Sushruta Samhita Sutrasthana Chapter 3: Adhyayana Sampradaneeya (Facilitating the Study)

The 3rd chapter of Sutrasthana of Sushruta Samhita is named as Prabhashaniya Adhyaya. This chapter deals with the information on facilitating the study.

अथातोऽध्ययनसंप्रदानीयमध्याद्यं व्यख्यास्यामः ॥१॥
यथोवाच भगवान् धन्वन्तरिः ॥२॥
We shall now expound the chapter-adhyayana sampradaya – facilitating the study (of the treatise); as revealed by the Venerable Dhanvantari.

Contents and sections of the chapter

प्रागभिहितम् सविंशमध्यायशतं पञ्चसु स्थानेषु । तत्र सूत्रस्थानमध्यायाः षट् चत्वारिंशत्,षोडश निदानानी,दश शारीराणि,चत्वारिंशच्चिकित्सितानि,अष्टौ कल्पाः,तदुत्तरं षट्षष्टिः ॥३॥
As stated earlier in Chapter 1, verse 39, Sushruta Samhita comprises one hundred and twenty chapters. These chapters are arranged in five sthanas i.e., sections. The division of these chapters amongst five sections is as below mentioned –

• Sutra Sthana – is a section consisting of doctrines, basics and fundamentals. There are 46 chapters in this section.
• Nidana Sthana – is a section which deals with diagnosis of diseases. There are 16 chapters in this section.
• Sharira Sthana – is a section which deals with embryology, cosmology, anatomy and physiology. There are a total of 10 chapters in this section.
• Chikitsa Sthana – is a section on treatment principles and therapeutics. There are 40 chapters in this section.
• Kalpa Sthana – is a section on toxicology. There are 8 chapters in this section.
  Uttara Tantra – is a section which deals with description of other diseases which have not been explained in other (above said) sections. This section also has 66 chapters in addition to the 120 chapters comprising the other 5 sections of Sushruta Samhita, as already said.

1. Chapters of Sutra Sthana

वेदोत्पत्तिः शिष्यनयस्तथाऽध्ययनदानिकः ।
प्रभाषणाग्रहणावृतुaचर्याऽथ यान्त्रिकः ॥४॥
शस्त्रावचारणं योग्या विशिखा क्षारकल्पनम् ।
अग्रिकर्म जलौकाख्यो ह्यध्यायो रक्तवर्णनम् ॥५॥
दोषधातुमलाद्यानां विज्ञानाध्याय एव च ।
कर्णव्यधामपक्वैषावालेपो व्रण्युपासनम् ॥६॥
हिताहितो व्रणप्रश्नो व्रणास्त्रावश्च यः पृथक् ।
कृत्याकृत्यविधिर्व्याधिसमुह्देशीय एव च ॥७॥
विनिश्चयः शस्त्रविधौ प्रनष्टज्ञानिकस्तथा।
श्ल्योद्धतिर्व्रणज्ञानं दूतस्वप्रनिदर्शनम् ॥८॥
पञ्चेन्द्रियं तथा छाया स्वभावाद्वैकृतं तथा।
अवारणो युक्तसेनीय आतुरक्रमभूमिकौ ॥९॥

Why is this section called as Sutra Sthana?

Sutra means something which is said in a simple and easily understanding way. The section of Ayurveda which explains the basics and fundamentals of the science of Ayurveda in a simple and comprehensive way is called as Sthana, wherein sthana means section. This section has 46 chapters in it which explain the principle basics of Ayurveda which are arranged in a clear and convincing way such that they convey the meaning of what needs to be conveyed to every level of understanding. Therefore, the section which encompasses the basic principles of a science in a simple understandable way is called Sutra Sthana.

2. Chapters of Nidana Sthana

वातव्याधिकमर्शंसि साश्मरिश्च भगन्दरः ।
कुष्ठमेहोदरं मूढो विद्रधिः परिसर्पणम् ॥१३॥
ग्रन्थिव्रृद्धिक्षुद्रशूकभग्राश्च मुखरोगिकम् ।
हेतुलक्षणनिर्देशान्निदानानीति षोडश ॥१४॥

Why is this section called as Nidana Sthana?

Nidana means causative factors of a disease. It also means diagnosis of a disease with the help of certain criteria. The word Nidana represents Nidana Panchaka. The Nidana section of any treatise explains about the Nidana – etiological factors, Purvarupas – premonitory symptoms, Rupa – symptoms and Samprapti – pathogenesis of every given disease. In this section, there are 16 chapters which describe the etiological factors, symptoms, etc of diseases. This section comprising of these 16 chapters which explain nidana etc of diseases is called as Nidana Sthana – section of diagnosis of diseases.

3. Chapters of Sharira Sthana

भूतचिन्ता रजःशुद्धिर्गर्भावक्रान्तिरेव च ॥
व्याकरणं च गर्भस्य शरीरस्य च यत्स्मृतम् ॥१५॥
प्रत्येकं मर्मनिर्देशः सिरावर्णनमेव च ॥
सिराव्यधो धमनीनां गर्भिण्या व्याकृतिस्तथा।१६॥
निर्दिष्टानि दशौतानि शारिराणि महर्षिणा ॥
विज्ञानार्थं शरीरस्य भिषजां योगिनामपि ॥१७॥

Why is this section called as Sharira Sthana?

Sharira means body. Shaarira is a section of Ayurveda treatises which explains about the creation of body, mind and senses, embryology, formation of organs and structures, anatomy, physiology and other important aspects of human body. There are 10 chapters in this section of Shaarira Sthana wherein the features of the human body are described which would provide an insight towards comprehensive understanding of the structure and functions of the body parts / structures, which is very important for a student of medical science. The knowledge is equally important for the Yogis who practice the methods to control their minds in order to attain salvation.

4. Chapters of Chikitsa Sthana

द्विव्रणीयो व्रणः सद्यो भग्रनां वातरोगिकम् ।
महावातिकमर्शंसि साश्मरिश्च भगन्दरः ॥१८॥
कुष्ठानां महतां चापि मैहिकं पैडिकं तथा |
मधुमेहचिकित्सा च तथा चोदरिणामपि ||१९||
मूढगर्भचिकित्सा च विद्रधीनां विसर्पिणाम् |
ग्रन्थिवृद्ध्युपदंशानां तथा च क्षुद्ररोगिणाम् ||२०||
शूकदोषचिकित्सा च तथा च मुखरोगिणाम् |
शोफस्यानागतानां च निषेधो मिश्रकं तथा ||२१||
वाजीकरं च यत् क्षीणे सर्वाबाधशमोऽपि च |
मेधायुष्करणं चापि स्वभावव्याधिवारणम् ||२२||
निवृत्तसन्तापकरं कीर्तितं च रसायनम् |
स्नेहोपयौगिकः स्वेदो वमने सविरेचने ||२३||
तयोर्व्यापच्चिकित्सा च नेत्रबस्तिविभागिकः |
नेत्रबस्तिविपत्सिद्धिस्तथा चोत्तरबस्तिकः ||२४||
निरूहक्रमसञ्ज्ञश्च तथैवातुरसञ्ज्ञकः |
धूमनस्यविधिश्चान्त्यश्चत्वारिंशदिति [१] स्मृताः ||२५||
प्रायश्चित्तं प्रशमनं चिकित्सा शान्तिकर्म च |
पर्यायास्तस्य निर्देशाच्चिकित्सास्थानमुच्यते ||२६||

Why is this section called Chikitsa Sthana?

This section deals with basic treatment principles of the diseases and therapeutics. Chikitsa means treatment and the section which deals with treatment of diseases is called Chikitsa Sthana. Prayascita, Prashamana, Cikitsa and Shanthikarma are synonyms of each other. These are also the synonyms of Chikitsa and all these terms bear common meaning. They are often used interchangeably. Since these are defined in the chapters of this section of the treatise, this section is named as ‘Chikitsa Sthana’. There are a total of 40 chapters in this section.

5. Chapters of Kalpa Sthana
   
   अन्नस्य रक्षा विज्ञानं स्थावरस्येतरस्य च ।
   सर्पदष्टविज्ञानं तस्यैव च चिकित्सितम् ॥२७॥
   दुन्दुभेर्मूषिकाणां च कीटानां कल्प एव च ।
   अष्टौ कल्पाः समाख्याता विषभेषजकल्पनात् ॥२८॥
   अध्यायानां शतं विंशमेवमेतदुदीरितम् ।

Why is this section called Kalpa Sthana?

Kalpa actually means formulations or preparations. The Kalpa Sthana section comprises chapters which deal with treatment of poisons and poisoning and various formulations and methods in doing the same. There are 8 chapters in the Kalpa Sthana Section.
Thus, 120 chapters are described as scattered in 5 sections of Sushruta Samhita.

6. Chapters of Uttara Sthana

अतः परं स्वनाम्रैव तन्त्रमुत्तरमुच्यते ॥२९॥
अधिकृत्य कृतं यस्मात्तन्त्रमेतदुपद्रवान् ।
औपद्रविक इत्येष तस्याग्र्यत्वान्निरुच्यते ॥३०॥
सन्धौ वर्त्मनि शुक्ले च कृष्णे सर्वत्र दृष्टिषु ।
संविज्ञानार्थमध्याया गदानां तु प्रति प्रति ॥३१॥
चिकित्साप्रविभागीयो वाताभिष्यन्दवारणः ।
पैत्तस्य श्लैष्मकस्यापि रौधिरस्य तथैव च ॥३२॥
लेख्यभेद्यनिषेधौ च छेद्यानां वर्त्मदृष्टिषु ।
क्रियाकल्पोऽभिघातश्च कर्णोत्थास्तचिकित्सतम् ॥३३॥
घ्राणोत्थानां च विज्ञानं तद्रदप्रतिषेधनम् ।
प्रतिश्यायनिषेधश्च शिरोगदविवेचनम् ॥३४॥
चिकित्सा तद्रदानां च शालाक्यं तन्त्रमुच्यते ।
Further on will be described the last section of Sushruta Samhita, Uttara Tantra, in its own name.
Uttara Tantra is also called as Aupadravika Tantra since it deals mainly with upadravas i.e. complications of the diseases (mainly the first chapter).

These 26 chapters of Uttara Tantra constitute of Shalakya Tantra and covers the knowledge of the diseases of the eyes, ears, nose, mouth and head and their treatments.

नवग्रहकृतिज्ञानं स्कन्दस्य च निषेधनम्॥३५॥
अपस्मारशकुन्योश्चरेवत्याश्च पुनः पृथक् ।
पूतनायास्तथाऽन्धायाः शीतपूतनमण्डिका ॥३६॥
नैगमेषचिकित्सा च ग्रहोत्पत्तिः सयोनिजा ।
कुमारतन्त्रमित्येतच्छारिरेषु च कीर्तितम् ॥३७॥

These twelve chapters of Uttara Tantra along with the first three chapters described in Sharira Sthana section constitute ‘Kaumara Tantra’ i.e. paediatrics – description of diseases of children and their treatment.
ज्वरातिसारशोषाणां गुल्महृद्रोगिणामपि |
पाण्डूनां रक्तपित्तस्य मूर्च्छायाः पानजाश्च ये ||३८||
तृष्णायाश्छर्दिहिक्कानां निषेधः श्वासकासयोः |
स्वरभेदचिकित्सा च कृम्युदावर्तिनोः पृथक् ||३९||
विसूचिकारोचकयोर्मूत्राघातविकृच्छ्रयोः |
इति कायचिकित्सायाः शेषमत्र प्रकीर्तितम् ||४०||

These 21 chapters of Uttara Tantra constitute Kaya Cikitsa (inner medicine).
अमानुषनिषेधश्च तथाऽऽपस्मारिकोऽऽपरः ।
उन्मादप्रतिषेधश्च भूतविद्या निरुच्यते ॥४१॥

These three chapters of Uttara Tantra constitute Bhuta vidya (demonology).

रसभेदाः स्वस्थवृत्तं युक्तयस्तान्त्रिकाश्च याः |
दोषभेदा इति ज्ञेया अध्यायास्तन्त्रभूषणाः ||४२||

These four chapters of Uttara Tantra are from Tantrabhusana i.e., merits of the treatise.

Why this section is called as Uttara Tantra or Paschima Tantra?

श्रेष्ठत्वादुत्तरं ह्योतत्तन्त्रमाहुर्महर्षयः ।
बह्वर्थसंग्रहच्छ्रेष्ठमुत्तरं वाऽपि पश्चिमम् ॥४३॥

1. This section of Sushruta Samhita is called as ‘Uttara Tantra’ by the revered sages since this section is highly meritorious and is also a compilation of meanings of many branches of Ayurveda.
2. This section is also called as Paschima Tantra. Paschima means ending or that which is placed last. Uttara Tantra comes at the end of the Samhita in the form of last section of the treatise and hence the name Paschima Tantra.

Inclusion of Ashtangas i.e., eight branches of Ayurveda in Sushruta Samhita

शालाक्यतन्त्रं कौमारं चिकित्सा कायिकी च या ।
भूतविद्येति चत्वारि तन्त्रे तुत्तरसंज्ञिते ॥४४॥
वाजीकरं चिकित्सासु रसायनविधिस्तथा ।
विषतन्त्रं पुनः कल्पाः शल्यज्ञानं समन्ततः ॥४५॥
इत्यष्टाङ्गमिदं तन्त्रमादिदेवप्रकाशितम् ।
विधिनाऽधीत्य युञ्ञाना भवन्ति प्राणदा भुवि ॥४६॥
The topics related to four sections i.e. Salakya Tantra, Kumara Tantra, Kaya Cikista and Bhuta Vidya, which are the four branches of Ashtanga Ayurveda are included and described in this Uttara Tantra.
The other two branches of Ashtanga Ayurveda i.e. Vajikarana and Rasayana are described in Chikitsa Sthana.
Visatantra, the seventh branch of Ashtanga Ayurveda is included and explained in Kalpa Sthana section.
Salyatantra, the eighth branch of Ashtanga Ayurveda is included everywhere in the treatise and has been considered as the most important branch.
Thus, this treatise – Sushruta Samhita consists of all the eight branches of Ayurveda i.e. Ashtangas, as propounded by Master Dhanwantari who is also called as Adideva. Any physician who would study this treatise attentively and puts the principles laid therein into practice faithfully would become a best ‘giver and protector of life’ for the ailing people (patients) in the world.

Qualities to become a Royal Physician

एतद्धचवश्यमध्येयम्,अधीत्य च कर्माप्यवश्यमुपासितव्यम्,उभयज्ञो हि भिषग् राजार्हो भवति ॥४७॥
Theoretical and practical knowledge is very essential for any physician to excel in the field of medical service. Master Sushruta further emphasizes on this and says that this treatise must be studied essentially. He also tells that the contents of the treatise should also be practiced diligently after studying it thoroughly. He who does both, i.e. comprehensively studies and practices what has been said in the treatises shall become eligible to become a Rajarha Vaidya i.e. royal physician. This treatise must be studied essentially. After studying, it should be practiced diligently. He who does (study and practice) both shall become eligible to become a royal physician.

भवन्ति चात्र:-
यस्तु केवलशास्त्रज्ञःकर्मस्वपरिनिष्ठितः ।
स मुह्यत्यातुरं प्राप्य प्राप्य भीरुरिवाहवम् ॥४८॥
यस्तु कर्मसु निष्णातो धाष्टर्चच्छास्त्रबहिष्कृतः ।
स सत्सु पूजां नाप्रोति वधं चर्च्छति राजत ः ॥४९॥
उभावेतावनिपुणावसमर्थौ स्वकर्मणि ।
अर्धवेदधरावेतावेकपक्षाविव द्विजौ ॥५०॥
Master Sushruta further explains this with suitable analogies.
Some verses here,
Just like a coward soldier / commander gets scared and confused when encountering the opponents in the battlefield, the person who is well versed only in the theoretical aspect of the medical science but not skilled in practicing the same, gets confused when approaching the patient.
On the other hand, the physician / surgery who is very much skilled only in the practical aspects and through his daringness acts against what has been indicated in the science would not get respect from the wise people and deservingly be ordered to be killed by the king.
Both the above said type of physicians / surgeons are dangerous because they are unqualified and are inefficient in performing their duties satisfactorily. This is because these people would possess half knowledge of the science. Such knowledge is equivalent to poison. Hence, such physicians should be avoided.

ओषध्योऽमृतकल्पास्तु शस्त्राशनिविषोपमाः ।
भवन्त्यज्ञैरुपहतास्तस्मादेतान् विवर्जयेत् ॥५१॥
Medicine is considered to be similar to nectar when peorperly administered by a qualified and responsible physician. On the other hand, the same medicine acts like a sharp weapon, fire or poison when administered by an ignorant physician or surgeon. Therefore, such physicians should always be avoided.

स्नेहादिष्वनभिज्ञो यश्छेद्यादिषु च कर्मसु ।
स निहन्ति जनं लोभात् कुवैद्यो नृपदोषतः ॥५२॥
A physician who is not well versed in knowledge or administration of snehana and other therapies or a surgeon who is not well versed in knowledge or practice of chedana etc surgical techniques would by all means kill the people / patients due to his greed. Such physicians and surgeons who are quacks would thrive and survive only due to the inefficiency of the king, who fails to identify them.

यस्तूभयज्ञो मतिमान् स समर्थोऽसाधने ।
आहवे कर्मनिर्वाढुंद्विचक्रः स्यन्दनो यथा ॥५६॥
A chariot with two stable wheels would perform all its functions and serve its purpose in a battlefield. Similarly, the physician who is possesses both these wheels i.e. knowledge of both theoretical and practical aspects of the science comprehensively, and is also intelligent can alone achieve the aims and goals in his life.

Method of Study

अथ वत्स ! तदेतदध्येयं यथा तथोपधारय मया प्रोच्यमानं -अथ शुचये कृतोत्तरासङ्गायाव्याकुलायोपस्थितायाध्ययनकाले शिष्याय यथाशक्ति गुरुरुपदिशेत् पदं पादं श्लोकं वाः ते चपदपादश्लोका भूयःक्रमेणामुसंधेयाः,एवमेकैकशो घटयेदात्मना चानुपठेत्;अद्रुतमविलम्बितमविशङ्कितमननुनासिकं सुव्यक्ताक्षरमपीडितवर्णमक्षरमपीदीतवर्णमक्षिभ्रुवौष्ठहस्तैरनभिनीतं सुसम्स्कृतं नायुच्चैर्नातिनीचैश्र्च स्वरैः पठेत् । न चान्तरेण तयोरधीयानयोः॥५४॥
Master Sushruta further says – ‘So, dear son, listen attentively as I tell you about the method of studying now’.
The teacher should make sure that the students are clean by taking bath and performed morning ablutions etc. They should have worn an upper garment in a customary way and seated near him with steadiness of mind.
The teacher should now instruct the students every word, part of verse or a complete verse depending on the ability of grasping of each student. At the same time, the teacher should make each student repeat every word, part of the verse or complete verse many times. Each student should be made to act similarly, the teacher himself repeating them later.
The teacher should take care that the chanting should neither be too fast nor too slow. It should not be tiresome and should not be in the nasal voice. It should be done without making unnecessary movements of eyebrows, lips and hands and should be done in a cultured way. Chanting should neither be very loud nor very low in sound. While the teaching and learning process is on, no one should be allowed to interrupt the teacher and the students. No one should be allowed to move in between the teacher and students while they are engaged in the study.

भवतश्चात्र
शुचिर्गुरुपरो दक्षस्तन्द्रानिविवर्जितः ।
पठन्नेतेन विधिना शिष्यः शास्त्रान्तमाप्रुयात् ॥५५॥
वाक्सौष्ठवेऽर्थाविज्ञाने प्रगल्भ्ये कर्मनैपुणे।
तदभ्यासे च सोद्धौ च यतेताध्ययनान्तगः ॥५६॥
Some verses here,
Eligibility of the student to reach shastranta i.e. end of the science or gain deep and wide knowledge
The student who has the below mentioned features is said to reach shastranta or end of science. It is a point which determines that the student has gained deep and wide knowledge. They are –

• Cleanliness / purity pertaining to body and mind
• Devoted to the teacher
• Efficient
• Devoid of laziness and sleep
• Indulged in dedicated studies
  The students who have completed their studies should put efforts for achieving the below mentioned –
• Clarity of speech
• Correct understanding of the implications of the teaching
• Boldness
• Good efficiency in doing any work
• Constant practice and
• Success

इति श्रीसुश्रुतसंहितायां सूत्रस्थानेऽध्यनसंप्रदानीये नाम तृतीयोऽध्यायः॥३॥
Thus ends the Third chapter, by the name Adhyayana Sampradaya-in Sutra Sthana of Susruta Samhita.