Charaka Samhita and Sushruta Samhita
by Nayana Sharma | 2015 | 139,725 words
This page relates 鈥楳ultiplicity of Textual Strata鈥� of the study on the Charaka Samhita and the Sushruta Samhita, both important and authentic Sanskrit texts belonging to Ayurveda: the ancient Indian science of medicine and nature. The text anaylsis its medical and social aspects, and various topics such as diseases and health-care, the physician, their training and specialisation, interaction with society, educational training, etc.
Go directly to: Footnotes.
Multiplicity of Textual Strata
It is evident, therefore, from the evidence we have considered, the 厂补峁僪颈迟腻蝉 were written over a long stretch of time and additions were made as medical knowledge progressed. The layers within the texts are not distinguishable at present. The multiplicity of textual strata can be seen as a response to enhancement of knowledge which is a continuous process. We have 顿峁涐笉丑补产补濒补鈥檚 affirmation that he compiled and restored aforementioned chapters of Caraka鈥檚 compendium by culling material from several important treatises. It is noteworthy that although 膧迟谤别测补 is a teacher of 办腻测腻-肠颈办颈迟蝉腻 or internal medicine, the present Caraka 厂补峁僪颈迟腻 takes cognizance of surgical procedures in the treatment of particular conditions. The procedures that find mention are blood-letting by means of horn (艣峁涐箙驳补), gourd (补濒腻产耻), leech (jalauka) or sharp instrument (迟颈办峁补 艣补蝉迟谤补);[1] cauterisation by application of alkalis (办峁Ｄ乺补-karma)[2] or heat (agni-karma)[3] and use of surgical instruments.
Blood-letting (rakta-mocana), for instance, is recommended in the following conditions: in certain types of fever (jvara);[4] phantom tumour (gulma);[5] skin disorders (办耻峁ａ弓丑补); psychological disorders (耻苍尘腻诲补);[6] 腻辫补蝉尘腻谤补 (epilepsy);[7] goitre (驳补濒补驳补峁囜笉补) and 驳补峁囜笉补尘腻濒腻 (cervical adenitis);[8] painful eruptions and swellings known as alaji, 肠补谤尘补苍补办丑腻苍迟补谤补 艣辞迟丑补 (whitlow) and 惫颈诲腻谤颈办腻;[9] 箩腻濒补办补驳补谤诲补产丑补 (suppuration with fever),[10] 辫濒墨丑辞诲补谤补 (enlargement of the spleen) and 测补办峁沝耻诲补谤补 (liver enlargement);[11] piles;[12] ulcers (惫谤补峁嘺);[13] gout (惫腻迟补-谤补办迟补)[14] and sciatica (驳峁沝丑谤补蝉墨).[15] There is also an explanation of why becomes necessary in certain conditions and the precautions to be exercised.[16] Caraka affirms that it is only after the elimination of blood impurities through blood-letting as well as elimination of vitiated 诲辞峁蝉 from the gastro-intestinal tract that the ointments for 办耻峁ａ弓丑补 become efficacious.[17] This acknowledgment must have come from the observation of the efficacy of blood-letting practised by the school of Dhanvantari.
The application of leeches is specified in piles if blood does not come out on its own.[18] There is reference to use of sharp instruments (艣补蝉迟谤补) and cauterisation by alkali and heat in the management of skin disorders,[19] piles[20] and in various types of swellings (艣辞迟丑补).[21] Thermal cauterisation is prescribed in ulcers with excessive bleeding, post-excision of protruding flesh, muscular over-growth, enlarged glands (caused by kapha), goitre, in stiffness and other ailments brought on by aggravated 惫腻测耻.[22]
Incision of fistula with 办峁Ｄ乺补 s奴tra (thread smeared with alkaline preparation) is also referred to by Caraka.[23] Besides, the management of granthi (hard tumour) follows that prescribed by 厂耻艣谤耻迟补: fomentation of the tumour, excision followed by cauterization.[24] Surgical removal of abscesses[25] and urinary stones and gravels[26] are also mentioned.
The change in the position of practitioners of 办腻测腻-肠颈办颈迟蝉腻 or internal medicine vis-脿-vis surgical intervention is perhaps best illustrated by the following two statements of Caraka occurring in the 厂奴迟谤补-蝉迟丑腻苍补 and 颁颈办颈迟蝉腻-蝉迟丑腻苍补 respectively:
(a) One the factors that indicates negative prognosis of a disease is one in which treatment surgery, application of alkalis and cauterization is involved[27] for they are difficult to cure (办峁沜肠丑谤补蝉腻诲丑测补 [办峁沜肠丑谤补蝉腻诲丑测补m]).[28]
(b) If the patient is 办峁沜肠丑谤补 (physically and mentally strong), then incision of the suppurated abscess is an excellent remedial measure (paramucyate).[29]
The polarity of the two statements reflects the change in attitude towards another line of treatment which is accepted as efficacious in certain clinical conditions. Blood-letting and scarification as we have seen above are incorporated in the treatment of skin disorders.[30] The use of 办奴谤肠补 (surgical brush with hard fibres) and sharp edged scalpel (艣补蝉迟谤补) are specifically mentioned in the chapter dealing with treatment of 办耻峁ａ弓丑补.[31] It is therefore not surprising that students of the 膧迟谤别测补 school had to be apprised of the six types of surgical procedures of 辫腻峁璦苍补 (incision), 惫测腻诲丑补苍补 (puncturing), chedana (excision), lepana or lekhana (scraping), pracchana (scarification) and 蝉墨惫补苍补 (suturing) and their specific conditions of application.[32] All these procedures as well as probing (别峁峁嘺), application of alkalis and leeches are included in surgical therapy (艣补蝉迟谤补pra峁噄dh膩na) as opposed to internal cleansing (补苍迟补岣补谤颈尘腻谤箩补苍补) and external cleansing (产补丑颈岣补谤颈尘腻谤箩补苍补).[33]
The processes involving surgical processes have generally been only a cursory treatment in Caraka鈥檚 treatise. 颁补办谤补辫腻峁噄诲补迟迟补 explains that since Caraka deals with medicine and surgical procedures fall in the domain of surgery, detailed explanation of the procedures is absent.[34] Post-operative measures are not mentioned by in the treatise.
It is also interesting to point out that the recognition of blood-letting as a therapeutic measure necessitated acquaintance with the functions and properties of blood. The 膧迟谤别测补 school recognises the three 诲辞峁蝉 (often translated as humours) of 惫腻测耻, pitta and kapha as the pathogenic factors in the body.[35] Nevertheless, in the twenty-fourth chapter of the 厂奴迟谤补-蝉迟丑腻苍补 there is notice of blood as an independent vitiating factor with as many as forty clinical disorders are attributed to it.[36] Two diseases mentioned among them are conjunctivitis (补办峁谤腻驳补) and skin disorders. In the 颁颈办颈迟蝉腻-蝉迟丑腻苍补, however, aetiologically both are attributed to the perturbation of the three 诲辞峁蝉 or all the three together. Blood is not seen as a vitiating factor in eye diseases;[37] while vitiation of blood is recognised in the pathogenesis of 办耻峁ａ弓丑补, it is said to be caused by the perturbation of the three 诲辞峁蝉 and not independently.[38] One may, therefore, construe that this portion relating to blood in the 厂奴迟谤补-蝉迟丑腻苍补[39] is an interpolation in the compendium.
A few interpolations in the 厂耻艣谤耻迟补 厂补峁僪颈迟腻 too may be indicated. Both the texts have described the seasonal regimen (峁泃耻肠补谤测腻) in the sixth chapter of their respective Sutra-蝉迟丑腻苍补.[40] In fact one could argue that this chapter appears to be in the nature of an interpolation in the 厂耻艣谤耻迟补鈥檚 compendium between the fifth chapter on 鈥淧reoperative Arrangements鈥� (补驳谤辞辫补丑补谤补峁嚹珁补-补诲丑测腻测补) and the seventh chapter on 鈥淭he Varieties of Blunt Instruments鈥� (yantravidhir补诲丑测腻测补). The chapter on 鈥淓ar Puncture and Plastic Surgery鈥�[41] describing fifteen patterns of repair of the ear lobule (办补谤峁嘺产补苍诲丑补) and rhinoplasty also appears to be a later insertion as the management of other ear and nose diseases are discussed in the Uttara-tantra.[42] We would also argue that the 24th chapter of the 厂奴迟谤补-蝉迟丑腻苍补 enumerating the classification of diseases is probably an interpolation.
The nature of management of children鈥檚 diseases is seems to be at variance with the treatment of other afflictions for they are all ascribed to malevolent beings (grahas) and not to the imbalance of 诲辞峁蝉.[43] The text recommends various offerings of food substances including cooked and uncooked meat for the appeasement of the grahas-a feature not noticed in other sections of the work. Finally the discussion of internal diseases like fever, diarrhoea, consumption, etc. in last section of the compendium is also a later addition for they are not present in the eight major diseases enumerated in the Nid膩na-蝉迟丑腻苍补. We may conjecture that this was necessitated by the complications arising from surgical procedures and their understanding became fundamental for the surgeon.
The presence of several textual layers makes the task of determination of time of composition of the treatises rather complex. The term 厂补峁僪颈迟腻 itself indicates that the treatises are compilations. It is necessary to take up a critical study of the extant manuscripts as has been accomplished by V.S. Sukhthankar for the 惭补丑腻产丑腻谤补迟补 which unfortunately we have not been able to take up.
Footnotes and references:
[1]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.51.
[2]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.101-106.
[3]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.107.
[4]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 3.289-290; Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 9.77.
[5]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 5.32.
[6]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 9.77.
[7]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 9.77.
[8]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.79-80.
[9]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.89-90.
[10]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.99-100.
[11]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 13.77,87-88.
[12]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 14.61.
[13]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.49.
[14]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 29.35-36.
[15]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 28.101.
[16]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 29.35-39.
[17]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.53.
[18]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 14.61.
[19]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.54.
[20]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 14.33.
[21]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.101.
[22]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.101-102.
[23]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.96-97.
[24]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.81-85. Compare with 厂耻艣谤耻迟补 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 8.17-18.
[25]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.49.
[26]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 26.68.
[27]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 10.15.
[28]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 10.16.
[29]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.54.
[30]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.40, 50-52.
[31]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.57.
[32]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 25.55-61.
[33]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 11.55.
[34]:
Cakarap膩峁噄datta on Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 12.96-97.
[35]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 1.57.
[36]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 24.11-16.
[37]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 26.129-130.
[38]:
Caraka 厂补峁僪颈迟腻 Cikits膩蝉迟丑腻苍补 7.9.
[39]:
Caraka 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 24.1-24.
[41]:
厂耻艣谤耻迟补 厂补峁僪颈迟腻 厂奴迟谤补蝉迟丑腻苍补 16.
[42]:
厂耻艣谤耻迟补 厂补峁僪颈迟腻 Uttaratantra 20-23.
[43]:
厂耻艣谤耻迟补 厂补峁僪颈迟腻 Uttaratantra 27-36.