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The Legacy of Susruta
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The Legacy of Susruta
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Preface:

Since The Legacy of Caraka was published three years ago it has drawn the favourable notice of reviewers and accounted for three new impressions and a translation into Malayalam. It was against this rosy background that friends, especially Dr Kuttykrishnan Nair of Thiruvananthapuram two reviewers and my wife Ashima urged me to write a similar volume on the Susruta Samhita which ranks in authority with Caraka's. I was persuaded that the welcome accorded to y Caraka study had not a little to do with its thematic approach would be appropriate in a book on the Susruta Samhita. Fortunately the use of a simpler and later version of Sanskrit, more logical presentation of material and the overall surgical orientation of the text made the study of the Susruta Samhita less difficult and less time-consuming than my Caraka endeavour. Apart from thematically arranged material which leaves out none of the chapters of the original and the tabular presentation of data, The Legacy of Susruta also features a large number of figures to illustrate events, instruments, anatomy and a variety of procedures.

I was introduced to the Susruta Samhita through Kaviraj Kunjalal Bhishagratna's classic and highly readable edition which continues to be popular. However, I found that a more accurate and contemporary understanding of the original was provided by using Professor P V Sharma's translation in association with Dalhana's Nibandhasangraha commentary. My practice throughout was to study the original on my own for rearranging the vast and carried material and to follow up by reading the translation and commentary before writing my text. I have differed from them here and there and clarified the description of several surgical procedures. I have made no attempt to survey the extensive literature on the Susruta Samhita (it would have been a pedantic exercise) and have confined myself to an overview of Susruta's times and contributions in the introductory essay as I did in The Legacy of Caraka. I am well aware that readers are less interested in what other say about Susruta than in what he himself had said.

My effort received a major boost by my appointment as a National Research Professor when the study was in progress. I am grateful to the Government of India for this singular honour and hopeful that the Professorship may, by a subtle alchemy, graduate into a national science initiative for research in ayurveda unburdened by herbal product development and global marketing. I was fortunate tht may endeavour caught the attention of Dr P K Warrier, the much-admired Managing Trustee and Chief Physician of the Arya Vaidya Sala, Kottakkal who laid me under a debt of obligation by offering whole-hearted cooperation. It was on his suggestion that Dr K Rajagopalan of Kollam, a consultant to the Arya Vaidya Sala, agreed to review my manuscript. A reputed senior physician who migrated to ayurveda from modern medicine, he is recognized widely for his profound scholarship of Brhatrayi. His insistence on fidelity to the original which he could often quote from memory, and his friendly demenour made my discussions with him in Kottakkal an enjoyable experience. Apart from allowing me free access to the Arya Vaidya Sala library, Dr Warrier also introduced me to Dr C Ramankutty of the Arya Vaidya Sala who is an ayurvedic physician, a meticulous scholar and an authority on medicinal plants. Dr Ramankutty liberally and cheerfully checked the accuracy of references and diacritical marks in my manuscript, prepared the botanical names of plant, formulated on index and also corrected the proofs. I have no words to thank these two outstanding scholars for their expert assistance. The Kottakkal team also included Dr T S Murali, Chief of R&D, who made sure that the arrangements for travel, meetings and exchange of information were always efficient and faultless. To all my friends in the Arya Vaidya Sala I owe a debt of gratitude.

I am grateful to Dr Ramdas Pai, President of Manipal Academy of Higher Education for continuing to provide excellent facilities for my study in the academically vibrant atmosphere of Manipal. Mr. Abraham Joy prepared the illustrations for the present volume based on whatever information and drawings were available in the literature and on his own innovative ideas. His drawings have enlivened the book, for which he deserves my sincere thanks.

I am beholden to Professor Jyotir Mitra of Banaras Hindu University for enlightening me on Panini's references to Susruta, to Dr K Sasidharan, Professor Urology, for drawing my attention to the revival of the perineal approach of Susruta by Gadhvi for prostatectomy and to Dr Suresh Pillai, Associate Professor of ENT, Kasturba Medical College, Manipal, who supplied the sketches for nose repair based on the terse account of Susruta. Special thanks are due to Ms Usha Kamath who typed and retyped the voluminous manuscript and kept track of files with admirable patience and efficiency as papers moved in and out between Manipal, Kottakkal and the publisher's office in Chennai. Last, but not least, I acknowledge gratefully the editorial assistance and support of Ms Padmaja Anant of Orient Longman Private Limited.

The Samhitas of Caraka and Susruta are timeless classics whose authority was acknowledged by the great Vagbhata many centuries ago. Their Forerunners-Agnivesatantra and Susrutatantra-and many other ancient texts are lost, probably forever. We should be thankful that the Samhitas are still with us and their language can be understood unlike the script of Mohenjo-daro which smiles enigmatically but remains indecipherable. We are Fortunate that we can not only read what Caraka and Susruta wrote but can also discover ourselves and out lives 'in sickness and in health' in what they wrote so very long ago.

 

M S VALIATHAN

About the Book:

 

The Legacy of Susruta

Susruta's name is synonymous with India's surgical inheritance. A legendary figure, he is believed to have lived and taught in Varanasi several centuries before the Buddha, and composed the Susrutatantra which became a timeless medical classic. Though the original text was lost long ago a redaction by Nagarjuna survived as Susruta Samhita and won universal acclaim. The Samhita is a study of the human condition in health and disease with undisguised emphasis on surgery, and rivals Caraka's classic in authority. In The Legacy of Susruta, the text of Susruta Samhita has been recast in a thematic fashion without sacrificing any of the content of the original chapters. Furthermore, it presents much of the data in tabular form, and features many tables and illustrations in an effort to reach out to readers who may include not only students of ayurveda but also of modern medicine, biological and social sciences and the history of science.

A native of Kerala, Dr. M S Valiathan received his medical education in India and training in surgery and cardiac surgery in the UK and USA. During a career spanning three decades as a surgeon and investigator, his major interests were cardiac surgery in Children, studies on a tropical heart muscle disease, and the development of cardiovascular devices. His contributions are embodied in a monograph, many scientific papers and a family of medical devices including a tilting disc heart valve, all of which are used widely in India. The present volume is a companion to The Legacy of Caraka which was published by Orient Longman in 2003.

Dr. Valiathan is a National Research Professor of the Government of India. He is married to Ashima, an orthodontist. They have a daughter, Manna, and a son Manish.

 

Introduction

SUSRUTA AND HIS PERIOD

A surgical colossus standing astride many centuries of India's past, Susruta nevertheless remains a historical puzzle. Cakrapanidatta, Bhavamisra and Dalhana are unanimous that he was the son of Visvamitra; this is supported by statements in the Susruta Samhita as well as the Mahabharata. This Visvamitra could not obviously be identified with the Rg vedic seer whose name is almost synonymous with the Gayatrimantra. Susruta studied ayurveda from Divodasa who was a king of Kasi and a descendant of Dhanvantari. As he was chosen by his classmates to put questions to the revered preceptor and interpret the answers for them, Susruta was admittedly the first among equals and gifted with a superior intellect.

The period when Susruta lived has been a subject of much debate. Hoernle who pioneered studies on ayurvedic texts in the early part of the twentieth century held the view that the original Susrutatantra. which was redacted probably more than once 'admittedly belongs to a much earlier period, possibly as early as about 1000 BC.' This view had been advanced by Hessler earlier in his Latin edition of the Susruta Samhita wherein he placed Susruta in 'the heroic age of India, the beginning of which is not known but the end of which is marked by 1000 BC.' Moreover, as pointed out by several authors, an indicator of Susruta's antiquity is the reference to him by Panini who used his name as a familiar example in elaborating on Sutras. In relation to 'tena prokram he added 'Susrutena proktam Sausrutarn' (what was stated by Susruta is Sausrutam); in Kartakauja padayasca, he stated 'Susrutasya prthosca chatrah" (the foremost of Susruta's pupils); in the gloss on the Sutra 'ktena nanvisstena anan', one finds 'kutapapradhanah sausrutah, kutapasausrutah' (the blanket-wearing pupils of Susruta). As the time of Panini has been fixed around 700 BC by Goldstucker and it would have taken one or two centuries for the name of Susruta from Banaras in the east to become so familiar to Panini who lived near or in Taxila in the west, it is reasonable to believe that he lived and taught well before Panini. A corroborating piece of evidence emerges from the life of Buddha's physician jivaka whose birth in Pataliputra, medical training in Taxila and admirable skills as a physician and surgeon are vividly recorded in Buddhist texts such as Mahavagga and the jataka tales. If the young and brilliant jivaka proceeded from Patalipurra to faraway Taxila for training in surgery and medicine, it is clear that Banaras had yielded preeminence in ayurvedic studies ro Taxila by the time of the Buddha. This decline can hardly be accounted for unless Susruta (who marked the zenith of salyatantra in Banaras) had passed away centuries earlier. Furthermore jivaka's trephining of the skull finds no mention among Susruta's techniques indicating that the procedure was non- existent in Susruta's time.

Professor Iyotir Mitra suggests that Kasiraja Divodasa had temporarily withdrawn to Bharadvaja's Asram in Uttarakasi following his defeat by Haihaya Ksatriyas and the teachings of the Susrutatantra had originated during his exile. This possibility is also supportive of the antiquity of the original text.

Susruta Samhita

The Samhita which bears Susruta's name and ranks with that of Caraka in authority is a product of one or more redactions of an original tantra which Susruta had composed. Tantras dealt with specific subjects in the manner of monographs and ancient India prided in tantras which dealt with subjects such as toxicology and eye disease. Among Kasiraja Divodasa's disciples, Susruta and his classmates Aupadhenava, Vaitarana, Aurabhra, Pauskalavata, Karavirya and Gopuraraksita authored tantras on salya but only Susruta's text managed to survive the ravages of time through successive renewals in the form of redactions. Its most important redaction is attributed to Nagarjuna whose identity has not however been established beyond doubt. The authorship of Uttaratantra has also been controversial but as it was a part of Susruta Samhita at the time of Vagbhata it has considerable antiquity and has a justifiable claim to have been added during the redaction of the Susrutatantra.

It is generally held that Susrutatantra was redacted by Nagarjuna, the great Buddhist philosopher who pioneered the Madhyamika or Sunyavada school. Nagarjuna argued that there is no truth, no essence in all phenomena which, therefore, are neither produced nor destroyed; nor do they come or go. They are a mere illusion and the so-called nirvana is no more than the cessation of the seeming flow of phenomena. In the Madhyamikavrrti he declared that Buddha was a phenomenon and was therefore a mirage or a dream, and so were his teachings! The claim that this path-breaking philosopher was the redactor of Susrutatantra is hardly credible for several reasons. In the first place, the depth of medical knowledge in terms of the structure and functions of the organs; manifestations, causes and prognosis of diseases; details of therapeutics and surgical techniques which abound in the Susruta Samhita could not be plumbed by anyone except an expert in medicine. Secondly, Nagarjuna-a nihilist--could not conceivably have redacted hymns addressed to gods including Krsna and Rama, endorsed the worship of brahmanas, or supported the rigid caste hierarchy, all three of which figure prominently in the Susruta Samhita. He could not possibly be a party to classifying snakes on the basis of caste!

Another school of thought attributed the redaction of Susrutatantra to Nagarjuna, the reputed alchemist of the tenth century AD. As pointed out by several scholars including Bhisagratna, this view lacks merit because verses from the present text of Susruta Samhita were quoted by Vagbhata in the Astangahrdaya two centuries before the alchemist Nagarjuna. Until new evidence appears, we may therefore conclude that an unidentified N agarjuna was responsible for reinventing the original Susrutatantra in the present form, and that he lived after Drdhabala who revised the Caraka Samhita. The redactions, over centuries, became the substrate for further changes by others especially by Candrata.

 

 
CONTENTS
 
Transliteration chart    
Preface    
Quotes from Susruta    
List of figures    
Introduction : Susruta – A Surgical Colossus    
 
SECTION –I
 
Chapter 1: At the feet, Divodasa, Dhanvantari 1
  Kasiraja Divodasa Dhanvantari begins instruction in ayurveda; emphasis on surgery as preferred by pupils; Susruta as the representative of pupils  
 
SECTION – II
 
Chapter 2: Initiation and training of physicians 7
  Initiation for the study of ayurveda; exhortation by the preceptor; equal importance of theory and practice; method of study and importance of understanding; royal permission to practice medicine  
 
SECTION – III :SURIGCAL PROFILE OF CLINICAL PRACTICE
 
Chapter 3: Surgical procedures; pre- and postoperative care (pradhana, purva and pascat karma) 16
  Eight surgical procedures; accessories for surgery; incision and drainage of abscess; chanting a protective hymn; detailed classification and indication for surgical procedures; bandaging; complications  
Chapter 4: Surgical instruments (yantras and sastras) 30
  Blunt and sharp instruments; classification; use and functions; supportive instruments  
Chapter 5: Use of alkalis (ksara) 47
  Two varieties; indications; methods of preparation; technique of application  
Chapter 6: Cauterisation (agnikarma); burns and treatment 51
  Cauterisation ranks above caustic alkali; procedure; indications; burns, classifications and treatment; inhalation injury  
Chapter 7: Blood-letting (raktavisravana) : methods and management 56
  Benefits; indications; two methods, scarification and venesection, indications of each; each; venesection at different locations and for varied clinical conditions; use of leeches  
Chapter 8: Assorted surgical techniques 66
  Piercing the ear; reconstruction of the ear lobe; pre0 and postoperative measures; reconstruction of the nose and lip; foreign bodies and their removal  
Chapter 9: Fractures and dislocations (kandabhagna; sandhimukta) 80
  Classification; treatment; management of regional injuries; oils for promotion of bone healing  
 
SECTION – IV : INTRODUCTION TO CLINICAL PRACTICE
 
Chapter 10: Diseases and their classification 91
  Surgical/Medical and other types of classifications; detailed classification under seven types on the basis of causation; dosas targeting dhatus to produce diseases  
Chapter 11: Time, seasons and the human body 95
  Units of time; classification of seasons; effects of seasons on life; deranged seasons turning habitat two wasteland  
Chapter 12: Dosas 100
  Three dosas as three pillars of support for the body; functions of dosas derived from etymology; perturbation of dosas; stages suitable for medical intervention during perturbation  
Chapter 13: Fall and rise of dosas, dhatus and malas; observations on blood 105
  Dosas, dhatus and malas as the basic components of the body; effects of the increase and decrease of each component; effects of derangement of ojas; disturbance in equilibrium of dosas, dhatus and malas; observation on blood  
Chapter 14: Rasas 114
  Six primary and sixty-three secondary tastes; dosas and rasas; characteristics of each rasa; classification of substances according to primary tastes  
Chapter 15: Wholesomeness: food incompatibilities 119
  Wholesome articles of diet; unwholesome combination of articles and incompatibilities in diet; unwholesomeness from cooking; combination of tastes causing incompatibility in potency and post-digestive taste  
Chapter 16: Geographical Influences influences in pharmacy 124
  The influence of locale on plants and human beings; criteria for the selection of land for harvesting plants; classification of land into six types; effects of wind  
Chapter 17: Principles of therapeutics 127
  The medical quarter for successful therapeutics; evaluation of patients to include traits of longevity, standard measurements for body parts, the dominance of dhatus, status of diseases, season, status of digestive fire, age, physical and mental strength adjustment, constitution and drugs; locale  
 
SECTION – V : FOOD AND DRINKS
 
Chapter 18: Liquids for intake 135
  Water quality; purification; qualities and effects of water from different sources; milk, curd, ghee, oils, honey, sugarcane products, wines, urine from different sources and their effects on the body  
Chapter 19: Food 160
  Classification; cereals; meats; fruits; greens; rubber; salts; prepared foods; sweet edibles; drinks after meals and their subgroups in details; their qualities and effects on dosas and the rest of the body  
Chapter 20: A code for dining 215
  Comfortable searing; protocol for serving meals and drinks; containers for different items of menu; meals to suit seasons; forbidden foods; conduct after meals; hints on managing indigestion; properties of food and their effects  
 
SECTION – VI
 
Chapter 21: Predictors of death and recovery 221
  What messengers, omens and dreams foretell; deranged sense as predictors of fatal outcome; derangements in form and function as predictors of death; inversion of qualities in body parts as predictors of death; incurability diseases  
 
SECTION – VII : DRUGS
 
Chapter 22: Basis of drug action: drugs as substances 233
  Properties of drugs based on the dominance of bhutas; drugs as substances affecting dosas; how drugs act  
Chapter 23: Tastes in the transformation of substances 238
  Bhutas and testes; six primary taster and each indicating the dominance of specified bhutas; dosas and tastes; characteristics and functions of tastes; drugs grouped according to tastes  
Chapter 24: Classification 244
  Classification into thirty-seven groups; drugs in each group, effect on dosas and rest of the body  
Chapter 25: Emetics and purgatives 250
  Central role in evacuative therapy; six emetics, their preparation, administration and indications; parts of six plants as purgatives, their preparation, actions; purgative wines; fruit formulations for purgation; milk juices for purgation and need for caution  
Chapter 26: Drugs for topical use in wounds, abscesses and ulcers 260
  Local applications on wounds, abscesses and ulcers; drugs for managing inflammation – hastening maturation, drainage, cleaning, promoting healing and promoting or destroying granulation tissue  
 
SECTION – VIII: SYSTEMIC DISEASES
 
Chapter 27: Vata disorders (Vatavyadhi) 264
  Types of vata and their derangements; clinical features; treatment by formulations; specific measures in different locations; major disorders and their management  
Chapter 28: Piles (arsas) 282
  Different types and locations; clinical features; treatment with caustic alkali; cauterization and excision; use of instruments; medical treatment in early stages  
Chapter 29: Urinary calculi (asmari) 291
  Four types based on kapha; anatomy of the urinary apparatus; treatment with formulations; management of gravel; removal of vesical calculus through perineal approach; postoperative management; structures to be safeguarded  
Chapter 30: Urinary obstruction; difficult urination (mutraghata, mutrakrcchra) 299
  Different types of obstruction; clinical features; formulations for treatment ; difficult urination; types and clinical features; formulations for treatment  
Chapter 31: Diseases of the urinary tract (prameha) 306
  Predisposing causes; premonitory signs and symptoms; different types and clinical features; treatment consisting of procedures and formulations; social considerations in treatment; diabetic boils and treatment  
Chapter 32: Fistula-in-ano (bhagandara) 317
  Different types; premonitory signs; clinical features of different types; treatment by surgery; postoperative are; special formulations  
Chapter 33 : Skin diseases (kustha) 323
  Erroneous conduct as the basic cause; communicable nature; minor and major diseases and clinical features of both categories; leprosy; treatment with reference to diet, medical procedures and formulations  
Chapter 34: Abdominal swelling (udararoga) 336
  Eight types and their clinical features; treatment of different types; formulations  
Chapter 35: Inflammation and suppuration (sopha) 344
  Six types of inflammation; inflammation progressing to suppuration; clinical features; principle of local treatment; generalised swelling distinguished from localised; formulations for treating generalised swelling  
Chapter 36: Abscesses (vidradhi) 349
  Different types; clinical features; treatment including local measures; suppuration of bone marrow
Chapter 37: Cellulitis, sinuses, breast disease in women (visarpa, nadi, stanaroga) 355
  Different types of cellulitis; clinical features and treatment; breast disease and treatment; sinuses and types; use of ksarasutra for treating sinuses; medicated wicks for treating sinuses; formulations  
Chapter 38: Ulcers (vrana) 363
  Different classifications based on causation; clinical features; prognosis; influence of location on healing; incurability and fatal signs, general and local treatment; sixty procedures in treatment; formulation in treatment; would care  
Chapter 39: Traumatic injuries (sadyaovrana) 381
  Different types and clinical features; surgical management; use of formulations; injuries in special locations  
Chapter 40: Cystic and glandular swelling; tumours; goiter (grandhi, apaci, arbuda, galaganda) 387
  Clinical features to distinguish the swellings; causative factors; treatment at local and general level for each condition; role of surgery including scarification, scraping, cauterization and incision and drainage; use of formulations  
Chapter 41: Scrotal swellings; genital inflammation and elephantiasis (vrddhi, upadamsa, slipada) 395
  Different types of swellings and clinical features; genital inflammation; elephantiasis; treatment of each type of scrotal swelling due to genital inflammation and elephantiasis; formulations in treatment  
Chapter 42: Minor disorders (ksudraroga) 401
  Minor disorders listed with clinical features and treatment; medical surgical aspects of treatment; local measures and formulations  
Chapter 43: Sukadosa 408
  Eighteen disorders caused by sukadosa; clinical features; treatment involving local measures and formations; poor prognosis of certain types  
Chapter 44: Oral diseases (mukharoga) 411
  Diseases affecting the lips gums, teeth, tongue, palate, throat and oral cavity; each group listed separately with clinical features; treatment of each condition; local and general measures including blood letting; incurable conditions  
 
SECTION – IX: MORE SYSTEMIC DISEASES AND RELATED CONDITIONS
 
Chapter 45: Fevers (Jvara) 421
  King of diseases; prodromal symptoms; classification based on dosas; specific fevers; fever following localization in various dhatus; externally induced fevers; samana, sodhana and dietary regimen to treatment; personal care; formulations; special measures for intermittent and complex fever; complications; use of enemas  
Chapter 46: Diarrhea (atisara) 441
  Causes, premonitory signs, clinical feature; treatment of different types of unripe diarrheas; ripe diarrheas following the control of unripe; dysentery; dietary management; role of enemas; grahani  
Chapter 47: Phthisis (sosa) 453
  Grave illness caused by three perturbed dosas; eleven clinical features; premonitory signs' treatment; diet; formulations  
Chapter 48: Gaseous lumps of the abdomen (gulma) 458
  Premonitory signs; clinical features; treatment; enemas; formulations; other measures including blood-letting and fomentation; management of colics with and without abdominal lumps; special colics  
Chapter 49: Heart disease; pallor and jaundice; internal bleeding (hrdroga, panduroga, kamala, raktapitta) 466
  Heart disease caused by perturbed dosas and its treatment; heart disease caused by worms; pallor and jaundice; kamala; treatment by evacuative measures and formulations; internal bleeding; management  
Chapter 50: Fainting; alcoholic disorders (murccha, panatyaya) 476
  Six types of fainting with clinical features; treatment of coma; wine; alcoholic disorders including severe intoxication and complications; treatment by formulations to address the perturbation of dosas; specific measures to treat burning sensation; management of the affluent  
Chapter 51: Morbid thirst; loss of appetite; regurgitations; vomiting; hiccup (trsna, arocaka, udavarta, chardi, hikka) 485
  Morbid thirst: clinical features and treatment by formulations; Loss of appetite: causes and treatment by evacuative measures and formulations Regurgitation: thirteen types; clinical features and treatment; serious manifestation; Vomiting; clinical features and treatment; Hiccup: varied causes; different types; procedures, diet preparations and formulations in treatment  
Chapter 52: Shortness of breath; cough; hoarse voice (svasa, kasa, svarabheda) 499
  Shortness of breath: types, clinical features and treatment; formulations and other measures; Cough: types, clinical features and treatment; formulations; Hoarseness of voice: types, clinical features and treatment  
Chapter 53: Worm infestation; diarrhea due to indigestion (krmiroga, visucika) 508
  Worm infestation: sources and types of worms; treatment; Diarrhea due to indigestion: three types of indigestion responsible for diarrhea; treatment by formulations, dietary regimen and evacuative measures  
 
SECTION – X: DISEASES OF THE HEAD AND NECK (SALAKYATANTRA)
 
Chapter 54: Eye and eye diseases 514
  Anatomy of the eyeball; eye diseases caused by perturbed dosas and prognosis; eye diseases according to precise location and clinical features; seventeen general diseases with clinical features; diseases of the pupil; diseases caused by trauma  
Chapter 55: Treatment of eye diseases 527
Chapter 56: Eye diseases; treatment by surgical measures 538
  Eye diseases treated by scraping, incision, excision; surgery for entropion; postoperative care  
Chapter 57: Diseases of the papillary region (Drsti) 543
  Twelve diseases; three curable, three incurable and six palliable; treatment of curable types by medical procedures and formulations; of palliable types of evacuative measures and formulations; general observations on cataract (timira); medical measures in early stage; surgical treatment; kaca disorder  
Chapter 58: Medical procedures in the treatment of eye diseases 551
  Commonly employed procedures – tarpana, putapaka, ascyotana, seka, sirovasti, collyrium application; royal collyrium  
Chapter 59 : Diseases of the ear, nose and head 558
Chapter 60: Diseases of the ear lobe following elongation 572
 
SECTION – XI: DISEASES OF PLANETARY ORIGIN
 
Chapter 61: Children's diseases caused by junior planets (balagraha) 574
  Seizure of children by junior planets; nine junior planets of female and male gender; mythical origins; preference for children; clinical features of seizure by each planets; treatment by medical measures, propitiatory procedure and special hymns  
Chapter 62: Role of planets in the origin of disorders 584
  Planets as noctural assailants; eight groups of masters of innumerable planets; signs of entry of planets in human beings; bhutavidya as the study of the influence of planets on human health; oblations to propitiate bhutas; role of formulations  
Chapter 63: Seizures (apasmara) 589
  Causes and premonitory symptoms; clinical features; seizures according to dosas; treatment; general and Specific for each type; special to dosas; treatment; general and specific for each type; special formulations; evacuative procedures including venesection  
Chapter 64: Insanity (unmade) 593
  Six types; premonitory signs; clinical features; treatment; medical procedures; surprise measures; dietary regimen; formulations; venesection; psychological support  
 
SECTION – XII: POISONING (VISA)
 
Chapter 65: Poisoning 596
  Supreme role of a physician in safeguarding the king from poisoning; a royal war camp; medical quartet as the prerequisite for successful treatment; supervision of the royal kitchen by the physician; watch over the staff; articles liable to poisoning and tests for detection; signs of poisoning; antidotes  
Chapter 66: Fixed and mobile poisons 604
  Ten varieties subclassified into fifty-five poisons; signs and symptoms of poisoning by each type; chronic poisoning; clinical staging of poisoning and treatment during different stages; mobile poisons from sixteen sources; symptoms of poisoning; antidotes and remedial measures; prognosis and general observations  
Chapter 67: Snake bite (sarpadasta) 612
  Eighty snakes and their groupings; three types of snake bites; snakes classified based on physical characteristics and also on caste basis; listing of eighty snakes; clinical features of snake bites; stages of poisoning; poisoning in animals and birds; treatment; hymns; blood-letting, cauterization and other procedures; treatment according to the stage of poisoning; according to the patient's constitution and clinical features; snake bites in animals; anti-poison formulations  
Chapter 68: Poisoning by rats and other animals (musikavisa and others) 624
  Types of rat; rat bite and clinical features; treatment; remedies to bites by different types of rats; medical procedures including evacuative therapy and the application of collyrium; bites by other animals; fear of water; treatment of bites by rabid animals; evacuative therapy, dietary regimen; hymn  
Chapter 69: Poisoning by insects (kitavlsa) 629
  Classification of insects according to dosa characteristics; clinical features of bites; bites by insects outside the dosa based grouping and clinical features; bites by frogs, visvambhara, flies and mosquitoes with clinical features; treatment; formulations used for various insect bites; scorpion bite; clinical features; treatment; spider bite; difficulty in diagnosis and treatment; clinical features according to the time elapsed after bite; classification of spiders; prognosis of spider bite; treatment by formulations; curable and incurable categories  
 
SECTION – XIII: MEDICAL PROCEDURES
 
Chapter 70: Lubricant therapy and fomentation (snehana, svedana) 640
  Lubricant and their sources; preparation of lubricants; administration of lubricants; ghee as a lubricant; importance of dosage; lubricants mixed with food; when lubricants should be withheld; signs of satisfactory and unsatisfactory therapy  
Chapter 71: Emesis and purgation (vamana, virecana) 649
  Emesis; preparation and procedure; when to perform and when forbidden; purgation; preparation and procedure; when to perform and when forbidden; dosage of drugs; precautions; faulty methods and complications thereof; secondary complications  
Chapter 72: Enemas (vasti) 661
  Most important among therapeutic measures; functions of enemas; conditions where beneficial; equipment; non-lubricant and lubricant enemas; faulty methods and complications in the use of non-lubricant enemas; lubricant enema, snuff and intake; management after enema; complications and management; urethral and vaginal douche; preparation of enema fluid; formulations  
Chapter 73: Complications of medical procedures 681
  Dietary regimen during medical procedures including lubricant therapy, emesis, purgation, blood-letting and enemas; regimen to suit the strength of the patient; effect of personal conduct on health; adverse consequences of imprudent conduct  
Chapter 74: Smoking, snuffing and gargling (dhuma, nasya, kavala) 684
  Smoking: five types; drugs used in each type; equipment; procedure; when to smoke and not to smoke; gargling; four types and characteristics of each  
 
SECTION – XIV: BIRTH AND DEVELOPMENT OF A HUMAN BEING
 
Chapter 75: Origin of Life 692
Chapter 76: Procreation; fetal anomalies 697
  Seminal and menstrual disorders associated with sterility; treatment of disorders; effects of maternal conduct during pregnancy on the fetus; sexual intercourse for procreation; sexual aberrations; effect of sexual and other conduct on the fetus  
Chapter 77: Development of the fetus 703
  Conception; fertile period; features of pregnancy;' stages of fetal development; special likes and dislikes during pregnancy as a reflection of fetal feelings; maternal desires influencing baby's prospects; sources of fetal parts  
Chapter 78: Development of the fetus; dosa prakrti 708
  Initial development of seven skin layers; appearance of seven membranes between dhatus and investing them; genesis of organs; liver, spleen, lungs, intestines, kidney, urinary bladder, blood vessels, ligaments, heart; heart as the seat of consciousness; dosa prakrtis; seven types; decided at conception and valid throughout life span; characteristics of each type; psychological personalities as satvic, rajasic and tamasic types; comments on sleep  
Chapter 79: Pregnancy; delivery; neonatal care 716
  Personal conduct of the mother during pregnancy; neonatal care on monthly basis; onset of labour; delivery; complications; care of the newborn; post partum care of the mother; retained placenta; pyometra (makkalla); care of the baby; role of the wet nurse; neonatal illnesses and treatment; care from infancy to adulthood; abortions and complications; treatment in threatened abortion  
Chapter 80: Malpresentations of the fetus (mudhagarbha) 727
  Circumstances favouring malpositions and malpresentations of fetus; four types based on abnormal presentation; fetal death; treatment: difficulty and high risk of surgical treatment; cesarean section when mother dies and fetus is alive; manual extraction of the dead fetus; surgical destruction of the dead fetus; postoperative management; special formulations  
Chapter 81: A count of body parts 733
  Parts and subparts; enumeration of body constituents; hollow viscera; nine openings; tendons; jala, kurcas; mamsa, rajju; sivani; sanghata; simanta; bones; enumeration and types of bones; enumeration and types of joints; enumeration of ligaments; muscle; cadaveric dissection essential for surgical training  
Chapter 82: Vital spots (marmas) 743
  One hundred and seven vital spots; based on muscle, blood vessels, ligaments, bone and joints; enumeration in different locations; distribution of the spots in the body; vital spots according to prognosis following injury; structure of vital spots; clinical features of injuries to vital spots in different locations; measurement of spots; implications of the spots for surgical procedures  
Chapter 83: Srotas; siras and dhamanis 753
  Dhamanis and srotas distinct from siras; siras radiating from the umbilicus; siras as conduits for vata, pitta, kapha and blood; location and enumeration of siras unsuitable for venesection or surgical incision; Twenty-four dhamanis arising from the umbilicus; functions of those causing upwards, downwards and in the oblique directions; srotas as conduits for air, food, water, rasa, blood, muscle, adipose tissue, urine, feces, semen and menstrual blood, consequences of injury  
 
SECTION – XV: RULES FOR HEALTHY LIVING
 
Chapter 84: Life in harmony with seasons 760
  A code of living for maintaining good health; perturbation of dosas by drastic changes in seasons; methods and merits of life in accord with changing seasons; guidelines to diet and drugs  
Chapter 85: Warding off diseases 764
  Code of daily conduct; teeth and oral hygiene; betel chewing; head massage with oil; oil massage and bath; physical exercise; cosmetics, clothes and adornments; worship; diet; personal conduct; general conduct; list of forbidden activities; drinks according to seasons, guidelines for sexual activity and consequences of violations  
Chapter 86: Virile therapy (vajikarana) 775
  Regular use of drugs for enhancing sexual potency, sexual stimulants other than formulations; four types of importance; formulations with method of preparation and effects  
Chapter 87: Rejuvenant therapy (rasayana) 778
  Useful in youth or middle age to counter disorders; formulations of vidanga sees or kasmari fruits; details of procedure during their administration and extraordinary results; other formulations; measures to promote intellect and long life; formulations to promote long life, for the care of face and hair; ceremonial aspect of rasayanas and details of procedure with daily progress; attaining supernatural powers; benefits of rejuvenant therapy; on the soma plant; eighteen drugs as potent as soma for rejuvenation; morphological features of the plants for identification; where and when to find them  
  Epilogue 791
  Thirty-two structural elements of the text (tantrayukti); necessary to interconnect statements, clarify ideas and contradict false views; key to understanding the text  
Botanical names   793
Glossary   808
Index   826

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The Legacy of Susruta

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2011
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Preface:

Since The Legacy of Caraka was published three years ago it has drawn the favourable notice of reviewers and accounted for three new impressions and a translation into Malayalam. It was against this rosy background that friends, especially Dr Kuttykrishnan Nair of Thiruvananthapuram two reviewers and my wife Ashima urged me to write a similar volume on the Susruta Samhita which ranks in authority with Caraka's. I was persuaded that the welcome accorded to y Caraka study had not a little to do with its thematic approach would be appropriate in a book on the Susruta Samhita. Fortunately the use of a simpler and later version of Sanskrit, more logical presentation of material and the overall surgical orientation of the text made the study of the Susruta Samhita less difficult and less time-consuming than my Caraka endeavour. Apart from thematically arranged material which leaves out none of the chapters of the original and the tabular presentation of data, The Legacy of Susruta also features a large number of figures to illustrate events, instruments, anatomy and a variety of procedures.

I was introduced to the Susruta Samhita through Kaviraj Kunjalal Bhishagratna's classic and highly readable edition which continues to be popular. However, I found that a more accurate and contemporary understanding of the original was provided by using Professor P V Sharma's translation in association with Dalhana's Nibandhasangraha commentary. My practice throughout was to study the original on my own for rearranging the vast and carried material and to follow up by reading the translation and commentary before writing my text. I have differed from them here and there and clarified the description of several surgical procedures. I have made no attempt to survey the extensive literature on the Susruta Samhita (it would have been a pedantic exercise) and have confined myself to an overview of Susruta's times and contributions in the introductory essay as I did in The Legacy of Caraka. I am well aware that readers are less interested in what other say about Susruta than in what he himself had said.

My effort received a major boost by my appointment as a National Research Professor when the study was in progress. I am grateful to the Government of India for this singular honour and hopeful that the Professorship may, by a subtle alchemy, graduate into a national science initiative for research in ayurveda unburdened by herbal product development and global marketing. I was fortunate tht may endeavour caught the attention of Dr P K Warrier, the much-admired Managing Trustee and Chief Physician of the Arya Vaidya Sala, Kottakkal who laid me under a debt of obligation by offering whole-hearted cooperation. It was on his suggestion that Dr K Rajagopalan of Kollam, a consultant to the Arya Vaidya Sala, agreed to review my manuscript. A reputed senior physician who migrated to ayurveda from modern medicine, he is recognized widely for his profound scholarship of Brhatrayi. His insistence on fidelity to the original which he could often quote from memory, and his friendly demenour made my discussions with him in Kottakkal an enjoyable experience. Apart from allowing me free access to the Arya Vaidya Sala library, Dr Warrier also introduced me to Dr C Ramankutty of the Arya Vaidya Sala who is an ayurvedic physician, a meticulous scholar and an authority on medicinal plants. Dr Ramankutty liberally and cheerfully checked the accuracy of references and diacritical marks in my manuscript, prepared the botanical names of plant, formulated on index and also corrected the proofs. I have no words to thank these two outstanding scholars for their expert assistance. The Kottakkal team also included Dr T S Murali, Chief of R&D, who made sure that the arrangements for travel, meetings and exchange of information were always efficient and faultless. To all my friends in the Arya Vaidya Sala I owe a debt of gratitude.

I am grateful to Dr Ramdas Pai, President of Manipal Academy of Higher Education for continuing to provide excellent facilities for my study in the academically vibrant atmosphere of Manipal. Mr. Abraham Joy prepared the illustrations for the present volume based on whatever information and drawings were available in the literature and on his own innovative ideas. His drawings have enlivened the book, for which he deserves my sincere thanks.

I am beholden to Professor Jyotir Mitra of Banaras Hindu University for enlightening me on Panini's references to Susruta, to Dr K Sasidharan, Professor Urology, for drawing my attention to the revival of the perineal approach of Susruta by Gadhvi for prostatectomy and to Dr Suresh Pillai, Associate Professor of ENT, Kasturba Medical College, Manipal, who supplied the sketches for nose repair based on the terse account of Susruta. Special thanks are due to Ms Usha Kamath who typed and retyped the voluminous manuscript and kept track of files with admirable patience and efficiency as papers moved in and out between Manipal, Kottakkal and the publisher's office in Chennai. Last, but not least, I acknowledge gratefully the editorial assistance and support of Ms Padmaja Anant of Orient Longman Private Limited.

The Samhitas of Caraka and Susruta are timeless classics whose authority was acknowledged by the great Vagbhata many centuries ago. Their Forerunners-Agnivesatantra and Susrutatantra-and many other ancient texts are lost, probably forever. We should be thankful that the Samhitas are still with us and their language can be understood unlike the script of Mohenjo-daro which smiles enigmatically but remains indecipherable. We are Fortunate that we can not only read what Caraka and Susruta wrote but can also discover ourselves and out lives 'in sickness and in health' in what they wrote so very long ago.

 

M S VALIATHAN

About the Book:

 

The Legacy of Susruta

Susruta's name is synonymous with India's surgical inheritance. A legendary figure, he is believed to have lived and taught in Varanasi several centuries before the Buddha, and composed the Susrutatantra which became a timeless medical classic. Though the original text was lost long ago a redaction by Nagarjuna survived as Susruta Samhita and won universal acclaim. The Samhita is a study of the human condition in health and disease with undisguised emphasis on surgery, and rivals Caraka's classic in authority. In The Legacy of Susruta, the text of Susruta Samhita has been recast in a thematic fashion without sacrificing any of the content of the original chapters. Furthermore, it presents much of the data in tabular form, and features many tables and illustrations in an effort to reach out to readers who may include not only students of ayurveda but also of modern medicine, biological and social sciences and the history of science.

A native of Kerala, Dr. M S Valiathan received his medical education in India and training in surgery and cardiac surgery in the UK and USA. During a career spanning three decades as a surgeon and investigator, his major interests were cardiac surgery in Children, studies on a tropical heart muscle disease, and the development of cardiovascular devices. His contributions are embodied in a monograph, many scientific papers and a family of medical devices including a tilting disc heart valve, all of which are used widely in India. The present volume is a companion to The Legacy of Caraka which was published by Orient Longman in 2003.

Dr. Valiathan is a National Research Professor of the Government of India. He is married to Ashima, an orthodontist. They have a daughter, Manna, and a son Manish.

 

Introduction

SUSRUTA AND HIS PERIOD

A surgical colossus standing astride many centuries of India's past, Susruta nevertheless remains a historical puzzle. Cakrapanidatta, Bhavamisra and Dalhana are unanimous that he was the son of Visvamitra; this is supported by statements in the Susruta Samhita as well as the Mahabharata. This Visvamitra could not obviously be identified with the Rg vedic seer whose name is almost synonymous with the Gayatrimantra. Susruta studied ayurveda from Divodasa who was a king of Kasi and a descendant of Dhanvantari. As he was chosen by his classmates to put questions to the revered preceptor and interpret the answers for them, Susruta was admittedly the first among equals and gifted with a superior intellect.

The period when Susruta lived has been a subject of much debate. Hoernle who pioneered studies on ayurvedic texts in the early part of the twentieth century held the view that the original Susrutatantra. which was redacted probably more than once 'admittedly belongs to a much earlier period, possibly as early as about 1000 BC.' This view had been advanced by Hessler earlier in his Latin edition of the Susruta Samhita wherein he placed Susruta in 'the heroic age of India, the beginning of which is not known but the end of which is marked by 1000 BC.' Moreover, as pointed out by several authors, an indicator of Susruta's antiquity is the reference to him by Panini who used his name as a familiar example in elaborating on Sutras. In relation to 'tena prokram he added 'Susrutena proktam Sausrutarn' (what was stated by Susruta is Sausrutam); in Kartakauja padayasca, he stated 'Susrutasya prthosca chatrah" (the foremost of Susruta's pupils); in the gloss on the Sutra 'ktena nanvisstena anan', one finds 'kutapapradhanah sausrutah, kutapasausrutah' (the blanket-wearing pupils of Susruta). As the time of Panini has been fixed around 700 BC by Goldstucker and it would have taken one or two centuries for the name of Susruta from Banaras in the east to become so familiar to Panini who lived near or in Taxila in the west, it is reasonable to believe that he lived and taught well before Panini. A corroborating piece of evidence emerges from the life of Buddha's physician jivaka whose birth in Pataliputra, medical training in Taxila and admirable skills as a physician and surgeon are vividly recorded in Buddhist texts such as Mahavagga and the jataka tales. If the young and brilliant jivaka proceeded from Patalipurra to faraway Taxila for training in surgery and medicine, it is clear that Banaras had yielded preeminence in ayurvedic studies ro Taxila by the time of the Buddha. This decline can hardly be accounted for unless Susruta (who marked the zenith of salyatantra in Banaras) had passed away centuries earlier. Furthermore jivaka's trephining of the skull finds no mention among Susruta's techniques indicating that the procedure was non- existent in Susruta's time.

Professor Iyotir Mitra suggests that Kasiraja Divodasa had temporarily withdrawn to Bharadvaja's Asram in Uttarakasi following his defeat by Haihaya Ksatriyas and the teachings of the Susrutatantra had originated during his exile. This possibility is also supportive of the antiquity of the original text.

Susruta Samhita

The Samhita which bears Susruta's name and ranks with that of Caraka in authority is a product of one or more redactions of an original tantra which Susruta had composed. Tantras dealt with specific subjects in the manner of monographs and ancient India prided in tantras which dealt with subjects such as toxicology and eye disease. Among Kasiraja Divodasa's disciples, Susruta and his classmates Aupadhenava, Vaitarana, Aurabhra, Pauskalavata, Karavirya and Gopuraraksita authored tantras on salya but only Susruta's text managed to survive the ravages of time through successive renewals in the form of redactions. Its most important redaction is attributed to Nagarjuna whose identity has not however been established beyond doubt. The authorship of Uttaratantra has also been controversial but as it was a part of Susruta Samhita at the time of Vagbhata it has considerable antiquity and has a justifiable claim to have been added during the redaction of the Susrutatantra.

It is generally held that Susrutatantra was redacted by Nagarjuna, the great Buddhist philosopher who pioneered the Madhyamika or Sunyavada school. Nagarjuna argued that there is no truth, no essence in all phenomena which, therefore, are neither produced nor destroyed; nor do they come or go. They are a mere illusion and the so-called nirvana is no more than the cessation of the seeming flow of phenomena. In the Madhyamikavrrti he declared that Buddha was a phenomenon and was therefore a mirage or a dream, and so were his teachings! The claim that this path-breaking philosopher was the redactor of Susrutatantra is hardly credible for several reasons. In the first place, the depth of medical knowledge in terms of the structure and functions of the organs; manifestations, causes and prognosis of diseases; details of therapeutics and surgical techniques which abound in the Susruta Samhita could not be plumbed by anyone except an expert in medicine. Secondly, Nagarjuna-a nihilist--could not conceivably have redacted hymns addressed to gods including Krsna and Rama, endorsed the worship of brahmanas, or supported the rigid caste hierarchy, all three of which figure prominently in the Susruta Samhita. He could not possibly be a party to classifying snakes on the basis of caste!

Another school of thought attributed the redaction of Susrutatantra to Nagarjuna, the reputed alchemist of the tenth century AD. As pointed out by several scholars including Bhisagratna, this view lacks merit because verses from the present text of Susruta Samhita were quoted by Vagbhata in the Astangahrdaya two centuries before the alchemist Nagarjuna. Until new evidence appears, we may therefore conclude that an unidentified N agarjuna was responsible for reinventing the original Susrutatantra in the present form, and that he lived after Drdhabala who revised the Caraka Samhita. The redactions, over centuries, became the substrate for further changes by others especially by Candrata.

 

 
CONTENTS
 
Transliteration chart    
Preface    
Quotes from Susruta    
List of figures    
Introduction : Susruta – A Surgical Colossus    
 
SECTION –I
 
Chapter 1: At the feet, Divodasa, Dhanvantari 1
  Kasiraja Divodasa Dhanvantari begins instruction in ayurveda; emphasis on surgery as preferred by pupils; Susruta as the representative of pupils  
 
SECTION – II
 
Chapter 2: Initiation and training of physicians 7
  Initiation for the study of ayurveda; exhortation by the preceptor; equal importance of theory and practice; method of study and importance of understanding; royal permission to practice medicine  
 
SECTION – III :SURIGCAL PROFILE OF CLINICAL PRACTICE
 
Chapter 3: Surgical procedures; pre- and postoperative care (pradhana, purva and pascat karma) 16
  Eight surgical procedures; accessories for surgery; incision and drainage of abscess; chanting a protective hymn; detailed classification and indication for surgical procedures; bandaging; complications  
Chapter 4: Surgical instruments (yantras and sastras) 30
  Blunt and sharp instruments; classification; use and functions; supportive instruments  
Chapter 5: Use of alkalis (ksara) 47
  Two varieties; indications; methods of preparation; technique of application  
Chapter 6: Cauterisation (agnikarma); burns and treatment 51
  Cauterisation ranks above caustic alkali; procedure; indications; burns, classifications and treatment; inhalation injury  
Chapter 7: Blood-letting (raktavisravana) : methods and management 56
  Benefits; indications; two methods, scarification and venesection, indications of each; each; venesection at different locations and for varied clinical conditions; use of leeches  
Chapter 8: Assorted surgical techniques 66
  Piercing the ear; reconstruction of the ear lobe; pre0 and postoperative measures; reconstruction of the nose and lip; foreign bodies and their removal  
Chapter 9: Fractures and dislocations (kandabhagna; sandhimukta) 80
  Classification; treatment; management of regional injuries; oils for promotion of bone healing  
 
SECTION – IV : INTRODUCTION TO CLINICAL PRACTICE
 
Chapter 10: Diseases and their classification 91
  Surgical/Medical and other types of classifications; detailed classification under seven types on the basis of causation; dosas targeting dhatus to produce diseases  
Chapter 11: Time, seasons and the human body 95
  Units of time; classification of seasons; effects of seasons on life; deranged seasons turning habitat two wasteland  
Chapter 12: Dosas 100
  Three dosas as three pillars of support for the body; functions of dosas derived from etymology; perturbation of dosas; stages suitable for medical intervention during perturbation  
Chapter 13: Fall and rise of dosas, dhatus and malas; observations on blood 105
  Dosas, dhatus and malas as the basic components of the body; effects of the increase and decrease of each component; effects of derangement of ojas; disturbance in equilibrium of dosas, dhatus and malas; observation on blood  
Chapter 14: Rasas 114
  Six primary and sixty-three secondary tastes; dosas and rasas; characteristics of each rasa; classification of substances according to primary tastes  
Chapter 15: Wholesomeness: food incompatibilities 119
  Wholesome articles of diet; unwholesome combination of articles and incompatibilities in diet; unwholesomeness from cooking; combination of tastes causing incompatibility in potency and post-digestive taste  
Chapter 16: Geographical Influences influences in pharmacy 124
  The influence of locale on plants and human beings; criteria for the selection of land for harvesting plants; classification of land into six types; effects of wind  
Chapter 17: Principles of therapeutics 127
  The medical quarter for successful therapeutics; evaluation of patients to include traits of longevity, standard measurements for body parts, the dominance of dhatus, status of diseases, season, status of digestive fire, age, physical and mental strength adjustment, constitution and drugs; locale  
 
SECTION – V : FOOD AND DRINKS
 
Chapter 18: Liquids for intake 135
  Water quality; purification; qualities and effects of water from different sources; milk, curd, ghee, oils, honey, sugarcane products, wines, urine from different sources and their effects on the body  
Chapter 19: Food 160
  Classification; cereals; meats; fruits; greens; rubber; salts; prepared foods; sweet edibles; drinks after meals and their subgroups in details; their qualities and effects on dosas and the rest of the body  
Chapter 20: A code for dining 215
  Comfortable searing; protocol for serving meals and drinks; containers for different items of menu; meals to suit seasons; forbidden foods; conduct after meals; hints on managing indigestion; properties of food and their effects  
 
SECTION – VI
 
Chapter 21: Predictors of death and recovery 221
  What messengers, omens and dreams foretell; deranged sense as predictors of fatal outcome; derangements in form and function as predictors of death; inversion of qualities in body parts as predictors of death; incurability diseases  
 
SECTION – VII : DRUGS
 
Chapter 22: Basis of drug action: drugs as substances 233
  Properties of drugs based on the dominance of bhutas; drugs as substances affecting dosas; how drugs act  
Chapter 23: Tastes in the transformation of substances 238
  Bhutas and testes; six primary taster and each indicating the dominance of specified bhutas; dosas and tastes; characteristics and functions of tastes; drugs grouped according to tastes  
Chapter 24: Classification 244
  Classification into thirty-seven groups; drugs in each group, effect on dosas and rest of the body  
Chapter 25: Emetics and purgatives 250
  Central role in evacuative therapy; six emetics, their preparation, administration and indications; parts of six plants as purgatives, their preparation, actions; purgative wines; fruit formulations for purgation; milk juices for purgation and need for caution  
Chapter 26: Drugs for topical use in wounds, abscesses and ulcers 260
  Local applications on wounds, abscesses and ulcers; drugs for managing inflammation – hastening maturation, drainage, cleaning, promoting healing and promoting or destroying granulation tissue  
 
SECTION – VIII: SYSTEMIC DISEASES
 
Chapter 27: Vata disorders (Vatavyadhi) 264
  Types of vata and their derangements; clinical features; treatment by formulations; specific measures in different locations; major disorders and their management  
Chapter 28: Piles (arsas) 282
  Different types and locations; clinical features; treatment with caustic alkali; cauterization and excision; use of instruments; medical treatment in early stages  
Chapter 29: Urinary calculi (asmari) 291
  Four types based on kapha; anatomy of the urinary apparatus; treatment with formulations; management of gravel; removal of vesical calculus through perineal approach; postoperative management; structures to be safeguarded  
Chapter 30: Urinary obstruction; difficult urination (mutraghata, mutrakrcchra) 299
  Different types of obstruction; clinical features; formulations for treatment ; difficult urination; types and clinical features; formulations for treatment  
Chapter 31: Diseases of the urinary tract (prameha) 306
  Predisposing causes; premonitory signs and symptoms; different types and clinical features; treatment consisting of procedures and formulations; social considerations in treatment; diabetic boils and treatment  
Chapter 32: Fistula-in-ano (bhagandara) 317
  Different types; premonitory signs; clinical features of different types; treatment by surgery; postoperative are; special formulations  
Chapter 33 : Skin diseases (kustha) 323
  Erroneous conduct as the basic cause; communicable nature; minor and major diseases and clinical features of both categories; leprosy; treatment with reference to diet, medical procedures and formulations  
Chapter 34: Abdominal swelling (udararoga) 336
  Eight types and their clinical features; treatment of different types; formulations  
Chapter 35: Inflammation and suppuration (sopha) 344
  Six types of inflammation; inflammation progressing to suppuration; clinical features; principle of local treatment; generalised swelling distinguished from localised; formulations for treating generalised swelling  
Chapter 36: Abscesses (vidradhi) 349
  Different types; clinical features; treatment including local measures; suppuration of bone marrow
Chapter 37: Cellulitis, sinuses, breast disease in women (visarpa, nadi, stanaroga) 355
  Different types of cellulitis; clinical features and treatment; breast disease and treatment; sinuses and types; use of ksarasutra for treating sinuses; medicated wicks for treating sinuses; formulations  
Chapter 38: Ulcers (vrana) 363
  Different classifications based on causation; clinical features; prognosis; influence of location on healing; incurability and fatal signs, general and local treatment; sixty procedures in treatment; formulation in treatment; would care  
Chapter 39: Traumatic injuries (sadyaovrana) 381
  Different types and clinical features; surgical management; use of formulations; injuries in special locations  
Chapter 40: Cystic and glandular swelling; tumours; goiter (grandhi, apaci, arbuda, galaganda) 387
  Clinical features to distinguish the swellings; causative factors; treatment at local and general level for each condition; role of surgery including scarification, scraping, cauterization and incision and drainage; use of formulations  
Chapter 41: Scrotal swellings; genital inflammation and elephantiasis (vrddhi, upadamsa, slipada) 395
  Different types of swellings and clinical features; genital inflammation; elephantiasis; treatment of each type of scrotal swelling due to genital inflammation and elephantiasis; formulations in treatment  
Chapter 42: Minor disorders (ksudraroga) 401
  Minor disorders listed with clinical features and treatment; medical surgical aspects of treatment; local measures and formulations  
Chapter 43: Sukadosa 408
  Eighteen disorders caused by sukadosa; clinical features; treatment involving local measures and formations; poor prognosis of certain types  
Chapter 44: Oral diseases (mukharoga) 411
  Diseases affecting the lips gums, teeth, tongue, palate, throat and oral cavity; each group listed separately with clinical features; treatment of each condition; local and general measures including blood letting; incurable conditions  
 
SECTION – IX: MORE SYSTEMIC DISEASES AND RELATED CONDITIONS
 
Chapter 45: Fevers (Jvara) 421
  King of diseases; prodromal symptoms; classification based on dosas; specific fevers; fever following localization in various dhatus; externally induced fevers; samana, sodhana and dietary regimen to treatment; personal care; formulations; special measures for intermittent and complex fever; complications; use of enemas  
Chapter 46: Diarrhea (atisara) 441
  Causes, premonitory signs, clinical feature; treatment of different types of unripe diarrheas; ripe diarrheas following the control of unripe; dysentery; dietary management; role of enemas; grahani  
Chapter 47: Phthisis (sosa) 453
  Grave illness caused by three perturbed dosas; eleven clinical features; premonitory signs' treatment; diet; formulations  
Chapter 48: Gaseous lumps of the abdomen (gulma) 458
  Premonitory signs; clinical features; treatment; enemas; formulations; other measures including blood-letting and fomentation; management of colics with and without abdominal lumps; special colics  
Chapter 49: Heart disease; pallor and jaundice; internal bleeding (hrdroga, panduroga, kamala, raktapitta) 466
  Heart disease caused by perturbed dosas and its treatment; heart disease caused by worms; pallor and jaundice; kamala; treatment by evacuative measures and formulations; internal bleeding; management  
Chapter 50: Fainting; alcoholic disorders (murccha, panatyaya) 476
  Six types of fainting with clinical features; treatment of coma; wine; alcoholic disorders including severe intoxication and complications; treatment by formulations to address the perturbation of dosas; specific measures to treat burning sensation; management of the affluent  
Chapter 51: Morbid thirst; loss of appetite; regurgitations; vomiting; hiccup (trsna, arocaka, udavarta, chardi, hikka) 485
  Morbid thirst: clinical features and treatment by formulations; Loss of appetite: causes and treatment by evacuative measures and formulations Regurgitation: thirteen types; clinical features and treatment; serious manifestation; Vomiting; clinical features and treatment; Hiccup: varied causes; different types; procedures, diet preparations and formulations in treatment  
Chapter 52: Shortness of breath; cough; hoarse voice (svasa, kasa, svarabheda) 499
  Shortness of breath: types, clinical features and treatment; formulations and other measures; Cough: types, clinical features and treatment; formulations; Hoarseness of voice: types, clinical features and treatment  
Chapter 53: Worm infestation; diarrhea due to indigestion (krmiroga, visucika) 508
  Worm infestation: sources and types of worms; treatment; Diarrhea due to indigestion: three types of indigestion responsible for diarrhea; treatment by formulations, dietary regimen and evacuative measures  
 
SECTION – X: DISEASES OF THE HEAD AND NECK (SALAKYATANTRA)
 
Chapter 54: Eye and eye diseases 514
  Anatomy of the eyeball; eye diseases caused by perturbed dosas and prognosis; eye diseases according to precise location and clinical features; seventeen general diseases with clinical features; diseases of the pupil; diseases caused by trauma  
Chapter 55: Treatment of eye diseases 527
Chapter 56: Eye diseases; treatment by surgical measures 538
  Eye diseases treated by scraping, incision, excision; surgery for entropion; postoperative care  
Chapter 57: Diseases of the papillary region (Drsti) 543
  Twelve diseases; three curable, three incurable and six palliable; treatment of curable types by medical procedures and formulations; of palliable types of evacuative measures and formulations; general observations on cataract (timira); medical measures in early stage; surgical treatment; kaca disorder  
Chapter 58: Medical procedures in the treatment of eye diseases 551
  Commonly employed procedures – tarpana, putapaka, ascyotana, seka, sirovasti, collyrium application; royal collyrium  
Chapter 59 : Diseases of the ear, nose and head 558
Chapter 60: Diseases of the ear lobe following elongation 572
 
SECTION – XI: DISEASES OF PLANETARY ORIGIN
 
Chapter 61: Children's diseases caused by junior planets (balagraha) 574
  Seizure of children by junior planets; nine junior planets of female and male gender; mythical origins; preference for children; clinical features of seizure by each planets; treatment by medical measures, propitiatory procedure and special hymns  
Chapter 62: Role of planets in the origin of disorders 584
  Planets as noctural assailants; eight groups of masters of innumerable planets; signs of entry of planets in human beings; bhutavidya as the study of the influence of planets on human health; oblations to propitiate bhutas; role of formulations  
Chapter 63: Seizures (apasmara) 589
  Causes and premonitory symptoms; clinical features; seizures according to dosas; treatment; general and Specific for each type; special to dosas; treatment; general and specific for each type; special formulations; evacuative procedures including venesection  
Chapter 64: Insanity (unmade) 593
  Six types; premonitory signs; clinical features; treatment; medical procedures; surprise measures; dietary regimen; formulations; venesection; psychological support  
 
SECTION – XII: POISONING (VISA)
 
Chapter 65: Poisoning 596
  Supreme role of a physician in safeguarding the king from poisoning; a royal war camp; medical quartet as the prerequisite for successful treatment; supervision of the royal kitchen by the physician; watch over the staff; articles liable to poisoning and tests for detection; signs of poisoning; antidotes  
Chapter 66: Fixed and mobile poisons 604
  Ten varieties subclassified into fifty-five poisons; signs and symptoms of poisoning by each type; chronic poisoning; clinical staging of poisoning and treatment during different stages; mobile poisons from sixteen sources; symptoms of poisoning; antidotes and remedial measures; prognosis and general observations  
Chapter 67: Snake bite (sarpadasta) 612
  Eighty snakes and their groupings; three types of snake bites; snakes classified based on physical characteristics and also on caste basis; listing of eighty snakes; clinical features of snake bites; stages of poisoning; poisoning in animals and birds; treatment; hymns; blood-letting, cauterization and other procedures; treatment according to the stage of poisoning; according to the patient's constitution and clinical features; snake bites in animals; anti-poison formulations  
Chapter 68: Poisoning by rats and other animals (musikavisa and others) 624
  Types of rat; rat bite and clinical features; treatment; remedies to bites by different types of rats; medical procedures including evacuative therapy and the application of collyrium; bites by other animals; fear of water; treatment of bites by rabid animals; evacuative therapy, dietary regimen; hymn  
Chapter 69: Poisoning by insects (kitavlsa) 629
  Classification of insects according to dosa characteristics; clinical features of bites; bites by insects outside the dosa based grouping and clinical features; bites by frogs, visvambhara, flies and mosquitoes with clinical features; treatment; formulations used for various insect bites; scorpion bite; clinical features; treatment; spider bite; difficulty in diagnosis and treatment; clinical features according to the time elapsed after bite; classification of spiders; prognosis of spider bite; treatment by formulations; curable and incurable categories  
 
SECTION – XIII: MEDICAL PROCEDURES
 
Chapter 70: Lubricant therapy and fomentation (snehana, svedana) 640
  Lubricant and their sources; preparation of lubricants; administration of lubricants; ghee as a lubricant; importance of dosage; lubricants mixed with food; when lubricants should be withheld; signs of satisfactory and unsatisfactory therapy  
Chapter 71: Emesis and purgation (vamana, virecana) 649
  Emesis; preparation and procedure; when to perform and when forbidden; purgation; preparation and procedure; when to perform and when forbidden; dosage of drugs; precautions; faulty methods and complications thereof; secondary complications  
Chapter 72: Enemas (vasti) 661
  Most important among therapeutic measures; functions of enemas; conditions where beneficial; equipment; non-lubricant and lubricant enemas; faulty methods and complications in the use of non-lubricant enemas; lubricant enema, snuff and intake; management after enema; complications and management; urethral and vaginal douche; preparation of enema fluid; formulations  
Chapter 73: Complications of medical procedures 681
  Dietary regimen during medical procedures including lubricant therapy, emesis, purgation, blood-letting and enemas; regimen to suit the strength of the patient; effect of personal conduct on health; adverse consequences of imprudent conduct  
Chapter 74: Smoking, snuffing and gargling (dhuma, nasya, kavala) 684
  Smoking: five types; drugs used in each type; equipment; procedure; when to smoke and not to smoke; gargling; four types and characteristics of each  
 
SECTION – XIV: BIRTH AND DEVELOPMENT OF A HUMAN BEING
 
Chapter 75: Origin of Life 692
Chapter 76: Procreation; fetal anomalies 697
  Seminal and menstrual disorders associated with sterility; treatment of disorders; effects of maternal conduct during pregnancy on the fetus; sexual intercourse for procreation; sexual aberrations; effect of sexual and other conduct on the fetus  
Chapter 77: Development of the fetus 703
  Conception; fertile period; features of pregnancy;' stages of fetal development; special likes and dislikes during pregnancy as a reflection of fetal feelings; maternal desires influencing baby's prospects; sources of fetal parts  
Chapter 78: Development of the fetus; dosa prakrti 708
  Initial development of seven skin layers; appearance of seven membranes between dhatus and investing them; genesis of organs; liver, spleen, lungs, intestines, kidney, urinary bladder, blood vessels, ligaments, heart; heart as the seat of consciousness; dosa prakrtis; seven types; decided at conception and valid throughout life span; characteristics of each type; psychological personalities as satvic, rajasic and tamasic types; comments on sleep  
Chapter 79: Pregnancy; delivery; neonatal care 716
  Personal conduct of the mother during pregnancy; neonatal care on monthly basis; onset of labour; delivery; complications; care of the newborn; post partum care of the mother; retained placenta; pyometra (makkalla); care of the baby; role of the wet nurse; neonatal illnesses and treatment; care from infancy to adulthood; abortions and complications; treatment in threatened abortion  
Chapter 80: Malpresentations of the fetus (mudhagarbha) 727
  Circumstances favouring malpositions and malpresentations of fetus; four types based on abnormal presentation; fetal death; treatment: difficulty and high risk of surgical treatment; cesarean section when mother dies and fetus is alive; manual extraction of the dead fetus; surgical destruction of the dead fetus; postoperative management; special formulations  
Chapter 81: A count of body parts 733
  Parts and subparts; enumeration of body constituents; hollow viscera; nine openings; tendons; jala, kurcas; mamsa, rajju; sivani; sanghata; simanta; bones; enumeration and types of bones; enumeration and types of joints; enumeration of ligaments; muscle; cadaveric dissection essential for surgical training  
Chapter 82: Vital spots (marmas) 743
  One hundred and seven vital spots; based on muscle, blood vessels, ligaments, bone and joints; enumeration in different locations; distribution of the spots in the body; vital spots according to prognosis following injury; structure of vital spots; clinical features of injuries to vital spots in different locations; measurement of spots; implications of the spots for surgical procedures  
Chapter 83: Srotas; siras and dhamanis 753
  Dhamanis and srotas distinct from siras; siras radiating from the umbilicus; siras as conduits for vata, pitta, kapha and blood; location and enumeration of siras unsuitable for venesection or surgical incision; Twenty-four dhamanis arising from the umbilicus; functions of those causing upwards, downwards and in the oblique directions; srotas as conduits for air, food, water, rasa, blood, muscle, adipose tissue, urine, feces, semen and menstrual blood, consequences of injury  
 
SECTION – XV: RULES FOR HEALTHY LIVING
 
Chapter 84: Life in harmony with seasons 760
  A code of living for maintaining good health; perturbation of dosas by drastic changes in seasons; methods and merits of life in accord with changing seasons; guidelines to diet and drugs  
Chapter 85: Warding off diseases 764
  Code of daily conduct; teeth and oral hygiene; betel chewing; head massage with oil; oil massage and bath; physical exercise; cosmetics, clothes and adornments; worship; diet; personal conduct; general conduct; list of forbidden activities; drinks according to seasons, guidelines for sexual activity and consequences of violations  
Chapter 86: Virile therapy (vajikarana) 775
  Regular use of drugs for enhancing sexual potency, sexual stimulants other than formulations; four types of importance; formulations with method of preparation and effects  
Chapter 87: Rejuvenant therapy (rasayana) 778
  Useful in youth or middle age to counter disorders; formulations of vidanga sees or kasmari fruits; details of procedure during their administration and extraordinary results; other formulations; measures to promote intellect and long life; formulations to promote long life, for the care of face and hair; ceremonial aspect of rasayanas and details of procedure with daily progress; attaining supernatural powers; benefits of rejuvenant therapy; on the soma plant; eighteen drugs as potent as soma for rejuvenation; morphological features of the plants for identification; where and when to find them  
  Epilogue 791
  Thirty-two structural elements of the text (tantrayukti); necessary to interconnect statements, clarify ideas and contradict false views; key to understanding the text  
Botanical names   793
Glossary   808
Index   826

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