susruthasamhitha

SUSRUTHASAMHITHA
Aesthetics of a glorious past and its continued remembrance
And practice

A culture’s selfawareness in terms of law ,medicine and grammer is an important precondition for awareness of its aesthetics.The knowledge of medicine –a system of management of pain,of anesthetics,of birth and death is interrelated to poetry,a system of management of pleasure ,of aesthetics and of creation.(G.N.Devy.After Amnesia.page 64-65.Orient Longman 1995)

Being involved in both the systems mentioned above ,I believe in the dictum “In the continued remembrance of the glorious past individuals and nations find their noblest aspirations “as did Sir William Osler ,the pathologist par excellance.Hence during my tenure as ateacher in the Medical college Calicut I probed into the medical history of our nation,and unearthe da precious jewel from its rubbles.The oldest surgical and pathological text of ancient India,the Susruthasamhitha.Being a student and practitioner of the allopathic system of medicine ,it was but natural for me to compare the ancient and the modern systems of medicine.Here I share some of my reflections with the readers.

The beginning
Both Ayurveda and allpathy originated as cults in and around temples.In the months of Hemantha and sisira ,rigorous penances followed by the oath and the holy pilgrimage to the temples on hilltops were common to India and Greece.The pilgrimage centers of vaishnava,saiva and devi cults,chaityas of Budhists and jains with their prathikarma and paryushan parva were of this tradition.These rites were to remove the thridosha accumulated during this and the previous births.The belief that mental (psychiatric)illnesses were due to bhootha (past life)was deeprooted in the ancient mind and it is being proved by modern science.The aesculapean cult of Greek medicine shared the same belief.It was the forerunner of modern medicine prevalent in the Mediterranean basin ,where Asculapeus lived.He had his Guru in a half naaga tribal Chiron,an inhabitant of the serpent country.,Paataala.In BC 429,the cult spread toAthens.The asculapean temples were on hilltops.They were medical schools were the healing art and philosophy were taught by rishis or priests.Students had to prove their merit before getting entry into the school.(temple).Once they pass the entrance exam ,they were to take an oath just like the oath taken before prathikarma ,and it was this oath which later became known as the Hippocratus oath.The temples were built in the most picturesque sites and holy baths,fasting,vegetarian diets,nonviolence,virechana(cleaning of the bowels)and prayers were mandatory for the disciple to get entrance into templeschool.Only after a prolonged period of such rigorous austerities did the main gates open for the aspirant student.Once the student gets entry he prostrates in front of the main deity and the Guru produces a healing dream by hypnosis.Depending upon the nature of the dream the disciple acquires the ability to read the past ,present,and the future and to heal mental and physical illness.In the Tamil epic Chilappathikaram we find evidence of such practices .In the Upanishadic traditions also the healing dream is mentioned many times.
In susruthasanhita ,the oath ,the upanayana into the cult(soothrasthana 2-6)of a meritorious disciple by a Guru as wellas the licensing and permission by the royal court to practice(10-2)are mentioned.The knowledge of the past ,present and futiure(thrikaala)or the Daivagna method was prevalent in Indian medical system and in the Cos island where Hippocratus ,the twentieth generation fromAesculapeus lived and taught the basic principles of modern socalled western medicine.How was the problem (mental or physical)created and what was its past history?What is the present status of the problem and how far it has progresses?Can the problem be solved by a particular line of treatment or other so that the patient be saved?What are the chances of survival of the patient?These were detrmined by history taken,physical examination,and the position of stars and planets.Even now we following modern medicine calculate the past history,aetiology,pathogenesis,and prognosis on the same line of thought.The only fact left out is the position of stars and their influence in modifying the outcome.
Hippo in Greece means a horse.The oldest known vedic doctors ,the aswins were also called horses.Hippocratus is a Greek name for Aswin ,from whom medicine originated.Hippocratus believed that the symptoms of a disease are only the reactions of the body to combat a disease and the duty of a doctor is not to treat symptoms but to increase the natural forces of the body.This is exactly what ayurveda and the tribal traditions also believe and teach..The homeostasis between body and mind was called health and the balance of the three humours was essential for healthy living.The samkhya philosophy and vedic medicine also believe in the homeostasis of three guna(qualities)and the three doshaas(imbalances derived from them)and balancing them for perfect health.Hippocratus said that if a doctor treats an occult cancer ,the chances of survival of the patient is less since the disease become overt by his/her treatment.He said philosophically ,”life is short,and the art of healing eternal.Experience may fail us.Many a time decisionmaking may be difficult.”The doctor in those early days was a kindhearted ,good,honest,divine being with ahealing touch ,a philosopher par excellance,and a rishi.Hippocratus said that as long as such people who love and practice the healing art remain on earth,people who love humanity will continue to exist to serve the world.

Dissection of the Human body
The first Greek to dissect a corpse was Alemaon ,the disciple of Hippocratus.He did it secretly ,and alone.Herophilus was bold enough to dissect and demonstrate it to his students (died in BC 290)but embalming and dissection were not considered a sin in ancient Egypt from time immemorial .In Tibet and India this was practiced.While the dissection was on royal corpses on Egypt,on criminals and enemies in in Peru and Mexico,on captured enemies among the scytheans,it was on Godmen and Laamaas in Tibet ,and on horses in ancient India,.At times a young adult also was selected for it instead of a horse in exceptional situations ,as in the case of Sunasepha ,whom Viswamithra saved.It was performed on royal corpses also as in the case of King Dasaratha of Ramayana by sage Vasishta.
Susrutha,the son of viswamithra lived in ancient times but susruthasamhitha ,the oral tradition bearing his name was codified a sa text only very late during BC 500.By that time there were many restrictions for dissecting a corpse inIndia.Therefore the body was taken secretly to the forest ,kept immersed in a freshwater lake (as if in a formalin tank ,nowadays)for 7 days (minimum)and taken out on a fullmoon night and dissected with sharp roots and bamboochips.This was the reason for adopting either 15 or 16 days for finishing the pithrukarma(burial rite)ceremonies.
During Susruth’s time there were 8 divisions for Ayurveda.
1.Salyathanthra(surgery)
2.Saalaakhyathanthra(E.N.T,Dentistry)
3.Kaayachikitsa(medical treatment)
4.Bhoothavidya(psychiatry ,psychotherapy)
5.Koumaarabrithya(pediatrics and adolescent medicine)
6.Aagathathanthra(toxicology and treatment of poisoning)
7.Rasaayanathanthra(pharmacopoeia and longevity)
8.Vajeekarana(rejuvenation and vitality).

PSYCHIATRY AND PSYCHOLOGY –MODERN AND ANCIENT
Sigmund Freud (1856-1939)forwarded a new trend in psychiatric medicine.His free association methods ,dream analysis,problems of the unconscious mind and Oedipus complex became popular.Freud’s central theme was sex,while Adler concentrated every action and reaction of the human mind on power.Carl Gustav Jung gave a more authentic and holistic explanation of the human mind ,its dreams and its aspirations .His archetypes and shadows resembled the ancient Indian way of analysis.Currently Dr Herbert Benson of the Harward medical university has gone back to the ancient yoga ,dhyana and japa methods for reducing sympathetic nervous system functions and relief of many mental and physical illnesses.In Massacheussets Medical school ,more than hundred hospitals follow praanaayaama and prayers for healing of mind and body and for increasing immunity.A variety of diseases like asthma ,intractable headaches and body pains ,blood pressure ,cardiac diseases ,diabetes ,side effects of cancer chemotherapy and dialysis ,irritable bowel syndrome ,insomnia,emphesema and skin diseases are treated by those methods in many American hospitals.The journal of biomedicine (1980)published an article on how transcendental meditation can be used to decrease stress responses and thereby keep the body and mind healthy.The old concepts are returning to stay.The past is the prologue of the future.
According to susrutha ,Purusha,the endless beginingless eternal changeless absolute principle assumes the shape or relative body of the living Jeevi,(including man).The sarvagnapurusha or absolute thus appear in a living body as a karmapurusha.When karmapurusha leaves the body to go back to his original state or abode ,we say that the jeevi is dead.It is the purusha while entering a zygote gives it consciousness ,creativity,mobility,observing,cognitive,analyzing powers.These were with the karmapurusha during its previous existence.That is past karma(action),vaasanaa(tendencies)of karmapurusha manifest in the new body as his character.The body characters are from ancesters.The character is controlled by the 3 guna(qualities)which are from the karmapurusha ,as prakrithy.(nature)In creating a child,man and woman have only limited roles.They just participate in a divine will.Selection of a suitable pair ,intercourse at the proper time so that a good soul comes to earth and inhabits within the zygote ,protecting the pregnancy are in their control.Mere sexual intercourse is not enough in the creation of a good offspring.For it,the couple need the help of karmapurusha ,one who had a previous past(bhootha)and is in the gandharva(gandabba according toBudhist)state of bardo.
The head ,face,body,hair,bone,nails,teeth,arteries,veins ,nerves ,semen are derived from the seed of the father.Blood,marrow,heart,umbilicus,liver,intestine,genitalia,muscles are contributed by the mother’s seed.The power,colour and shape of body are imparted by the nourishing liquid that flows through the mother’s blood which in turn is derived from mother’s diet..Consciousness ,knowledge ,wisdom,experience of pain and pleasures,and longevity come from the karmapurusha.
When Thamas overwhelms the consciousness ,a natural reaction of the body happens periodically,which is called swabhaavikanidra or sleep.This is different from the Thaamasikanidra or coma where satwa and rajas are very weak.In sleep jeeva is not asleep ,but wide awake according toSusrutha.It visualizes the past experiences and events and gives and gives them to the rajasic mind as dreamvisions.One can awake from sleep only if satwa is powerful.In deep coma when satwa is too weak the state continues to death.Jeevathma in sleep see visions of his sarvagna state through the agency of karmapurusha.Therefore visionary dreams are the signs of sarvagnapurusha(sareerasthaana 4.35)
One can increase one’s intelligence and sustain it upto old age and death.For this,and to increase the healing powers of man and their longevity several methods are prescribed.
1.Medicines,with gold and honey.(chikitsa sthaanam.28,2-8,28,2,21)
2.Living in a cultured environment with no contact with uncultured minds and antisocial elements
3. daily swaadhyaaya and learning
4.discussions,discourses with learned men in various disciplines,and contact with good people(sadsangha)

Among medicines,24 types of somalathaas are prescribed and also other plants with same properties as it.Many people consider that soma was an ancient alcoholic drink .This is not true.susrutha says that those who drink soma has to follow rigorous austerities like refraining from bad company,bad deeds,laziness,alcoholism,medicines with opposite effects,and should lead a pious life .For complete effects of the soma drink ,specific daily routines are prescribed which will be very difficult for an alcoholic to do .These require immense mental and physical control over the senses.The entire period of austerity lasts for a minimum of three months.
Only people who control the senses are free of unmaada(psychiatric illness).There are different types of unmaada.Four of them are due to thridoshakopa(imbalance of the 3 humours)The fifth is due to intense grief or emotions.A sixth is due to chemicals ,toxins,poisons producing the imbalance of humours.Apart from removing the toxins,and giving medicines to combat the imbalance ,methods to avoid intense grief or emotions,depressions etc and give peace of mind are needed and these are devised..pilgrimages to hilltop temples,riverbanks,seacoasts,forests,the cooling prasaada and chandana on forehead,reading holy scriptures,and above all singing the names of God in perfect harmony(keertha)are all prescribed.(the ancient raagachikitsa)Most of the devakarma(rituals for God)are for this purpose.
Unmaada is due to bhootha (past life,causing impurity of the elements)Past life may be this life or the previous lives.(previous life’s karma)Pretha just means a person wholived on this earth ,and went out of it after completing its tenure.The pretha represents the collective experiences of all the ancestors of the human race.Personal as well as collective past experiences of human race give rise to mental disturbances,as well as to mental peace.If it is disturbing ,then we call it paisaacha(that which produce tension and fear)and it causes symptoms of unmaada .That is Bhoothaprethapisaachakrith means madness (unmade)is caused by past experiences of the personal and collective level which cause disturbances and impurity of the 5 elements with which we are made of.Therefore,the 5 elements of our body,of the earth,and the cosmos(our external environment)should not be polluted.This probably is the first recognition of the need for environmental protection.Unless we know the exact meaning of these words it is likely that we may blindly believe the words of others and criticize it.Ot may blindly believe and become mad people ourselves.
It is evident that samsaara (domestic and social life )cause mental tensions and therefore mental disease.To reduce these tensions dhyana ,yoga,bhakthy and gnaana were devised for people of different temperaments .Another very effective method was through the artistic medium-music,dance and literature.When all these preventive and curative methods fail and for people who don’t have tastes for any of these,and immersed in the mundane things only,sometimes it becomes necessary to give a shock treatment.For this they devised creation of a fearful atmosphere or a weird scene and painful experiences.Just like the modern allopaths devised the electric shock treatment.It was not the only method of treatment and it never was the choice treatment the ancients.Once the disease manifests ,bloodletting,oilbaths,swedana,virechana,food mixed with sesame oil were all tried.Susrutha knew that uncontrolled sensory pleasures and falsehoods lead to apasmaara(loss of memory and consciousness –either partial or complete)and prevention was better than cure.

Surgical treatment
Susrutha describes three stages for surgery.
1.poorvakarma(preoperative preparation)
2.Pradhaanakarma(the surgical procedure proper)
3.paschaadkarma(postoperative care)
Poorvakarma includes astrological calculation of best time for surgery,depending upon the position of stars and planets ,the seasons etc,prayers/bhajans/music on presiding deities,for invoking blessings from God,Guru and natural spirits,ancestors(previous teachers or guru –the pithru),examination of the patient ,deciding whether surgical intervention is necessary or not,positioning for the procedure,tightly held by the disciples.For internal surgeries and removal of the dead foetus from uterus Susrutha prescribes an empty stomach by fasting.For minor procedures light liquid diet was allowed.Whether anaesthesia was used or not during Susrutha’s time had been a controversial issue for a long time.I found the word for anaesthesia in chikitsaasthaanam.The reference is of supthivaatham(supthy = sleep,and vaatham =gas)which means the gas that produce deep sleep like coma.This indicates that susrutha knew the use of anaesthetic gas.(supthivaatha sringmoksham kuryarthu bahusho bhishak 4-12 chikitsasthanam).The checking of clean instruments kept at the surgeon’s armslength ,availability of trained nurses to assist,and even the alabu(specimen collection container)are described with precision and accuracy by the text just as an operative surgery text of modern medicine.
Pradhaanakarma can be attempted by a surgeon who can perform the eight karma with accuracy ,speed and experience.Th e 8 karma are
1.chedana(excision)
2.bhedana(incision)
3.lekhana(scraping and curettage)
4.vedhana(puncturing)
5.eshana(probing)
6.aaharana(extraction)
7.vishravana(tapping of fluids including bloodletting)
8.Seevana(suturing)
The surgeon should have complete knowledge of the human body ,and the science of surgery ,should be experienced,courageous,confident,powerful,unselfish,and should possess hands that do not sweat while doing surgery.
The postoperative care is important.At least for 48 hours the bandages should not be loosenened or disturbed.Because the healing should take place from below upwards .On the third day examine the site ,remove dead tissues and pus if any and apply new bandage .In hot and rainy season daily dressings were changed after that.In snowy seasons dressings are changed on alternate days .If the patient complains of pain in an apparently clean healed wound ,pure ghee and liquorice were made into a paste and applied hot.The doctor should be available on call and the nurse should intimate if any emergency or complications arise. All these procedures ,the operative surgery notes of various conditions ,the descriptions of instruments etc are all very scientific and this is really remarkable when we consider the period of the text.It was a time when the western world had never ever imagined it possible to have a surgical intervention for a disease.

Cancer(Arbudha)

W.A.D.Anderson had mentioned in his textbook of pathology that Ramayana was the first known text where arsenic and surgery are mentioned as treatment for cancer.Susrutha considers cancer as growth of tissue,accompanied by pallor.He describes it as stony hard ,fixed to deep tissues ,and spreading from one place to another.According to him some of the cancers are untreatable(asaadhya)and others are treatable.He classifies cancer according to sites and nature.While describing cancer of the yoni,larynx and skin ,he compares it to the white lotus flower(swethapundareeka).In allopathy ,even in presentday classrooms the description of the squamous cell carcinoma of these sites is cauliflowerlike.(the whiteness and the flower like appearence0.Susrutha prescribes a vegetarian diet ,a modest life avoiding illicit sensual pleasures,daily food containing yava and mudga,virochana,dhooma ,daily oilbaths and the use of “karkaruka,naarikela,priyaala,panchamagulachoornam”for prevention of cancer.I think this may be tried for prevention of cancer.Modern science is of opinion that a nonvegetarian diet and excesses of sensual pleasures can lead to certain types of cancer.
We know that cancer is an excessive uncontrolled proliferation of a clone of abnormal cells.I often wonder whether the ancient Indian sage too knew this secret.If not why did he gave the name arbudham to this disease?In Sanskrit arbudham means a number ,a clone more than a crore cells can be an arbudham.Another interesting thing is that in yogavasishta ,sage vasishta ,the teacher of Srirama tells his disciple that the monsterous karkadi (meaning crab-in latin this is translated as cancer)enters the human body as a jeevasoochi(live needle)and gobbles its entire nourishment so that it becomes weak and perish.He adds that karkadi can enter only the bodies of men and women who have excesses of sensual pleasures and uncontrolled lifestyles.Prevention of diseases ,including cancer ,was the aim of the ancient Indian lifestyle .The scriptures ,the different systems of arts and sciences ,the methods of temple worships ,the food habits and even the festivities in relation to the different seasons were devised carefully so that people live a peaceful healthy life .It is sad that in the modern times ,this fact is forgotten and a lifestyle of a particular geographic region ,devised suitable to its geographic and climatic features ,is mistaken and misconstrued as areligion and in its name atrocities are committed.

Indian culture,ans sciences and arts are for the whole world,for the entire humanity.It can never be destroyed by anyone.Nor can it be protected by a few who takes up arms against our fellow countrymen.This eternal spring of wisdom existed and will exist forever ,as long as there are people who love and serve humanity ,on this planet earth,as hippocratus put it centuries back.