|Year : 2019 | Volume
| Issue : 3 | Page : 77-79
Jivaka: The great surgeon and physician of ancient India
KAS Medical Center, New Delhi, India
|Date of Submission||30-Jun-2020|
|Date of Decision||14-Sep-2020|
|Date of Acceptance||01-Jul-2020|
|Date of Web Publication||22-Sep-2020|
Dr. Ajaya Kashyap
G-160 Palam Vihar, Gurugram - 122 017, Haryana
Source of Support: None, Conflict of Interest: None
Background: Indian civilization has been home to some of the greatest surgeons since antiquity. Jivaka has been one of the greatest. Three different systems of medicine including Indian, Thai and Chinese look up to him as one of the greatest physicians and surgeons in antiquity. Aims and Objectives: The aim of the present article was to study his contributions to modern medicine and specifically to surgical techniques. Results: Jivaka's approach to surgery was quite modern in giving due importance to pre and post surgical care. His famous cases and innovations include the surgery for fistula in ano, surgical treatment of a volvulus as well as surgery for hydrocele. He was the physician to Lord Buddha and took care of him for several ailments. Conclusion: While we study about the great surgeons in the medevial and modern times we only have to look back at great surgeons like Jivaka in antiquity to realize how it all started.
Keywords: Ancient, Buddha, craniotomy, fistula-in-ano, volvulus
|How to cite this article:|
Kashyap A. Jivaka: The great surgeon and physician of ancient India. Indian J Colo-Rectal Surg 2019;2:77-9
| Introduction|| |
Jivaka (also spelled Jeevak) was among the greatest surgeons in ancient India and in all the civilized world in antiquity [Figure 1]. He was also called Komarbaccha having been brought up by Prince or Kumar Abhaya, son of Prince Bimbisara in the 6th-century B.C.E. He was the healer to many kings, Gautama Buddha, the monks of all orders, and to people from all over the known world. There is a significant amount of literature in Sanskrit, Pali, Tibetan, and Chinese that describes his life and his contributions, although there is considerable variation in the accounts.
|Figure 1: Jivaka: The great physician and surgeon of ancient India, shown here with some of his surgical instruments|
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| Birth and Early Life|| |
He was born of a courtesan who was called Amrapali (or Salavati in other texts) from the Republic of Vaishali and was the son or grandson of Bimbisara (depending on the source). Amrapali's beauty and love affairs are the stuff that legends are made of, but so was her ruthlessness toward her child. She discarded her unwanted newborn in a garbage dump outside the city of Ratnagiri in the kingdom of Magadha. Prince Abhaya found the newborn alive in unbelievably harsh circumstances and called him “Jivaka” meaning “Life” for his intense will to survive. The Prince brought him up as his own son and he received a royal education with other princes but was found to be exceptionally intelligent and exceptionally sensitive. Once as a teenager, he was told of how he was not of royal birth (although, as mentioned, unknown to him and to others, he was the illegitimate child of the king). This made him feel ashamed of himself and also greatly indebted to Prince Abhaya. He found a vocation where he could independently make money and repay his adoptive father for his upbringing. The medics had fascinated him in the city but found their treatments lacking in quality and efficacy. He went to the greatest university of those times, Taxila, in the northwestern part of India. There are stories of how he got entry into the university by passing a test of deductive reasoning and of his excellence at the university, under the great Guru Atreya Punarvasu. It is likely this Guru was one descendant of the ancient Guru Atreya. Jivaka studied and trained for 7 years, proving himself to be worthy of his great Guru. The master gave him an outgoing test instead of fees for his education. He asked Jivaka to find a plant or herb in the area that had no medicinal value, as a test of his skills. Jiivaka eventually enumerated all the plants and herbs in the region with all their uses and benefits and concluded that there was not a single plant or herb that had no medicinal value. According to Jivaka, “Everything on earth is nothing but medicine.”
| The Healer|| |
He returned to Magadha, performing many therapeutic and surgical miracles on the way and making an excellent amount of money for his services from the rich patients. Once back in Magadha, he tried to give the money to his adoptive father Abhaya, who not only did not accept the money but also built up an infirmary for his son to treat patients. There is also documentation of a magic tree stick which let Jivaka see into the body like an ultrasound or X-rays. There is one version where this magical stick had a stone embedded in it. Jivaka became the physician to King Bimbisara who was a follower of Gautama Buddha. His fame and the word of his medical treatments for infectious diseases, pediatrics, and internal medicine spread all over. He became the most highly regarded surgeon and gynecologist of his time, and patients traveled long distances to seek his treatments. He is probably the most highly regarded physician and surgeon of the ancient times in all of Asia and the world, along with Sushruta.
| Effect on Buddhism|| |
Jivaka became the healer of the Buddha's physical body as the Buddha, the “enlightened one,” was healing the soul of humanity. He treated all the Bhikkhus (monks) and even the followers of Mahavira Jain who was the spiritual Guru of Prince Abhaya. He did make a lot of positive changes in the life of the Bhikkhus, although he remained a lay follower of the Buddha. He even made a Vihara (Jivakarama Vihara) in Rajgir for “the enlightened one” to give his discourses. There is a famous discourse, Jivaka Sutra, where Jivaka wonders why Buddha accepts and eats meat which appears to be in conflict with the concept of nonviolence. Buddha explains that if an animal has not been killed with the purpose of being consumed by Buddha or the Bhikkhus, it is acceptable to eat meat. The monks would wear rags taken from dead bodies, in an attempt to show complete renunciation, which led to many diseases. Once, an expensive shawl was given to Jivaka by a grateful king for his successful treatment. Jivaka wanted Buddha to use it in the cold weather. Buddha accepted the gift but had it torn up into rags and then sewn back together, to make it worthless in worldly terms.
It was Jivaka's influence that eventually made freshly stitched robes acceptable for the monks, preventing a lot of sickness. It was Jivaka who also influenced Buddha to have the monks exercise their bodies to prevent metabolic diseases caused by indiscriminate eating and lack of exercise. Jivaka was influential in spreading Buddhism as well. He gave preference to bhikkhus for treatment, which made a lot of patients turn to Buddhism and become monks.
King Bimbisara's other son and successor Ajatshatru had his father imprisoned and made several attempts on his father's life. Jivaka eventually prevented Ajatshatru from killing his father, who died anyway. Jivaka took the young king, filled with remorse, to the Buddha. Ajatshatru accepted the way of the Buddha and propagated the religion far and wide.
| Approach to Surgery|| |
Like Sushruta before him, Jivaka believed in three stages of surgery:
- Purva Karma – Preoperative methods. Jivaka found the most important part of this stage to be careful observation, making the correct diagnosis, and laying down a proper course of action
- Pradhan Karma – Operation or the procedure itself. There would usually be an audience watching the procedure, much like the later concept in the West of an “Operation Theater.” This was the magical, the “wow” part
- Pashchata Karma – Postoperative care. This would often be entrusted to the relatives of the patients or attendants. The successful outcome of the procedure often depended on following proper postoperative instructions, then as much as now.
| Famous Cases|| |
There are many surgeries that are attributed to the brilliant surgeon. These include:
- Surgery for fistula-in-ano performed on King Bimbisara. This is the procedure that made him famous. It is said that surgery for fistula-in-ano was practiced before but caused a high degree of incontinence. King Bimbisara, a husband to several young wives, became a subject of ridicule because of staining of his underclothes with blood. No royal physician would dare suggest an invasive procedure. Jivaka approached the king with an instrument called “nakha sastra” which has often wrongly been translated as a fingernail, but the actual instrument is one finger in breadth and two to nine fingers in length with a cutting edge. It appears that Jivaka probably made an incision into the fistula which subsequently healed. The king was pleased with his “grandson” and appointed Jivaka as the royal physician. This eventually led to Jivaka becoming the physician to the Buddha himself
- Craniotomy (Susabadho) to remove what were probably parasites (“panaka”) or clots was one of his other famous operations, which is mentioned in almost all the texts. He performed this on a merchant who was suffering from intense chronic headaches
- Surgery for a volvulus. Jivaka operated on a youth whose intestines had gotten “entangled.” Jivaka did a laparotomy, derotated the intestines, and sutured them back in proper position. There is a similar description for a strangulated hernia
- Removal of a foreign body from the foot of the Buddha. A splinter of a rock got embedded in Buddha's foot that had been hurled by his rival Devadutta. It was extricated using a small knife “Khaja”
- Surgery for hydrocele (andavuddhi). The surgery involved opening the covering of the testicles and removing a hard “bija.”
There are many other surgeries that have been attributed to Jivaka as also a variety of medical treatments. The Buddha had many ailments including constipation that were successfully treated by Jivaka who took care of the Buddha almost till the Buddha decided to leave his mortal body at an advanced age. Jivaka was, unfortunately, not present at the time.
| The Legacy|| |
The passage of time often causes history to become legend and respect to become reverence. Jivaka's name became synonymous with a miracle man over decades and centuries. Therapies that were probably not known in India at that time like acupuncture were later attributed to the great physician and surgeon. Massage therapists from Thailand also regard Jivaka to be the father of Thai massage. The Chinese regard him as the greatest of all ancient physicians. The remains of his Vihara are still visited by thousands in the city of Rajgir from all over Asia and the world.
It is said that Jivaka eventually became an “Arahant,” one who has achieved nirvana while still alive. He is one of the 16 arahants protecting the teachings of the Buddha till the arrival of the next Buddha. As legend has it, he is still living somewhere between India and Sri Lanka on a mountain peak “Gandhamadana.” The great healer, it seems, is waiting for his own healer.
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Conflicts of interest
There are no conflicts of interest.
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