. abiogenous' , the Andaja ( egg-born or oviparous ), the Udbhijja (vegetable) and the Jarayuja (placental or viviparous j. The Purusha or the subjective personalit}' (man) is the greatest of them all, because all other forms of life are made to minister to his wants on Earth.
Disease : Sts Definition :— The Purusha
(man) is the receptacle of any particular disease, and that which proves a source of torment or pain to him, is deno- minated as a disease.* There are four different types of disease such as, Traumatic or of extraneous origin (Agantuka), Bodily (Sharira), jNfenla] (Manasa) and Natural (Svabhavika). A disease clue to an extraneous blow or hurt is called Agantuka. Diseases due to irregularities in food or drink, or incidental to a deranged state of the blood, or of the bodily humours acting either singh' or in concert, are called Sharira. Excessive anger, grief, fear, joy, despondency, envy, miser};, ])ride, greed, lust, desire, malice, etc. are
other fundamental material principles, it is not improper to classify all under the head of hot or cold, a third factor being non-existent. Hence the world (^Trf) is possessed of the twofold virtues, hot and cold.
* A disease may be defined as something whicli affiicts the Purusha (self-conscious personality), or those things or incidents which combine to afflict the Purusha are usually interpreted to connote that meaning.
Chap. I. ] SUTRASTHANAM. 1 1
included within the category of^ mental (Manasa) distempers ; whereas hm7.ger, thirst, decrepitude, imbecility, death, sleep, etc. are called the natural (Svabhavika) derangements of the body. The Mind and the Bodv are the seats of the abovesaid distempers according as they are restricted to either of them, or affect both of them in unison. *
Samshodhanam (Cleansing), and Samshamanam (Pacification of the deranged or agitated bodih' humours giving rise to the disease^ and the regimen of diet and conduct are the four fectors which should be duly emplo3"ed in order to successfully cope with a disease.!
Food is the principal factor which materially contri- butes to the strength, complexion and vitality (Ojah) of animated beings. Food consists of six different tastes
* The Self or Ihe feevitma of a person is above all human concerns and, as such, can never be affected by any disease.
t Cleansing (Samshodhanam) is of two kinds, viz. External and Internal. External purification consists in employing such measures as surgical operations, cauterisation of the affected part or organ, external use of alkaline preparations and medicated plasters, the internal one including such measures as exhibition of purgatives and emetics, application of intestinal enemas (Asthapanam) and blood-letting. Diet comprises four different factors such as, food, drink, lambative, etc., which, for the purposes of the Ayurveda, are again grouped under three different heads, such as the pacifier of the deranged bodily humours (Dosha-prashamanam), thera- peutical (VyMhi-prashamanam) and health-giving (Svastha=Vrittikara). Achara (conduct) appertains to three different factors, such as the body, the speech, and the mental acts. The abovesaid measures, duly employed, arc potent enough to combat all sorts of bodily distempers, if the special exigencies of each case arc carefully taken into consideration.
12 THE SUSHRUTA SAMHITA. [Chap. I.
(Rasa) '[which capnot exist independently of the subs- tances] in which they are inherent. These substances which are called the (3shadhis may be di^■ided into two classes such as the mobile and the immobile. The immobile Oshadhis in their turn, admit of being grouped under four sub-heads such as, the ^'"anaspatis, the Vrikshas. the Virudhas and the Oshadhis proper.
Those trees which bear fruit without blossoming are called the Vanaspatis such as, the Plaksha and the Oudumvura). Those that bear both fruits and flowers are called the \'rikshas. Shrubs and creepers that trail on the ground are called Virudhas, whereas those plants which die with the ripening of their fruits, are called Oshadhis proper such as cereals .
The mobile Oshadhis or animals are divided into four classes such as the viviparous, the oviparous, the sweat-begotten, and those that are born of decomposed vegetable matter. Man and other mammals belong to the first group ; birds, snakes, and reptiles belong to the second ; ants, worms, etc. belong to the third ; while frogs and Indragopas belong to the fourth. For medicinal pur- poses, bark, leaves, flowers, fruits, roots, bulbs, the ex- pressed juice, and milky or resinous secretions of plants, etc.* are .obtained from the vegetable world. The
* The use of oil expressed oui of diutjs and seeds, as well as of iheir ashes or alkaline preparations are likewise indicated.
Chap. I.] SUTRASTHAWAM. I-^
skin, nails, wool, blood, flesh, fat., marrow, bones, are procured from the animal world.
JMetals and minerals such as gold, silver, gems, and Manahshila i Realgar), as well as pearls, clay and Kapalas (bones^, etc. should be included in the list of the earthy substances. *
Gale, windfall, sunshine, shade, moonshine, dark- ness, heat, cold, rain, day, night, fortnight, month,
» seasons, and solstices, etc. should be deemed as the
works of eternal time, which, by virtue of their natural
effects, contribute to the accumulation, augmentation,
pacification or diminution of the deranged bodilv
humours (such as, wind, etc. .
Authoritative verses on the sub- ject : — Physicians should look upon these four factors of ffood, conduct, earth and time , as the accumulators, aggravators and pacifiers of the deranged bodilv humours and of the diseases resulting therefrom in man. Diseases due to causes which are extraneous to the bodv ma\' affect the mind or the body. When it would affect the body in the shape of any traumatic disease (such as an inflammation due to a blow or a sword cut >, it "should be treated medicinally like the rest of the physical mala- dies, while the remedy should consist in the enjovmentof
* Oxide of Iron, sand, yellow sulphurale of arsenic (Orpiment), sail, Gairika (ferruginous earth), Rasdnjana (antimony) should be regarded as appertaining to the class of earthy substances.
14 THE SUSHRUTA SAMHITA. hap. I.
pleasurable sound?, touch, sights, taste or smell where the mind would be found to be the seat of the distemper.
Thus I have briefly dealt with the Purusha, Disease, Medicine, Appliances and the Specific Time. The term Purusha should be interpreted to include within its meaning the combination of its five material com- ponents, and all things resulting therefrom, such as the limbs and members of the body, as well as the skin, the flesh, the blood, the veins and the nerves, etc. The term Disease signifies all distempers incidental to the several or combined actions of the three deranged bodily humours and blood. The term Medicine signifies drugs and their virtues, tastes, potency, inherent efficacy Prabhava and reactionary properties Vipaka . Appliances (kriya denotes such processes as, surgical operations, injections, emulsive measures, lubrications, etc. The term Time signifies all opportune moments for medical appliances.
Authoritative verses on the sub- ject : —The primary principle of the Science of medicine has thus been briefly stated and will be fully dealt with in the'following one hundred and twenty chapters distri- buted among the fi-\e main sub-divisions or Sthanas of the present work. These hundred and twenty chapters will be found to be elaborately discussed according to the specific import or significance of their denominations under the sub-heads of Sutra- Sthanam
Chap. I.] SUTRASTHANAM.
15
(Definitive Aphorisms or Fundamental principles, Nidanam ^Etiology", Sharira-Sthanam (Anatomy and Physiology , Chikitsa-Sthanam (Therapeutics) and Kalpa-Sthanam (Toxicology . Subjects other than the preceding ones will be discussed in the closing chapters of the book by wa}- of an Appendix (Uttara-Tantranv.
Authoritative verse on the sub- ject : — The man who reads this Eternal Science of Medicine ( Ayurveda-Shastram ) discoursed by the self- origined Brahma and propagated by the King of Kasi, becomes noted for his piety, is honoured by the kings on earth, and attains to the region of Indra (the lord of the celestials) after death.
Thus ends the first chapter of the Sutra-SthSnam in the Sushrula Samhitd which deals with the origin of the Ayurveda.
CHAPTER II.
Now we shall discuss the Chapter which deals with the rites of formal initiation of a pupil into the
science of Medicine (Shishyopanayaniya- madhya'yam).
Such an initiation should be imparted to a student, belonging to one of the three twice-born castes such as, the Brahmana, the Kshatriya, and the Vaishya, and who should be of tender years, born of a good family, possessed of, a desire to learn_, strength^ energy of action, contentment, character, self-control, a good retentive me- mory, intellect, courage, purity of mind and bod)', and a simple and clear comprehension, command a clear insight into tlie things studied, and should be found to have been further graced with the necessary qualifications of thin lips, thin teeth and thin tongue, and possessed of a straight nose, large, honest, intelligent eyes, with a benign contour of the mouth, and a contented frame of mind, being pleasant in his speech and dealings, and usually painstaking in his efforts. A man possessed of contrary attributes should not be admitted into the sacred precincts of) medicine.
lYlode of Initiation :— A Brahmana preceptor sliould initiate a disciple or student in the following way — A square sand cushion or platform, measuring a cubit
L"hap. 11. I SUTkASTHANAM. j-
f
in length and breadth, should be laid out on a plot of smooth, level and sacred' ground under the benign in- fluence of any auspicious phase of the moon or astral combination such as, the "Karanam," e»tc. and in a direc- tion of the compass whifch is held most auspicious to that end. The cusliion or the jilatform should be plastered over with a solution of water and cow-dung ; and blades of Kusha grass should be strewn over it. Then the gods, the Brahmanas and the ph5''sicians should be worshipped with oblations of flowers, fried paddy, gems and sun- dried rice. Then having drawn straight lines across the Sthandilara so as to meet the top of the furthest side of the square, and having sprinkled them over with holy water, the preceptor should lay down a blade of Kusha grass tied up in the form of a knot, known as the Brahmana, along the side of the sacred cushion to his right, and kindle the sacred fire close to his seat. Then having soaked the twigs of the four sacrificial trees of Khadira, Palasha, Devadaru and Vilva, or of Vata, Oudumvara, Ashvattha and Madhuka in curd, honey and clarified butter, he should perform the rite of Homa according to the rules of a Darvi Homa ceremony^ Then libations of clarified butter should be cast into the sacrifi- cial fire with a repetition of the Maha Vyahriti Mantras preceded by the mystic Omkara. After that, libations of clarified butter should be cast into the fire in honour of each of the gods and Rishis (celestial physicians) invoked
3
1 8 THE SUSHRUTA SAMHITA'. 1 Chap. 11.
b}^ repeating the Svaha Mantra, and the disciple should be made to do the same. *
A Brahmana preceptor is competent to initiate a student belonging' to any of the three twice-born castes. A Kshatriya preceptor can initiate a student of the Kshatriya or the Vaish3'a caste, while a Vaishya preceptor can initiate a student of his own caste alone. A Shudra student of good character T.nd parentage may be initiated into the mysteries of the A5'urveda by omitting the Mantras enjoined to be recited on such an occasion.
Then having thrice circumambulated the sacrificial fire, and having invoked the firegod to bear testimony to the fact, the preceptor should address the initiated dis- ciple as follows :— "Thou shalt renounce lust, anger, greed, ignorance, vanity, egotistic feelings, envy, harsh- ness, niggardliness, falsehood, idleness, ndij all acts that soil the good name of a man. In proper season thou shalt pair thy nails and clip thy hair and put on the sacred cloth, dyed brownish yellow, live the life of a truthful, self-controlled anchorite and be obedient and respectful towards thy preceptor. In sleep, in rest, or while moving about— while at meals or in studv, and in all acts
"^ The libations should he oftered as follows -Svah^ (obeisance) to P,i-ahm4, Svah.4 to Praj^pati (the lord of the created beings), SvahA to Ashvins, .Svaha to Indra, Sv.nhA to Dhanvantari, Sv^hA to Bharadv^ja, and SvAh^ to A'treva.
Chap. il. I SUTRASTHA'NAAl. 19
thou shalt be guided by my directions. Thcju shalt do what is pleasant and beneficial to me, otherwise thou shalt incur sin and' all thy study and knowledge shall fail to bear their wished for fruit, and thou shalt gain no feme. If I, on the other hand, treat thee unjustly even w'ith thy perfect obedience and in full conformity to the terms agreed upon, may I incur equal sin with thee, and may all my know- ledge prove futile, and never have any scope of work or display. Thou shalt help with thy professional skill and knowledge, the Brahmanas, thy elders, preceptors and friends, the indigent, the honest, the anchorites, the helpless and those who shall come to thee (from a distance;, or those who shall live close by, as well as thy relations and kinsmen [to the best of thy knowledge and ability], and thou shalt give them medicine [without charging for it any remuneration whatever], and God will bless thee for that. Thou shalt not treat medicinally a professional hunter, a fowler, a habitual sinner, or him who has been degrad- ed in life ; and even by so doing thou shalt acquire friends, fame, piety, wealth and all wished for objects in life and thy knowledge shall gain pubhcity." ,
Prohibited periods of the study of the Ayurveda : — The day of the new moon, the eighth day of the moon's wane, the fourteenth day of the dark fortnight, as well as the corresponding days in
20 tHE SUSHRUTA SAMHITA. I Chap. II.
the brio^ht one, the day oi the tlill moon, and the meet- ings olday and night such as (morning and evening) are occasions when the study of the Ayurveda is prohibited. Similarly, a clap of thunder heard at an improper season (months of Pousha, Phalguna and Chaitra), or a Hash of lightning occurring at a' time when such pheno- mena are naturall)' rare, or an evil befalling one's country, relations, or king, should be deemed as occasions jnohibiting the study of the Ayurveda. Moreover, one should not read it in a cremation ground, nor while riding (an elephant, horse, or any) conveyance, nor in a battle-held, nor in a place of execution. A festi- ^ al or the appearance of inauspicious omens, and the days of the fortnight usually avoided by the Brahmanas in studying the Vedas, as well as an unclean state of the body, should be regarded as occasions prohibiting the studv of the Avurveda.
riuis lmhIn llic sccijiul clinitlci' ul ihc .SuLiasLhanaiii in llit; SublmiUi. Sanihila which Ireals oflhc foniuil inil.i;Ui<jn of a .sUulunl intM ihc Aviiivcda.
C H A P T E R in.
Now we shall discuss the chapter which deals with the classification of the Ayurveda and the order [in which the venerable Dhanvantari discoursed on them to his pupils]. Adhyayana-Samprada'niyam.
It has been stated before, that a hundred and twenty chapters have been distributed among the five parts or subdivisions (of the present work, in the following- order :— Forty six in the part of Definitive Aphorisms (Sutra-Sthanam) ; sixteen in the part dealing with the Etiology of diseases (Nidanam) ; ten in the part explain- ing the Anatomy and physiology of the human body (Sharira Sthanam); forty in the part of Therapeutics Ciiikitsitam ; and eight in the part dealing with poisons and their antidotes (Kalpa-Sthauam). In addition to these the Uttara-Tantram consists of sixty-six chapters.
Metrical texts : The Sutra-Sthanam which contains tbrty-six chapters, is so called because it dis'jusses in the form of hints, arranges in the form of aphorisms and connects by links topics relating to longevitv. Chapter i Describes the origin of the science of the Ayurveda. 2 Relates to the formal initiation of a inipil into the science of medicine. ' ; Deals with the
22 THE SUSHRUTA SAMHITA. I Chap. III.
classi^cation and order of the study of the Ayurveda. 4 Dwells on general interpretations and explanations of subjects studied, 5 Treats of preliminary preparations for surgical operations. 6 Deals with seasons and their influence on health and drugs. 7 Treats of surgical appliances. 8 Describes surgi(l:al instruments. 9 Gives practical instructions for surgical operations. 10 Dwells on the duties of medical men preliminary to their commencing practice. 1 1 Pharmacy of alkalies (potential cauteries). 12 Cauteries and the rules to be observed in their use. 13 Leeches how and which to use). 14 Blood. 15 Dwells on the study of development and non-development of the humorous constituents of the body and excrements,
1 6 The ceremony of piercing the lobules of the ears.
17 How to distinguish between suppurating and non- suppurating swellings. 18 Dressings and bandages of ulcers. 19 The management of patients with ulcers, etc. 20 The salutary and non-salutary effects of regimen, etc. ?.i The decisive modes in the treatment of sores, etc. 22 The opening of abscesses, etc. 2S General rules to be observed in the treat- ment of curable and incurable (surgical diseases. 24 The nature of diseases in general. 25 The (eight different) ways of using surgical instruments. 26 The exploration of splinters lost (deep seated; in the body. 2 J The extraction of splinters. 28 How to know favourable' and unfavourable terminations
Chap. III. ] SUTRASTHANAM. o-
in surgical diseases. 29 The favourable or unfavourable prognosis in diseases as' known from messengers, omens and dreams. 30 Prognosis from the per- version of sense perception. 31 Prognosis based on the altered condition of features, etc. 32 Prognosis based on the perversion in the external appearances of the body. 33 Palliative treatment of incurable diseases. 34 The precautions to be taken (against dangers, such as poisoning of water, etc. by a medical man for the safety of a king whose army is on the march. 35 Clinical observations made b}' phy- sicians. ^6 Miscellaneous subjects connected with the treatment of injuries and surgical diseases. ^y The examination of the soil for the selection of vegetable products growing on it to be used as medicines. 38 Classification of drugs according to their therapeutical uses.; 39 The two classes of drugs which cleanse the system [by evacuating bad humours] and drugs which pacify the irritated humours.
40 Drugs, their flavours, properties and maturity.
41 The properties of drugs specially considered.
42 Flavours. 43 The choice of emetics. 44 The choice of purgatives. 45 Liquids. 46 Food and drink.
From their investigatmg the (pathological) causes and symptoms of diseases, they 'are called Nidananij (etiology) and are sixteen in number.
24
»
THP: SUSHRL'IA SAiMHlTA. [Chap. III.
Chapter i Causes and S5''niptoms of diseases caused b}' wind. 2 Hoemorrhoids. 3 Urinaiy calculi 4 Fistulas. 5 Skin diseases Kushtha), 6 Urethral discharges. 7 .Abdominal tiVmours and dropsy. 8 Abortion and unnatural labours. g Abscesses. 10 ErN'sipelas and Carbuncles. 1 1 Tumours 12 Scrotal tumours. 13 Fractures 'and disl(>."ations) 14 Diseases of the male organ of generation caused by Shuka. 15 Minor .and _ mis- cellaneous diseases. 16 Diseases of the mouth.
The great sage has devoted ten chapters to the subject of Anatomy and Physiology (Sharira-Sthanam) for medical men and contemplative saints to learn the component parts of the human body. They are : —
Chapter i Cosmology. 2 Healthy and un- healthy) condition of male and female germs. 3 Development of the foetus. 4 Analytical descrip- tion of the fetus. 5 Component parts of the body. 6 Investigation of each vital part. 7 Description of the veins. 8 \'enesection. g Arteries. 10 Pregnancy (child-birth and management of womt.-n in child-birtli and of children).
The division of Therapeutics, (Chikitsitam) includes (amongst others; the modes of treating diseases by medicines, expiatory ceremonies, propitiatory rites, and tranquillizing efforts. Torty chapters have been devoted to this division. Chapter i 'Prcatment of two varieties
Chap. III. J SUTRASTHANAM. 25
of ulcers. 2 Treatment of instant wounds and ulcers resulting therefrom, 3 Fractures and dislocations. 4 Diseases of wind. 5 Grievous maladies caused by wind. 6 Haemorrhoids. 7 Urinary calculi. 8 Fistulas. 9 Skin diseases. 10 Grievous skin diseases. 11 Urethral
9
discharges. 12 Warts, pustules and sores caused by urethral discharges, 13 Diabetes. 14 Abdominal Dropsy. 15 Abortions and unnatural hibours. 16 Ab- scesses. 17 Erysipelas and Carbuncles. 18 Tumours. 19 Scrotal tumours and Syphilis. 20 Minor diseases. 21 Diseases of the male genital organ caused bv Shuka. 22 Diseases of the mouth. 2^ Swellings. 24 Prophylactic treatment against diseases in general. 2=) Miscellaneous diseases. 26 Tonics for virile debility. 27 Tonics for general debility. 2S Remedies for increasing mental powers and duration of life. 2g Remedies for innate maladies. 30 Means for removing wordly distresses. 31 Treatment of diseases where oleaginous substances are useful. ^^2 Treatment by diaphoretics. 33 Emetics and Purgatives. J4 Treatment for mishaps from the injudicious use of emetics and purgatives. 35 Nozzles and pipes, and enema apparatus. ^6 Mishaps from injudicious use of enemas. 37 Enemas and injections. ^S Clysters. 39 Treatment of complications in general. 40 Inhalation, fumigations, gargarismata, etc.
From their proposing remedies against poisons, they are called Kalpas, and are eight in number. 4
46 THE SUSHRUTA SAMHITA'. I Chap. ill.
ChUpter I Preservation of food. 2 A'egetable and inorganic poisons. 3 Poisons from organic creation. 4 Snake poison. 5 Treatment of snake-bites. 6 Rat- bite and its treatment. 7 Emitting the sound ol kettle-drums (for the eh'mination of poison). 8 Antidotes for and treatment of venomous insect-stings.
Thus a synopsis of one hundred and twenty chapters has been given. Now here follows the supplementary division called after its own name (Uttara-Tantram).
The Chapter on Sympathetic diseases is placed first, as this division has for its main object the description of such diseases and their treatment. 2 Diseases of the joinings (margin of the eyelids) of the eyeball. 3 Dis- eases of the eyelids. 4 The Sclerotic of the eye. 5 The Cornea. 6. The eyeball, as a whole. 7 Diseases of the pupil. 8 Treatment of eye diseases. 9 Prophylac- tic and curative treatment of wind affections of the eye and ophthalmia. 10 Treatment of Bile affections of the eye and ophthalmia. 1 1 Treatment of Phlegm affec- tions of the eye and ophthalmia. 1 2 Treatment of Blood affections of the eye. 13 Treatment of aftections in which scarification is needed. 14 Treatment in which paracentesis is needed. 15 Treatment by incisions. 16 Entropium and ectropium. 17 Treatment of the diseases of the pupil and vision. 18 General rules regarding ophthalmic medicine and surgery. 19 Treat- ment of traumatic affections of the eyeballs. 20 General
Chap. III. I SUTRASTHA'NAM.
27
signs and s3nnptoins of ear diseases. 2 1 Treatment ol ear diseases. 22 Signs and S3'mptoms of nose affections. 2}, Treatment of nose affections. 34 Treat- ment of nasal catarrli. 25 Signs ai^d sj'mptoms of cranial diseases. 26 Ti;eatment of cranial affections. These (twenty-six ciiapters) form the end of the eight divisions of the A^'urveda, called Shilikyam.
Chapter 2-] Signs of diseases caused by the Nava- grahas. 28 Prophylactic treatment of diseases caused by Skandha. 29 Treatment of convulsions caused by Skandha. 30 Treatment of Sakuni affections. 31 Treat- ment of Revati affections. },2 Treatment of Putana. 33 Treatment of Andha Putana. 34 Treatment of Slueta-Putana. 35 Treatment of Mukhamandika. 36 Treatment of Naigamesha. i"] Origin of the nine Grahas. 38 Diseases of the Vagina (and internal female genital organs). These twelve chapters together Vvith what is included in (the last chapter of the division on ; anatomy, form the fifth division of the A5'urveda) called Kaumara Tantram.
Chapter 39 Fevers and their treatment. 40 Enteric Catarrh and its treatment. 41 Consumption and its treatment. 42 Diseases of the abdominal glands and their treatment. 43 Diseases of the heart 'Angina Pectoris etc. 44 Anaemia and allied diseases and their treatment. 45 HfCmorrhag^c affections and their treatment. 46 Apoplectic diseases and their treatment.
2-8 THE SUSHRUTA SAMHITA'. 1 Chap. ill.
47 Diseases from excessive drinking and their treatment.
48 Symptoms, causes, and treatment of excessive thirst. 49 Causes, S5'mptoms and treatment of vomiting. 50 Causes, s5^mptoms and treatment of Hiccough. 5 1 Causes, symp- toms, and treatment of Dyspnoea. 52 Causes, symp- toms and treatment of cough. 53 Aphonia. 54 Entozoa. 55 Causes, symptoms and treatment of retention of excrements. 56 Causes, symptoms and treatment of Dyspeptic and Choleric diarrhoea.' 57 Anorexia and its treatment. 58 Causes, symptoms and treatment of cystic and urethral affections. 59 Causes and treatment of urine diseases. These twenty one chapters describe the remaining diseases of Kayachikitsa ; (which forms the third division of the Ayurveda \
Chapter 60 Causes, symptoms and treatment of diseases caused by superhuman powers. 61 Causes svmptoms and treatment of Epilepsy. 62 Mania. These three chapters form the Bhuta Vidya (the fourth division of the Ayurveda).
Chapter 63 on the different varieties of flavour. 64 (leneral rules for the preservation of health. 65 Deductions and inunctions drawn from tbe texts and study of the Ayurveda. 66 On the varieties of mor- bid elements (h^^mours;. These four chapters are to be understood as being supplementary, and as orna- ments to this division.
Chap. III. j SUTRASTHANAM. 20
This last division from its superiority over the others, the great sages have called the Excellent (Uttarani). From the information it gives on varied subjects, it is called the best, the permanent and ihe last.
In this division which is called the last, there are included four divisions (of the Ayiirveda) viz, Shalakyam, (treatment of diseases of parts situated above the clavicles), 2 Kaumarabhrit^'am (management of children), 3 Kayachikitsa general diseases) and 4 Bliuta-Vidya.
The division (named) Vajeekaranam (on the strength- ening of virile power, etc.) and Rasayanam remedies preserving vigor, etc.) have been included in the (fourth ) division (of this treatise called Chikitsa.
The doctrine of antidotes comes under the head of Kalpa of this treatise and Shah'am surgery is incident- ally treated throughout the book. Thus these are the eight limbs divisions, of tne Science of Medicine proclaimed to the world by the original god. Those, who stU'ly them with due care and make use of the knowledge with caution, shall preserve the li\'es of men on this earth. It is imperatively necessary that the book should be read ; and after having read it one should attend to the practice (of the science . The physician who has learnt these both, is lit to be honour- ed by kings,
30 THE SUSHKUTA SAiMHlTA. f Chap. III.
Authoritative verses on the sub- ject :— A ph^'sician, well versed in the principles of the science of medicine (Ayurveda), but unskilful in his art through want of practice, loses his wit at the bedside of his patient, just as, a coward is at his wit's end to determine what to do when for the first time he finds himself in the ranks of a contending army. On the other hand a physician, experienced in his art l)ut deficient in the knowledge of the Ayurveda, is condemned by all good men as a quack, and deserves capital punishment at the hands of the king. Both these classes of ph3^sicians are not to be trusted, because th}- are inexpert and half educated. Such men are incapable of discharging the duties of their vocation, just as a one-winged bird is incapable of taking flight in the air. Even a panacea or a medicine of ambrosial virtues administered b)' an unpractised or ig- norant ph)^sician, will prove j^ositively baneful as a draught of poison, or a blow with a weapon, or a thunder- bolt. A physician, ignorant of the science and art of sur- gery and emollient measures Sneha-karma , etc. is but a killer of men out of cupidity, and who is allowed to carry on his nefarious trade only through the in- advertence of the king. A physician well --ersed in the principles of surger}-, and experienced in the prac- tice of medicine, is alone caj^able of curing distempers, just as only a two- wheeled cart can be of service in a field of battle.
Chap. III. SUTRASTHANAM.
31
Now hear me, O child, describe the mode of st'adying the present science of the Ayurveda.) The pupil having worshipped and recited his daily prayers should calmly sit near his preceptor, pure in body and mind, who should teach him a full i^hloka or couplet of the Ayurveda), or a half or a quarter part thereof, adapted to his intellectual capacity. Then he should make a full and elaborate paraphrase of the recited couplet or any piwi thereof, and ask his pupils individually to do the same. When the pupils have paraphrased the same to the satisfaction of the precep- tor, he should again recite the same stanza or couplet. The passages or shlokas should not be recited too hastily, nor drawled out in a timid or faltering voice, nor with a nasal intonation. The voice should be neither too loud, nor too weak, but each sound should be clearly and distinctly uttered, and the lips, the eyes, the eye- brows, and the hands, etc. should not be lifted or moved to keep time with the recitation. Xo one should be allowed to pass between the pupil and the preceptor at the time of study.
Authoritative verses on the sub- ject : — A pupil who is pure, obedient to his preceptor, applies himself steadily to his work, and abandons laziness and excessive sleep, will arrive at the end of the science (he has been studying .
.\ student or a pupil, having 'finished tire course ol.
32
THE SUSHRUTA SAMHITA. L Chap. III.
his studies, would do well to attend to the cultivation ol" fine speech and constant practice in the art he has learnt, and make unremitting efforts towards the attainment of perfection (in the art).
Thus ends the ihird Chapter uf the Siilraslhanani in the Sushrul.i Sanihila wliich deals with the Classification of tlie Ayurveda.
CHAPTER IV.
Now we shall discuss the Chapter which deals with General Explanations (Prabha'Saniya- madhyaryam).
The endeavours of a man who has studied the entire Ayurveda (shastra) but fails to make a clear exposition of the same, are vain like the efforts of an ass that carries a load of sandal wood (without ever being able to enjoy its pleasing scent).
Authoritative verse on the sub- ject : — A foolish person who has gone through a large number of books without gaining any real insight into the knowledge propounded therein, is like an ass laden with logs of sandal-wood, that labours under the weight which it carries without being able to appreciate its virtue.
Hence the preceptor will clearly explain each shioka or a half or a quarter part thereof as contained in the present work, divided into a hundred and twenty chapters (as well as in the concluding portion of the Uttara-Tantram appended to it) ; and the student or the disciple shall attentively hear everything explained or discoursed on by the preceptor. Since it is extremely difficult to classify drugs, ta^te, virtue (Guna), potency (Virya), transform at ory or reactionary effect
34 THE SUSHRUTA SAMHITA. [ Chap. IV.
(Vipaka), fundamental bodily principles i Dhatu) bodily excrement (Mala), hollow viscera ( Ashaya), vital parts cMarma\ veins (Sira), nerves (Snayu), joints (Sandhi), bones (Asthi; and the fecundating principles of semen and ovum, and to extricate any foreign matter lodged in an ulcer), or to ascertain the nature and position of ulcers or fractures, or the palliative, curable or incur- able nature of a disease, etc. ; and since these subjects perplex even the profoundest intellects though a thousand times discussed and pondered over, not to speak of men of comparatively smaller intellectual capacity, hence it is imperatively obligatory on a pupil or a disciple to attentively hear the exposition of each shloka^ or a half or a quarter part thereof, made by the preceptor (while studying the science of medicine).
For explanations of truths and principles quoted from other branches of (science or philosophy) and incidentally discussed in the present work, the student is referred to expositions made by the masters fof those sciences or philosophies;, since it is impossible to deal with all branches of science, etc. in a single book (and within so short a compassX
Authoritative verses on the sub- ject: — By the study of a single Shastra, a man can never catch the true import of this ( Science of Medicine). Therefore a physician should study as many allied branches of (science or philosophy) as possible. The
Chap. IV. ] SUTRASTHANAM.
35
physician who studies the Science of Medicine from the h"ps of his preceptor, and practises medicine after having acquired experience in his art by constant practice, is the true physician, while any other map dabbling in tne art, should be looked upon as an impostor.
The Shalya-Tantras (surgical works) written or propagated by Aupadhenava, Aurabhra, Sushruta and Paushkalavata, are the bases of the works or Tantras written by others {^Karavirya, Gopura-rakshita, etc, i.
Thus ends the fourth chapter of the Sutrasthanam in the Sushruta Samhit^ which deals with General Explanations.
CHAPTER V.
Now we shall discuss the Chapter which treats of Preliminary measures in connection with the curative remedies of a disease).* (Agropaharaniyam- adhyaryam).
The entire course of medical treatment in connec- tion with a disease ma)?' be grouped under Ihree subheads, as the Preliminary measures (Purva-karma) ; the Principal therapeutical or surgical appliances (Pradhana-karma'> ; and the After-measures (Paschat- karma). These measures will be discussed under the head of each disease as we shall have occasion to deal with them. As the present treatise principall)'-
* Several authorities hold that acts such as fasting, administration of purgatives, etc. should be included within the preliminary measures ; application of absorbent (Pachana) or healing medicinal agents, within the second or the principal measures ; and the administration of tonics or restoratives within the third or the after-measure group. Others, on the contrary, lay down that measures adopted for the absorption, lubrication (pacification by the application of oily substances) or elimination of the deranged bodily humours Ijy sweating should be grouped under the first subhead ( Purva-karma), the administration of active purgatives, emeticsr etc., under the second (Pradhana-karma) and the giving of rice meal, etc. to the patient under the (Paschat-karma) last ; while according to others the active medicinal agents employed to cope with the deranged humours in the incubative stage of a bodily disease till the appearance of its first characteristic symptoms, should be denominated as the Preliminary measure ; measures employed for the subjugation of a disease in its patent or fully developed stage as the Pradhana-karma, and measures employed to guard against the recrudescence of a disease and for the restoration of health in a patient is the sequel treatment or the Pasch^t-karma.
Chap.^ V. 1 SUTRASTHA'NAM. -^7
treats of surgical acts or operations, we shall discourse on them and their accessories at the outset.
Surgical acts or operations are divided into eight different kinds such as Incising (Chhedya), Excising (Bhedya), Scraping (Lekhj^as Puncturing (Vedhya), Searching or probing (Eshya), Extracting (Abarj'-a), Secreting fluids (Visravya) and Suturing (Seevya). A surgeon (Vaidya) called upon to perform any (of the eight preceding kinds) of operations, must first equip himself with such accessories as surgical appliances and instru- ments, alkali, fire, probe or director (Shalaka), horns, leeches, gourd (Alavu), Jamvavoushtha (a kind of pencil shaped rod made of slate with its top-end cut into the shape of a Jamboline fruit), cotton, lint, thread, leaves, tow(Patta), honey, clarified butter, lard, milk, oil, Tarpanara (powdered wheat soaked in water), decoc- tions Kashaya , medicated plasters, paste (Kalka), fan, cold water, hot water, and cauldrons, etc., and moreover he shall secure the services of devoted and strong- nerved attendants.
Then under the auspices of blissful astral coi-Qbina- tions, etc., and having propitiated the Brahmanas and the physicians, with gifts of curd, sun-dried rice, cordials and gems, etc., and having made offerings to the gods and uttered benediction, etc., the surgeon should commence his work. The pa'dent should be given light food (before the act), and made to sit with
38 THE SUSHRUTA SAMHTTA'. [ Chap. V.
his face turned towards the east. His limbs should be carefully fastened (so as to guard against their least movement during the continuance of the operation). Then the surgeon, sitting with his face towards the west, and carefulh' avoiding the vital parts (Marmas), Veins, nerves (Snayus), joints, bones and arteries of the patient,should insert the knife into the affected part along tlie proper direction till the suppurated part would be reached and swiftly draw it out. In case of extended suppuration, the part opened (length of incision) should be made to measure two or three finger's widths in length. An incision (Vrana) which is wide, extended, equally and evenly divided, should be deemed the best.
Authoritative verses on the sub- ject : — An incision which is wide, extended, well divided, does not involve any vital part, etc. of the patient, and is well-matured as regards time, is the best of its kind*. Courage, light handedness, non-shak- ing, non-sweating, sharp instruments, self confidence and self command are what should be possessed by a surgeon engaged in opening a boil or an abscess.
Two or three incisions should be made if a single opening does not seem large enough for the purpose.
* Certain commentators interpret the couplet as follows : A boil or an abscess which is wide, extended, well defined in its shape, equally suppurated in all its parts and does not involve any vital part of the body is the fittest thing for a surgeon's knife — Tr.
Chap, v.] SUTRASTHANAM. 39
Authoritative verse on the 'sub- ject : — The knife (lancet) should be freely used wherever a fissure, sinus, or a cavity would appear in a boil, so as to ensure a complete flowing out of the pus accumulated in it.
Lateral (tirjak) incisions should be made in regions of the eye-brows, temple, forehead, cheeks, eyelids, lower lip, gums, armpits, loins, belly and the groins.
An incision made in the region of the hand or root should be made to resemble the disc of the moon, while those about the anus and the penis should be made semi-circular ! half-moon j in shape.
Authoritative verse on the sub- ject : —An incision in any of the abovesaid regions not made as directed, may give rise to extreme pain, pro- longed granulation (healing) and condylomatous growths in and about the ulcer, owing to an inadvertent cutting of the local veins, or nerves. In a case of artificial or instrumental parturition, in ascites, in piles, in stone in the bladder, in fistula in ano, and in diseases affecting the cavity of the mouth, the patient operated on should be kept on an empty stomach (before thS^act).
Then sprays of cold water should be dashed over the face and the eyes of the patient to relieve the pain and the sense of exhaustion incidental to the operation. The sides of the incision should be firmly pressed fso as to ensure a good outflow of the accumulated pus) and
40 THE SUSHRUTA SAMHITA. [Chap. V.
the margins of the wound should be rubbed with the fingers (so that they may have a level surface and be of uniform structure throughout.) Then the wound should be washed with an astringent decoction (of Nimba, Triphala, etc.) which should be wiped and made thoroughly dry with a piece of clean linen. Then a lint plug 'Varti) plastered over with the (paste) Kalka of sesamum, hone)' and clarified butter, and soaked in disinfectant (lit : — purifying medicines such as Ajagandha, etc. i should be inserted deep into the cavity of the wound. After that, a poultice made of offi- cinal substances should be applied over it and the whole should be bound up with thick layers of tow (Kavalikas— such as the leaves and bark of the Indian figtree etc.) which are neither too irritant nor too cooling in their effect ; and finally scraps of clean linen should be wound round them. The limb, [or the affected part] should be subsequently fumigated with the fumes of pain-killing (anodyne) substances and also with those of drugs which are supposed to ward off all malignant spirits (from the bedside of the patient.)*
Then it should be fumigated with the drugs, known as Guggulu, Vacha, white mustard, Saindhava and the leaves of the Ximva tree, soaked in clarified butter. The residue of the clarified butter [dripped
* Even the bedsheels, etc. of the patient should be fumigated as above. This foreshadows the germ theory of the modern days— Tr.
Chap. V. ] SUTRASTHA'NAM. 41
down and collected from the fumigating corftpound described above], should be rubbed over the region of the heart and other vital parts of the patient, and the floor of the chamber should be washed and sprinkled over with drops of water previousl)^ kept in a (new) pitcher for the purpose. The rites of protection from the influences of baneful spirits, should then be performed by reciting the Mantra which runs as follows : — "I am about to practise the prophylactic incan- tation for guarding thy person against the malignant influences of Rakshas and conjured demonesses, and may the god Brahma be graciously pleased to approve of its performance. May the Gods and deities and mini- sters of grace disperse and confound the hosts of wrathful Nagas (celestial serpents), Pishachas, Gandhar- vas and Pitris that might be maliciously disposed to strike thee in thy sickly confinement. May the spirits, which stir abroad in the night and roam about in the sky and on earth, defend thy person in recognition of thy fervent devotion to them. May the concourse of Brahma-begotten sages 'such as, Sanaka, etc.), the saintly and canonised kings (Rajarshis) in heaven and the sacred mounts, streams and oceans of the earth protect thee from evil. May the fire-god guard thy tongue ; the wind-god protect thy breath ; and the Moon-god, Parjanya, Vidyut lightning) and the spirit of the clouds preserve the healthy coursings of» those vital winds in th}' organism which are respectively known as Vy^na, 6
42 THE SUSHRUTA SAMHITA [ Chap, v
Apana; Udana and Samana. May Indra, the presiding deity of all physical energies, keep thy bodily strength immaculate. May Manu defend the two side tendons at the nape of thy neck, as well as thy facult)^ of intellect ; the Gandharvas, thy faculty of desire ; Indra, thy fortitude ; Varuna, thy faculty of cogni- tion ; the Ocean, thy region of umbilicus ; the Sun- god, thy eyes ; the Quarters of the Heaven, thy ears ; the Moon-god, thy mind ; the Stars, thy complexion ; the Night, thy shadow ; the Water, thy vigour ; the Oshadhis, thy hair ; Infinite Ether, the space which is imprisoned in thy body ; \\isundhara, thy body ; Vaishvanara, thy head ; Vishnu, thy moral courage ; Purushottama (the foremost of beings), thy energy of action (dynamical action of purposes); Brahma, thy self; and Dhruva (immutable being), thv eyebrows. May these divinities, which perpetually reside in thy body, ensure thy safe continuance in being and may thou enjoy a long life through their grace. May the gods such as, Brahma, etc., confer blessings on thy head. May the Sun, the Moon, the twin sages Narada and Parvata, the fire-god, the wind, and the other celestial helpmates of Indra, bring thee good. May the pro- phylaxis devised by Brahma keep thee from evil. Mav thou be spared to witness the return of many a long and happy year on earth. May such abnormal physi- cal phenomena as, droyght, deluge, excessive downpour of rain, and excessive germination (or wholesale
Chap, v.] SUTRASTHANAM. .,
43
extinction of such vermin as) rats, mosquitoes, flies which invariably portend evil and mortality in a community, as well as bloody feuds among kings, abate and cease. May thou be relieved of all pain and misery. We close the prayer with a "Svaha" (obeisance\ The present Vedic mantra exercises an occult power in relieving ailments which are due to the malignant influences of conjured up she-devils. May thou acquire a long life through the protective energy of the pro- phylactic prayer (lit :— incantation; now read by me.
Then having protected the body of the patient with the recitation of the above Vedic Mantra, the surgeon shall see his patient taken to his own chamber, and prescribe the proper course of medicine and diet accord- ing to the exigencies of each case. The old bandage should be loosened on the third day of the operation, when the wound or the ulcer should be washed, and a fresh bandage should be wound round as before. The bandage should not be loosened on the day following the lancing of a boil, as such a measure might give rise to a sort of excruciating pain and formation of knots in the wound and retard the process of granulation (healing). On the third day, the surgeon (Vaidya) should prescribe the proper medicated plaster, diet, etc. after fully considering the strength of the patient, the nature of the disease, and the then prevailing season of the year. A wound should not be tried to be healed up, as long as
44
THE SUSHRUTA SAMHITA [ Chap. V.
the least morbid matter, or pus remains in its inside, as it would lead to the formation of fresh cavities in the surrounding health}^ tissues, and ultimately to a recrudescence of the disease.
The authoritative verses on the subject : — Accordingly a wound or an ulcer should be made to heal up after the perfect purification of both of its inside and exterior has been fully brought about. Even after the healing of the wound the patient should studiously avoid all sexual connections, indigestive viands, fatiguing physical exercises and indulgence in emotions of grief or fright, or in ecstasies of joy, until the cicatrix has acquired enough toughness. The dressings and bandages should be untied and changed ever}' third day in winter, in spring and in the season of Hemanta, and on each alternate day in summer and in the rains. But a physician (surgeon) should not be guided by these rules in cases where there would be reasons to apprehend imminent danger, and in such cases the wound or the ulcer, like a house in flames, should be checked as speedily as possible.
Clarified butter boiled with Yashtimadhu, and applied tepid to a wound, incidental to a surgical operation, is sure to alleviate the excruciating pain that is usually experienced in such an affected part.
Thus ends llie fifih chapter, of the Sutiasthanani in ihc SushnUa Sanihita which treats of Preliminarv nieasiues.
CHAPTER VI.
Xow we shall discuss the Chapter which treats of the characteristic features of the differetit seasons of the year and their influence on health and drugs fRitucharya'dhya'yam).
The Eternal Time is without origin, middle, or end, self-l/egotten, and the lord of all attributes. Contrariety or non contrariety of the natural attributes of drugs or substances endued with characteristic tastes, such as sweet, etc., are brought about by time ; and time is the principal factor that controls the births or deaths of beings.
Etymology of the term Ka'Ia (t^me): — The Kala or the Eternal time is so called from the fact of its not suffering even one of its own minutest particles or subdivisions (Kala) to perish, though perpetually moving, and in constant motion in itself ; or it derives its epithet from the. fundamental quality of its destroying all beings and laying their dead remains in heaps in succession. Some assert that the name is due to the fact that time blends ( kalanam ) all beings with misery or happiness according to their respective acts, or to its leading all beings to destruction ( kala).
The Sun-god, by his peculiar motions, divides eternal time which is measured by years ( Samvatsaras)
I
46 THE SUSHRUTA SAMHITA. [ Chap. VI.
into 'increasingly progressive but smaller subdivisions) such as, Nimeshas (lit : — time taken in closing the eyelids^, Kashthas^ Kalas, Muhurtas, days and nights, fortnights, months, seasons, solstices, years and Yugas.
Time taken in articulating any of the short vowels (such as A. etc.), is called an Akshi-Nimesha. Fifteen Akshi-Nimeshas make one Kashtha. Thirty Kashthas make one Muhurta. Thirty Muhurtas make one day and night. Fifteen days and nights make one fort- night. A fortnight is either dark or bright. Two fort- nights make one month. The twelve months such as, Magha, etc. are divided into six seasons such as. Winter, Spring, Summer, Rains, Autumn and Hemanta, each consisting of two months.
The two months known as Tapas and Tapasva (Magha and Phalgunai constitute the season of winter. Spring consists of two months called Madhu and Madhava (Chaitra and Vaishaka . Summer is marked by two months known as Shuchi and Shukra Jaistha and Ashadha '. The rains or the rainy season is marked by two months called Nabhas and Xabhasya (Shravana and Bh^dra\ The two months known as Isha and Urja (Ashvina and Kartika) constitute what is called the season of Autumn. Hemanta is marked by two months called Sahas and Sahasya ' Agraha5^ana and Pousha). These six seasons are respectiveh^ characterised by cold, heat, rains, etc.
Chap. VI. 1 SUTRASTHA'NAM.
47
The two Ayanams are ushered in by the sun afid the moon changing their respective courses in the heavens (passing over the tropics of Cancer and Capricorn) as the measurers of time. The rains, autumn and Hemanta follow one another in succession when the sun is over the Tropic of Capricorn or is in the Winter Solstice (Dakshinayanami and the moon gains in strength in this part of the year. Rasas (Serum or sap) possessed of acid, saline and sweet tastes, grow strong and become dominant when the sun is over the Tropic of Capricorn ^Dakshinayanam) and all beings gain in strength and energy more and more. Winter, spring and summer mark the passing of the sun over the Summer Solstice ' Uttarayanam . The sun grows stronger in heat and light, and saps rasas i of bitter, pun- gent and sour tastes increase in intensity, and all animals gradually begin to lose strength and energy.
Authoritative verses on the sub- ject :— The moon imparts the moisture and humi- dity to the earth which is soaked up by the sun in his daily course, while the wind in conjunction with the sun and the moon, contributes towards the preservation of animal life. The successive change of the two solstices marks a year.
Five such complete years count as a Yuga. The sub- divisions of eternal time from the- minutest Ximesha to a complete Yuga, are constantly revolving like a wheel_,
48 THE SUSHRUTA SAMHITA. [Chap. VI.
and this constant or perpetual revolution is called the wheel or C5Tle of time ^,Kala-Chakra 1 by certain authorities.
The six seasons such as, the Rains, etc., have been again adverted to in this chapter for the purpose of fully describing the accumulation, excitation aggravation) and pacification of the bodily humours, such as wind, etc. According to some, the rainy season consists of two months known as Bhadra and Ashvina ; Autumn consists of the two months of Kartika and Margashirshya ; He- manta consists of the two months of Poushaand Magha ; spring consists of the two months of Phalguna and Chaitra ; summer, of Vaishakha and Jaistha ; and Pr^^Tit, of Ashadha and Shravana.
Oshadhis ' Medical plants and cereals sprout during the rains and are enfeebled in their properties. Water becomes muddy or turbid and the earth is covered over with fresh deposits of washed off or silted mud. The sky becomes overcast with clouds, and the wind, charged with an excess of humidity, dulls the appetite and organisms of beings. Hence the food of beings which principally consists of tender and new-grown vegetables of feeble potency, consider- ably vitiated by the turbid water partaken of as drink during the season, proves acid in its digestive reaction, and germinates exce-ssive bile in the human system. In autumn the skv becomes cloudless, the mire is dried
Chap. VI. ] SUTRASTHA'NAM. ^g
up, and the bile originated and accumulated during the rains, is liquefied by the , rays of the sun and gives rise to bilious diseases*
Plants and vegetables (Oshadhis) tlmt grow or sprout during the rainy season, are matured in course of time and ripen in their virtues and potency in the season of Hemanta. The water becomes clear, cool and heavy in this season. The sun's rays become feeble and mild ; and the winds moistened with frost and snow, make the human system a little numb and heavy. Hence water and vegetables partaken of in Hemanta are divested of their properties of acid reaction after being assimilated in the human system, but they give rise to an accumulation of phlegm in the body owing to their heaviness, sliminess, and cooling and oily character. In spring, the phlegm thus accumulated in the body is hquefied and ushers in diseases due to a deranged state of that bodily humour, t
The said plants and vegetables, in their turn, lose their sap, moisture and nutritive element in summer, and become dry and extremely light. In the same manner water becomes drought-making [produces a state of parchedness in the organism — Ruksha] in its virtue,, and considerably loses its natural coolness and
* This should be regarded as the excited, aggravated or agitated state of bile (Pitta) in the parlance of Ayurveda.
i This is called the excited or agitated state of phlegm (Kafa).
50 thp: sushruta samhita. [ chap. vi.
nutritive properties. The sun's rays dry up the natural moisture of the human system, and accordingly water and vegetables largely partaken of in summer, give rise to an accumulation of wind in the system owing to their lightness, dryness, or expansive and drought-making properties. Subsequently wind thus accumulated in the summer, is agitated by the rains and cold winds in the '^Cr^V^rt of the rainy season (V^^vrii) when the ground is flooded witii water and thus gives rise to diseases \v^hich are incidental to a deranged state of the bodily wind.*
The fundamental bodily humours such as, wind, bile, etc. augmented and accumulated during the rains, Hemanta and summer, should be checked as soon as they become aggravated (manifest themselves) in autumn, spring, or in the forepart of the rainy season (Pravrit;.
Diseases which owe their origin to a deranged state of bile, phlegm and wind, are respectivel}'- amelio- rated in Hemanta, summer, and autumn by natural causes, [such as the variations of atmospheric or earthly temperature, rainfall, etc.]. Thus far we have discussed the accumulation, excitation and pacification or alleviation of the deranged bodily humours.
Likewise the features, which specifically mark the different seasons of the year are observed to
* This is called the excited state of wind (Vayu).
Chap. VI. ] SUTRASTHANAM. ^ i
• characterise the different parts of a complete day and
night, [or in other words] .traits peculiar to spring time
exhibit themselves in the morning ; the noon is marked
by all the characteristics of summer r, the evening by
those of the rainy season ; the midnight by those of
autumn ; and the hours before dawn by those of
Ilpmiinta And similarly, like the seasons of the year,
the diffeieftypkiLs'of the day and night arc -/x«.rked b"^
variations of heat, cold, etc. [or in other words] the
deranged bodily humours such as wind, bile, etc.
naturally and spontaneously accumulate, aggravate, or
subside during the different parts of the day as they do
in the different seasons of the year [represented by
those parts of the day and night as stated above].
Water and vegetables retain their natural properties when the seasons are natural, and do not exhibit con- trary features, and they then tend to increase the appetite, vitality, strength, and power of the human system. Contrary or unnatural seasons are but the consequences of sin committed by a whole community and portend the workings of a malign destiny. A season, exhibiting unnatural or contrary features, affects or reverses the natural properties of water and vegetables peculiar to it, which, drunk or partaken of, cause dreadful epidemics in the country. The best safe- guard lies in not using such defiled water and vegetables when an epidemic breaks out in the country.
52 THESUSHRUTA SAMHITA, [ Chap. vi.
Sometimes a town or a city is depopulated by a curse, anger, sin, or by a monster or a demoness conjured up by a spell or incantation. Sometimes the pollens of poisonous flowers or grasses, etc., wafted by the winds, invade a town or a village, and produce a sort of epidemic cough, asthma, catarrh, or fever, irrespective of all constitutional n^^nii-vit^^c kDr'^dei'Un^::! bodily humours agitateS'l^/Lkll^^, fTowns and villages are known to have been depopulated through malignant astral influences, or through houses^ wives*, beds, seats, carriages, riding animals, gems and precious stones assuming inauspicious features.
Prophylactic measures:— In such cases migration to a healthy or unaffected locality, perfor- mances of rites of pacification and atonement, (wearing of prophylactic gems and drugs), recitations of mantras, libations of clarified butter cast into the sacrificial fire, offerings to the gods, celebration of sacrificial cere- monies, obeisance with clasped palms to the gods, practice of penances, sell-control and charity, kindness, spiritual initiation; obedience to one's elders and preceptors, and devotion to the gods and the Bramhanas, and observance of such like rules of conduct may prove beneficial to the affected community.
* Marriages with girls of prohibited description have been known as well to have ushered in an epidemic which devastated a whole town or a country.
Chap. VI. ] SUTRASTHANAM. 53
The characteristic features of the seasons Avhich c|o not exhibit un- natural traits (Metrical texts) -Cold winds from the north blow in the season of Hemanta. The quarters of the sky are enveloped in smoke and assume a dusky aspect. The sun is hid in the frost, and lakes and pools are frozen or lie covered over with flakes, or thin layers of ice. Cro\^'s, rhinoceroses, buffaloes, lambs and elephants become excited and sprightly in this part of the year ; and the Lodhra, Priyangu, and Punnaga trees begin to blossom.
Winter exhibits the same features as above, only in a greater degree of intensity ; and the quarters of the sky are agitated by strong gales of wind and showers of rain.
In spring, when the summits of the mount Malaya are besmeared red with the moist foot-prints of the brides of the Siddhas and the Vidyadharas, and are perfumed in contact with the sweet-scented sandal forests, the lively south- wind is roused up from his lair and winnows gladness to damsels burning with desires, and kindles up the flame of love and appeases the amorous anger of the beloved pairs by turning their fancies to themes of love. The quarters of the sky are cleared up and look joyful. The woods are decked with the full-blown flowers of the Kinshuka, lotus,
54 THE SUSHRUTA SAMHITA. [Chap. VI.
Vakula, mango and Ashoka trees. The bee hums and the notes of the Cuckoo are heard to reverberate through the skies. The south wind fans this king of the seasons, and the forests are hung with the festoons of tender and sprouting leaves in his honour.
The sun's rays become stronger and more intense in summer. Unhealthy winds blow from the south-east. The earth is heated ; the rivers run narrow and shallow in their beds ; the quarters of the sky glare with a blazing light, the birds Chakravakas with their mates roam about in quest of cool ponds and reservoirs of water ; herds of deer are tormented and overwhelmed with thirst ; trees, plants and creepers are scorched by the intense heat, and withered leaves drop off from the trees which alone serve to make the identification of their parents possible.
In the forepart of the rainy season (Pravrit', packs of detached clouds, spangled with lightning and driven before the gales of the west-wind, come thundering over and envelop the skies. The Earth is robed in green with luxurious growth of corn, enlivened here and there by the dark crimson of the cochineal insects (Indragopa), and Kadamva, Nipa, Kutaja, and the Ketaki trees begin to flower.
During the rainy season, the rivers overflow their banks, tumbling down the trees which grow on them. Ponds and lakes are decked with the full-blown Kumud
Chap. VI. ] SUTRASTHANAM.
55
and Nilotpala flowers. The earth is covered with firofuse vegetation. All distinction between dry lands and resers^oirs of water becomes impossible, and the sun and the planets are enveloped in dark clouds that shower torrents of rain but do not roar.
In autumn the sun's rays assume a mellow golden tint. Masses of white clouds are seen to sail the dark deep blue of heaven. Ponds are decked with the full blown lotus flowers, agitated by the wings of the diving swans The high grounds become dry, while the low- lands still retain their muddy character. The level plains are covered with shrubs and undergrowths, and plants and trees such as, Vana, Saptahva, Vandhuka, Kasha and Asana, flower in abundance.
The bodily humours such as wind, etc. aie disturbed and aggravated by the contrariety, excess or vari- ations in the characteristic features of the seasons. Hence it is prudent to check the deranged phlegm in spring, to conquer the deranged bile in autumn, and to subdue the deranged bodily wind in the rains, before they develop themselves in any patent or manifest bodily ailment.
Thus ends the sixth chapter of the Sutrasthanam in the Sushruta Sanihit^ which treats of the characteristic features of the seasons and their influence on health and drugs.
C H A P T E R V I I .
Now we shall discuss the Chapter which treats of Surgical Appliances, their Uses and Construction. (Yantra-VicJhimadhya'yam).
Surgical instruments number one hundred and one * in all, of which the hand is the most important, inas- much as (all of them depend on the hand for • their principal auxiliary) and as none of them can be handled without it ; and further because all sur- gical operations pre-eminentlj^ require its co-operation. Any foreign or extraneous substance, which finds a lodgment in the Inunan system and becomes painful to the body and the mind alike, is called a Shalyam ; and surgical instruments are the means of extracting it (from its seat or place where it is embedded \
(Surgical Appliances may be divided into six different groups or types, such as the Svastika, the Sandansha, the Tala, the Nadi Yantras, and the Shalakas, besides those that are called the minor or accessory appliances (Upa^yantras).
The Svastika instruments (forceps) in their turn, are divided into twenty-four sub-classes ; the Sandansha instruments (tongsi into two ; the Tala Yantras
* According to certain authorities hundred is here indefinitely used for a large number.
Chap. VII. ] SUTRASTHA'NAM. 5-
• into two ; the Nadi Yantras tubular) into twent)^ ;
and the Shalakas (bougies; into twenty-eight ; while the Upa-yantras admit of being divided into twenty- five different types. These instrumeijts are all made of iron which ma}" be substituted for any other similar or suitable substance where iron would be unavailable.
The mouths of these appliances are usuall}' made to resemble those of birds and beasts, and hence they should be made to resemble the mouths of some particular animal in shape, or otherwise, according to the advice of old and experienced ph3"sicians - surgeons;, or accord- ing to the directions as laid down in the Shastras (Medical books of recognised authority, or according to the exigencies of the case, or after the shape and structure of other appliances used on similar occasions.
Metrical texts: — Appliances should be made neither too large nor too small, and their mouths or edges should be made sharp and keen. They should be made with a special eye as to strength and steadiness, and they should be provided with convenient handles.
Appliances of the Svastika class should be made to measure eighteen fingers in length ; and their mouths should be made to resemble those of lions, tigers, wolves, hyenas, bears, cats, jackals, deer, Erv^rukas ;a species of deer, crows, cormorants,
58
THE SUSHRUTA SAMHITA'. [ Chap. Vll.
Kururas la species of birdi, Hasas (a species of sparrow vultures, falcons, owls, kites, herons, Bhringarajas (a species of bird , Anjalikamas, Avabhanjanas, Nandimukhas, and such like beasts and birds. The two blades or halves of a Svastika should be welded together b}- means of a bolt resembling a Masura pulse 1 lentil; in size, and the handles should be turned inward in the shape of a mace, or an Ankusha. Apph- ances of this type should be used in extracting an}' thorn or foreign matter which may have entered into the bones.
Sandanshas tongs are divided into two classes as thev are soldered together with or without a bolt. They should he made to measure sixteen fingers in length, and should be used to withdraw any thorn- like substance from below the skin, tlesh_, veins or nerves.
The Tala Yautras which measure twelve fingers in length, mav be divided into two classes as the siiigle Tala and the double Tala. The former resemble the scales of fish in shape, while the latter, according to certain authorities, are made to resemble the entire mouth of a fish of the Bhetuli species. These Yantras are used in extracting splinters from inside the nose, ears and other external channels or passages ot the body.
The Nadi Yantras tubular instruments like syringe,s
Chap. VII. ] SUTRASTHANAM. ^o
enemas, etc, with a passage or aperture running through their entire .length^ are constructed in a variet}' of shapes and for various purposes. Some of them are open at one end, while others are open at both. These instruments are used for the purpose of extracting any shalyam that has pricked into the external canals or passages of the body, or for inspecting the seat of affection as in piles, etc., or for sucking (blood, etc. from any affected part , or simply as accessories to other surgical appliances. The length and circumference of a Nadi Yantra should be made to commensurate with those of the passage 'Srota'i or outlet of the human system into which it is intended to be introduced. We shall describe, later on, the types of Nadi Yantras which are to be used in connection with such diseases as fistula in ano, piles, etc. or in tumours and ulcers, in Mutradvriddhi (Hydrocele) in Niruddha Prakasha ( Phimosis ), in Niruddha Guda 'Stricture of the rectum) and in ascites, as well as those to be used for the purpose of injecting anything into the urethra, the bowels, the vagina and the uterus, or are used in connection with medicated inhalation, or with those that are known as the Alavu Yantras (gourd used for cupping).
The Shalaka- Yantras bougies are of various shapes and serve a variety of purposes. The lengths and girths of these instruments should be determined
6o THE SUSHRUTA SAMHITA. : Chap. vil.
according to the necessity of each individual case. Four probes or directors shalaka in two pairs, are used for the purposes of searching Eshana pus in a suppurated part or limb, or in connection with uplifting, cutting and thereby withdrawing a shalyam from the part it has pricked into, or with a view to transfer such a body from one place to another Chalanam , or for the purpose of extracting it i Shalyam from the affected part. The mouths of the two types of these directors respectively resemble those of a Gandupada earthworm and of a Sharapunkha Tephrosia Purpurea, Pers while the other two are respectively headed like the hood of a serpent and a fish hook. A couple of directors are used for the pur- pose of withdrawing a foreign matter 'Shalyam; imbedded in any outer canal of the body (Srotas ). The top-ends of these directors are bent down a little, and they resemble a lentil seed in size. Six types of directors or probes are used in cleansing the pus from an affected part of the human organism ; and their top-ends are fitted with caps of loose cotton. The three sorts of directors used in applying alkaline medicines, are shaped like ladles, and their mouths resemble the cavities of little stone mortars (Khala.) Of the six sorts of directors used in connection with the process of cauterisation (Agni- Karma) three are mouthed like the Jamboline fruit, while the other three are faced like a mace or a spear (^Ankusha. . A kind of director used in removing nasal
Chap. VII. ] SUTRASTHANAM. 6l
tumours, is mouthed like the half of the kernel 'found in the inside of a Jujube-stpne, with a little dip in the middle, its lip or end having a keen or sharp edge. The ends of the type of probe used in applying Anjanams medicated collyria to the eyelids are wrought into two small round lobes like the Matara pulse and are blunted, while the sort of probe used in cleansing the urethra, is made round like the end of tht; stem of a Mdlati flower.
The Upa-yantras or minor surgical accessories — include such substances as rope, the Venika (braided hair;, silk thread, the bark and the inner-skin of trees, creepers, linen, Ashthila 'stones , large oval shaped pebbles, a hammer, the palms of the hands, the soles of feet, fingers^ tongue, the teeth, the nails, hair, the mane of horses, branches of trees, a magnet, alkali, fire, and medicine, and such acts as spitting, straining (kunthanam;, exhilaration and intimidation.
IVIetrical texts : —These accessories should be applied to the entire body of a patient, or to any part thereof such as, the arteries, the ^'iscera, or the joints, according to the necessities of each case to be determined by the surgeon.
The Functions of Surgical Instru- ments : — are striking out Nirghatanam-lit : — with- drawing a Shalyam by moving it to and fro), mjection or filling, binding, up-lifting, cutting and
62 THE SUSHRUTA SAMHITA. [Chap. vii.
thereby withdrawing a Shalyam, resetting by means of a twirling motion, removing of a Shalyam from one place to another, twisting, expanding, pressing, purifying of a passage, drawing off, attracting, bringing to the surface, uplifting, lowering down, applying pressure all round a part, or an organ, agitating, sucking, searching, cutting or cleaving, straightening, washing or flushing, stuffing the nose and cleansing. They number twenty-four in all.
IVIctrical texts :— The intelligent surgeon shall exercise his judgment and determine the nature of the surgical operation required in each individual case, for surely the shalj^as requiring a surgeon's aid are infinitely varied in their character.
An appliance A^antraUvhich is too thick, or. made of inferior metal and hence) not substantially made, or too short or too long, or does not admit of being easily handled and is incapable of taking in the entire Shalyam, or is curved, loosely fitted, or soft-bolted, or loosely tied up with cords, 'should not be used in surgical operations). These are the twelve defects of a surgical instrument.
Metrical texts : — The use of an instrument
devoid of the abovesaid defects and measuring eighteen
fingers in length, is commended in surgical operations,
Shalyas which are manifest and visible to the naked
eye, should be extracted with the instruments of the
Chap. VII. ] SUTRASTHA'NAM, 6^
Sinha-mukha (lion-mouthed) type, while those that can not be seen, should be removed with the help of the Kanka-mukhas ( heron-mouthed ) instruments, etc., according to the directions laid down in the Shastras medical or surgical works of recognised authority). The Kanka-mukhas are the best of all other types of instruments, inasmuch as the}'- can be inserted and taken out without the least difficulty, are capable of drawing out a'Shalyam with the greatest ease, and are applicable to all parts of the human body 'be they an artery or a bone- joint.)
Thus end.s the sevenih chapter "( ihc SiUiasthSnam of the Sushruta SamhitS which treats of the shape, construction and dimensions of surgical appliances.
C H A P T E R V I I I.
Now we shall discuss the Chapter which treats of instruments used in connection with a surgical operation. (Shastrarvacharaniyamaclhya^am).
These instruments are twenty in number such as, the Mandalagram, the Karapatram, the Vriddhipatram, the Nakhashastram, the Mudrik^, the Utpalapatram, the Arddhadh^ram, the Suchi, the Kushapatram, the Atemukham, the Shardrimukham, the Antarmukhanij the Trikurchakam, the Kuth^rika, the Vrihimukham, the Ar^i, the Vetasapatrakam, the Vadisha,the Dantashanku, and the Eshani.*
■ The MandaMgram measures six fingers in length and is provided with a round or circular face. The Karapatram is the same as the modern saw. The term Vriddhipatram signifies a razor. A Vriddhi- patram measures seven fingers in length, the handle alone measuring five fingers. The Nakhasastram is the same as the modern nail-clipper, the blade of the instrument measuring a finger in breadth. The Utpala- patram resembles a lotus leaf in shape. The Arddhadhfiram (lancet) measures eight fingers' breadth' in length, being one finger broad at the middle, and two fingers at the blade. The Suchi. is the same as the modern needle. The Kushapatram is so called from its resemblance to the blade of a Kusha-grass. An Atemukham resembles the bill of a bird of the Ate species. The blade of an Atemukham measures two fingers in length, the handle measuring five fingers and thus giving an entire length of seven fingers. The SharSrimukham (scissors) is so-called from the resemblance of its blades to the bills of a Shariri bird and looks somewhat like a modern black-smith's clipper, the measure of its entire length being twelve fingers. The Antarmukham is semicircular in shape and is provid- ed with a toothed edge like that of a hand-saw. The Trikurchakam (trocar) is provided with three separate blades. The intervening space between the couple of blades attached to a handle measuring five fingers in length, is equal to ihe width of a Vrihiseed, its entire length being eight fingeis.
Chap. VIII. ] SUTRASTHANAM. 65
Of the abovesaid instruments the Mandalagram and the Karapatram should be 'used in incising and scraping. The Vriddhipatram, the Nakhasastram, the Mudrik^, the Utpalapatram, and the Arddhadharam, should be employed in incising f Chhedanam ) and excising (Bhedanani) ; and the Kushapatram, the Shuchi, the Atemukham, the Shararimukham, the Trikurchakam and the Antarmukham should be made use of in exudating or secreting (Visravanam.i The Kutharika, the Vrihimu- kham, the Ara, the Vetasapatram and the Suchi (needle) should be used in puncturing. The Vadisha and the Danta-Shanku should be used in extracting sohd bodies. The Eshani 1 probe or director) in probing or search- ing the course or direction of the pus (in a suppurated part), and the Suchi (needle; should be used in suturing. Thus we have explained the eight different func- tions ol the instruments in connection with surgical operations.
The kutharika (small, blunt axe) measures seven lingers and a half in liic handle, the blade is half a finger in width and is blunted like the tooth of'a cow. The Vrihimukham measures six fingers in its entire length and its top is like that of a Vrihi seed, and the edge is cut into small thorn- like projections. The Ar5 resembles the awl of a cobbler and measures ten fingers in its entire length, the blade is wide as the seed of a sesamum and has the girth of a Durva (grass) stem. The Vetasapatram (knife) resembles the leaf of a Vetasa plant. The blade is four fingers in length, one finger in width, and is keenly edged, the handle measur- ing four fingers in length. The Vadisha is shaped like a modern fishing hook. The Danta-shanku (pincers for extracting teeth) somewhat resembles the Vrihimukham in shape. The face of an Eshani (probe) is like that of a Gandupada (earth-worm). 9
66 THE SUSHRUTA SAMHITA. [ Chap. Ylll.
No^v we shall deal with the mode ol handling the abovesaid instruments. — The Vriddhipatram and other instruments for excising (Bhedanam; should be caught hold of at a part between the blade and the handle. In acts of scraping the Vriddhipatram and the MandaUgram should be handled with the palm of the hand slightly turned up. The instruments for secreting should be caught hold of at the roots of their blades at the time of using them, while in the case of a king, an old man, a timid or a delicate person, a child, a woman and specially in the case of a prince of the royal blood, the Trikurchakam should be used when any secreting or exudating opera- tion would be necessary. The handle of a Vrihi- mukham should be kept concealed within the palm of the hand and the blade should be caught hold of with the thumb and the index finger (Pradeshini). The Kuth^rika should be first supported on the left hand and then struck with the thumb and third finger of the right. The Ara, the Karapatram and the Eshani, should be caught hold of at their roots. The rest of the surgical instruments should be grappled according to requirements.
The abovesaid instruments are shaped like things which their very names imply, as ha^^e been al- ready described. The Nakashastram and the Eshani measure eight fingers in length. The Suchi (needle)
Chap. VIII. ] SUTRASTHA'NAM. 67
shall be described later un. The top-ends of the Vadisha and the Danta-Shankhu pental pincers'; are a little bent down and their faces are made to resemble sharp thorns, or the newly sprouted leaves of a barley plant. The top-end of an Eshani closely resembles the mouth of an earth-worm. Tlie lenj^th of a Mudrika should be made equal to that of the top phalanges of the index finger 'of a man of avera'ge height.) A Shararimukham measures ten fingers in length. The rest of the instruments are mostly made to measure six fingers in length.
Commendable features in a Surgi- cal instrument : —Instruments that are fitted with handles of easy grip and are made of good and pure iron, well shaped, sharp, and are set with edges that are not jagged and end in well formed points or tops, should be deemed as the best of their kind.
Curvature, bluntness ( Kuntha— lit :— incapable of cutting hair , unequal sharpness of the edge, rough- edgedness, over- thickness, over-thinness, over-lengthi- ness, and over-shortness are the defective traits in a surgical instrument. Those possessed of contrary features should be used. But a Karapatram set with a very rough (dentated) edge may be used for the purpose of sawing the bones.
A surgical instrument meant *'or excision 'Bhedanann should be set with an edge as thin as that of a Musura
68 THE SUSHRUTA SAMHITA'. [ Chap. VIII.
pulse 'lentil seed , while an instrument used in scraping should be set with an edge half as thin as that of the former. An instrument used either in connection with the measures of secretion or cutting by uplifting (Vyadhanam) should be set with an edge as fine as the human hair, while an instrument of incision should have an edge half as thin as that of the former.
Surgical instruments should be tempered with one of the three substances such as, alkali, water, and oil. Instruments used in cutting an arrow, a bone, or any foreign matter (Shalyami pricked into the human body, should be tempered with alkali, whereas those that are made use of in cutting, cleaving, and lopping off the flesh from an affected part), should be tempered with water. Instruments used in opening Vyadhanam) a vein (Shira) or in cutting open a nerve .Sna)^!: should be tempered with oil, and should be whetted upon a species of stone-slab resembling a Masha pulse in colour, and their set- edge should be protected by putting it in a sheath made of Sh^lmali wood.
Authoritative verses on the sub- ject :— An instrument, well-ground, well-shaped, fitted with a convenient handle and capable of (laterally) cutting a hair in two and made according to measures laid down in the Shastras, should be alone used in a surgical operation.
Chap. VIII. ] SUTRASTHA'NAM. 6g
The Inferior or substitutive instru- ments (the Anu-Shastras : — The skin of bamboos, crystals, bits of glass, Kuruvindas Ca sort of crystal"* leeches, fire, alkali, nails, the leaves of trees known as Goji, Shephalika and Shakapatra, the tender sprouts of corn, hair, and the fingers, should be included within the category of the minor instruments of surgery and (which may be used in certain instances in substitution for the principal and usual ones.
Metrical texts :— The four articles such as strips of bamboo skin, crystals, bits of glass, and the rock known as Kuruvinda, should be used by an intelli- gent physician in incising or excising Bhedanam i opera- tions, where the patient would be found to have a dread of the knife, or too young to be surgically operated upon with it, or where the proper instrument cannot be pro- cured. The nails of fingers should be used in operations of incising, excising or extracting in (substitution for the instruments enjoined to be used for the purpose), when such a course would appear feasible. The processes of applying alkalis, leeches and cauterisation will be dealt with later on. In Diseases affecting the eyelids or the cavity of the mouth, operations for the purposes of secreting or evacuating 'the accumulated pus or phlegm), may be performed with the leaves of Shakapatra, Shephalika or Gojis. In the absence of a probe or director, searching may be done with the help
^o
THE SUSHRUTA SAMHITA. L Chap. vili.
of a finger, or with a hair, or with a corn sprout. An intelligent physician should deem it his im- perative duty to get his surgical instruments made by a skilful and experienced blacksmith, and of pure, strong and sharp iron steel >. A physician, skilled in the art of using surgical instruments, is always successful in his professional practice, and hence the practice of surgery should be commenced at the very outset of medical studies.
Thus ends the eighth chapter of the Sutrasthiinam in the Sushruta SamhitS which treats of Surgical|Instruments.
CHAPTER IX. Now we shall discuss the Chapter which treats of practical instructions in surgical operations (Yogya- Sutra).
The preceptor should see his disciple attends the practice of surgery even if he has already thoroughly mastered the several branches of the science of Medicine, or has perused it in its entirety. In all acts connected with surgical operations of incision, etc. and injection of oil, etc. the pupil should be fully instructed as regards the channels along or into which the operations or applications are to be made (Karma-patha\ A pupil, otherwise well read, but uninitiated into the practice (ol' medicine or surgery) is not competent > to take in hand the medical or Surgical treatment of a disease . The art of making specific forms of incision should be taught by making cuts in the body of a Pushpaphala (a kind of gourd , Alavu, watermelon, cucumber, or Ervaruka. The art of making cuts either in the upward or downward direction should be similarly taught. The art of making excisions should be practically demonstrated by making openings in the body of a full water-bag, or in the bladder of a dead animal, or in the side of a leather pouch full of slime or water. The art of scraping should be instructed on a piece of skin on which the hair has been allowed to remain. The art of venesection
72 THE SUSHRUTA SAMHITA. [Chap. IX.
c
(Vedhya) should be taught on the vein of a dead animal, or with the help of a lotus stem. The art of probing and stuffing should be taught on worm (Ghuna) eaten wood, or on the reed of a bamboo, or on the mouth of a dried Alavu (gourd). The art of extracting should be taught by withdrawing seeds from the kernel of a Vimbi, Vilva or Jack fruit, as well as by extract- ing teeth trom the jaws of a dead animal. The act of secreting or evacuating should be taught on the surface of a Shalmali plank covered over with a coat of bee's wax, and suturing on pieces of cloth, skin or hide. Similarly the art of bandaging or ligaturing should be practically learned by tying bandages round the specific limbs and members of a full-sized doll made of stuffed linen. The art of tying up a Karna-sandhi (severed ear-lobe) should be practically demonstrated on a soft severed muscle or on flesh, or with the stem of a lotus lily. The art of cauterising, or applying alkaline preparations \^causticsj should be demonstrated on a piece of soft flesh ; and lastly the art of inserting syringes and injecting enemas into the region of the bladder or into an ulcerated channel, should be taught (by asking the pupil) to insert a tube into a lateral fissure of a pitcher, full of water _, or into the mouth of a gourd (Alavu).
Authoritative verses on the sub- ject :— An intelligent physician who has tried his
Chap. IX. ] SUTRASTHANAM. 73
prentice hand in surgery ion such articles of experiment as, gourds, etc., or has learnt the art with the help of things as stated above , or has been instructed in the art of cauterisation or blistering (application of alkali) by experimenting on things which are most akin, or simi- lar to the parts or members of the human body they are usually applied to, will never lose his presence of mind in his professional practice. >
Thus ends the ninth chapter of the SutrasthSnam in the Sushruta Samhit^ which treats of Instructions in Surgical operations.
10
C HAPTER X.
Now we sliall discuss the Chapter wliich treats of the essential qualifications of a physician before he formally enters his profession (Vishlkha'-
nupravcshaniya-madhya'yam).
A physician haying thoroughly studied the Science of medicine, and fully pondered on and yerified the truths he has assimilated, both by obseryation and practice, and haying attained to that stage of (lucid ) kno^vledge, ^yhich \yould enable him to make a clear exposition of the science (^vhene^■er necessary), should open his medical career conmience practising) with the permission of the king of his country. He should be cleanly in his habits and well shaAed. and should not allow his nails to grow. He should wear white garments, put on a pair of shoes, carry a stick and an umbrella in his hands, and walk about with a mild and benignani look as a friend of all created beings, read}- to help all, and frank and friendly in his talk and demeanour, and neyer allow- ing the full control of his reason or intellectual powers to be in any way disturbed or interfered with.
A physician, haying met with a messenger of happy augury, or having been encouraged on his journey by the notes of auspicious birds or sights, should go to the house of his patient. [Then, haying entered the
Chap. X. ] SUTRASTHANAM. >jz^
sick room], the physician should \ie\v the bod>' of his patient, touch it with his own hands, and enquire (about his complaint . SeNcral authorities hold that these three, (inspection, touch and questioning; largely form the means of our ascertaining the nature of a disease. But that is not correct, inasmuch as the five sense- organs of hearing, sight, etc. and oral enquiry material- ly contribute to a better diagnosis.
Diseases, which are to be diagnosed with the help of the organ of hearing, will be fully treated, later on, in the Chapter on Vrana-Srava (secretions from an ulcer). The wind (Vayu), making the blood ebullient, forces it up with a distinctly audible report and thus affects the sense of hearing. But this will be dealt with later on in the abovesaid chapter. The heat and coldness of the body, or the gloss, roughness, hardness, or softness of the skin of the affected part as in fever, or in an oedematous swelling of the body, are perceptible by the sense of touch. Fullness or emaciation of the body (cachexia), state and indications of ^■itality, strength, complexion, etc. are perceived by the sense of sight. Secretions or discharges (from the inflamed mucous membrane of the urethral in Prameha etc., should be tested with the organ of taste.* The characteristic smell emitted
* The .-jwecl, ur an}' olher ta.'^lc of ihe dibcharj^eb should Ijt; inleiicd from the fad of iheir bting or not being swarmed wiili hosts of ants or flies, etc.
76 THE SUSHRUTA SAMHITA. [ Chap. X.
by an ulcer in its critical stage f Arishta) should be determined with the help of the organ of smell.
While such facts as the time or season (of the first appearance) of the disease, the caste which the patient belongs to, and things or measures which tend to bring about a manifest amelioration of the disease, or prove comfortable to the patient (Satm3'ami as well as the cause of the disease, the aggrava- tion of pain, the strength of the patient, and his state of digestion and appetite, the emission of stool, urine and flatus, or their stoppage, and the maturity of the disease as regards time, should be specifically ascertained by directly interrogating the patient (on those subjects). Though the abovesaid five organs of sense, like the three fundamental vital humours, help us to make the correct diagnosis of a disease, still the objects locally perceived by these senses should not be left out of account in ascertaining its specific nature.
Authoritative verse on the sub- ject : — A disease wrongly observed or incorrectly described, or wrongly diagnosed, is sure to mislead a physician.
Ha^'ing made these observations the physician will try to cure diseases that are curable, adopt palliative measures in cases where palliation is the only remedy that can be offered, and give up a case which is beyond
Chap. X. ] SUTRASTHANAM . ^7
all medical treatment, and mosth' those which are of more than a year's standing. Diseases affecting a Br^hmana well versed in the Vedas_, or a king, or a woman, or an infant, or an old man, or a timid person, or a man in the royal service, or a cunning man, or a man who pretends to possess a knowledge of the science of medicine, or a man who conceals his disease, or a man of an excessively irascible temperament, or a man who has no control over his senses, or a man in extremely indigent cir- cumstances of life or without any one to take care of him, are apt to run into an incurable type though appearing in a common or curable form at the outset. The physician, who practises his art with a regard to these facts, acquires piety, wealth, fame and all wished for objects in life.
Authoritative verse on the sub- ject : — A physician should abjure the company of women, nor should he speak in private to them or joke with them. A physician is forbidden to take anything but cooked rice from the hands of a woman.
Thus ends the tenth Chapter of the Sutrasthanam in the Sushruta Samhiti which treats of the essential qualifications of a physician.
CHAPTER XI.
Now we shall discuss the Chapter which treats of the pharmacy of alkalis or potential cauteries (KshaTa- pa'ka-vidhi-madhya'yam).
In cases that require incising, excising and scraping, alkalis or alkaline preparations are of greater importance than surgical instruments and appliances (both principal and secondary or substitutive, as they are possessed of the virtues of subduing the three deranged bodily humours such as wind, bile and phlegm).
The etymological signification of the term Kshara (alkalis) is based on their property of corroding i the skin or the flesh of an affected part of the body), or on their peculiar quality in destroying the skin and flesh where such an effect is desired . Since a variety of substances enter into the composition of Kshara alkalis , they are endued with the virtue of subduing the three deranged bodily humours. Owing to their white colour, Ksharas should be included within the category of cooling substances ( Saumya'.
But since many drugs or substances of a hot or fiery nature ( Agneya) enter into their composition, KshiCras (alkalis) are endued with the properties of blistering, burning, suppurating • Pachana >, opening etc., without
Chap, XI. 1 SUTRASTHA'NAM,
79
involving any contradiction to their generic iSanimya) nature, and lience the}- are included within the list of those substances which are both hot and cooling (Saum^^a and Agne^'a in their ^'irtues. The}' are pungent in taste, of a heat- making potency, irritant, digestive, corrosive, absorbent, liquefacient, improve unhealth}' sores and granulation, and act as styptic and paralysing agents. They exercise destructive action on aaimal tissues. They are antitoxic, anthelmintic and possess the propert}- of curing mucous accumu- lations in the intestines. They tend to reduce fat and phlegm and they have the ^'irtue of destroying skin diseases. In large doses, 'alkalis) have the effect of destroying the virile potency of a man.
Kshara (caustics may be grouped under two distinct heads according to their mode of administration \ such as the Pratisaraniya i for external application) and the Pania i alkaline potions . Alkaline preparations should be externally used in such skin diseases as Kitima, Dadru, Kilas, Mandala, Fistula in ano, tumour, bad ulcer fDushta Vrana', sinus, Charma-kila, Tilkalaka, Nacchya, Vyanga, Mashaka and external abscesses and hoemorrhoids. In cases of worms and poisoning as well as in the seven forms of diseases which affect the cavity of the mouth, such as Upajihva, Upakusha, Danta-Vaidarbha, and in the three types of Rohini, external applications of alkalis act like substitutive
go THE SUSHRUTA SAMHITA'. [Chap. XI.
surgical instruments. Alkaline potions or any other internal use of alkalis, should be prescribed in cases of Gulma (abdominal glands;, Ascites, loss of appetite, indigestion, flatulent distension of the abdomen with suppression of stool and urine, urinary calculi, stone in the bladder, internal abscesses, worms in the intestines and hcemorrhoids, as well as for subduing or eliminating any sort of poison from the system.
Alkalis or alkaline potions will prove positively injurious to a patient laid up with fever or hsemoptysis, to a man of bilious temperament, to an infant, or to an old man, and they will work similar mischief in a weak person, or in a patient suffering from vertigo, insensi- bility, syncope and Timira (darkness of vision). These preparations of Alkalis should be made in one and the same way b}- filtering ; and we reserve the full description of this process for another occasion.
Alkalis for external application are prepared in three different potencies ; the mild, middling and strong (extremel}' irritant'. A physician wishing to prepare such an alkali, should first purif^^ his body and mind, and observe a l^st on a day in autumn marked by auspicious astral combinations. Then having ascended the brow of a hill, he should select a full grown Ashita-mushka (Ghanta parul i tree of middle age, and growing on soil recommended in the works on pharmacy and not anywise affected. Then having
Chap. XI. SUTRASTHANAM. 8l
formally invoked the spirit of the aforesaid tree, which bears no white flowers) the physician should fell it on the day following, — reciting the Mantra which reads as : — " O thou possessed of mighty virtues, O thou endued with fiery potency, may thy potency never decrease or vanish. Stay here, O thou blissful one, execute my work, and after the performance thereof thou shalt be at libert}- to ascend to the heavenly regions."
Then haA'ing performed the Homa ceremon}' with thousands of white and red flowers, the physician should cut the wood of the abovesaid tree into small pieces and put them in a place pro- tected from the wind. Then having placed pieces of unslaked limestone over them, the physician should burn them to ashes with the lighted faggots of dried sesamum plants. Then after the fire has fairly burnt itself out, the ashes of the limestone and the Ghanta-parula wood should be separately collected and stored. Similarly the wood as well as the leaves, roots and fruits of Kutaja, Palasha, Ashva- karna, Paribhadra, Vibhitaka, Aragvadha, Tilvaka, Arka, Snuhi, Apamarga, Patala, Naktamala, Vrisha, Kadali, Chitraka, Putika, Indra-Vrilvsha, Asphota, Ashvamaraka, Saptachchhada, Agnimantha, Gunja, and the four species of Koshataki, should be burnt
down to ashes. II
S2 THE SUSHRUTA SAMHITA'. [Chap. XI.
Then a Drona measure of the ashes thus prepared* should be dissolved and stirred up in six Drona measures of pure water or cow's urine, and be filtered twenty-one times in succession. The ('alkaline water filtered as abo\-e) should ])e kept in a large caldron over a fire and boiled by gently agitating it with a ladle. . It should be taken down from the fire when bv gradual stirring, the saturated water would appear transparent, slimy, red and irritating. It should then be filtered through a piece of clean linen, and the dregs thrown away. After this a Kudava measure and a half 12 Palas) of the (abovesaid) saturated or alkaline water should be taken out of the caldron, and the rest should be again kept boil- ing over the fire. Following this, substances laiown as Kata-Sharkara, the ashes of the burnt limestone pre^■iously obtained, Kshirapakas (fresh water oysters) and Sankhanabhi, should be burnt red hot in equal proportions, and then immersed and pressed in the Kudaba measure of alkaline water previoush" set apart in an iron basin as above described.
Then having immersed eight Pala measures of the substances known as the Shankhanabhi etc., in the abovesaid alkaline water, the physician should boil it by continuous and steady stirring, care being
* Two piuia of tht buinl ashes of Ghanla-panila and one pari of ihc ashes of Kuiaja, n^Ic.
Chap. XI. ] SUTRASTHA'NAM. 8
o
taken not to make it of too thin nor of tod thick a consistency. Then the basin or the caldron should be taken down from the oven, and its contents poured into an iron pitcher, carefully covering its mouth after filling it. The alkali thus prepared is called the Kshara (alkali of middling potency, which, if prepared without the subsequent addition (lit : throw-over) of the ashes of Katasharkara, etc., goes by the name of mild alkali 'IVLi-idu Kshara). Similarly, alkali prepared with the addition of the powders of the drugs known as Danti, Dravanti, Chitraka, Langulaki, Putika- Pravala Talpatri, \'idha, Suvarchika, Kanaka-Kshiri, Hingu, Vacha, and Visha, or with as many of them as are available, each weighing four tolas, is called the strong Kshara (extremely irritating alkali). These alkaline pre- parations of different potencies, should be severally used in cases where their adnn'nistrations would be clearlv indicated. An alkaline preparation, any way weakened, should be strengthened by adding to it alkaline water (water saturated with an alkali) as before described.
Authoritative verses on the sub- ject ; The commendable features in an alkali are based on its whiteness, on its being neither too mild nor too strong, on its gloss and sliminess, on its sticking to the place of application, and on its power of secreting (Abhisyandi the morbid fluid, and on its rapid effect. On the other hand, its defective traits consist in its being
8^ THE SUSHRUTA SAMHITA. | Chap. XI.
too m'lld, of excessive whiteness, excessive strength or
irritability, of over-sliminess, excessive stickiness or
thickness, insufficient boiling, and insiifiiciency of component ingredients.
A patient laid up with a disease amenable to an application of alkali potential cautery or caustic) should be kept in a spacious chamber, and should not be ex- posed to draughts and to the hot rays of the sun, [Then the physician having secured] the necessary appliances etc, as already laid down in the Chapter V, should view the part of the patient's body to which the alkali is to be applied. The affected part should be then* rubbed or scarified t with an alkali, and covered overt with a piece of linen. The alkaline prepara- tion should be applied with a rod or director* and kept undisturbed for a period needed to articulate a hundred long letter sounds).
Metrical texts : The perfect burning (blis- tering, should be inferred from the black colour of the skin of the affected part. Madhuka and the substances included within the Amla-varga (group of acid drugs) pasted with clarified butter, should be applied to allay the incidental burning isensation). A plaster composed
♦ In a case brought about by (Pitta) ascendency of the deranged bile.
t It sliould be scraped with the alkali where the skin would appear hard and benumlied owinp; In ihc action of the deranged vital winds (V5yu).
i In a case of deranged phlegm (Kafa) the affected part being marked by itching and swelling.
Chap. XI. ] SUTRASTHA'NAM. g^
of the shreds of Amla-Kaiijika, sesamum and Madhiikam taken in equal parts, and pasted together, should be applied to the part burnt with an alkali ; in the event of the latter having failed to produce the desired effect owing to the disease being deepl}" seated. Madhukam and the Kalka paste of sesamum mixed with clarified butter would cause such an incidental; ulcer to heal.
Now you may ask the question how can an acid subst'ance, which is fiery in its virtue and heat-making in its potency, tend to subdue the effects of an alkali which is possessed of similar virtues and properties, instead of augmenting them, as can naturally be apprehended ? Well my child, the question can be fairly answered by stating, that substances of all tastes enter into the composition of an alkali except the acid one. The pungent (Katu : taste is the principal taste of an alkali, while the saline :Lavana forms its minor or accessory flavour LAnurasa). Xow this saline taste in conjunc- tion with the acid one renounces its extremely sharp or irritating property and is thus transformed into one of sweetness or of soothing virtue. Hence it is that an acid taste tends to alla)^ the burning incidental to an application of alkali (potential caustic) in the same way as water tends to put out fire.
An operation of perfect cauterisation with an alkaline application brings about an amelioration of the disease, or the disease is entirely subdued, accompanied by
86 THE SUSHRUTA SAMHITA'. [ Chap. XI.
Hghtne^ss of the limbs and absence of secretion from the affected part ; while an insufficient burning [of the part] is generally attended by symptoms of aggravation of the malad}' and also gives rise to local pain, itching and numbness, [On tire other hand], excessive burning [of the part] with an alkaline preparation may ha^'e a fatal termination, and is attended by such symptoms as burning, suppuration, redness, secretion in and from the seat of affeqtion. A feeling of languor and fatigue comes upon the patient accompanied with thirst, swooning and an aching sensation. An ulcer incidental to a burn by an alkali should be treated with a special eye to the nature of the disease and the deranged bodily humour specifically involved in the case.
A weak person, an infant, an aged person, a man of timid disposition, a patient suff'ering from abdominal dropsy with general anasarca or from haemoptysis, a pregnant woman, a woman in her menses, a person suffering from an attack of high fever or urethral discharges, or emaciated with chronic inflammation of the lungs, or a person subjected to fits of faint- ing or abnormal thirst, or a person suffering from virile impotency, or whose testes ha^'e become deranged either upwards or downwards, or a woman suffering from retro\'ersion or introversion of the uterus or prolapsus of the vagina, should be deemed
Chap. XI. ] SUTRASTHANAM. 87
unfit for being cauterised with alkalis. More- over their application is. not to be sanctioned over the veins, nerves, joints, gristles or tender bones or cartilages, sutures, arteries, throat, umbilicus, genitals, regions of Srotas (external channels), parts covered over with a thin layer of flesh, inside the nails and other vulnerable parts of the body, nor in diseases of the eyes, excepting those which affect the eyelids.
Alkalis fail to produce any beneficial effect in a patient suffering from oedema of the limbs, or suffering from bone- ache, or laid up with a disease affecting the joints or the heart, or in a person of impaired appetite who has lost all relish for food, even when their use is otherwise indicated.
Authoritative verse on the sub- ject : An Alkali adnn'nistered by an ignorant phv- sician is to be dreaded more than poison, fire, blows with a weapon, thunder-bolts, or death itself ; while in the hand of an intelligent physician it is potent enougli to speedily subdue all serious diseases in which its use is indicated.
Thus ends the eleventh Chapter of the Suliasthanam in the Siishiuta Samhita which treats of the Pharmacv of AlkaHs.
C H A PT E'R XII.
Now we shall discuss the Chapter which treats of cauteries and the rules to be observed in their use
(Agni-Karma-Vidhimadhyayam).
A fire (cautery ) is better than an Alkali as far as its healing property is concerned. A disease burnt with fire, is cured for good and knows no recrudescence ; and diseases which ordinarily baffle the skill of a surgeon or a physician, and never prove themselves amenable to medicinal or surgical remedies, are found to yield to fire I cauterisation .
The following drugs, articles and substances should be understood as accessories to an act of cauterisation, viz., Pippali, the excreta of goats, the tooth of a cow I Godanta'', Shara, a rod, the surgical instrument known as the Jamvavaustha, articles made of copper or silver, honey, treacle, oil, or any other oily substance. Out of these, Pippali, the Godanta, Shara and the rod should be (made red hot and) used in cauterising the affected part in a disease which is restricted only to the skin ; similarly the surgical instsument known as the Jamvavaustha, as well as the appliances made of copper or silver should be used in a disease which is seated in the flesh. Honey, treacle and oil should be (boiled and employed in cauterising the disease
Chap. XII. ] SUTRASTHANAM. 89
which affects any of the veins, nerves, bones or'bone- joints.
Cauterisation is admissible in all seasons of the year except summer and autumn; but no such distinction should be observed in cases of impending danger, when it should be practised with the help of such appliances of a contrary (cooling) nature, [as wet sheets, cooling drinks and cooling plasters, etc.]
In all diseases and in all seasons of the year, the patient should be fed on a diet of slimy (mucilaginous) food before actually applying the cautery ; while the patient should be kept on an empty stomach before the act where the complaint would be a case of Mudagarbha rfalse presentation), fistula in ano, haemorrhoids or a disease affecting the cavity of the mouth.
According to certain authorities the processes of cauterisation may be grouped under two heads according as the skin or the flesh is cauterised. The present work does not lay an}^ injunction against the cauterisation of any nerve, vein, bone or bone joint (as stated before). A burning of the skin is accompanied by a peculiar bursting or cracking sound. The skin becomes con- tracted and emits a fetid smell. Similarly, in a case where the flesh is burnt, (the affected part) assumes a dove color of (blackish brown), marked by pain and a little swelling, and the incidental ulcer becomes dr)' and contracted. In the case where a nerv^e or a vein
12
90
THE SUSHRUTA SAMHITA'. [ Chap. Xll.
is burnt, the ulcer presents a raised (elevated) and black aspect with the stoppage of all secretions ; while an ulcer incidental to the cauterisation of any of the bone joints has a parched red hue and becomes hard and rough.
The regions of the eye-brows, forehead and temple- bones, should be cauterised in diseases affecting the head as well as in a case of Adhimantha (Ophthalmia). In diseases affecting the ej'elids the eye should be covered over with a moist piece of Alaktaka (a thin pad of red pigment principally used in d3'eing the feet of ladies) and the roots of the eyelashes should be duly cauterised. Cauterisation is specificall}' enjoined to be resorted to incases of glandular inflammation, tumour_, fistula in ano, scrofula, elephantiasis, Charmakila, warts, Tilakalaka, hernia, sinus hoemorrhage, and on the occa- sion of cutting a vein or a bone joint, as well as in the event of the vital wind (Vayu) being extremely agitated and lodged in the local skin, flesh, vein, nerves and the bone-joints and giving rise to excruciating pain in and about the ulcer which in consequence presents a hard, raised and inert surface.
The modes of cauterisation vary according to the
seat of the disease, and number four in all, viz., the
Ring, the Dot, the Lateral or Slanting lines, and the Rubbing modes.
Chap. XII. ] SUTRASTHANAM.
91
Authoritative verse on the subject : —
A physician, after having tarefully considered the seat of the disease and judiciously ascertained the patient's strength and the situations of the Marmas the vital parts of the patient's') body, should resort to cauterisation with an e3''e to the nature of the malady and the then prevailing season of the year.
>
The part, after being properly cauterised, should be rubbed with an unguent composed of honey and clarified butter. A man of bilious temperament or with a quantity of bad blood lying stagnant and locked up in any part of his bod}', or of lax bowels, a person with any foreign substance (such as a thorn or a splinter still lodged in his body), a weak or an old man, an infant, or a man of timid disposition, or a person afflicted with a large number of ulcers, as well as a patient suffering from any of the diseases in which diaphoretic measures are forbidden, should be regarded as a subject unfit for cauterisation.
Now we shall describe the characteristic sym- ptoms of the several kinds of burns other than those caused (for surgical purposes). Fire feeds both upon fatty and hard fuels, [such as oil and logs of wood etc.]. Hot or boiling oil has the property of permeating or entering into the minutest nerves and veins, and
g2 THE SUSHRUTA SAMHITA. [ Chap. Xli.
hence, it is capable of burning the skin, etc. Accord- ingly an ulcer incidental to such a burning (scald) is characterised by extreme pain, etc.
Burns may be grouped under four distinct heads viz., the Plush tam, the Dur-Dagdham, the Samyag-Dagdham and the Ati-Dagdham. A burn characterised by the discolouring of its seat and extreme burning and mark- ed by the absence of any vesicle or blister, is called the Plushtam, from the root "plusha" to burn. A burn, which is characterised by the eruption of large vesicles or blisters, and assumes a red colour, and is characterised by excessive burning and a kind of drawing pain, and which suppurates and takes a long time to heal, is called the Dur-Dagdham (bad burn or scald). A burn, which is not deep (superficial) and assumes the colour of a ripe Tala fruit, and does not present a raised or elevated aspect and develops the preceding symptoms, is called the Samyag-Dagdham (fully burnt one). A burn in which the flesh hangs down, and where the veins, nerves and bones are destroyed, accompanied with fever, burn- ing, thirst, fainting and such like disturbances, and which leads to a permanent disfiguration of the body, retarding the healing of the incidental ulcer which leaves a discoloured cicatrix even after healing, is called the Ati-Dagdham (over burnt one). A physician should try to heal any of these four types of burns with the measures already laid down before.
Chap. XII. ] sutrasthanam 93
Authoritative verses on the sub- ject.— The blood of a. man is agitated and made hot by fire, and the blood thus heated tends to excite or causes it to raise the bile. And since fire and bile (Pittam) are similar in their taste, essence, effect, potency and natal factors, the effects of Pittam (burning sensation etc.), are naturally aggravated and augmented through a contact with fire. Blisters or vesicles crop up in rapid' succession and mark the seat of burning, and fever, thirst, etc., supervene.
Now I shall describe the course of medical treat- ment to be adopted for the cure of burns. Hot and dry fomentations, as well as warm plasters should be applied to a burn of the Plushtam type, and a course of hot food and drink should be likewise prescribed for the patient. The blood becomes thin when the body is diaphorised by m.eans of warm fomentations, and water, in virtue of its natural cooling properties, tends to thicken the blood. Hence warm fomentations or appli- cations exercise curative virtues in the case of a burn of the foregoing t)^pe, and water or cold appli- cations produce the contrary effect.*
Both warm and cold measures are to be adopted in the case of a burn of the Dur-Daghdha t5''pe, the
* By arresting the radiation of the incarcerated heat and thereby favouring the elevation of the local temperature and the increase of the burning sensation.
94 THE SUSHRUTA SAMHITA. [ Chap, xil
medicinal remedies consisting of cold applications and unguents of clarified butter.* •
A plaster composed of Tugakshiri, Plaksha, Chandana, Gairika, and Amritam Guduchi), pasted together with clarified butter, should be applied over a bum of the Samyag-Dagdha type, or the flesh of domestic or aquatic or amphibious animals should be pasted and plastered over the affected part. A burn ol the present type, marked by excessive burning, should be medicinally treated in the same manner as a case of bilious abscess (Pitta-vidradhi).
In the case of a burn of the Ati-Dagdha (over-burnt i t3^pe, the loose or the dangling integuments (skin) and flesh should be removed, and cold applications should be made over the ulcer. Then the affected part should be dusted over with pulverised Shali rice, or a plaster composed of the pulverised skin of Tinduki and clarified butter pasted together, should be applied over its surface.! The affected part should be covered over with the leaves of Guduchi, or of lotus, or other aquatic plants, and all measures and remedial
* Cold applications and cooling measures should be resorted to in the case of a deep and excessive burn, while the contrary should be held as the correct remedy in the case of a slight and superficial one.
•)• Several authorities prescribe Tinduki bark and human cranium powdered together and mixed with clarified butter, while others prescribe a decoction of Tinduki bark.
Chap. XII. ] SUTRASTHANAM. 95
agents, indicated in the case of a bilious erysipelas, should be resorted to in the present instance as well.
A plaster composed of bee's wax, Madhukam, Sarjarasa, Manjistha, (red) Chandanam and Murva pasted together and boiled with clarified butter should be regarded as beneficial to burns of all types to promote rapid healing.
In the case of a burn from boiling oil, clarified butter or such like substances should be externally applied and all measures which promote dryness of the part (Ruksha) should be adopted without the least hesitation.
Now we shall describe the s5''mptoms which become manifest in a person [whose nostrils and larynx] are choked with smoke. — The respiration becomes laboured and hurried and the abdomen is distended accompanied by constant sneezing and coughing. The eyes look red and seem as if burning. The patient breathes out smoke and fails to catch any other smell than that of it. The sense of hearing is considerably affected ; the sense of taste becomes inert ; fever, thirst and a burning sensation supervene ; and the patient drops down utterly unconscious.
Now hear me discourse on the course of medical treatment to be adopted in the case of one
g6 THE SUSHRUTA SAMHITA'. [ Chap. XII.
over-powered with smoke.— Emetics in the shape of clarified butter mixed with sugarcane juice or milk saturated with the juice of grapes, or lumps of sugar- candy dissolved in an adequate quantity of w^ater, or any acid potion slightly sweetened, should be administered to th.e patient. The contents of the stomach are speedily discharged by vomiting ; the disten- sion of the abdomen is removed ; the smell of smoke in the breath is mitigated, and the accompanying fever with (its concomitants) of sneezing, languor, thirst, cough, laboured breathing etc. is abated, and the patient is restored to consciousness. Gargles having a sweet, saline, acid or pungent (katu) taste restore the sense- perception of the patient, and gladden his mind. Medi- cated snuffs in adequate quantities should be adminis- tered by a well-read physician to such a patient, whereby his head, eyes and neck would be able to resume their normal functions. And a course of diet, which is light, emollient and not acid in its reaction, should be prescribed.
Cooling measures or applications should be prescribed or made in the event of any part of the body being scorched by excessive heat, or by being exposed to a draught of hot and parched wind. Similarly, hot and emollient measures or applications should be re- sorted to where any part of the body has become frozen or shrivelled by snow or cold winds. A person struck
Chap. XII. ] SUTRASTHA'NAM. gy
by lightning should be regarded as beyond the pale of medicine.*
* Additional texts :— \\Tieie the scorching would be found to be consi- derably extensive ; otherwise such measures as lubrication with medicated unguents etc. should be adopted in a case where the patient is picked up alive.
Thus ends the twelfth Chapter of the SutrasthSnam in the Sushruta Samhit^ which treats of Cauteries and the rules to be observed in their use.
'3
CHAPTER XIII.
Now we shall discuss the Chapter which treats of leeches and of how and which to use (Jalaukar- vacharraniyamadhyaryam).
Leeches should be applied where the patient would be found to be old or imbecile, or a woman, or an infant, or a person of an extremely timid disposition, or a person of a delicate constitution, and as such is not fit to be surgically operated upon, since this mode of bleeding is the gentlest that can be possibly devised. The blood vitiated by the deranged wind (Vayu\ bile (Pittam), and phlegm (Kapham) should be respectively sucked through a horn^ by leeches and a gourd appliance (Alavu-Yantra) or with whichsoever of them is available at the time, irrespective of the cause of such vitiation, whenever such bleeding or sucking would be found to be imperatively necessary.
Authoritative verses on the sub- ject : — A CO whom is described in the Shastras as of a hot or heat making potency, and as possessed of a slightly cooling (Snigdha) or soothing (Madhura) pro- perty. Accordingly it should be used in sucking the blood vitiated through the action of the deranged bodily wind. Leeches, which are born in water, are possessed of Madhura (sweet or soothing) properties, and hence they
Chap. XIII.] SUTRASTHANAM. 9^
should be used in sucking the blood vitiated throoigh a deranged condition of the bile (Pittam\ The gourd (Alavu) is pungent, parching and irritating in its potency and should be therefore used in sucking the blood vitiated through the action of the deranged phlegm (Kapham).
Mode of application :— The part from which the blood is to be sucked should be first scarified or slightly cut in two or three places, and then the mouth or the open end, of the horn, covered with a thin piece of muslin tied round its edges should be placed over it and sucked with the mouth through the aperture at its tip or top- end, or with a gourd appliance equipped with a lighted lamp placed in its inside.
The term Jalauka (leeches) may be etymolo- gically interpreted to mean creatures whose life (Ayu) or whose longevity is in, or depends upon, water, whereas the derivative meaning of the term Jalauka (leeches) is based upon the fact of their dwelling ("Oka"— dwelling place) in water (Jalam). Leeches may be divided into twelve distinct species of which six are venomous, and six non-venomous. The six venomous species are named Krishna, Karvura, Alagarda, Indrayudha, Sdmudrik^ and Gochandana. The leeches of the first-named species (Krishna) are marked by thick heads, and of a colour resembling powdered lampblack. The leeches of the Karvura type have extended or
lOO THE SUSHRUTA SAMHITA. [Chap. XIIl.
elongated bodies like the Varmifishes, and are indented and thick at the waist. The Alagarda leeches are hairy, thick and round at the sides, and black at the mouth. The leeches of the Indrayudha species are marked on the surface with up-pointed rainbow coloured lines. The skins of the Samudrikas are black- ish yellow, dotted over with white spots of a variety of shapes. Leeches which are provided with narrow mouths and are marked by bifurcating line at the bottom like the scrotal sac of a bull are called Gochandanas.
A person bitten by any of the abovesaid venomous leeches has an irresistble inclination to scratch the seat of the bite which is marked by a considerable swelling. Fever, with burning, retching, drowsiness and delirium supervenes and ultimately the patient loses all conscious- ness. The remedy consists in the administration of an anti-toxic medicine known as Mahagada, as snuffs, potions and unguents, etc. A bite by an Indrayudha usually proves fatal. Venomous leeches, as well as cures for their bites, have thus been described.
The non-venomous species include Kapilas, Pingalas, Shankhamukhis, Musikas, Pundarimukhis and Saravikas. The Kapilas are coloured like Manah-Shila ( realgar ) at the sides, and their backs are tinged with a glossy hue like that of a Mudga pulse. The Pingalas have a reddish colour, are round in shape and
Chap. XIII. ] SUTRASTHANAAI. loi
capable of speedy locomotion. The Shankhamuldiis are marked by a blackish red hue like that of the liver, are provided with sharp elongated moutlis, and are capable of sucking blood with the greatest swiftness. The Musikas are coloured like the common blind moles, and emit a fetid smell from their bodies. The Pundarimukhas are coloured like the IMudga pulse and are so called from the fact of the resemblance of their mouths to the full-blown lotus hhes TPimdarikas). The Saravikas have cold bodies marked with impress- ions like lotus leaves and measure eighteen fingers' width in length, and they should be employed in sucking blood from the affected parts of lower animals. This exhausts the list of non-venomous leeches.
The countries, such as Turkesthan (Yavana), the Deccan (Pandya), the tract of land traversed by the Ghaut mountains (Sahya), and Pautana (modem Mathura), are the natural habitats of these leeches. The leeches, found in the aforesaid countries, are specifically non- venomous, strong, large-bodied, greedy and ready suckers.
The venomous leeches have their origin in the de- composed urine and fecal matter of toads and venom- ous fishes in pools of stagnant and turbid water. The origin of the non- venomous species is ascribed to such decomposed vegetable matter, as the petrified stems of the several aquatic plants known as Padma, Utpalam,
I02 THE SUSHRUTA SAMHITA. [ Chap. XIII.
Nalina, Kumuda, Pundarika, and the common zoophytes which live in clear waters.
Authoritative verse on the sub- ject.— The non-venomous leeches swim about in sweet scented waters, live on non-poisonous weeds, lie on the leaves of flowering water plants instead of on the dank and ooz)^ beds of pools, and suck blood from the affected part of a human organism without causing any discomfort.
Leeches should be caught hold of with a piece of wet leather, or by some similar article, and then put in to a large-sized new pitcher filled with the water and ooze or slime of a pool. Pulverised zoophytes and powder of dried meat and aquatic bulbs should be thrown into the pitcher for their food, and blades of grass and leaves of water-plants should be put into it for them to lie upon. The water and the edibles should be changed every second or third day, and the pitchers should be changed each week, (the leeches should be transferred to a new pitcher at the end of every consecutive seven days).
The authoritative verse on the sub- ject : — Leeches that are venomous, thick about the middle, elongated, of slow locomotion, look fatigued, do not readily take to the part they are appHed to, and capable of sucking only a small quantity of blood, should be looked upon as not belonging to the proper or the commendable type.
Chap. XIII. ] SUTRASTHA'NAM, 103
Then having seated or laid down the patient 'suffer- ing from a disease which requires the application of leeches, the seat of bleeding, if not previously ulcerated, should be roughened b}' dusting it over with a compo- sition of loose earth and pulverised cowdung. Then the leeches should be taken out of their receptacles and sprinkled over with water saturated with mustard seed and pasted turmeric. Then for a moment they should be kept in a basin full of water, and after they have regained their natural vivacity and freshness, they should be applied to the affected part. Their bodies should be covered with a piece of thin and wet linen, or with a piece of white cotton. The affected part should be sprinkled over with drops of milk or blood, or slight incisions should be made into it in the event of their refusing to stick to the desired spot. Other fresh leeches should be applied even when the preceding measures should prove ineffectual. That the leeches have taken to the affected part may be inferred from the mouths of the leeches assuming the shape of a horse-shoe, and the raised and arched position of their necks after they had become attached to the seat of the disease. While sucking, the leeches should be covered with a piece of wet linen and should be constantly sprinkled over with cold water.
A sensation of itching and of a drawing pain at the seat of the application would give rise to the pre-
104 ^^^ SUSHRUTA SAMHITA'. [Chap. XIII.
sumption that fresh blood was being sucked, and the leeches should be forthwith removed.*
Leeches refusing to fall off even after the production of the desired effect, or sticking to the affected part out of their fondness for the smell of blood, should be sprinkled with the dust of powdered Saindhava (rock salt.)
After falling off, the leeches should be dusted |
over with rice powder and their mouths should be j
lubricated with a composition of oil and common salt. Then they should be caught by the tail-end with the thumb and the forefinger of the left hand and their backs should be gently rubbed with the same fingers of the right hand from tail upward to the mouth with a view to make them vomit or eject the full quantity of blood they had sucked from the seat of the disease. The process should be continued until they manifest the fullest symptoms of disgorging. Leeches that, -y.^
had vomited the entire quantity of blood sucked as above, would briskly move about in quest of food if placed in water, while the contrary should be inferred from their l5nng dull and inert. These should be made to disgorge again. Leeches not made to emit the entire quantity of the sucked
"^ The leeches, though a blissful dispensntion of Nature in themselves, instinctively draw off the vitiated blood from a diseased part, attacking the healthy vital fluid (red blood) \Yhen the former has been completely tapped or sucked.
Chap, XIII. ] SUTRASTHANAM. 105
blood stand in danger of being attacked* with an incurable disease peculiar to their genus, and which is known as Indramada. The leeches should then be put into a new pitcher, and treated as before laid down, after they had fully emitted the sucked blood.
An ulcer incidental to an application of leeches should be rubbed with honey or washed with sprays of cold water, or bound up with an astringent (kashaya) sweet and cooling plaster, according to the quantity of blood removed from the part.*
Authoritative verse on the sub- ject : — The physician who is fully conversant with the habitat, mode of catching, preservation and appli- cation of leeches, can well aspire to cure the diseases which yield to them or in which their use is indicated.
* In case of full and proper bleeding (Voga) the ulcer should be rubbed with clarified butter technically known as the Shatadhautam (lit: hundred times washed) Ghritam (clarified butter), or a piece of cotton, soaked in the same substance, applied as a compress over the part. The ulcer should be rubbed with honey in a case of insuflicient bleeding, while it should be washed with a copious quantity of cold water if excessive bleeding (Ati-Yoga) should set in. Similarly in a case marked by the absence of any bleeding at all (Mithya-Yoga) a sour, sweet and cooling plaster should be applied over the ulcer.
Thus ends the thirteenth Chapter of the Sulrasthinam in the Sushruta Samhita which treats of Leeches and of how and which to use.
14
CHAPTER XIV.
Now we shall discuss the Chapter which treats of blood (Shonita-Varnaniya- mad hya'yam).
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.*
The lymph chyle (Rasaj, 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 bod5\ Of the aforesaid twenty-four vessels, ten are up-coursing, ten are down-coursing, and four have a lateral direction. The Rasa or the
* It is free from all sorts of impurities such as fecal matter, etc., and permeates the minutest vessels and capillaries.
Chap. XIV. ] SUTRASTHANAM.
107
lymph chyle, thus flowing out of the heart, constantly soothes, maintains, and irrigates b}^ 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 bod5\
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 (Saum3'a) 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 sub- ject:—The Rasa or the lymph chyle, coloured through the effect of the healthy normal d5''eing 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.
I08 THE SUSHRUTA SAMHITA'. [ Chap. XIV.
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 o\'um (Garbha) is both cooling and heat- making in its properties on accoimt 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 (Panchabhautikam).
lYIctrical 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 Chyl«-
Chap. XIV. ] SUTRASTHANAM 109
born in its origin, and hence an intelligent person should carefully preserve his bodily Rasa dymph 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.*
* 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 bodv, 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
I JO THE SUSHRUTA SAMHITA. [Chap. XIV.
Authoritative verse on its com- putation:— 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 s like rivulets of water.
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, ?7-, 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, v!~, 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, vh, 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, I'i:. 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.
Chap. XIV. ] SUTRASTHANAM. 1 1 1
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 (Vajikaranam.) 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 earl}^ 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.
112 THE SUSHRUTA SAMHITA. : Chap. XIV.
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 (Pittam), 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 (Kapham), 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 mnning down, and is marked by an increase of its slimy character. The blood, vitiated through a concert- ed 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.
Cain . XIV. ] SUTRASTHANAM.
113
The blood in its healthy and natural state is possess- ed of a vivid red colour like that of an Indragopa (Cochineal) insect, and is neither too thin nor too transparent.*
Cases where blood-letting is pro- hibited : — A person afflicted with an oedematous 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 haemorrhoids 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 (Prachchhanam) or venesection (Sira- Vyadhanam) 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
* 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.
15
114 THE SUSHRUTA SAMHITA. [ Chap. Xiv
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 sub- ject : — 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 accom- panied by suppression of the flatus i 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 haemorrhage, which may be followed by such dreadful results as Shirobhitapa or violent headache, blindness or loss of sight (Timria, Adhimantham (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.
Chap. XIV. ] SUTRASTHANAM. n^
Authoritative verses on the sub- ject : — 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 im- properly 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 b}' 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, Chitraka, 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 hcem- orrhage, the mouth of the incision should be gently rubbed with a composition consisting of the powders of Lodhra,
Il6 THE SUSHRUTA SAMHITA. [ Chap. Xiv.
Priyangii, Madhiika, 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 Sdla, 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
[Chap. XIV. ] SUTRASTHANAM. II7
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 pres- cribed, and the complications should be subdued according to the nature of the deranged bodily humours respectively involved therein.
Authoritative verses on the sub- ject:— Excessive blood-letting is followed b}' im^paired 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 Kttle or no acid taste.
The four measures indicated for the stoppage of bleeding are known ; as the Sandhanam (process by contracting the affected part), the Skandanam (thickening or congealing the local blood), the Pachanam (process of setting up suppuration in the wound) and the Dahanam (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
Il8 THE SUSHRUTA SAMHITA. [Chap. XIV.
woimci or ulcer, whereas cauterisation has the property of .contracting a vein.
Remedies and appHances 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 (Sandhanam) 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 pro^-ed 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 aggi-avate the disease but prevent its perfect healing. In such a case bleed- ing should not be again resorted to, but the derang- ed 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
Chap. XIV. ] SUTRASTHANAM. 119
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 fourteenlh Chapter of the Sutrasthan^m in the Sushrula Samhit^ which treats of Blood.
CHAPTER XV.
Now we shall describe the Chapter which treats of development and non-deA'elopment of the humoral constituents . of the body and excrements (Dosha- Dhai:u-IVIaIa- Kshaya-Vriddhi - Vijnaniya-madhya^am).
Since the human body is constituted of humours, (Doshas), excretions (Mala\ and the fimdamental princi- ples (Dhatus. of blood, marrow, etc., hear me discourse on the features which are peculiar to each of them.
The Vayu. — The imparting of motion to the body : Praspandanam;, the carrsing of the sensations of the respective sense organs (Udvahanam', the passing down of food to its proper receptacles (Puranam), the separation of excretions from the assimilated food matter (,Viveka , and the retention and evacuation of urine and semen, etc. (Dharanam' should be ascribed to the fimctions of the five kinds* of Vayu inerve forcei which support the body.
The Pittam. — Pigmentations or coloiu-ing (Ragakrit), the digestion of food and metabolism of tissues (Paktikrit), the vitalisation and nutrition of the protaplasmic cells (Ojakrit), the origination and preser-
* They are called Pr^na, Ud<ina, Samdna, \'y^na and Apina.
Chap. XV. ] SUTR ASTHANAM . 1 2 i
vation of eye-sight (Teja-Krit), the germination df heat and maintenance of the temperature of the body (Ushma- Krit), and the origination of the faculty of intellection (Medha-Krit) should be regarded as the functions of the five kinds* of Pittam, which contribute to the preservation of the body through its thermogenetic potency (Agni-Karma).
The Shieshma'.— The function of the five kindsf of Shieshma is to lubricate the interior of the joints (Sandhi-Samshleshanam), to contribute to the gloss of the body (Snehanam), to aid in the formation of healthy granules in sores (Ropanam), to add to the size of the body (Puranam', to build fresh tissues (Vrimhanam), to impart a pleasant or soothing sensation to the body (Tarpanam), to increase its strength ' Valakrit , and to give firmness to the limbs 'Sthairya- krit), thereby contributing to the welfare of the body by supplying it with its watery element.
The Rasa or the lymph chyle exercises a soothing effect upon the entire organism and tends
* They are named as Ranjaka. P^chaka, SSdhaka (Medh^krit and Ojakrit), Alochaka and BhrSjaka.
t They are known as Shleshmaka, Kledaka, Vodhaka, Tarpaka, Avalamvaka.
A^. B, — The V^yu, Pittam, andShleshmS, (Kaphham), though ordinarily translated as wind, bile and phlegm, differ in their meaning from their usual English synonyms. We reserve the treatment of these subjects for a separate place in another part of the book when we shall have occasion to deal with the essentials of Ayurvedic Physiology — Tr. i6
122 THE SUSHRUTA SAMHITA'. [Chap. XV.
to contribute to the increased formation of blood. The blood, in its turn, increases the healthful glow of the complexion, leads to the increased formation of flesh and muscles and maintains vitalit}- in the organism. The flesh contributes towards the stoutness or rotundity of the limbs and occasions the formation of fatty matter in the system. The fat gives rise to the glossiness (formation of oily or albuminous matter) of the body and primarily contributes towards the firm- ness and growth of the bones. The bones, in their turn, support the body, and contribute to the formation of marrow. The marrow contributes towards the for- mation and increase of semen, and fills in the internal canities of the bones, and fomis the chief soiu"ce of strength, amorous feelings and hilarity. The semen gives rise to valour and courageousness, makes a man amor- ously disposed towards the female sex, increases his strength and amativeness, is the sole impregnating principle in the male organism, and is possessed of the virtue of being quickly emitted.
The excreta or the fecal matters of a man are in- dispensably necessary for the preser\^ation of the body. They contain the wind and digestion .being primarily connected with the movements of the bodily Vayu and the feeling of hunger). The urine fills the receptacle of the bladder, and is possessed of the property of washing or draining off the waste or refuse matter of the organism ; whereas perspiration tends to moisten the skin.
Chap. XV. ] SUTRASTHANAM.
123
The Artavam (menstrual blood) is endued with the same properties as its arterial namesake, and is one of the essential factors in a woman which makes impregnation possible. The foetus or impregnated matter (Garbha) serves to make patent the features characteristic of pregnancy. The breast-milk in its turn tends to bring about an expansion of the mammae lof a woman , and maintains the life of her child (by suppl}'ing it with the necessary and nutritive element of food). These Vayu, etc. should be duly preserved in their normal condition.
Now we shall describe the symptoms which attend the loss or waste of any of the foregoing principles of the body.*
The loss of the bodily Vayu f nerve-force) is followed bv a state of languor, shortness of speech, uneasiness or absence of hilarity, and loss of consciousness. The loss of fPittam) is marked b}' a dulness of complexion, diminution of the bodily heat and an impaired state of internal fire (digestive heat). The loss of phlegm (Kapham) is marked by dryness, a sensation of internal burning, a feeling of emptiness in the stomach and other
* Such a loss or perceptible deterioration of any of them should be ascribed to the use of exce^^sive cleansing or cathartic (Samshodhanam) and pacifying (Samshamanam) measures, or to a repression of the natural urgings of the body, or to a course of violent or overfatiguing physical exercise, or to amorous excesses, or to the use of unwholesome and unsuitable food, or ta grief, etc.
124 THE SUSHRUTA SAMHITA. [ Chap. XV.
cavities or chambers of the body, looseness of the joints (a feeling as if the joints were all broken), thirst, weak- ness, and insomnia. In such cases the medical treatment should consist of remedial agents which are capable of directly contributing to the growth or formation of the humour so lost or deteriorated.
Similarly the loss of lymph chyle is marked by
pain about the region of the heart, Angina Pectoris,
with palpitation of the heart, a sensation of
emptiness or gone-feeling in the viscus, and thirst.
The loss of blood is attended with such symptoms as
roughness of the skin, and a craving for acid food
or drink. The patient longs to be in a cool place
and asks for cool things, and the veins become loose
and flabby. The loss of flesh is marked by emaciation
of the buttocks, cheeks, lips, thighs, breasts, armpits,*
neck, and the calves of the legs. The arteries seem
loose and flabby, and the body seems to be dry and
inert, accompanied by an aching or gnawing pam
in its members. The loss of fat is followed by such
symptoms.as the enlargement of the spleen, a sense of
emptiness in the joints, and a peculiar dryness of the
skin and a craving for cold and emollient meat. The
degeneration of the bones is marked by an aching pain
in the bones and bone-joints, a wasting of teeth and
ffums, and a general drvness of the body. Similarly, .
* The armpits look thin, narrow and contracledt
Chap. XV. ] SUTRASTHA'NAM. 125
the loss or waste of marrow is characterised by the for- mation of a lesser quantity of semen, aching pain in the bones and breaking pain in the bone-joints which have become marrowless. The loss or waste of semen is mark- ed by pain in the penis and the testes, and by incapacity for sexual intercourse. In such cases the emission of semen but rarely happens, and is then perceptibly deficient in its quantity, the emitted matter consisting of a small quantity of sehien marked with shreds of blood. The medical treat- ment under the preceding circumstances should consist of remedies of such medicinal virtues as are found to directly and immediately contribute to the formation of the bodily principle (thus wasted or lost).
The loss absence, suppression or scanty forma- tion of fecal matter is attended with a sensation of pain at the sides and the region of the heart, and the upward coursing of (the incarcerated) wind or flatus, accompanied with a rumbling sound about the region of the liver and the intestines. Similarly, the loss, absence or scanty formation) of urine is marked by an aching pain in the bladder, causing it dribble or to come out in thin and scanty jets. Here, as in the foregoing instances, the remedial agents should consist of drugs which directly contribute to the formation of urine. Similarly the waste, absence or scanty formation of perspiration is followed by such symptoms as numbness about the pores of the hair, and
126 THE SUSHRUTA SAMHITA. [ Chap. XV.
dryness of the epidermis (skin\ The sense of touch is perceptibly affected, and perspiration is entirely stopped. The medical treatment in such a case consists in the application of medicated unguents, lubrications, diaphoretics, and adoption of measures (that tend to produce a copious perspiration\
In the case of loss or waste of the catamenial flow, the menses do not appear at the appointed time or are scant}'. The vagina seems stuffed and painful. The medical treatment in such cases consists in the adoption of alterative or cleansing measures, and in the administration of drugs of a heat-making (Agneya) potency or virtue.
The loss or waste of breast-milk is characterised by a shrunken condition of the mammae, and suppression or scanty secretion of the fluid. The medical treatment in such cases lies in the administration of drugs which generate Kapham.
The atrophy or wasting of the foetus in the womb (during the period of gestation) is marked by the absence of any movement in the uterus and the non- distended condition of the sides or walls of the abdomen. The treatment consists in the application of Kshira Vastis (enemas of medicated milk into the region of the utenis) in the eighth month of gestation, and prescribing courses of emollient fare for the patient mother)*
* Several editions read invigorating diets, egg, etc.
Chap. XV.] SUTRASTHANAM.
127
Now we shall describe the symptoms which mark the excess (excessive accumulation in the body > of any of the fundamental humours, ]>rinciples and excrements of the body.
The quantities of these humours, principles and secretion, are abnormally increased through the use of substances that primarily contribute to their formation in the organism.*
An excess of Vayu in the body is marked by such symptoms as roughness of the skin, t emaciation of the body, darkness of complexion flit : blackness of hue), a little tremor or trembling of the limbs, longing for heat, or for hot things, insomnia, thickness or increased consistency of the fecal matter and decrease of bodily strength. (Similarly, an abnormal) increase of Pittam is characterised by a sallow complexion or a yellowish colour of the skin, a general burning sensation in the body as well as insomnia, a craving for cold contacts and cooling things, diminution of strength, weakness of the sense organs, fits of fainting and yellowness of the conjunctivae, stool and urine.
An excess of Kapham in the body is marked by such symptoms, as the whiteness, coldness and numbness of the body, heaviness of the limbs, a
* Several Editions read it as an additional text. + Several Editions read roughness of speech.
128 THE SUSHRUTA SAMHITA. [ Chap. XV.
sense of drowsiness and languor_, somnolence, and a feeling of looseness of the bone-joints.
Similarl}', an increased germination of lymph chyle (Rasa) in the body is manifest by such characteristics as, nausea, water-brash, and an increased flow of salivary secretion. A plethora of blood in the system gives a reddish glow to the complexion and the white of the eyes, and imparts fullness to the veins. An increase of flesh is marked by the rotundit}" and fullness of the buttocks and the lips, as well as of the penis, arms, and the thighs, and an increased heaviness of the whole body. An excess of fat in the body imparts an oily gloss to the skin. The sides of the abdomen are increased in bulk, and the body emits a fetid smell, and the person is assailed with cough and dyspnoea. An excessive forma- tion of bone (abnormal ossification) is attended with such symptoms as the cutting of additional teeth and the abnormal development of any of the bone-structures. An excessive formation of marrow gives rise to a heaviness of the eyes and to the members of the body.
An excess of semen in the body is marked b}' an ex- cessive flow of that fluid and gives rise to the fomiation of gravels (concretions) in the bladder which are known as Shukrashmari. An abnormal increase in the forma- tion of fecal matter is attended with distension of the abdomen and colic pains in the loins and the intestines. An excessive formation of urine is manifest by constant
Chap. XV. SUTRASTHANAM. 129
urging for micturition and distension of the bladder, attended by a kind of gnawing or aching pain.
Similarly, an increased secretion of perspiration is attended with an itching of the skin which emits a bad odour. An excess in the quantity of catamenial blood* gives rise to an aching of the limbs and an excessive flow. So also an excess in the quantity of the breast-milk is attended with frequent secretions of that fluid, and with inflaihmation and pain in the mammae. An excessive growth of the faetus in the uterus tends to abnomially swell .the region of the abdomen, and is accompanied by anasarca, or dropsy, of the lower extremities (phlegmasia dolens;.
These abnormal excesses of the aforesaid humours and principles, etc. of the body should be checked or remedied with corrective (cleansing) or pacifying measures as would be indicated by their respective natures, so as not to reduce them to a smaller quantity than that in which they are found in the normal and healthy state of a body.
IVIetrical text : — An increased quantity of a bodily principle gives rise to a similar increase in the quantity of one immediately succeeding it in the order of enumeration as stated above ; aud hence an
* An abnormal flow tends to stimulate the voluptuous sensation of a woman to a considerable extent, and is followed by a sense of reactionary weakness. Il emits a fetid smell and originates ovarian tumours.
17
130
THE SUSHRUTA SAMHITA. [ Chap. XV.
increase in any of the fundamental principles of the body should be checked and reduced to its normal quantity.
Now we shall describe the characteristic features of the strength-giving principles of the body, as well as the symptoms that mark their loss or waste. The quintessence of all the fundamental principles of the body, starting with lymph chyle and ending with semen, is called the Ojas, which is identical with what is termed "vital power." This view of oneness of vitality with protoplasmic albumen has been adopted in the present work*
This Ojas (albumen) or strength-giving principle serves to impart a firm integrity to the flesh (and the muscles), exercises unbounded control over all acts of vitality, improves the voice and complexion, and helps both the external (operative") and the internal ^intellectual) sense organs, in duly performing their natural functions.
Authoritative verses on the sub- ject:— Ojas (albumen being of a white colour belongs to the class of Somatmakam (cooling) substances.
* The Sanskrit lerm "Ojas"' has a variety of meanings. Primarily it means protoplasmic matter as found in cells (Vindus). Secondarily it means albumen as we shall describe later on in the chapters on etiology and therapeutics of Prameha. Several authorities hold a contrary view staling that Ojas (albumen) forms only one of the essentials of vitality and that the two are by no means identical.
Chap. XV. ] SUTRASTHA'NAM. 131
It is cooling, oleaginous, and firm (Sthira), contributes to the formation and growth -of flesh, maintains its integrity or holds it firm, and is mobile or capable of moving about from one place to another within the organism. * It is further soft and shiny, and is possessed of the most efficacious virtue and should be regarded as the most important element (seat) of vitality. The whole body with its limbs and members is permeated with Ojas, and a loss or diminution in its natural quantity leads to the gradual emaciation (and ultimate dissolution) of organism.
A blow, a persistent wasting disease, anger, grief, cares and anxieties, fatigue and hunger, are the causes to which should be ascribed the wasting or disappearance of this strength-giving principle (albumen) of the body. The bodily albumen, through the agency of the above- said causes, is wasted through the channels carrying the different fundamental principles of the body. Albumen is transformed into strength which radiates from the heart.
A deranged or vitiated albumen (Ojas) is characterised firstly by its dislodgment from its proper seat or locality (Visransha), secondly, by a change or modification of its native virtues in contact with the deranged humours or disordered organs (Vyapad) and thiidly, by wasting away (Kshaya\
* Several editions read Rasam, meaning it to be possessed of a sweet taste.
132 THE SUSHRUTA SAMHITA. [ Chap. XV.
The first of the preceding properties (dislodgment) gives rise to such symptoms as looseness of the bone-joints, numbness of the hmbs, dislodgment of the deranged humours from their respective recep- tacles and suppression of the (bodily and intellectual) functions. To the second of the foregoing properties, (change or modification of its natural virtue through contact with the deranged bodily humours etc) should be ascribed such symptoms, as numbness and heaviness of the limbs, dropsy due to the action of the deranged bodily Vayu, discoloured or changed complexion, feeling of malaise, drowsiness and somnolence. The third pro- perty of the deranged albumen, loss or wasting), brings on fits of fainting, loss of flesh, stupor, delirium and ultimately death.
Authoritative verses on the sub- ject:—A deranged state of albumen is marked by the three abovesaid properties of dislodgment from its proper seat (Visransha) ; by a change of its natural virtues through contamination (Vyapadi and by wasting (Kshaya . The first of these properties (Visransha) is characterised by looseness of the joints, by an inert state of the body, by a sense of fatigue, by a dislodgment of the deranged humours from their natural seats, and by a suppression of the bodily and intellectual functions. Numbness and heaviness of the limbs, malaise, a discoloured complexion, drowsiness,
Chap. XV. ] SUTRASTHA'NAM. 133
somnolence and dropsical swelling brought about by a deranged state ot t\\e bodily Vayu, should be considered as natural consequences of the Vyapad ^change of the natural virtues of albumen through contamination). The loss or waste of Ojah (albumen) is marked by such symptoms as fits of fainting, emaciation of the body, bewilderment and distraction of the mind, delirium and loss of consciousness and ultim?itely death.
The medical treatment in cases of dislodgment or flowing out external secretion) of albumen from its natural seat (Visransha), as well as in the event of it becoming contaminated by the vitiated principles of the body, should consist in improving its quantity by elixirs and remedies possessed of rejuvenating properties, tending to increase the quantity of such fluid (albumen 1 in the body. A patient who has lost all consciousness owing to an excessive loss or waste of albumen) should be given up by a physician as incurable\
The oily or albuminous matter found within the components of the other fundamental principles (Dhatu) of the body as metabolised by the internal heat and regularly metamorphosed into the succeeding ones) should be grouped under the head of fiery or thermogenetic (Agneya)) substances. This fatty matter iVas^'i predominates in the female organism and produces its peculiar softness,
134 ^^^ SUSHRUTA SAMHITA'. [Chap. XV.
beauty and pleasing shape, causes the grovrth of scanty but soft hair on its surface. It strengthens the eyesight and increases the energy of the body, improves its power of digestion and heightens its glow and com- plexion. Fat is deranged by such acts as, an abuse of astringent, bitter, cold, parchifying or Vistambhi (indigestible food which remains stuffed in the stomach^ substances, a voluntary repression of the natural urging for evacutions of the body, by excessive sexual in- dulgence, and fatiguing physical exercise, or by the draining action of any particular disease.
An instance of dislodgment of fat from its proper seat or locality is attended by such symptoms as roughness of the skin, loss of the natural healthful glow of the body and a breaking or an aching pain in the limbs. Anaemia or a gradual emaciation of the body, impaired digestive function and a slanting or downward course of the deranged humours, mark the case where the bodily fat has undergone a change in its natural properties through any foul contamination. A case of loss or waste of the bodily fat is marked by such S5aTiptoms as, impaired digestive function, dulness of sight, decay of strength and aggra- vation of the bodily Vayu, and always ends in death.
The medical treatment in the latter case (loss of fat) should consist in the administration of oily or emollient drinks, use of medicated unguents or lubrications, Pradeha (plasters of oleaginous substances) and
Chap. XV. ] SUTRASTHANAM. 13^
Parisheka (washes) and a diet comprising light, cooling and well-cooked articles of food.
lYIetrical texts : — A person suffering from a wasting of any of the constituent humours or fundamental principles or excrements of the body, as well as one suffering from loss of Ojah (albumen) naturally craves for drink and food that tend to con- tribute directly to the formation of the matter (or bodily principle) so lost or wasted. Conversely, the particular food or drink longed for b}' a person suffering from a loss or waste of any of the abovesaid fluids or principles, should be looked upon as possessed of a curative virtue in that particular case. Such a person devoid of consciousness and divested of his bodily and intellectual functions through a deranged state of the bodih' Vayu ner\-e-force) and extremely weak and enfeebled owing to the loss of the vital fluid should be regarded as past all cure.
Etiology of Obesity :— Obesity or loss of flesh (Karsha) should be ascribed to changes in the condi- tion of the lymph chyle. The lymph chyle derived from the assimilated food of a person, who is habituated to a course of diet which tends to promote the quantitv of the bodily Kapham or is in the habit of pampering his belly even when a previous meal has not been thoroughly digested, or who is addicted to a habit of sleeping in the day, or leading a sedentary life, or is averse to taking
136 THE SUSHRUTA SAMHITA. t Chap. XV.
any sort of physical exercise, continues in an immature State and is transformed into a serum of sweet taste which moves about within the body, engendering the formation of fat which produces excessive stoutness. A person afflicted with obesity develops such symptoms as short- ness of breath, thirst, ravenous appetite, excessive sleepi- ness, perspiration, fetid odours in the body, wheezing sound in the throat during sleep or sudden suspension of breath, inert feeling in the limbs, dulness or heaviness of the body, and indistinctness of speech. Owing to the softness of fat, a fatty person is unntted for every kind of work. Capacity for sexual intercourse is dimi- nished (in such a one), owing to the obstruction of the passage of semen by phlegm and fatty deposits ; and the growth of the rest of the root-principles of the body such as, lymph chyle, albumen, semen, etc., is considerably arrested owing to the deposit of fatty matter within the channels of the internal passages of the body, thus seriously affecting his bodily strength. An obese or excessively corpulent person is likely to be afflicted with any of the following diseases such as, urethral discharges, eruptions, boils, carbuncles, fever, fistula in ano, or with any of the diseases which are caused by a deranged state of the bo