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A History of Indian Medical Literature v1.c23.s2: The layers of the Suśrutasaṃhitā

A History of Indian Medical Literature v1.c23.s2

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The layers of the Suśrutasaṃhitā

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Hemarājaśarman belongs to the group of scholars who postulate two Suśrutas and, accordingly, attempt to isolate elements belonging to an older and a younger stratum of the Suśrutasaṃhitā. Apart from these two layers, some distinguish a third one, attributed to a reviser who is called Nāgārjuna by Dalhaṇa. Others again assume the presence of two strata, ascribed to Suśruta and the reviser. A few scholars assume a succession of four layers, supposed to derive from Suśruta I, Suśruta II, the reviser, and, finally, Candrata, who wrote a Suśrutapāṭhaśuddhi.

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This state of affairs, liable to give rise to confusion, can best be elucidated by giving a few examples, illustrating the reasonings of a number of authors and their ideas on the age to which particular elements of the Suśrutasaṃhitā belong.

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A scholar who assumes that one and the same Suśruta first wrote a Sauśrutatantra, which was rewritten later and thus transformed into the Suśrutasaṃhitā, is R. Śāstrī.62 He expresses as his opinion that the Suśrutasaṃhitā is based on the earlier surgical treatises by those four of the seven pupils of Divodāsa who are mentioned at the end of chapter four of the Sūtrasthāna. The concluding verse of this chapter says that the treatises of Aupadhenava, Suśruta and Pauṣkalāvata form the basis (mūla) of other works on surgery (śalyatantra). This implies, according to Dalhaṇa, that the śalyatantras of the three pupils called Karavīrya, Gopurarakṣita and Vaitaraṇa, were considered to be less important than that of Suśruta. R. Śāstrī claims that these quotations partially agree, partially disagree with the text of the Suśrutasaṃhitā makes R. Śāstrī compare the relationship between Suśruta’s tantra and his saṃhitā with that between Vāgbhaṭa’s Aṣṭāṅgasaṃgraha and Aṣṭāṅgahṛdayasaṃhitā.

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A scholar distinguishing four layers in the Suśrutasaṃhitā is P.V. Sharma,63 who put forward that Ādyasuśruta, the earliest one, also called Vṛddhasuśruta, belongs to the period of the Upaniṣads. The description of the initiation of students (Su.Sū.2) is regarded as deriving from this age, although the text as it is known shows that changes have been introduced, as attested by the passage mentioning that, according to some authorities, śūdras may be admitted (Su.Sū.2.5).64 P.V. Sharma highlights in particular agreements between passages from the Śvetāśvataropaniṣad and chapters one and nine of Suśruta’s Śārīrasthāna.65 The Sāṃkhya doctrines of Suśruta (Śā.1) betray in his view, in spite of their being mostly in line with Īśvarakṛṣṇa’s Sāṃkhyakārikā, influences from an earlier stage, represented by the Śvetāśvataropaniṣad.66 Suśruta divides the twenty-four tattvas into a group of eight, belonging to prakṛti, and a group of sixteen vikāras (Śā.1.6), whereas Īśvarakṛṣṇa adheres to a threefold classification: mūlaprakṛti, seven prakṛtivikṛtis, and sixteen vikṛtis.67 One need not agree with P.V. Sharma on this point, since Suśruta’s classification of the tattvas was not necessarily influenced by the Śvetāśvataropaniṣad; the same classification is found in the Mahābhārata, the Tattvasamāsa, 68 Aśvaghoṣa’s Buddhacarita, and the Bhāgavatapurāṇa.69

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P.V. Sharma places Suśruta II in the second century A.D., during the reign of Gautamīputra Śātakarṇi, a king of the Śātavāhana dynasty.70 This hypothesis is underpinned by several arguments that will be surveyed.

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The Śātavāhanas were brāhmaṇas,71 and Gautamīputra Śātakarṇi is known as a king who sought to restore the dharma;72 the brāhmaṇas and the lower classes were objects of his special care, while the kṣatriyas were repressed as a conceited class. The religious conditions found in the Suśrutasaṃhitā show that Hinduism was predominant, as to be expected during the Śātavāhana dynasty. The story about a conflict between Vasiṣṭha and Viśvāmitra (Su.Ka.8.90–93) reflects, in P.V. Sharma’s opinion, Gautamīputra’s hostility to the kṣatriyas. The rather numerous passages of the Suśrutasaṃhitā which refer to a king,73 the chapter on the surgeon of the royal army (Sū.34), etc., are in favour of regarding Suśruta as a physician living during the reign of a powerful king. P.V. Sharma believes that Gautamīputra is mentioned as Vikrama in the first chapter of the Kalpasthāna (1.4), where enemies attacked by Vikrama may be alluded to.74

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Many passages give evidence of developments within Hinduism in Suśruta’s times. Śiva appears under various names: Bhava (U.57.16);75 Īśāna (Ci.29.13; U. 39.270); Paśupati (Sū.19.23); Śūlin (U.37.4). The worship of Ambikā (U.39.270)76 and Umā (U.37.4 and 5) is attested.77 Nāgas are repeatedly referred to,78 as well as yakṣas 79 and their lord, Kubera (Sū. 19.23) or Alakādhipati (Ka.7.61). The worship of Rāma and Kṛṣṇa began to flourish (Ci.30.27).80 Viṣṇu is mentioned under the name of Acyuta (Ci.13.26),81 Sarasvatī as Vāgdevī (Ci.28.5). Temples (Ci.24.93: devāyatana) and images of deities (Śā.3.24: devāpratimā) are known.

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The dominance of Hinduism is shown by numerous references to the Vedas, sacrifices and priests;82 brāhmaṇas, gurus and cows are to be revered;83 the four varṇas are mentioned;84 the gāyatrī85 and śrīsūkta 86 are referred to; some varieties of the soma plant have names of Vedic origin;87 a number of saṃskāras are mentioned;88 tales from the Purāṇas are alluded to;89 the jāti and gotra systems are referred to. 90

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The presence of some terms indicates that Jainas and Buddhists are known.91

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The prohibitions concerning pratibhū (bail),92 sākṣitva (acting as a witness),93 samāhvāna (summoning), etc.,94 reflect a society markedly differing from that in the age of the Guptas.

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In support of his hypothesis that Suśruta II lived during the reign of Gautamīputra Śātakarṇi, P.V. Sharma advanced that this Suśruta must have belonged to Southern India,95 since many geographical names connected with the South are found in the Suśrutasaṃhitā,96 while they are for the larger part absent from the Carakasaṃhitā.97 Names connected with other regions are, however, far from rare.

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Relevant names of countries, mountains, rivers, etc., are: the Arbuda mountain98 (Ci.29.07; 30.37); the country called Avanti99 (Sū.45.21); Dakṣiṇāpatha 100 (Ci.4. 29); the Devagiri mountain101 (Ci.29.27); the Devasaha mountain (Ci.29.27); lake Devasunda (Ci.29.28; 30.30); the river Gaṅgā (U.37.5);102 the Himavant mountains (Sū.45.21; Ci.29.27); Kāśmīra 103 (Ci.29.30; 30.32); the river Kauśikī104 (Ci.30.34); lake Kṣudrakamānasa 105 (Ci.29.30; 30.32); the Mahendra mountains 106 (Sū.45. 21; Ci.29.27); the Malaya mountains 107 (Sū.45.21; Ci.29.27; 30.36); Nalasetu 108 (Ci.30.36); the Pāṇḍya country 109 (Sū.13.13); the mountain Pāriyātra 110 (Sū.45.21; Ci.29.28); the country called Pautana 111 (Sū.13.13); the mountain Sahya 112 (Sū.13.13;

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45.21; Ci.29.27); the river Sindhu (Ci.29.29; 30.30); 113 the mountain Śrīparvata 114 (Ci.29.27); the river Tāpī 115 (Ci.13.17); the people called Uttarakurus 116 (Ci.29.17); the Vindhya mountain range 117 (Sū.45.21; Ci.29.28); the river Vitastā 118 (Ci.29.28); the country of the Yavanas 119 (Sū.13.13).

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In contrast with these views of P.V. Sharma, the majority of the scholars who studied the structure and contents of the Suśrutasaṃhitā agree that the work is due to two authors and consists of two layers, an early one, attributed to Suśruta, and a later one, deriving from a reviser, who not only rewrote parts of the text, but also added the Uttaratantra. This reviser is usually referred to as Nāgārjuna.

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Some of the Indologists, who studied MSS of the Suśrutasaṃhitā or its editio princeps, expressed disagreeing opinions on the structure of the text. F. Hessler, who translated the Suśrutasaṃhitā into Latin, 120 regarded the whole work, its Uttaratantra included, as composed by one author, a very ancient Suśruta. 121 Others were inclined to see the parts in verse as older than those in prose, which were supposed to form a kind of commentary or complement. 122 An early scholar who clearly stated that the text of the Suśrutasaṃhitā consists of layers belonging to various ages and must be the result of a series of revisions was G. Liétard; he also stressed that the Uttaratantra cannot be but a kind of appendix of a later date. 123

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The opinions put forward on the identity and date of the author who revised an earlier surgical treatise attributed to Suśruta, and who has probably added the Uttaratantra, are very diverse. The arguments adduced in favour of a particular hypothesis are usually intimately connected with the elements of the Suśrutasaṃhitā thought to belong to this reviser. A survey of some of the opinions may be useful in clarifying the complications of the situation.

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Atrideva 124 suggested that the following features may be due to a reviser who lived during the Śātavāhana dynasty: the four different colours of the soil on which, dependent on the varṇa of the woman in childbed, the delivery hut (sūtikāgāra) should be constructed (Śā.10.5); the four different kinds of timber from which, dependent on the varṇa again, the hut and the bed should be made (Śā.10.5); the admission of śūdra students to the medical training (Sū.2.5); the reference to the feeding of brāhmaṇas after the preparation of a particular compound medicine (Ci.4.29); the veneration of (Bala)rāma and Kṛṣṇa (Ci.30.27).

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P.V. Sharma, who accepts the tradition that the reviser was a Nāgārjuna and places him in the Gupta period, mentions as elements added by him: 125 passages indicating the presence of Pāśupatas, 126 Kāpālikas 127 and Tāntrikas; 128 passages pointing to an increasing influence of astrology; 129 the reference to the viṣakanyā; 130 the use of the term viśikhā; 131 a number of geographical names; 132 the presence of the term kuhaka; 133 the important place of inorganic substances in the materia medica; 134 the use of enigmatic language. 135

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K.R. Srikanta Murthy 136 mentions as elements due to the reviser, whom he supposes to be a Nāgārjuna who lived in the fourth or fifth century: the reference to Subhūti Gautama; 137 the association of the surgeon with the king and his army; 138 the use of mercury as a medicinal substance; the presence of muraṅgī/muruṅgī as a medicinal plant; 139 the names of mountains and rivers found in Southern India.

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S. Dasgupta,¹⁴⁰ who accepts that a Nāgārjuna was the reviser, observed that an ardhaśloka, incorporated in the current text of the Suśrutasaṃhitā (Ni.3.13ab), is quoted as a variant ascribed to Nāgārjuna in Gayadāsa’s commentary (ad Ni.3.12), which may mean that it is an interpolation.¹⁴¹ Another quotation from Nāgārjuna, found in Narahari’s Vāgbhaṭamaṇḍana, presents a variant of Ni.8.14 disagreeing with the reading accepted by Gayadāsa and Dalhaṇa, which is hard to explain, unless we assume that a later reviser changed Nāgārjuna’s reading again. S. Dasgupta also suggested that the process of making additions to the Suśrutasaṃhitā continued until rather late times. He advanced that parts of the material on bastikriyā (Ci.37–38) were still unknown to Cakrapāṇidatta who, though very well conversant with the Suśrutasaṃhitā, ignores this material in his commentary on the Siddhisthāna of the Carakasaṃhitā and does not use it in his own Cakradatta; this made S. Dasgupta infer that the relevant particulars were added in the twelfth century, since Dalhaṇa did know the material in question and explained it in his commentary.

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As remarked earlier, the identity of the reviser, who may have added the Uttaratantra, is a controversial issue. Dalhaṇa, the only commentator to mention his name, calls him Nāgārjuna,¹⁴² but it is difficult to accept this tradition, which dates from a period in which Nāgārjuna had developed into a multifaceted legendary figure. This did, however, not prevent many scholars from expressing their opinion on the question which Nāgārjuna Dalhaṇa may have had in mind. Others expressed their doubt on the trustworthiness of Dalhaṇa’s assertion or rejected it altogether.

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A.F.R. Hoernle¹⁴³ appears to have inclined to the view that the Nāgārjuna of Dalhaṇa was the well-known Buddhist patriarch of that name, often regarded as a contemporary of Kaniṣka. Accordingly, the compendia of Agniveśa and Suśruta would, in this theory, have been revised at about the same time.

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Jyotir Mitra¹⁴⁴ is one of the contemporary scholars to hold that the Buddhist philosopher Nāgārjuna redacted the Suśrutasaṃhitā. S.K. Ramachandra Rao¹⁴⁵ put forward that the reviser may have been the great Mahāyāna master and alchemist Nāgārjuna, who lived in the first century A.D.

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Gaṇanāthasena¹⁴⁶ identified the reviser as Siddhanāgārjuna, author of Lohaśāstra, Kakṣapuṭa, etc., whom he assigned to the beginning of the Christian era. Similarly, G.P. Srivastava¹⁴⁷ regarded the Buddhist chemist Nāgārjuna, placed by him in the first century B.C. or the first century A.D., as the reviser and the author of the Uttaratantra. Bāpālāl Vaidya¹⁴⁸ and Umeśacandragupta¹⁴⁹ claimed that Siddhanāgārjuna, assigned to the beginning of the Christian era, was the proper candidate. P.S. Sankaran¹⁵⁰ chose the chemist Nāgārjuna who lived during the reign of Kaniṣka, R. Śāstrī¹⁵¹ the Nāgārjuna who lived during the Śātavāhana dynasty.

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J. Filliozat,¹⁵² who accepted as a possibility that the reviser was indeed a Nāgārjuna, suggested that he may have been the author of the Yogaśataka, who lived in the sixth century, or the Nāgārjuna of the tenth century, mentioned by al-Bīrūnī.¹⁵³ O.P. Jaggi¹⁵⁴ showed to have a preference for the Nāgārjuna of al-Bīrūnī.

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P.V. Sharma¹⁵⁵ argues that the revision of the Suśrutasaṃhitā and the addition of the Uttaratantra are due to a Nāgārjuna who lived in the Gupta period, in the fifth century. His arguments are: the tantrayuktis (U.66) are borrowed from the Kauṭilīya Arthaśāstra; 156 the author of the Uttaratantra made use of Dṛḍhabala’s contributions to the Carakasaṃhitā; Vāgbhaṭa was acquainted with the Uttaratantra. P.V. Sharma regards this fifth-century Nāgārjuna as the author of a Lohaśāstra and the Rasavaiśeṣikasūtra. An alternative solution is, according to the same scholar, that the name of Nāgārjuna became associated with the Suśrutasaṃhitā because the Nāgārjuna, known as a friend and counsellor of the Śātavāhana king Gautamīputra Śātakarṇi, was a contemporary of Suśruta II.

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K.R. Srikanta Murthy 157 employs some of the same arguments as P.V. Sharma. He regards a physician Nāgārjuna, who belongs to the fourth or fifth century, as the most probable candidate and credits him with a series of medical treatises. This Nāgārjuna was in his opinion a Buddhist scholar who had many followers known as the Nāgārjunīyas.

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G. Hāldār 158 rejected Ḍalhaṇa’s claim and developed his own theory by distinguishing an early Suśruta, author of the Sauśrutatantra, and a Navīnasuśruta, who revised this tantra and made it into the Suśrutasaṃhitā. He regarded the quotations from a Vṛddhasuśruta as evidence proving that an earlier version of the saṃhitā once existed. He was also convinced that the early tantra dealt with all eight divisions of āyurveda and that the Uttaratantra has not been added later, but already formed part, in a shorter version, of the original work. The Navīnasuśruta, who revised the tantra and expanded it, was in his view Kāpilabala, the son of Kāpilabala, who lived during the reign of Kaniṣka in the second century A.D. 159 G. Hāldār repudiated Ḍalhaṇa’s identification of the reviser, arguing that Nāgārjuna, as a Buddhist, would have left traces of Buddhist thought in the Suśrutasaṃhitā; the absence of these vestiges made him see Ḍalhaṇa’s claim as untrustworthy.

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Hariprapanna 160 is another author who categorically refuted Ḍalhaṇa’s claim, considering it to carry no value from a historical point of view. Atrideva 161 also held that the reviser was not Nāgārjuna, but someone whose name remains unknown.

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Hemarājaśarman 162 developed his own theory on the author of the Uttaratantra. He called attention to the absence of colophons, of the same type as those in the Carakasaṃhitā, pointing to a revision of the Suśrutasaṃhitā. 163 He also stressed that an interest in surgery cannot be detected in any of the writings attributed to authors called Nāgārjuna. The presence of Suśruta as a physician interested in the properties of medicinal substances in the Upāyahṛdaya, 164 by some ascribed to Nāgārjuna, pleads against the latter’s involvement in the Suśrutasaṃhitā. Moreover, Buddhist influences are entirely lacking in Suśruta’s work. Decisive evidence is, according to Hemarājaśarman, found in a MS of the Suśrutasaṃhitā, dating from the year 633 of the Newar era (A.D. 1511). The colophon of this MS reads, at the end of the Kalpasthāna, ‘suśrute śalyatantre’; the colophon at the end of the appended nighaṇṭu has ‘sauśrutyāṃ saṃhitāyāṃ mahottarāyām’. Hemarājaśarman concluded from this that the Uttaratantra was added to Suśruta’s text by a Sauśrutācārya belonging to Suśruta’s lineage; the nighaṇṭu must have been written by the same ācārya, because items found in the Uttaratantra only are incorporated in it. Hemarājaśarman supposed that this ācārya revised Suśruta’s text by filling in incomplete parts. He suggested that the Sauśrutācārya of the MS he studied was one of the saśrutas mentioned in the Mahābhāṣya.¹⁶⁵

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Yādavaśarman¹⁶⁶ refused to acknowledge the Uttaratantra as a later addition to the Suśrutasaṃhitā. This scholar adduces as an argument in support of his thesis that the Harivaṃśa¹⁶⁷ describes Dhanvantari as having divided the āyurveda into eight branches and taught it to his pupils; this implies that he also gave instruction in the subjects dealt with in the Uttaratantra. The thesis that Dhanvantari’s teachings, embodied in the Suśrutasaṃhitā, comprise all the divisions of āyurveda and not only surgery (śalya), is thought to be supported by the verse (Sū.1.21) where Dhanvantari proclaims that he has re-appeared in the world in order to teach śalya, along with the other aṅgas.¹⁶⁸ Ḍalhaṇa’s reference to the commentators Sukīra and Sudhīra, who regarded particular verses of the Uttaratantra (U.58.58–65ab) as genuine (ārṣa), is considered to constitute additional evidence, as well as a verse of the Uttaratantra (U.40.7), where Kāśirāja defends his own view against that of other authorities. Yādavaśarman arrives at the conclusion that the original Uttaratantra got partially lost and was completed again by some later author (a Nāgārjuna or a member of Suśruta’s school); an alternative possibility is that it was a rather short work, expanded later.

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Yādavaśarman’s exposition is acknowledged with approval by Sūramcandra.¹⁶⁹

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Ideas similar to those of Yādavaśarman have been expressed by Bhishagratna, one of the translators of the Suśrutasaṃhitā into English.¹⁷⁰ Although accepting a revision by Nāgārjuna, Bhishagratna considered the Uttaratantra to have formed an integral part of the original treatise. He asserted that it would be unthinkable for Divodāsa to fall short of his duties by omitting to instruct his pupils in all the divisions of medicine which are listed and specified in the first chapter of the Sūtrasthāna.¹⁷¹ He added that the general plan of the work shows that the more elementary topics were dealt with in the first five sections, while the discussion of those requiring a more advanced knowledge were reserved for the Uttaratantra, which has the nature of a supplement.¹⁷² Bhishagratna identified the reviser Nāgārjuna as the founder of the Mādhyamika school of Buddhist philosophy and placed him in the latter part of the fourth century B.C.

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The Chronology Committee of the National Institute of Sciences of India concluded that a Nāgārjuna who belonged to the third or fourth century revised a much older work by Suśruta.¹⁷³

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Authors accepting that the Suśrutasaṃhitā was redacted by a Nāgārjuna, but who did not reach a decision as to his identity and date are: D. Chattopadhyaya,¹⁷⁴ P. Cordier,¹⁷⁵ R.C. Majumdar,¹⁷⁶ P. Rāy c.s.,¹⁷⁷ and S.N. Sen.¹⁷⁸

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Some scholars assert that the text of the Suśrutasaṃhitā as known to us represents the version made by Candraṭa in the tenth century.¹⁷⁹ This thesis, developed first by P.V. Sharma, makes the current text identical with Candraṭa’s Suśrutapāṭhaśuddhi, which was, according to Candraṭa’s own information, based on Jejjaṭa’s commentary.¹⁸⁰ Elements which, in P.V. Sharma’s opinion, derive from Candraṭa are: a theoretical digression on the doṣas (Sū.24.11);¹⁸¹ the concept of blood as the fourth doṣa;¹⁸² the procedures for the purification of turbid water and the cooling down of water (Sū.45.17–19);¹⁸³ the references to epidemic diseases as aupasargikaroga (Ni.5.34)¹⁸⁴ and maraka (Sū.6.17); the mention of aśvabalā as a medicinal plant (Sū.46.256).¹⁸⁵

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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 of 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 Dhanvantari, a mythic personality. 186 Suśruta himself too is, as the son of Viśvāmitra, embedded in legendary tales. Both figures may have been selected to give authority to the treatise. Another reason for the choice of the name Suśruta may have been that it means ‘the famous one’ or ‘who listened (to his teacher) in the right way’. 187

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The positions of Divodāsa Dhanvantari and Suśruta in the *Suśrutasaṃhitā* tally with those occupied by Ātreya Punarvasu and Agniveśa in the *Carakasaṃhitā*, which supports the thesis that they are literary fictions. 188

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The honorific epithets given to Suśruta are in favour of this view, 189 since it is not likely that an author refers to himself as an ṛṣi 190 (Ci.2.3), or as one who is śubha and vinayopapanna (Ni.7.3). 191

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The appearance of a king of Kāśī as a medical expert is not a unique feature of the *Suśrutasaṃhitā*. Other royal sages, connected with Kāśī, such as Vāmaka 192 and Vāryovida, are known from the *Caraka*- and *Kāśyapasaṃhitā*, though without being characterized as surgeons. Both Vāmaka and Vāryovida are conspicuously absent from the *Suśrutasaṃhitā*.

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Kāśī is sometimes depicted as an ancient centre of medical learning, in particular surgery. 193 A.F.R. Hoernle 194 emphasized that at least the origin of ophthalmic surgery is placed by Indian tradition in Eastern India, in Bihar, being credited to Nimi, lord of Videha. Buddhist literature, on the other hand, does not picture Kāśī as a centre of instruction in surgical skills, but mentions, instead, Takṣaśilā. 195

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