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A History of Indian Medical Literature v1.c26.s8: Structural features of the Saṃgraha and the Hṛdaya

A History of Indian Medical Literature v1.c26.s8

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Structural features of the Saṃgraha and the Hṛdaya

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The division into sections (sthāna) agrees, broadly, with that of the Suśrutasaṃhitā, and differs considerably from that found in the Carakasaṃhitā. The Vimāna-, Indriya- and Siddhisthānas are absent, as they are from the Suśrutasaṃhitā. An Uttarasthāna is added, in the same way as the Uttaratantra to the Suśrutasaṃhitā, but, as its title indicates, it forms an integral part of the treatise. The order of the sections differs from that found in Caraka- and Suśrutasaṃhitā in placing the Śārīrasthāna before the Nidānasthāna. This may be seen as an improvement, because the subject matter is arranged more systematically in this way, by dealing first with all general subjects before beginning to describe the diseases and their treatment.

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The contents of the sthānas show many innovations.

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The procedures belonging to pañcakarman, dealt with in the Siddhisthāna of the Carakasaṃhitā and the last part of the Cikitsāsthāna of the Suśrutasaṃhitā, form part of the Sūtrasthāna and Kalpasthāna, and are, in the Sūtrasthāna, preceded by chapters on oleation (sneha) and sudation (sveda), as in Suśruta’s Cikitsāsthāna, while the chapters on these topics in Caraka’s Sūtrasthāna appear to have no appropriate context. 552 The subjects discussed in Caraka’s Indriyasthāna, which are incorporated in the Sūtrasthāna of the Suśrutasaṃhitā, are found in the last chapters of the Śārīrasthāna of Saṃgraha and Hṛdaya.

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The order of the diseases discussed in the Nidānasthāna is peculiar and differs considerably from that found in the corresponding sections of Caraka- and Suśrutasaṃhitā.

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The first chapter (sarvaroganidāna) is on the five elements constituting nidāna, on some related concepts, the causes of excitement of the doṣas, and astrological considerations relating to fevers.

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Chapter two is on fever, which is also the first disease described in the Nidānasthāna of the *Carakasaṃhitā*. Chapter three is on raktapitta and kāsa, thus illustrating a pronounced special feature, consisting of the grouping together of particular diseases in one chapter, a practice already present, but less conspicuously, in the Nidānasthāna of the *Suśrutasaṃhitā*. Raktapitta is dealt with in chapter two of Caraka's Nidānasthāna, not in Suśruta's Nidānasthāna; the nidāna of kāsa is absent from the Nidānasthānas of Caraka and Suśruta and discussed in Ca.Ci.18 and Su.U.52 respectively; the description of kāsa immediately after raktapitta is explained by the statement that it is a dangerous complication of raktapitta (A.s.Ni.3.18cd-19 = A.h.Ni.3.16cd-17ab); an interesting parallel is the presence of a chapter on kāsanidāna in the *Bhelasaṃhitā* (Ni.4). Chapter four is on śvāsa and hidhmā, subjects not dealt with in the Nidānasthānas of Caraka and Suśruta, but often clustered together, for example in Ca.Ci.17, and thought to be related to kāsa (Ca.Ci.18). Chapter five begins with the nidāna of rājayakṣman, described in the Nidānasthāna of the *Carakasaṃhitā* (Ni.6: śoṣanidāna), but absent from the Nidānasthāna of the *Suśrutasaṃhitā*; it proceeds with the nidāna of svarabheda, arocaka, chardi, hṛdroga and tṛṣṇā, regarded as upadravas of rājayakṣman and not discussed in Caraka's Nidānasthāna. Chapter six is remarkable in being devoted to madātyaya, absent from the Nidānasthānas of Caraka and Suśruta; the same chapter discusses mada, mūrchā and saṃnyāsa. Chapter seven deals with arśas, absent from Caraka's, but present in Suśruta's Nidānasthāna. Chapter eight describes the nidāna of atīsāra and grahaṇī, both absent from Caraka's and Suśruta's Nidānasthānas. Chapter nine is about mūtrāghāta and related disorders, not described in the Nidānasthāna of Caraka; Suśruta has a chapter on the nidāna of aśmarī and śarkarā (Ni.3). Chapter ten, on prameha, has a corresponding chapter in the Nidānasthānas of Caraka (Ni.4) and Suśruta (Ni.6); this chapter also describes the pramehapiṭikās. Chapter eleven is devoted to the cluster consisting of vidradhi, vṛddhi and gulma; gulma is dealt with in the Nidānasthāna of Caraka (Ni.3) and vidradhi in a separate chapter of the Nidānasthāna of the *Suśrutasaṃhitā* (Ni.9), while vṛddhi is described, together with upadaṃśa and ślīpada, in a chapter of Suśruta's Nidānasthāna (Ni.12). Chapter twelve deals with udara, absent from Caraka's, but present in Suśruta's Nidānasthāna (Ni.7). Chapter thirteen has an unusual cluster: pāṇḍu(roga), śopha and visarpa; Suśruta deals with visarpa in a chapter with another cluster (Ni.10: visarpa, nāḍī, stanaroga), while all three are absent from Caraka's Nidānasthāna. Chapter fourteen is about kuṣṭha, śvitra and kṛmi(roga); kuṣṭha, to which śvitra is closely related, is described in the Nidānasthānas of both Caraka (Ni.5) and Suśruta (Ni.5), where kṛmiroga is absent. Chapter fifteen discusses vātavyādhi, absent from Caraka's, but present in Suśruta's Nidānasthāna (Ni.1). Chapter sixteen is devoted to vātaśoṇita, absent from Caraka's and Suśruta's Nidānasthāna.

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The Cikitsāsthāna describes the treatment of the diseases discussed in the Nidānasthāna, but has more chapters by splitting up some of the clusters.

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The Kalpasthāna differs from the sections of the same name of *Caraka-* and *Suśrutasaṃhitā* in being devoted to emetic and purgative procedures, to complications that may occur during them, to the treatment with clysters and its complications, and to rules for the preparation of drugs.

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The contents of the Uttarasthāna differ from those of Suśruta’s Uttaratantra in dealing only partly with the same topics and these in a different order. Remarkable is the systematic arrangement of its subject matter: kaumārabhṛtya, 553 bhūtavidyā, 554 mānasaroga (mental disorders), 555 śālākya, 556 śalya, 557 kṣudrarogas, 558 guhyarogas, 559 agadatantra, 560 rasāyana, 561 and vājīkaraṇa. 562 The presence of the chapters on rasāyana and vājīkaraṇa at the end of the treatise is very remarkable; these subjects are discussed at the beginning of the Cikitsāsthāna in the Carakasaṃhitā, while the relevant chapters precede those on pañcakarman and related topics in the Cikitsāsthāna of the Suśrutasaṃhitā.

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This survey demonstrates that Saṃgraha and Hṛdaya do not simply follow either Caraka or Suśruta by selecting when to follow the one or the other, but have, apart from being influenced by the preceding two works, an independent orientation, shown by the structure of their sthānas.

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Hoemle 563 expressed as his opinion that it was Vāgbhaṭa’s object to gather up into a harmonious whole the more or less conflicting medical systems current in his time, especially those contained in the saṃhitās of Caraka and Suśruta. Hoemle added that, in pursuance of this object, Vāgbhaṭa introduced, especially with reference to the diseases of the eye, many modifications in the classification and nomenclature which had hitherto been accepted. He also supposed that it led Vāgbhaṭa to the adoption of compromises – by no means always successful – of which his exposition of the skeleton presents a conspicuous example.

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These conclusions, mainly based on Hoemle’s detailed and systematic study of Indian osteology, require a critical appraisal, departing from a renewed comparison of the texts of Saṃgraha and Hṛdaya with the Caraka- and Suśrutasaṃhitā.

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Both Saṃgraha and Hṛdaya contain much material that is literally found in the Carakasaṃhitā. Adaptations, very close to the original text, are also frequent.

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The attitude towards the Suśrutasaṃhitā is completely different, since it is less frequently quoted. Passages in prose and verse found in Saṃgraha and Hṛdaya may be close to the text of the Suśrutasaṃhitā, but contain almost always changes.

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These contrasting ways of handling the treatises of Caraka and Suśruta are hard to explain.

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Worthy of as much attention, but less taken notice of, 564 is the absence of material found in Caraka and Suśruta. The expositions of theories allied to the Vaiśeṣika, Sāṃkhya and Nyāya systems of philosophy, important aspects of the Carakasaṃhitā, are conspicuous by their absence. This applies, for example, as well to the chapter on the three aims of life (Sū. 11: traiṣaṇīya), the description of the way to liberation (mokṣa), and the discussions of groups of sages. In general, the role of the mahābhūtas recedes into the background.

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Hoemle is not justified in claiming that the object of both treatises was to harmonize conflicting views of Caraka and Suśruta. In any case, it is not the only aim. The Saṃgraha in particular very often mentions side by side disagreeing opinions which derive from these authorities. Sometimes one of them or both names are mentioned, sometimes they are absent.

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An example is the list specifying the amounts of the bodily constituents. Saṃgraha (Śā.5.63) and Hṛdaya (Śā.3.80–81) follow Caraka, but the Saṃgraha adds the opinion of the Dhanvantarīyas (Śā.5.65), which agrees with that of Suśruta.

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The chapter on the vessels of the Saṃgraha states that sirās and dhamanīs are specialized types of vessels (srotas), which means that they are essentially the same. The point of view that all three are different structures is referred to as held by others, as is a third opinion that vessels have many names (Śā.6.20). The first theory, accepted by the author, is that found in the Carakasaṃhitā, the second theory is characteristic of the Suśrutasaṃhitā.

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Both examples do not testify to a tendency to harmonization.

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This is not to say that a tendency to accept both Caraka- and Suśrutasaṃhitā is completely absent.

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An example illustrating this tendency in the Saṃgraha is the presence of two mantras aiming at an easy delivery (Śā.3.20–22). The first derives from Caraka (Śā.8.39), the second is identical with one of Suśruta’s cyāvanamantras (Ci.15.6–8). The Hṛdaya omits these mantras, restricting itself to the recommendation to perform the required ceremonies (Śā.1.77).565 Another example is the osteological system.566 A third example is the typology of the napuṃsakas in the Saṃgraha. Its eight types (Śā.2.21–28) clearly result from a combination of the lists of Caraka and Suśruta.567 A fourth example is the classification of the types of prameha,568 a fifth that of the types of kuṣṭha,569 a sixth that of the types of sveda.570

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Another feature of both Saṃgraha and Hṛdaya consists of a tendency to complete developments already on their way in the works of Caraka and Suśruta. This is illustrated by the names of the five kinds of kapha, absent from Caraka and Suśruta, but supplied for the first time by Saṃgraha and Hṛdaya (A.h.Sū.12.15–18ab; A.s.Sū.20.4).

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A remarkable feature of the Saṃgraha is that it versifies the material found in prose in one of the chapters of the Carakasaṃhitā.571 Evidence of the same procedure, applied to the Suśrutasaṃhitā, is found in the chapters on groups of drugs in both Saṃgraha and Hṛdaya.572

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The obvious fact that Saṃgraha and Hṛdaya have many features in common belongs to the arsenal of arguments adduced by many scholars to defend the view that they were written by the same person. Such a conclusion is, however, not justified at all. The Hṛdaya is simply largely based on the Saṃgraha or it is the other way round, which explains what is common to both, while, moreover, the considerable number of discrepancies conflicts with a common authorship.

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