Caraka, the master physician, is believed to have lived in the first century AD. The Samhita composed by him forms the bedrock of ayurvedic practice today. His contribution to India's cultural inheritance was profound.

Caraka Samhita was, in fact, a revision of an older text Agnivesa Tantra, which was written several centuries before Caraka's time. Caraka's revision became so popular that it was translated into Tibetan, Arabic, English and many Indian languages. The Legacy of Caraka retells the Samhita in a new format. Instead of adhering to the sequence of the Sthanas in the original, the author has retold the Samhita through thematically structured chapter, in contemporary idiom. The retelling has involved some degree of restructuring and condensation but ha ensured that whatever is stated can be traced back to the original. In a detailed introduction, the author has commented on specific of view of modern medicine.

This book will be special interest to students of Ayurveda, medicine and other sciences, and those interested in the history of science in India.

About the Author

A native of Kerala, Dr. MS Valiathan received his medical education in India and subsequent training in surgery and cardiac surgery in the UK and USA. During a career spanning three decades as a cardiac 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 in these areas are embodied in a monograph and many scientific papers. A Vice-Chancellorship followed before he took up the study of the Caraka Samhita as Homi Bhabha Senior Fellow at the Manipal Academy of Higher Education, Karnataka, India.

Dr. Valiathan is married to Ashima, an orthodontist. They have a daughter, Manna, and a son Manish.

ISBN: 9788173716669
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:

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.

Vagbhata completes the Great three (Brhatrayi) of Ayurveda with his predecessor, Caraka and Susruta. His identify and period are controversial but a major section of the scholarly community believes that he was a native of Sindh, who lived in the sixth century and wrote Astangadrdayam and Astangasangrah. The two texts frankly acknowledge the authority of the Samhitas of Caraka and Susruta and closely follow in the footsteps of the earlier masters.

The legacy of Vagbhata is based on a study of Astangahrdayam and employs a thematic approach with the plentiful of tables. As in the earlier volumes on Caraka and Susruta great care has been taken in this volume on Vagbhata to maintain fidelity to the original text while ensuring easy readability for the students of Ayurvedic medicine and the sciences.

A native of Kerala Dr. M S Valiathan received his medical education in Indian and training in surgery and cardiac sugary in the UK and USA. During a career a panning 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 contributors are embodied in a monograph many scientific papers and a family of medical devices including a tilting disc heart valve which are used widely in India.

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.

This volume is the third in my Legacy series the two previous ones on Caraka and Susruta having appeared in print during the last five years. The welcome received by the earlier books from a growing readership and their positive appraisal by scholarly persuaded me to undertake a similar exercise on Vagbhata and complete the series on the Great Trinity (Brhattrayi) of Ayurveda.

In writing the Legacy series, I had adopted from the start a format which I hoped would make them readily accessible to the students who opt for Ayurveda and medicine after twelve years of school while maintaining utmost fidelity to the original texts. In The Legacy of Vagbhata, I have therefore refrains form lengthy and inconclusive discussion on non medical topics such as the identity of Vagbhata his date place and so on. Apart form the fact that our ancestors who shaped India’s cultural inheritance were loath to talk about themselves the results of scholarly debates on the historical and personal data of Vagbhata seemed to me to be of limited inters tot benefit to students who are impatient to get on with medical studies. I read many reference to Vagbhata in the books on Ayurvedic history by reputed authors such as Heinrich Zimmer PV Sharma and NVK Varier and also held discussions with senior Ayurvedic colleagues before settling on two editions of Astangahrdaya as the basic texts for my study. These were Asrangahrdayam (three volumes) text and English commentary by Professor Srinath Murthy and Astangahradayam text with Malayalam translation by PM Govindan Vaidyar Astangahrdayam (text with Sarvangasundare commentary of Arunadatta and Ayurvedarasayana tika of Hemadari) edited by harisastry. Once again I followed the thematic approach on the lines of my books on Caraka and Susruta, which seems to have been well accepted by the readers. I must acknowledge that the work on Vagbhata made less demands on my time and effort than the study of the two Samhitas and often became a joyful experience.

Though I had opted to study Astangahrdaya as it represented the essence of Vagbhata’s legacy I had to consider Astangasangraha regardless of whether it was authored by the same Vagbhata. However on going through Sangraha with its extensive commentary by my mentor Shri Ragahvan Thirumulpad I soon realized that neither time nor my training would permit me to write on Vagbhata’s legacy based on a critical and exhaustive study of Sangraha and Hrdaya. Nevertheless as Astangahrdaya proudly claimed that its sprang from the churning of the ocean of Astangasangraha I have attempters a limited comparative analysis of three identical subjects drawn from the Carakasamhita Astangasangraha and Astangahrdaya in the Introduction. The analysis confirmed the general impression that the core of Ayurvedic doctrines profile of diseases and procedures remained unchanged over centuries whereas changes which did over were more or less confined to the domain of medical formulations. The limited exercise also suggested the appropriateness of doing a well planned comparative study on the evolution of Ayurvedic concepts and practice based on classical texts form Caraka to Vagbhata because the five or six centuries which separated them were marked by foreign incisions and major social upheavals in India.

Dr. Ramankutty of the Arya Vaidya Sala Kottakkal a brilliant Ayurvedic scholar and authority on medicinal plants has been a friend philosopher and guide during my Ayurvedic studies for the last few years. He not only encouraged scanned my entire manuscript and made numerous suggestions for corrections and improvements. Additionally he gave valuable assistance by listing the botanical names of plants mentioned in this book preparing an index and reading the proofs. I have no words to thank him for his untiring support and assistance. As Astangahrdaya is a distillate of earlier texts. I have taken the liberty of reproducing some of the figures drawn by MR. joy for my books on Caraka and Susruta in the present volume for the permission of which I express my thanks to Orient Blackswan. The inimitable picture of Vagbhata on the cover which has allusions to his legendary connection with Kerala was drawn specially for this volume by the renowned artist Nabudiri of Keral to whom I am much beholden.

I am grateful to the Ministry of Human Resources Development Governments of India for the award of a National Research Professorship which has supported me during my years of labor in the Ayurvedic vineyard. I am equally grateful to DR. Ramdas Pai President of the Manipal University for continuing to provide me excellent facilities and a congenial environment to follow my academic pursuit in Manipal. It is a pleasure to acknowledge with thanks the assistance of Ms Usha Kamath who typed and retyped my bulky manuscript untiringly and oversaw the smooth movement of papers in the Manipal Kottakkal Chennai triangle. I am grateful to Ms Ramaa kishore for reading the proofs. Ms Padmaja Anant or Orient Blackswan has been unfailingly supportive fore which I am grateful to her.

I can do no better than conclude by quoting Goethe Nowhere would anyone grant that science and poetry can be united. People forgot that science had developed from poetry and they failed to take into consideration that a swing of the pendulum might beneficently reunite the two at a higher level and to mutual advantage Vagbhata represents Goethe’s beneficent reunion of science and poetry at a higher level.

Caraka Susruta and Vagbhata are the Great (Brhatrayi) of Ayurveda. In line with his predecessors Vagbhata cared to say little about himself or the times he lived in and let his works speak for himself. In the Astangahrdaya (AH) he stated explicitly that Astangasangraha (AS) grew out of the boundless and immaculate knowledge of ancient sages and AH was no more than its distillate which would benefit even the less industrious. He affirmed that AH fulfilled the 18 requirements for an authoritative text which was at the same time free from 15 defects which bedevil inferior works. His confidence in AH was so great that he threw a challenge to his contemporaries and posterity on the inescapability of studying masterly texts such as AH regardless of whether they had been composed by ancient sages in the line of Caraka and Susruta. For him the heart of the massive literature of Ayurveda throbbed in AH which he believed would radiate beneficence for the whole world. One would therefore do no injustice to Vagbhata if a twenty first century study on his legacy were to be based on AH.

Astangahrdaya is one of the authorities’ texts of Ayurveda which continues to be equally popular among students practitioners and scholars. It is medically oriented work with principal emphasis on internal medicine(kayacikitsa) and only brief references o surgical obstruct that of the Samhitas of Caraka and Susruta whose names are revered but whose works are not widely read. The descriptions of medical concepts procedures and herbal formulations in AH can be traced to the Samhitas of Caraka and Susruta which were to the source for as well as. AH owned its great appeal over earlier texts to the beauty of its verses its masterly style of condensation logical arrangement of topics clarity of description another merits. No wonder it was translated into foreign languages such as Arabic Persian Tibetan many centuries ago and more recently into European languages.

Uttaratantra constitutes a large part of AH and deals with diseases of children disease caused by evil spirits disease of the head and neck surgical treatment poisoning rejuvenant and virilising therapies. The existence of Uttarasthana in CS is controversial but many of the subjects discussed in AH under Uttaratantra are conversed in the Cikitsa and other Sthanas of CS. Unlike CS and AS which contain a mixture of prose and poetry AH is composed in verse barring a few prose lines at the beginning and end of each chapter. A summary of the subjects dealt with in AH is indicated below.

Sutra: Wish for long life code of daily and seasonal conduct food and drinks ensuring safety of food substance and properties tastes dosas in health and disease principles of treatment procedures in treatments instruments and their use in surgery.

Sarira: Development of the embryo; pregnancy and disorders associated with it; parts of the body; vital spots; significance of messengers; omens and dreams.

Nidana: Diagnosis based on clinical features; fever pitta-induced bleeding, cough, hiccup shortness of breath hoarseness of voice phthisis alcoholic intoxication, piles, diarrhea and bowel disorders, loss of appetite, vomiting, heart disease, morbid thirst scrotal enlargements, gaseous lumps of abdomen urinary obstruction, polyurias including diabetes, abscesses, abdominal enlargement pallor swelling cellulites skin disease including leprosy, leucoderma, worm infestation vata disorders blood disorders.

Cikitsa:Fever, Pitta-induced bleeding, cough, shortness of breath, hiccup, hoarseness of voice, phthisis vomiting loss of appetite heart disease urinary obstruction intoxication, piles, diarrhea, bowel disorders urinary obstruction polyurias including diabetes abscess abdominal enlargement scrotal swelling worm infestation, gaseous lumps of the abdomen, pallor, swelling, celluttuis, skin disorders including leprosy leucoderma vata-induced blood disorders.

Kalpa: Siddhi : Emesis purgation and complication enemas and complications drugs employed in the procedures.

Uttara: children’s diseases, disease caused by evil spirits insanity epilepsy, eye diseases; diseases of the car, nose, mouth, head; ulcers, fracture, ano-rectal fistula, tumors, filarial, swelling, glandular swellings and sinuses; minor diseases; poisoning bites by snakes spiders rats insects rejuvenent therapy virilising therapy.

The immense popularity of AH is testified by the many commentaries on it numbering over thirty excluding commentaries partly regional only in manuscript form and only six are said to be available in print form. Among these Arunadatta’s Savangasundara which reaches back to the twelfth century has received the highest critical acclaim. Among the commentaries in regional languages, PM Govindan Vaidyan’s Arunodaya century and chapped Achutha varier’s commentary in Malayalam have been popular in Kerala where AH became a great favorite among the intelligentsia centuries ago.

Vagbhata identity place of birth date and religious affiliation are far form certain. Scholars are equally divided on the question whether AS and AH were composed by an identical Vagbhata or whether Vagbhata Senior authored AS and Vagbhata Junior summarized it later as AH. There is a scholarly view that another Vagbhata (Madhya Vagbhata) intervened between the senior and junior Vagbhata and wrote Astangavatara. The Vagbhata who wrote AS stated in the concluding verse there lived a great physician named Vagbhata who was my grandfather whose name I bear. His son was Simhagupta who was my father. I was born I Sindhudesa. After learning the science form Avalokita my teacher and more form my father and devoting myself to a large number of books in this science. I have composed this text. He also claimed that the text was written to suit his times (yanagupta). The scholars who claim that the Vagbhata of AS is the same individual who composed AH point to the statement at the end of AH that it is a distillate of AS which is an ocean of medical science; and a large number of verses from AS reproduced without changes in AH etc., as evidence of the identify of the authors. On the other hand other s noted that ancient commentators distinguished Vrddha Vagbhata who wrote AS from Vagbhata who authored AH and the dissonance between the two texts in relation to style observation on faith and sociology scientific principles etc. (PV Sharma). In the present state of learned ignorance the identity of Vagbhata cannot be established with certainly nor can the question in AH antedating AS be answered on the basis of irrefutable evidence.

Vagbhata’s date: As AH contains several verses form the CS which was revised and completed by Drdhabala, Vagbhata probably lived after Drdhabala whose date has been fixed by general agreement around 500 A.D Professor Srikantha Murhty has pointed to a verse closely similar to one form AH or probably taken from it in the Brhatsamhita of Varhamihira who is known to have lived between 500-580 AD. This would support the view the Vagbhata lived in the sixth century when Gupta rules was beginning to decline in north India.

Legendary Vagbhata : Reputed commentators such as Jejjata and Niscalakara have described Vagbhata as a raja or Rajarsi. Professor PV Sharma was of the opinion that Vagbhata might have left his small kingdom in Shindh and moved to Ujjain Following the invasion by sakas. Vagbhata’s connection with Kerala is also legendry. He is the patron saint of Ayurveda and Astangahrdaya the principal text for the traditional learning of Ayurveda in Kerala. According to popular belief, Vagbhata a Brahmana masters Ayurveda under the guidance of a Buddhist teacher in Sindhiseas when Buddhism was a dominant religion and Buddhist physicians the leaders of Ayurvedic practice and training. On the completion of training Vagbhata found himself ostracized by Brahmans whereupon he left Sichudesa on a long journey which ended in Kerala. There he found intelligent and admiring pupils among the Namputiris who were hungry for Ayurvedic knowledge. According to this belief he establish the Astavaidya families each specializing in one branch of Ayurveda and all depending on AH as their therapeutic manual. Unfortunately no evidence of Ayurveda and Astangahrdaya in Sri Lanka believe that Vagbhata lived in the island after his departure form Sind.