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The Sushruta Samhita (, ) is an ancient Sanskrit text on medicine and one of the most important such treatises on this subject to survive from the ancient world. The Compendium of Sushruta is one of the foundational texts of Ayurveda (Indian traditional medicine originating from the Atharvaveda), alongside the Charaka Samhita, the Bhela Samhita, and the medical portions of the Bower Manuscript. It is one of the two foundational Hindu texts on the medical profession that have survived from ancient India.Wendy Doniger (2014), On Hinduism, Oxford University Press, , page 79;
Sarah Boslaugh (2007), Encyclopedia of Epidemiology, Volume 1, SAGE Publications, , page 547, Quote: "The Hindu text known as Sushruta Samhita is possibly the earliest effort to classify diseases and injuries"
The Suśrutasaṃhitā is of great historical importance because it includes historically unique chapters describing surgical training, instruments and procedures. The oldest surviving manuscript of the Suśrutasaṃhitā is MS Kathmandu KL 699, a palm-leaf manuscript preserved at the Kaiser library, Nepal that is datable to 878 CE.
In Suśrutasaṃhitā - A Scientific Synopsis, the historians of Indian science Ray, Gupta and Roy noted the following view, which is broadly the same as Meulenbeld's:
"The Chronology Committee of the National Institute of Sciences of India (Proceedings, 1952), was of the opinion that third to fourth centuries A. D. may be accepted as the date of the recension of the Suśruta Saṃhitā by Nāgārjuna, which formed the basis of Dallaṇa's commentary."The above view remains the consensus amongst university scholars of the history of Indian medicine and Sanskrit literature.
Hoernle's date of 600 BCE for the Suśrutasaṃhitā was challenged by intervening scholarship over the last century. This scholarship was summarized by Meulenbeld in his History of Indian Medical Literature.
Central to the problem of chronology is the fact that the Suśrutasaṃhitā was the work of several hands. The internal tradition recorded in manuscript colophons and by medieval commentators makes clear that an old version of the Suśrutasaṃhitā consisted of sections 1-5, with the sixth part having been added by a later author. However, the oldest extant manuscripts include the sixth section, called "The Later Book" (Skt. Uttara-tantra). Manuscript colophons refer to the whole work as "The Suśrutasaṃhitā together with the Uttara-tantra," reinforcing the idea that they are a combined work. Thus, it does not make sense to speak of "the date of Suśruta." Like "Hippocrates," the name "Suśruta" refers to the work of many authors working over several centuries.
After a review of all past scholarship on the identity of Suśruta, Meulenbeld concluded that:
As is obvious from the foregoing, it is rather generally assumed that we owe the main part of the Suśrutasaṃhitā or an earlier version of it to a historical person called Suśruta. This assumption, however, is not based on uncontrovertible evidence and may be illusory. The text of the Suśrutasaṃhitā does not warrant that the one who composed it was a Suśruta. The structure oif the treatise shows without ambiguity that the author, who created a coherent whole out of earlier material, attributed the teachings incorporated in his work to Kāśirāja Divodāsa...
The Sushruta Samhita and Caraka Samhita have religious ideas throughout, states Steven Engler, who then concludes "Vedic elements are too central to be discounted as marginal". These ideas include the use of terms and same metaphors that are variously pervasive in Buddhist and Hindu scriptures – the Vedas, and the inclusion of theory of Karma, self (Atman) and Brahman (metaphysical reality) along the lines of those found in ancient Hindu and Buddhist texts. However, adds Engler, the text also includes another layer of ideas, where empirical rational ideas flourish in competition or cooperation with religious ideas. Following Engler's study, contemporary scholars have abandoned the distinction "religious" vs. "empirico-rational" as no longer being a useful analytical distinction.
The text may have Buddhist influences, since a redactor named Nagarjuna has raised many historical questions, although he cannot have been the person of Mahayana Buddhism fame. Zysk produced evidence that the medications and therapies mentioned in the Pāli Canon bear strong resemblances and are sometimes identical to those of the Suśrutasaṃhitā and the Carakasaṃhitā.
In general, states Zysk, Buddhist medical texts are closer to Sushruta than to Caraka, and in his study suggests that the Sushruta Samhita probably underwent a "Hinduization process" around the end of 1st millennium BCE and the early centuries of the common era after the Hindu philosophy identity had formed. Clifford states that the influence was probably mutual, with Buddhist medical practice in its ancient tradition prohibited outside of the Buddhist monastic order by a precedent set by Buddha, and Buddhist text praise Buddha instead of Hindu gods in their prelude.Terry Clifford (2003), Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing, Motilal Banarsidass, , pages 35-39 The mutual influence between the medical traditions between the various Indian religions, the history of the layers of the Suśruta-saṃhitā remains unclear, a large and difficult research problem.
Sushruta is reverentially held in Hindu tradition to be a descendant of Dhanvantari, the mythical god of medicine,Monier-Williams, A Sanskrit Dictionary, s.v. "suśruta" or as one who received the knowledge from a discourse from Dhanvantari in Varanasi.
Much of the scholarship on the Suśruta-saṃhitā is based on editions of the text that were published during the nineteenth and early twentieth centuries. This includes the important edition by Vaidya Yādavaśarman Trivikramātmaja Ācārya that also includes the commentary of the scholar Dalhaṇa.
The printed editions are based on the small subset of surviving manuscripts that was available in the major publishing centers of Bombay, Calcutta and elsewhere when the editions were being prepared — sometimes as few as three or four manuscripts. But these do not adequately represent the large number of manuscript versions of the Suśruta-saṃhitā that have survived into the modern era. Taken together, all printed versions of the Suśrutasaṃhitā are based on no more than ten percent of the more than 230 manuscripts of the work that exist today.
The Sushruta and Charaka texts differ in one major aspect, with Sushruta Samhita providing more detailed descriptions of surgery, surgical instruments and surgical training. The Charaka Samhita mentions surgery, but only briefly.
The Suśruta-Saṃhitā is divided into two parts: the first five books (Skt. Sthanas) are considered to be the oldest part of the text, and the "Later Section" (Skt. Uttaratantra) that was added by the author Nagarjuna.Prof.P.V.Sharma, Ayurveda Ka Vaijnannika Itihas,7th ed., Ch. 2, Pg.87, Chaukhambha orientalia, Varanasi (2003) The content of these chapters is diverse, some topics are covered in multiple chapters in different books, and a summary according to the Bhishagratna's translation is as follows:
| >+ Sushruta Samhita | ||||
| Book | Chapter | Topics (incomplete) | Translation Comments | |
{ class="wikitable collapsible collapsed"
! colspan=4 style="background: #ffcd66;" | 1. Sutra-sthana | |||
| 1.I | '''Origin of the Ayurveda''': eight divisions, history, definition of ''Purusha'' (patient), what is a disease, stages of a disease, classifications | |||
| 1.II | '''Medical education''': qualifications of a student, oath of care, promise of the student to the teacher, ethical prohibitions | |||
| 1.III | '''Classification of (Original) Samhita''': Table of contents, synopsis of the text, skilful and unskilful physicians, how to study for medical practice, need for "constant practice to attain perfection" | |||
| 1.IV | '''Preface and explanations''': Need for clear exposition, defects resulting from unclear statements, duties of a student | |||
| 1.V | '''Preliminary surgical measures''': Types of surgical operations, collecting equipment and accessories, prophylactics, modes of incision, post surgical steps, dressing wounds, instructions to the patient after surgery, measures to remove pain | |||
| 1.VI | '''Seasons and their influence on health and medicine''': effect of weather, change in weather, causes of epidemics, prophylactic measures, natural and unnatural seasons | |||
| 1.VII | '''Surgical appliances, their use and construction''': names, dimensions, use and functions, excellence of each appliance, defect of each appliance, accessories | |||
| 1.VIII | '''Surgical instruments, their use and construction''': handling instruments, sharpening, edging, tempering, maintenance, when should each be used and not used | |||
| 1.IX | '''Training for surgery''': use of dummies and fruits to learn and pre-practice surgery | |||
| 1.X | '''Qualifications and certification of a physician''': effect of weather, change in weather, causes of epidemics, prophylactic measures, natural and unnatural seasons | |||
| 1.XI | '''Preparing Alkalis, their uses''': how to prepare the solutions, external and internal uses, cauterization, potencies, defects, dangers, reaction, preventing abuse | |||
| 1.XII | '''Cauterization''': preparation and process for various injuries and diseases, various types of cauterization | |||
| 1.XIII | '''Leeching''': suitable and unsuitable patients, mode of vitiating ''dhatu'' (blood), finding, collecting and keeping leeches, good leeches and bad leeches, post-treatment measures | |||
| 1.XIV | '''Lymph chyle''': menstrual blood and its nature, swellings, venesection, causes of excessive bleeding, causes of scanty bleeding, measures to be adopted in either | |||
| 1.XV | '''Excretory disorders''': nature, locations, theory of why they increase or decrease | |||
| 1.XVI | '''Ear piercing and bandages''': proper piercing, accidents, treatments | |||
| 1.XVII | '''Swellings''': types, suppurating and non-suppurating, causes, symptoms, treatments, dangers of misdiagnosis, anaesthesia, lancing, surgery | |||
| 1.XVIII | '''Ulcers''': classification, preparing medicinal plasters, dressing, evils of not bandaging, benefits of bandaging, when not to bandage, lubricating bandage for faster healing | |||
| 1.XIX | '''Nursing and management''': bed, chamber, prohibited articles, prophylaxis and mantras against monsters and demons, diet, conduct, care | |||
| 1.XX | '''Food and regimen for patient's recovery''': Food and drinks, their role in patient's recovery, salutary regiment, non-salutary regimen | |||
| 1.XXI | '''Vayu, Pittam and Shleshma''': the role and impact of diseases on Vayu, Pittam and Shleshma (body aeration, body fluids) | |||
| 1.XXII | '''Boils and ulcers, secretions''': shapes, types, secretion, role of ''Vayu'', pains and their kinds associated with different types of ulcers, colors of ulcers | |||
| 1.XXIII | '''Prognosis of ulcers''': symptoms, identification of curable and incurable types, palliation, factors which reopen healed ulcer | |||
| 1.XXIV | '''Classification of diseases, deciding if medicine or surgery is needed''': types of diseases, congenital, mental, physical, providential; causes of fever | |||
| 1.XXV | '''Eight forms of surgery''': description, suitability in different cases, avoiding injuries to blood vessels and ligaments, action if accidentally injured | |||
| 1.XXVI | '''Injuries from splinters''': ''Shalyam'', accidental injuries, arrow injuries, necessity for removing arrow shafts | |||
| 1.XXVII | '''Injuries, extraction of splinters''': fifteen methods of extraction, dangers of not extracting splinters completely from a wound | |||
| 1.XXVIII | '''Progress in treating ulcer''': signs of improvement, signs of worsening, fatal symptoms | |||
| 1.XXIX | '''Disease prognosis, use of omens, augury''': Dreams and their analysis for diagnosis | |||
| 1.XXX | '''Prognosis from sense organs''': Testing sensory functions of a patient for symptoms and disease prognosis | |||
| 1.XXXI - 1.XLVI | Various topics |
|-
| colspan=4 |
| ! colspan=4 style="background: #ffcd66;" >2. Nidana-sthana | ||||
| 2.I | '''Nervous system diseases''': causes, pathology, symptoms, prognosis. Epilepsy, Hemiplegia, Torticellis, Facial paralysis, Indistinct speech, etc. | |||
| 2.II | '''Haemorhoids''': classification, causes, pathology, symptoms, prognosis. | |||
| 2.III | '''Urinary calculli''': Aetiology, symptoms, indications, theory on how bladder stones are formed | |||
| 2.IV | '''Fistula''': classification, pathology, symptoms, prognosis. | |||
| 2.V | '''Skin diseases''': classification, aetiology, symptoms, treatment, contagious nature, avoiding its spread, prognosis. | |||
| 2.VI | '''Urinary diseases''': pathology, symptoms, prognosis. | |||
| 2.VII | '''Dropsy''': classification, causes, pathology, symptoms, prognosis. | |||
| 2.VIII | '''Birth, Difficult labor''': causes, classification, symptoms, abortion, miscarriage, prognosis. | |||
| 2.IX | '''Abscess, Vidradhi''': classification, curability, treatment | |||
| 2.X | '''Mammary glands diseases (women)''': classification, symptoms, healthy breast milk and its character, abnormal traits, baby care | |||
| 2.XI | '''Tumors and goitres''': classification, symptoms, causes, prognosis | |||
| 2.XII | '''Andrology and gynecology''': genital organ diseases, classification, symptoms, causes, prognosis | |||
| 2.XIII | '''Kshudra roga''': minor diseases, classification, symptoms, causes, prognosis | |||
| 2.XIV | '''Shuka dosha''': classification, symptoms, prognosis | |||
| 2.XV | '''Fracture and dislocation''': causes, features, symptoms, classification, curable and incurable types, treatment, management | |||
| 2.XVI | '''Mouth, tongue, larynx and lip diseases''': classification, causes, symptoms, classification, prognosis |
|-
| colspan=4 |
| ! colspan=4 style="background: #ffcd66;" >3. Sarira-sthana | ||||
| 3.I | '''Theory of Being''': Tattvas, Purusha and Prakriti, ''[[Samkhya]]'' theories and its use in medical practice, human mind | |||
| 3.II | '''Reproductive health''': classification of semen and menstrual fluid, disorders, treatment, sexual activity for conception, difficulty in conception, causes, description of fetus | |||
| 3.III | '''Pregnancy''': Theory of ''Sarira'' (body, matter), ''Atman'' (soul), theory on gender formation, signs of pregnancy, care of pregnant woman, fetal development, cravings, twin, time of delivery, care during labor | |||
| 3.IV | '''Womb, baby development''': theory on placenta, limbs, organ development during pregnancy | |||
| 3.V | '''Human anatomy''': Enumeration of limbs, body organs, their numbers, vessels, bones, joints, ''Sandhis'', ligaments, muscles, differences between organs of men and women, reproductive organs | |||
| 3.VI | '''Marmas, vital organs''': classification, numbering and location of organs, different theories on which organs are vital, symptoms associated with specific organs when injured | |||
| 3.VII | '''Vascular system''': classification, numbering and location of ''Siras'' (vascular system) | |||
| 3.VIII | '''Venesection''': classification and definition, determining who is fit and who unfit for venesection | |||
| 3.IX | '''Arteries, Nerves and Ducts''': classification, locations, theory on their roles, symptoms in cases of disorder | |||
| 3.X | '''Nursing, care of pregnant women''': needs from conception to parturition, regimen during gestation, diet, natal rites, lactation, infantile diseases, miscarriage and its treatment, management of pregnancy | |||
|-
| colspan=4 |
| ! colspan=4 style="background: #ffcd66;" >4. Cikitsa-sthana | ||||
| 4.I | '''Ulcers''': causes, symptoms, traumatic and idiopathic ulcers, dosha-originated ulcers, therapeutics, sixty treatments of different types of ulcers | |||
| 4.II - 4.XXIII | Various topics: Treatment of ulcers, wounds, sores, fractures, nervous disorders, urinary infections, skin infections, tumors, swellings, hernia, hydrocele, genital sores, urethra infections, mouth infections, other minor ailments | |||
| 4.XXIII - 4.XL | Various topics on '''Hygiene''': tooth brushing, dental care, face care, hands and feet washing, bathing, exercise, healthy meal, rules on drinking water, benefits of ''Dahi'' (yoghurt), good sleep, effect of not taking care of body, improving strength, elixirs, rejuvenators, remedial agents, Soma, tonics, Sneha, Sveda, Emetics, Purgatives, effects of abusing or overdosing medicine and solutions, use of Dhuma (fumes) and Kavala (gargling) for relief from some symptoms. |
|-
| colspan=4 |
| ! colspan=4 style="background: #ffcd66;" >5. Kalpa-sthana | ||||
| 5.I | '''Preserving food and drink''': theory on why food or drink poisons, how to detect poisoned food or drink, treatment of food poisoning | |||
| 5.II - 5.VIII | Various topics on '''Poisons''': Classification, description and treatment of animal poisons, snake bite, rat poisoning, scorpions, spiders, other insect bites |
|-
| colspan=4 |
| ! colspan=4 style="background: #ffcd66;" >6. Uttara-tantra | ||||
| 6.I-6.XIX | '''Eye disorders, injuries and infections''': eye diseases, appendages, causes of eye diseases, symptoms, eyelid infections and their treatment, classification of eye lens problems and prognosis, need and protocols for eye surgery, eye injuries and their treatment | |||
| 6.XX-6.XXI | '''Ear disorders, injuries and infections''': ear diseases, causes and their treatment | |||
| 6.XXII-6.XXIII | '''Nose disorders, injuries and infections''': classification of nose diseases, symptoms and their treatment | |||
| 6.XXV-6.XXVI | '''Head diseases''': classification of head diseases, symptoms and their treatment | |||
| 6.XXVII-6.XXXVII | '''Malignant grahas''': attack by grahas (superhuman influences), symptoms, procedures for sprinkling, fumigation and mantra recitals | |||
| 6.XXXIX-6.LIII | '''Fever, diarrhea, phthisis, gulma, heart disease, jaundice, hemorrhage, alcoholism, vomiting, asthma, cough''': classification, symptoms, causes, prognosis, changes in diet as cure, use of drinks, milk and meat as medicine. | |||
| 6.LIV-6.LIX | '''Worms, problem urinating, other diseases''': classification, symptoms, causes, prognosis | |||
| 6.LXII | '''Insanity''': type, symptoms and treatment | |||
| 6.LXIV | '''Rules of health''': indications and importance of health, knowledge of foods, varying food intake with seasons, effective ways to administer medicines, proper time for taking food and medicines | |||
| 6.LXV-6.LXVI | '''Glossary and short list''': technical terms in the text, their definitions, list of diseases and drugs, various lists and their numbers |
The osteological system of Sushruta, states Hoernle, follows the principle of homology, where the body and organs are viewed as self-mirroring and corresponding across various axes of symmetry. The differences in the count of bones in the two schools is partly because Charaka Samhita includes thirty two teeth sockets in its count, and their difference of opinions on how and when to count a cartilage as bone (both count cartilages as bones, unlike current medical practice).
The ancient text, state Menon and Haberman, describes haemorrhoidectomy, amputations, plastic, rhinoplastic, ophthalmic, lithotomic and obstetrical procedures.
The Sushruta Samhita mentions various methods including sliding graft, rotation graft and pedicle graft. Reconstruction of a nose (rhinoplasty) which has been cut off, using a flap of skin from the cheek is also described. Labioplasty too has received attention in the samahita.
Sushruta's treatise provides the first written record of a cheek flap rhinoplasty, a technique still used today to reconstruct a nose. The text mentions more than 15 methods to repair it. These include using a flap of skin from the cheek, which is akin to the most modern technique today.
The nose in Indian society has remained a symbol of dignity and respect throughout antiquity. Rhinoplasty was an especially important development in India because of the long-standing tradition of rhinotomy (amputation of the nose) as a form of punishment. Convicted criminals would often have their noses amputated to mark them as untrustworthy, but amputation was also frequently practiced on women accused of adultery – even if they were not proven guilty. Once branded in this fashion, an individual had to live with the stigma for the rest of his or her life. Reconstructive surgery, therefore, offered a hope of redemption and normalcy.
The text was known to the Khmer king Yaśovarman I (fl. 889-900) of Cambodia. Suśruta was also known as a medical authority in Tibetan literature.
Earlier commentaries existed but have only been transmitted to modern times in fragmentary form. These include lost or partially-lost commentaries by Jejjaṭa (ca. 700 CE), Gayadāsa (ca. 1000 CE), and Cakrapāṇidatta (ca. 1025 CE).
Commentaries continued to be written on the work into the nineteenth century, e.g., the Suśrutārthasandīpanī by Haranachandra written in the 19th century AD.
An English translation of both the Sushruta Samhita and Dalhana's commentary was published in three volumes by P. V. Sharma in 1999. Scholars of Ayurveda generally consider this to be the most accurate and scholarly translation of the complete work to date.
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