Dhanvantari - the Father of Surgery in Ayurveda

Born in 1000 BCE, Kashiraj Divodas Dhanvantari is hailed as the Father of Surgery in Ayurveda, the oldest and the most holistic medical science in the world. It forms a part of the Atharva Veda, one of the four Vedas.

Ayurveda means ‘science of longevity’, derived from the Sanskrit root ayus, meaning longevity and vid, meaning knowledge. Ayurveda originated from Brahma, the Creator. He created Ayurveda before  creating man, as an upa-Veda - subsidiary of the Atharva Veda – in one thousand chapters containing 100,000 shlokas, He taught this to Daksh, who then revealed it to Ashwini Kumars, the celestial twins and physicians of the devas. They transmitted it to Indra, who revealed it to the risihis of Ayurveda. Three Important rishis of Ayurveda are: Dhanvantari, Sushrut and Charak.

The name Dhanvantari first appears in the ancient Hindu shastras as the twelfth avatar of Vishnu during the Samudra Manthan – churning of the ocean. Of the fourteen gems that sprung forth, one was Bhagwan Dhanvantari, who emerged with an urn of amrut the divine nectar which delivered its drinker from death, to attain immortality. He is also known as the original, Adi Dhanvantari, the celebrated physician of devas.

The second, down to earth Dhanvantari, was Kashiraj Divodas Dhanvantari, the King of Kashi.  He was the first surgeon of Ayurveda. His teachings and surgical techniques were compiled by his foremost pupil, Sushrut, in the Sushrut Samhita which has survived over the ages. Samhita means compendium. Some of his teachings, too, were compiled in works, now lost, by his other pupils, namely Aupadhenava, Aurabhra, Bhoja, Galava, Gargya, Gopurarakshita, Kankayana, Nimi, Paushkalavata and Vaitarana. He is also the founder of the school of surgeons which came to be known as Dhanvantariyas.

One of Kashiraj Dhanvantari’s ancestors categorized the vast range of Ayurveda into astang – eight faculties:

1. Kayachikitsa – internal medicine
2. Kaumarabhrtya – pediatrics
3. Bhutavida – psychiatry
4. Salakyatantra – oto-rhino-laryngology & ophthamology
5. Salyatantra – Surgery
6. Vishatantra – toxicology
7. Rasayantantra – rejuvenation
8. Vajikarantantra – revitalization

According to Dhanvantari, the fifth faculty, Salyantantra, was the oldest of all faculties of Ayurveda. Only after the formation of the school of surgery did the school of physicians emerge, heralded by Bhagwan Punarvasu Atreya. The latter recognized Dhanvantari as a high authority of surgery. A contemporary medical treatise, Agnivesh Samhita, also mentions that specialization in surgery had reached such a stage that general practitioners referred all cases needing surgical treatment to specialists in surgery. In this Samhita, Divodas Dhanvantari details the formation and development of the human embryo by Dhanvantari, which correlates with the vivid description given by Sushrut in his Samhita.

“The surgical instruments of Hindus were sufficiently sharp indeed as to be capable of dividing hair longitudinally.”
– Dr. Mrs. Manning (British surgeon)

A proficient surgeon, Dhanvantari laid great emphasis on the study of anatomy using cadavers. The Sushrut Samhita cites a lecture on anatomy. Jurgeon Thorwald, in his Science and Secrets of Early Medicine (1962), averred, “Certainly this was the oldest lesson in dissection known to history.” Dhanvantari meticulously described the preparation of a dead body by first disemboweling and then placing it in a stream of body of running water for seven days. He advocated preceptors to demonstrate surgical techniques in detail to their pupils, in addition to their mastery in other branches of medicine. “Otherwise,” he asserted, “a well read pupil, but not initiated in the practice of medicine or surgery, is not competent to take in hand the medical or surgical treatment of a disease.”

In the absence of PVC or the foam materials available to trainee surgeons today, Dhanvantari creatively improvised an astonishing array of natural objects for practicing surgical procedures:

Technique	Objects used for Practice
Incision (cuts) Chhedya	Groud, Watermelon, cucumber
Excisions (removal) Bhedya	Bladder of a dead animal, puncturing a leather pouch filled with fluid.
Scraping – Lekhya	Piece of skin with hair
Venesection (puncturing a vein) Vedhya	Vein of a dead animal, lotus stem
Probing & Stuffing	Wormeaten wood, bamboo, Eshya reed, mouth of a dried groud
Extraction – Aharya	Withdrawing seeds from the kernel of a bimbi (aegle marmelos), bilva (Cephalandra indica) or ljack fruit, teeth from jaws of a dead animal.
Secreting or evacuating fluids – Visravaniya	Surface of Shalmali (Bombax malabaricum)
Suturing – Sivya	Pieces of cloth, skin or hide
Bandaging	Limbs of a full-sized doll stuffed with linen
Repairing a severed ear-lobe	Soft severed muscle of flesh, stem of lotus or lily
Cautery & applying caustics	Piece of soft flesh
Inserting a syringe or injecting enemas	Inserting a tube into a lateral fissure or pitcher full of water or mouth of a groud in bladder region or ulcerated channel

(Sushrut, Sutrasthan 9/2,3)

The advantage of such experimental practice, according to Divodas Dhanvantari, was that an intelligent physician would never lose his presence of mind in professional practice, Divoda’s methods, as compiled by Sushrut illustrates his emphasis and insistence on discipline and high standard of training expected from a student training in surgery.

In addition to these innovative practices he also devised ingenious instruments, cited in the Sushtrut Samhita, for skilled surgery. He devised twenty sharp and 101 blunt instruments, in addition to special tables for use in major operations. Thorwald comments on these surgical instruments of ancient India. “The vast variety of Indian surgical instruments which have come down to us from the first millennium A.D. suggest that surgery had developed to an extraordinary extent in early India”

Some of the surgical procedures include lithotomy – removal of stones, skin grafting and rhinoplasty – repairing a mutilated nose. The latter two earned him the title “Father of Plastic Surgery.” However, recent scholars have conferred the title to his pupil Sushrut, probably because it was first penned in his Samhita, since Dhanvantari had no written treatise to his credit. Jurgeon Thorwald, in his book Science & Secrets of Early Medicine – Egypt, Mesopotamia, India, China, Mexico & Peru (1962), has observed that his method for rhinoplasty, which used a flap from the cheek was adopted and practiced by Gasparo Tagliacozzi, professor of surgery at Bolgona, in the sixteenth century, “There is scarcely any doubt that this method… which seemed to emerge out of nothing (in Europe), … had its roots in early India… Nowhere else in the whole world of antiquity do we find any precedent for that conception,” observes Thorwald. He added that in 1814, a newspaper account from India inspired Joseph Constantine Carpue, a pioneer of modern plastic surgery to restore a nose. This was the first attempt in Europe then. Carpue was greatly impressed by such successful operations performed by Indian village surgeons exactly as described thousands of years ago in the Sushrut Samhita.

Regarding lithotomy, Dhanvantari gave a detailed description of the removal of stones from the bladder and urethra by perineal incision (Sushrut Samhita, Chikitsasthan 7/14). Yet according to medical historians of Europe, the founders of the “Modern art of Lithotomy” were Giovanni de Romain and Marios Santos of Italy, in the late 15th and early 16th centuries. However, Thorwald doubts this and asserts that these men learned their methods from India. “Now that the texts of the Sushrut Samhita are available of at least 2000 years before that they contained an exact description of bladder surgery.”

“The vast variety of Indian surgical instruments which have come down to us from the first millennium suggest that surgery had developed to an extraordinary extent in early India.” -Jurgeon Thorwald (Science and Secrets of Early Medicince 1962)

Dhanvantari also made contributions in the fields of physiology and anatomy, dravya vignan –  pharmacology and material medica – and chikitsa vignam – therapeutics. One of his important contributions has led modern scholars to also call him a molecular biologist. He gave a complete theory of drug-composition, molecular structure, physio-chemical properties and therapeutic actions of food and drugs. 

He based these concepts on the Nyaya system of paramanu (atoms) and anu (molecules). In physiology, he was the first in the world to cite the haemopoetic, or blood forming factor in yakrut – liver – known as ranjakpitta, and the role of both the liver spleen in the formation of blood. He was also the first to prescribe raw goat liver for treating anemia and naktandhya (night blindness). Acharya Vagbhatta, a later proponent of Ayurveda, in the fifth century CE, described a similar factor occurring in the stomach with identical functions. In 1926, Minot and Murphy showed that liver was the most effective ingredient in the treatment of anemia. Ricks in 1948, and Smith, a few years later, described an amorphous red-principle from proteolysed liver, to be effective in pernicious anemia in very small doses – now known as Vitamin B12.  Vaghbhatt’s factor was re-discovered by Castle in 1929, in the stomach and was named Castle’s Intrinsic Factor.

Many such original discoveries can be listed which originated in ancient India, attributable to Dhanvantari and his followers. The few examples discussed remind us that these stalwarts of Ayurveda practiced an astonishingly scientific, sophisticated and advanced art of medicine as early as the third and second millennium BCE. Several millennia later, so called “modern medicine” is retreading their beaten paths.