Does Ayurveda Begin With Dhanvantari, The Ancient Physician
By D.P. Agrawal
In the history of Indian medicine, Dhanvantari, though very famous, is an elusive name, shrouded in the mist of antiquity. According to some authorities, he was the giver of Ayurveda or the science of life to the world. In this essay we will try to trace his identity, as researched by Dwarkanath. We will also quote the legends associated with Dhanvatari.
Dwarkanath in his interesting essay admits that though names such as Asvins (the celestial physicians), Kasiraja Divodasa and terms like Bhisak and Bhesaja occur frequently in the Vedas, the name of Dhanvantri does not occur in them. As we shall see, Dhanvantri is considered to be a divinity and the god of medical science. Another Dhanvantri was the king of Kasi and the preceptor of Susruta. Dwarkanath explains that a study of the puranas, the Harivasma and some later works shows that there were, in addition to the divine Dhanavantri, three other Dhanvantars who belonged to different periods of time. They were: (i) Sri Dhanvantari who, according to Brahmavaivarta, was one of the 16 disciples of Bhaskara, the sun-god, under whom he is stated to have studied Ayurveda; (ii) Kasiraja Divodasa, surnamed Dhanvantari, an incarnation of the divine Dhanvantari who, it is said, was no other than Lord Visnu, the preserver and protector of the universe; and (iii) Sri Dhanvantari who was one of the ‘nine jewels’ that adorned the court of Samrat Vikramaditya. Some authorities think that the last-mentioned Dhanvantari was the author of the well-known lexicon on drugs, the Dhanvantarinighantu.
Outstanding authorities on Ayurveda, were also honoured in ancient and medieval India with the honorific Dhanvantari. Thus Dhanvantari refers not only to the progenitor of Ayurveda but is also associated with a rich medical tradition and a hierarchy in the history of medicine in India.
Little is known about the lives of the several Dhanvantaris except for a few references available in the Ayurveda-samhitas and the Puranas. These sources have referred to Adi-Dhanvantari, Kasiraja Divodasa Dhanvantari and Dhanvantariyas, i.e., the school of surgeons. According to the Srimad Bhagavata Purana, it was Bhagavan Dhanvantari, who revealed Ayurveda to the world. This Dhanvantari, who is said to be the original or the first, has been known as Adi-Dhanvantari. He is worshipped even today as the presiding deity of medical science.
According to the tradition given in Brahmavaivartapurana, the creator of the universe, while studying the four Vedas, separated Ayurveda from them. He is then stated to have imparted the knowledge of this science to Bhaskara (sun-god). Surya, thereafter, wrote his own samhita on Ayurveda and taught the same to 16 disciples of whom Dhanvantari was the foremost. Each one of these 16 disciples, in his turn, wrote a separate treatise of his own.
That Kasiraja Divodasa Dhanvantari was a prehistoric figure derives support from the internal evidence provided, among others, by the Susrutasmhita, the Agnivesasamhita, the Carakasamhita, the Visnupurana and the Harivamsa. The Visnupurana and the Harivamsa have, between them, furnished credible and consistent genealogical accounts of the dynasty to which Kasiraja Divodasa belonged.
(According to Visnupurana)
The genealogical accounts, referred to above, show that Kasiraja Divodasa belonged to the royal line founded by Pururavas of the lunar dynasty. According to the Harivamsa, Kasiraja Divodasa belonged to the line of Anena who was himself a descendant of Pururavas. Kasya, referred to in the Visnupurana genealogy, represents the fifteenth generation from Anena; Dhanvantari the third from Kasya and Divodasa the third form Dhanvantari. Dhanvantari is stated to have divided the entire range of Ayurveda into eight divisions (the Astangas), each division representing a speciality. These specialities are:
(i) Kayacikitsa (Internal Medicine)
(ii) Kaumarabhrtya or Balacikitsa (Paediatrics)
(iii) Bhutavidya or Grahacikitsa (Psychiatry)
(iv) Salakyatantra (Otto-Rhino-Laryngology & Opthalmology)
(v) Salyatantra (Surgery)
(vi) Visatantra (Toxicology)
(vii) Rasayanatantra (Geriatrics)
(viii) Vajikaranatantra (The therapy for male sterility, impotency and the promotion of virility)
This Dhanvantari, whom we may refer to as the Senior, was the great grandfather of Kasiraja Divodasa Dhanvantari.
It is not known if Kasiraja Divodasa Dhanvantari himself wrote any treatise on Ayurveda, specially on salyasalakyatantras. Probabaly the author of Cikitsatattvavijnana and Cikitsadarsana was Dhanvantari Divodasa and that of Cikitsakaumudi, Kasiraja. The only available work which fully reflects the contribution made by Kasiraja Devodasa Dhanvantari is the Susrutasamhita. It is seen from the opening passages of this work that Susruta, who was foremost among the disciples of the Kasipati, compiled the teachings of his preceptor.
Acarya Susruta has quoted Kasiraja Divodasa Dhanvantari as telling his pupils that “Ayurveda originally formed one of the sub-sections of Atharvaveda“. During the times of Kasiraja Divodasa Dhanvantari medical science adopted a well-developed scientific methodology (pramanas), comprising observation (pratyaksa) and inductive, deductive and analogical reasoning (anumana and upamana), in addition to the authoritative knowledge (aptopadesa). These developments eventually led to the theory and practice of medicine into two broad-based but interrelated branches, viz., (i) preservative, promotive and preventive medicine, and (ii) curative medicine. Kasiraja Divodasa Dhanvantari was also responsible for the division of the two main branches of surgery, viz., Salyatantra and Salakyatantra.
Dwarkanath dates Kasiraja Devodasa Dhanvantari to about 3000 BC, which is difficult to sustain.
With the rapid growth of knowledge and the increasing tendency among the practitioners to specialise in one or the other of the eight branches of Ayurveda, particularly surgery, a stage seems to have reached when the demand for making provision for imparting proper training in the specialities and the production of specialities in them became imperative and pressing. This inference is based on the dialogue that is stated to have taken place between Kasiraja Devodasa Dhanvantari on one hand and on the other Acarya Susruta, Aupadhenava and others, who had approached the former at his hermitage in the Himalayas with the request that they may be taught surgery. Kasiraja is seen to have initially enquired of them as to which of the eight specialities of Ayurveda they desire to learn from him. Said the disciples, “Instruct us all, O Lord, in the science of surgery (Salya) and let that be the chief subject of our study.” Replied the holy Dhanvantari, “Be it so.” Then, the disciples said, “We are all of one mind in the matter, O Lord, that Susruta shall be our spokesman and ask you questions conforming to the general trend of our purpose. All of us will attentively hear what you will be pleased to discourse to Susruta (and that will save you the trouble of teaching us individually).” To which replied the venerable sage, “Be it so. Hear me discourse on the science of surgery (Salyatantra) which is the oldest of all the branches of Ayurveda… All hold this tantra to be the most important of all the branches of Ayurveda inasmuch as instantaneous effects can be produced with the help of such measures as surgical operations, external application of Ksaras (alkalies/caustics), cauterisation, etc., and inasmuch as it contains all that can be found in other branches of Ayurveda as well. Hence it is eternal, is a source of infinite piety, imparts fame and opens the gates of heaven to its votaries, increases the duration of human existence on earth and helps men in successfully fulfilling their mission and earning a decent competence in life.”
There is adequate evidence in the Agnivesasamhita, a contemporary medical work, to show that specialisation had reached a stage when general practitioners and medical specialists preferred to refer all cases that may need surgical treatment to specialists in surgery. This ancient medical classic is not only encycolopaedic in its sweep, but is also held in great esteem as a highly authoritative treatise on Kayacikitsa. It may be incidentally stated that Kayacikitsa, like its modern counterpart, internal Medicine, is a department of medicine which deals with diseases that involve metabolic disturbances to a lesser or greater extent and cannot be treated surgically. The reference it has made in several contexts to Dhanvantariyas and Dhanvantari support the view (a) that Kasiraja Divodasa Dhanvantari was not only a contemporary of Bhagavan Punarvasu Atreya but was also recognised by the latter as a great authority on surgery; (b) that the school of surgeons was already well established; (c) that this school comprised surgical specialists, specialists in the surgery of the mouth, throat, nose, ear, eye and head, as well as experts in cauterisation (agnior dahakarma), the application of ksara (alkalies/caustics) and other special procedures employed in the practice of surgery; and (d) that, as in modern times, the internists confined themselves to the practice of medicine only and, by a convention and tacit understanding, they either sought the help of surgical specialists in cases which needed surgical intervention or referred such cases to surgeons.
Obstertrical surgery too seems to have been highly developed. This is evidenced not only by references that occur in the Agnivesasamhita but also by the description of the procedures for (i) the induction of abortion in cases where the pregnancy may either endanger the health or the life of the mother, (ii) curetting in cases of incomplete abortion, (iii) the induction of labour in cases of delayed delivery or uterine inertia, (iv) versions of different kinds, in cases of mal-positions and mal-presentations, (v) the removal of the foetus in cases of difficult labour or defects in the maternal passage, by an abdominal section, reminiscent generally of the modern Caesarian section, (vi) evacuation of a dead foetus by craniotomy, and (vii) the delivery of retained placenta by manual manipulation, specially massage which is reminiscent of the Credas method.
The reference to the views of Dhanvantari (Kasiraja Divodasa) on the formation and development of the human embryo in thr Agnivesasamhita bears out the vivid description furnished by Acarya Susruta in his samhita. Commenting on this description, Prof. Keswani observes:
“The various development stages of the human embryo from the time of its fertilisation until full term have been so well described that one is amazed at the acuity of their observations. The only interference one can therefore draw is that they must have had some sort of aid of optical instruments to be able to describe even the microscopic appearance of the early zygote (fertilized ovum) and must have studied embryology in experimental animals; or, that it was their routine practice to examine and even to dissect the abortus and the still born. (Quoted by Dwarkanath)”
Even though the Kasiraja had preferred the Samkhya system of natural philosophy, he is yet seen to have accepted the logical methods and concepts of the Nyaya system of natural philosophy as a matter of course. These concepts refer to dravya (substance), guna (attribute), karma (action/motion), samanya (generality), visesa (particularity) and samavaya (inherence) as well as paka (reaction/transformation), samyoga (combination/synthesis) and vibhaga(separation/analysis). It may be noted that the Nyaya methodology and concepts were taught earlier by the sage Bharadvaja and Bhagavan Punarvasu Atreya who discoursed on them as well as on the principles of the Samkhyasystem. Kasiraja Divodasa Dhanvantari, on the other hand, did not expatiate on them. He confined himself to the teaching of the Samkhya system.
A matter of considerable significance, worthy of mention here, is the fact that Kasiraja Divodasa Dhanvantari and his followers had a complete theory of drug-composition, molecular structure, physico-chemical properties, therapeutical actions of articles of food and drugs and pharmacological actions, viz., rasa, guna, virya, vipaka, and prabhava. These concepts were based on the Nyaya doctrines of paramanus (atoms) and anus (molecules).
He is seen to have had no patience with the dialecticians of his time who stoutly held that attributes or qualities, rather than the substance to which they relate, are of primary importance. After adverting to various theories advanced by contemporary schools of thought, the Kasiraja observed:
“Dravya (substance) is the most important factor with which medical science is concerned. Dravya is necessarily actions and attributes which are inseparable and of which it (the dravya) is the primary cause or, to put it more precisely, the attributes have an inseparable inherence – samavaya – with the substance by way of cause and effect.”
In this view, the strucructural composition of the dravya (substance), or better still, its anus (molecules), the kind and number of paramanus (atoms) that compose the latter, and their spatial relationships are factors that uniquely determine the attributes or qualities of the substance. Dwarkanath thinks that these and similar other ideas that punctuate the discourses of Kasiraja Divodasa Dhanvantari show that his approach, besides being rational, was that of a molecular biologist.
The Kasiraja has wholly adopted the Samkhya system of natural philosophy as the main basis of the Ayurvedic concept of man, his body, senses, mind and soul, comprehended in the term sarira, on the one hand, and his physical and biological environment, on the other. He has accorded to this system the status of a fundamental or pure science. In fact, he has prefaced his discourses on sarira with the Samkhya theory of cosmogenesis and evolution of matter, mind and senses.
Kasiraja Divodasa Dhanvantari has not derived some of the fundamental physical and biological (including the psychological) concepts, or the psychosomatic concept of man, which forms the essential basis of Ayurveda, from the Samkhya school of natural philosophy but also adopted the three-fold Samkhya classification of dukhas or miseries, viz., adhyatmika, adhibhautika and adhidaivika. He has, besides, enlarged the Samkhya classification, referred to above, on the basis of the nature of stressors – abhighatas – that cause one or the other kind of diseases.
Thus, diseases belonging to the adhyatmika class are stated to be of constitutional and/or idiopathic types. They include saririka or somatic and manasika or psychic disturbances. Of the three-fold functional factors of the body, viz., vata, pitta and kapha (slesma), and the latter the upheavals of rajas and tamas. The saririka or somatic diseases are of three kinds. They are: (a) the adibalapravrtta or genetically determined diseases – either father-derived (pitrja) or mother-derived (matrja), (b) janmabalapravrtta or congenital diseases that are determined by the vicissitudes of the mother when pregnant, and (c) dosabalapravrtta or diseases engendered by errors in diet, actions, and faulty observance or non-observance of health regimen.
The adhibhautika type of diseases is said to be caused by environmental stressors, both physical and biological (including invisible living things). Known as the sanghata–balapravrtta or the traumapatic, it involves external or internal injuries – abhighatas – caused by blows, sharp instruments, overstrain, bites of wild animals, poisonous reptiles, etc.
The third kind, the adhidaivika, comprises three sub-groups. Of these, the first group, the kalabalapravrtta, includes diseases engendered by meteorological disturbances, such as variations in atmospheric temperature, hot or cold, humidity or dryness, rain and wind, seasonal or otherwise. The second group, the daivabalapravrtta, comprises diseases that are caused by forces beyond human control or due to providential dispensation. Examples of these are injuries caused by lighting, heat-stroke, pandemics and the like. The third group, the svabhavabalapravrtta, includes natural, organic and functional changes that occur in the human body due to the passage of time, as in aging.
The profound influence the Samkhya concept of evolution had on Kasiraja Divodasa Dhanvantari is seen reflected in his discourse on dosakriyakala – a concept which refers to the pathogenesis of diseases in general, and reactions of the body that lead to vrana or inflammation leading to ulcers, in particular.
The concept of kriyakala taught by the Kasiraja should assume importance today in the fields of medicine and surgery in view of the developing trends relating to the concept of pathogenesis, especially in the field of rheumatoid diseases. These developments envisage what is termed as ‘anticipatory guidance’ which is expected to make it possible ‘to look at the natural history of any disease as a process that can be averted, interrupted or delayed at various points in its evolution’.
The versatile nature of Kasiraja Divodasa Dhanvantari’s teachings, both fundamental and applied, embracing all the astangas or eight specialities of Ayurveda, his discourses on surgery and subjects basic to the study of this speciality, have been acknowledged by some of the well-known authorities as outstanding, pioneering and the earliest in the world. Dwarkanath mentions that the latest to make an objective assessment of the compilation of the teachings of the Kasipati by Acarya Susruta is Jurgeon Thorwald of Germany, the author of The Triumph of Surgery, The Triumph of Surgeon and The Dismissal, published by Thames & Hudson, London. In his latest work, entitled Science and Secrets of Early Medicine – Egypt, Mesopotamia, India, China, Mexico and Peru, (translated and published in 1962 by Thames & Hudson) , he has, referring to the teachings of the Kasiraja (which he has described as Susruta’s collection), observed: “They reflected an unusual degree of rational medical experience. In particular, it revealed a creative strain in surgery.”
Referring to the discipline of anatomy, which is basic to the study and practice of surgery, says Thorwald: “Beyond all that, the Susrutasamhita contained a lecture dealing with the study of anatomy.” After discussing the method of preparing the human cadaver and the procedure for dissection described in this lecture, he says: “Certainly this was the oldest lesson in dissection known to history.”
The importance attached by the Kasiraja to anatomical knowledge as an essential pre-requisite for the study and practice of surgery is seen from the following observations he had made:
“Therefore, a surgeon desiring knowledge free of all doubt must investigate well the dead body and study the human anatomy. In short, direct observation and theoretical knowledge together contribute to the enhancement of the surgeon’s store of knowledge as a whole.
“It is for this reason that the body of a man who has not died of poison or of a long-standing disease and who has not lived to be too old and whose bowels and excrements have been removed should be fitted in a case and wrapped in sacred grass or bark, cloth or reeds, etc., and placed in a running current of water at a spot not exposed to public view. When it is soaked well for seven days, it should be taken out and scrubbed slowly with a brush made of either cuscus grass, hair bamboo or balwaja grass and all the details of the external and internal body-limbs as have been described (in the text) should be observed keenly with the eyes.
“It is not possible to see with the physical eyes the subtle principle of the spirit in the body, for it is visible to the eye of wisdom or meditation alone.
“The wise physician therefore should know the truth both by studying the body as well as the text of the science and resort to practice, having cleared all his doubts by the help of both observation and authoritative texts.”
Another pre-requisite for training in surgery was the insistence on the practice of operative surgery. Emphasising its importance, the Kasipati observes:
“The preceptor should see that his disciple attends to the practice of surgery even if he has already thoroughly mastered the several branches of the science of medicine, or has perused it in its entirety. In all acts connected with surgical operations of incision, etc., and injection of oil, etc., the pupil should be fully instructed as regards the channels along or into which the operations or applications are to be made (karmapatha). A pupil, otherwise well read, but uninitiated into the practice of medicine or surgery, is not competent to take in hand the medical or surgical treatment of a disease. The art of making specific forms of incision should be taught by making cuts in the body of a puspaphala (a kind of gourd), alabu, watermelon, cucumber or urvaruka. The art of making cuts either in the upward or downward direction should be similarly taught. The art of making excisions should be practically demonstrated by making openings in the body of a full water-bag or in the bladder of a dead animal or in the side of a leather pouch full of slime or water. The art of scraping should be introduced on a piece of skin on which the hair has been allowed to remain. The art of venesection (vedhya) should be taught on the vein of a dead animal or with the help of a lotus-stem. The art of probing and stuffing should be taught on worm (ghuna) – eaten wood or on the reed of a bamboo or on the mouth of a dried alabu (gourd). The art of extraction should be taught by withdrawing seeds from the kernel of a bimbi, bilva or jack fruit, as well as by extracting teeth from the jaws of a dead animal. The act of secreting or evacuating should be taught on the surface of a shalmali plank covered over with a coat of bee’s wax and suturing on pieces of cloth, skin or hide. Similarly the art of bandaging or ligaturing should be practically learned by tying bandages round the specific limbs and members of a karnasandhi (severed ear-lobe) should be practically demonstrated on a soft severed muscle or on flesh, or with the stem of a lotus lily. The art of cauterising or applying alkaline preparations (caustics) should be demonstrated on a piece of soft flesh; and lastly, the art of inserting syringes and injecting enemas into the region of the bladder or into an ulcerated channel should be taught by asking the pupil to insert a tube into a lateral fissure of a pitcher full of water, or into the mouth of a gourd (alabu).
“An intelligent physician who has tried his prentice hand in surgery (on such articles of experiment as gourds, etc.) or has learnt the art with the help of things as stated above or has been instructed in the art of cauterisation or blistering (application of alkali) by experimenting on things which are most akin or similar to the parts or members of the human body they are usually applied to, will never lose his presence of mind in his professional practice.”
The extracts above, from the discourses of Kasiraja Divodasa Dhanvantari as compiled by Susruta, are meant to highlight the insistence on rigid and high standard of training expected of a student who has opted for surgery.
Thorwald’s comments on the different kinds of surgical instruments, mentioned by the Kasipati in his lectures on the subject, are significant. He observes:
“The vast variety of Indian surgical instruments which have come down to us from the first millennium A.D. suggests that surgery had developed to an extraordinary extent in early India. Many of these instruments evidently come from times almost inconceivably remote. Their forms testify to extreme practical good sense. That is apparent from a comparison of the early Indian instruments (a) with Roman, (b) and modern (c) tools intended for the same purposes. Whole epochs of world history lie between the Indian and modern bone forceps in group 1, or the pincers, trocars, and cauteries in 2, 3 and 4.” “But the modern forms are already anticipated by those of the ancient instruments. Twenty sharp and 101 blunt instruments are described in the Susrutasamhita. In addition, special types of tables are mentioned, to be used in ‘major operations’.”
The field of surgery covered by Kasiraja Divodasa Dhanvantari in his lectures is extensive. It includes, among others, such details as purvakarma (pre-operative measures), pradhanakarma (main operative techniques and procedures) and pascatkarma (post-operative measures including care); the employment of different kinds of sutures and needles; measures for the prevention of sepsis (raksoghna); different kinds of bandages and the art of bandaging; the use of alcoholic drinks for producing insensitiveness to pain during and after operations; amputations; the setting up of dislocations and fractures and the use of different kinds of splints.
Among the various surgical measures taught by the Kasipati which became world-famous, mention has to be made of rhinoplasty or skin-grafting and lithotomy. The former has since formed the basis for the development of plastic surgery in modern times. Commenting on the Kasiraja’s discourse on this subject, Thorwald observes:
“Restoration of a mutilated nose by plastic surgery might well have been a chapter-heading in the Susrutasamhita. The following directions were given: ‘When a man’s nose has been cut off (as a punishment) or destroyed (by disease), the physician takes the leaf of a plant which is of the size of the destroyed parts. He places it on the patient’s cheek and cuts out of his cheek a piece of skin of the same size (but in such a manner that the skin at one end remains attached to the cheek). Then he freshens with his scalpel the edges of the stump of nose and wraps the piece of skin from the cheek carefully all around it and sews it at the edges. Then he places two thin pipes in the nostrils to facilitate breathing and to prevent the sewn skin from collapsing. Thereafter he strews powder of span wood, licorice-root and barberry on it with cotton. As soon as the skin has grown together with the nose, he cuts through the connection with the cheek.”
After referring to the practice of nose-repair in Europe in the latter half of the sixteenth century and to the illustrated description of it furnished by Gasparo Tagliacozzi, Professor of Surgery at Bologna, in his book De Curtorum Chirugia per Insitonem as well as to the work of Bishop Ranzano of Lucure, written earlier in 1492, in which this operation was described, Thorwald observes:
“There is scarcely any doubt that this method of operation, which seemed to emerge out of nothing, out of obscurity of medieval medicine, had its roots in early India. It was there that the basic idea of the attached flap had been born. The point was that the flap remained connected to the part of the body to which it belonged until it had grown into the site of the transplant. Nowhere else in the whole world of antiquity do we find any precedent for that conception.”
Tracing the history of the development of rhinoplasty in modern medicine, Thorwald proceeds to note:
“In 1814 a newspaper account from India promoted a pioneer of modern plastic surgery, Joseph Constantine Carpue, to attempt Europe’s first restoration of a lost nose. Branca and Tagliacozzi had been forgotten, but Carpue was greatly interested to read of a method for restoring noses practised successfully by itinerant surgeons in the villages of colonial India – exactly as described in the Susrutasamhita thousands of years before. Among other things, the nineteenth century newspaper story is testimony to the vast spans of time over which medical practices should survive in India. That is good reason for assuming that the oldest tangible evidence of Indians medicine were based upon still older traditions.”
As regards lithotomic operations, Kasiraja Divodasa Dhanvantari has given a detailed description of it in connection with the surgical removal of stones from the bladder and urethra by perineal incision.
Known as mutresmari (cystic calculus), this condition has been a common complaint in India, as in other tropical countries, due to high evaporation of body-fluids and the concentration of urine when not removed, the patient is subjected to prolonged agony and dies of uraemia or the rupture of the bladder.
The development of the operation for the removal of cystic stones, known as ‘cutting for the stone’ in Europe was for a long time traced to Rome and Greece. The Hippocratic oath includes a promise by the physician that he should leave the lithotomy operation ‘to those who are experienced in it’. But for this solitary reference, there does not appear to be any mention of the treatment of the stone bladder in early European medicine. Celsus in the first century A.D. is seen to have referred to the removal of the stone in the bladder ‘with the knife’.
However, lithotomy came to be known in Europe from the fourteenth century. It is seen that “itinerant lithotomists went from country to country practising the art”. According to the medical historians of Europe, Giovanni de Romanis and Marios Santos, of the late fifteenth and early sixteenth centuries, were the founders of the ‘modern art of lithotomy’. Now Thorwald has raised the question as to “where these men learned the method and where the method had been invented.” He has himself sought to answer these questions thus:
“Now that the texts of the “Susrutamamhita, of at least two thousand years before the times of these Italians, were available, it was found that they contained an exact description of bladder surgery. The surgeon was to rub the second and third fingers of his left hand thoroughly with fat, and make sure that his nails were clipped close. Then he introduced these fingers into the patient’s anus. He must thrust them vigorously, high enough until he could feel the stone in the bladder, for it would probably be pushed backward and down by pressure on the abdominal wall. Then he had to press the stone down against the rectum, and with the knife wielded by his right hand cut through the perineum towards the stone. A forceps was then introduced through the incision, the stone grasped and drawn out.”
He then proceeds to observe:
“Bold and incredible as this operation sounds, the findings of medical history have left no doubt that it was performed in the manner described and that it could have been performed successfully. From the days of Atreya and his predecessors, a direct line leads through Greece and Rome to the middle ages, and on still further to the surgeons of the nineteenth century who, until the development of bloodless fragmentation of the stone in the bladder and the discovery of antisepsis, took the same measures to save sufferers from bladder stone. They too could point to quite a few cases in which the operation succeeded, although they did not even stitch up the wound, but waited for natural healing.”
Thus Dwarkanath gives a brief discussion of the more important contributions made by Ksiraja Divodasa Dhanvantari. The areas covered by him, otherwise, have been vast and they embraced such fields as sarira (physiology and anatomy), different aspects of dravyadi–vijnana (pharmacology and material medica) and cikitsa (therapeutics, relating to internal medicine). However, the more widely acknowledged contribution made by him relates to sarira and salyasalakya–tantras. So much so, some scholars, who belonged to a much later period, had described his pupil Susruta who complied the teachings of the Kasiraja in his now well-known samhita – the Susrutasamhita – as an authority on sarira: sarire Susrutah proktah.
As an example of some very significant contribution, made by the Kasiraja in the field of sarira (physiology, in particular) may be cited the discovery of the haemopoietic or blood-forming principle or factor in the yakrt (liver) known as the ranjakapitta and the role of both liver and spleen in the formation of the blood.
The functions attributed by the Kasipati to this pitta are seen to be nearly the same as those ascribed to the liver extract in modern times.
Chronologically speaking, it was Kasiraja Divodasa Dhanvantari who was not only the first in the world of medicine to locate and describe the functions of the principle or factor directly concerned with the formation of the blood, but also to prescribe the raw liver of goats in the treatment of anaemia that follows in the wake of certain forms of (idiopathic) haemorrhage, known in Ayurveda, as the raktapitta.
He also suggested the administration of preparations containing goat’s liver in the treatment of naktandhya or night blindness.
It will be of interest to mention that Acarya Vagbhata, one of the trinities of Ayurveda, who belonged to about the fifth century A.D., located and described a similar principle or factor with identical functions, in the stomach.
There are also references in the early Ayurvedic literature to the use of the stomach and intestines of animals in the treatment of anaemia due to the loss of blood.
Dwarkanath says that the importance of these discoveries are highlighted by the fact that, after an interval of more than two thousand years, Minot and Murphy showed in 1926 that the liver was the most effective ingredient in the treatment of anaemia, specially the pernicious type. Ricks and his co-workers in 1948 and Smith, a few years later, described an amorphous red-principle from proteolised liver and showed it to be effective in pernicious anaemia in very small doses, around half a milligram. This substance has since been shown to be the Vitamin B12. Likewise, Castle in 1920, showed the presence, in the stomach tissue, of a factor (the Castle’s Intrinsic Factor) necessary in the formation of the haemopoietic principle. He showed that this principle was effective in the treatment of pernicious anaemia.
The few examples of the discoveries made by Kasiraja Divodasa Dhanvantari and his followers should be sufficient to emphasise the fact that his contribution, both in the fundamental and applied aspects of the science and art of medicine, made so far back in time, were perhaps revolutionary. Several thousand years later, ‘modern medicine’ has been rediscovering many of the findings of the Kasipati and other early pioneers of Ayurveda.
C. Dwarakanath. 1990. Dhanvantari. In Raghvan, V. (Ed.) Scientists: Cultural Leaders of India. New Delhi: Ministry of Information and Broadcasting.
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Commenting on Agrawal’s article on Dhanvanatari, Paul Wilson says, I’m surprised that Agrawal failed to mention the passages at the beginning
of Charak that deal with the origins of Ayur-Ved. Wilson quotes the following relevant passage:
In Charaksamhita, Charak says, With the idea of a remedy in view, the assembly of sages went into meditation. (I:15-17)
The sages duly visualized (the categories) by force of their intuitive power. (I:28)
He, the sage of great wisdom and dedication, grasped instantly the whole science of span of life consisting of three branches (etiology, symptomatology, and therapeutics) but of immeasurable extent; thereby the sage Bharadvaja enjoyed an infinitely long and healthy life and conveyed all this to the other sages. (I:25-26).