Acharya Vagbhata

When surgeons read the classical texts of Indian medicine, Sushruta naturally commands most of the attention. His operations are vivid, his instruments numerous, and his confidence unmistakable. Yet between the age of Sushruta and the later medieval period, surgical knowledge might easily have thinned out or fragmented. It is largely through Vagbhata that the surgical tradition was gathered, condensed, and transmitted forward.

Vagbhata probably lived around the 6th–7th century CE, was not primarily an operative innovator. His importance lies in preserving surgical principles and presenting them in a structured and teachable form. His two great works, the Aṣṭāṅgasaṅgraha (अष्टाङ्गसंग्रह) and the Aṣṭāṅgahṛdayasaṃhitā (अष्टाङ्गहृदयसंहिता) include substantial material on surgery (Śhalyatantra), wound care, fractures, cautery, and surgical instruments. Though briefer than Suśhruta’s descriptions, they show that a coherent surgical tradition was still alive in early medieval India. Modern philological research, however, argues that these two texts are unlikely to be the work of a single author. The relationship between the two treatises, as well as their authorship, remains a subject of ongoing scholarly debate and has not been conclusively resolved.

The title Aṣṭāṅga refers to the eight branches of medicine: internal medicine, surgery, diseases of the head and neck, pediatrics and obstetrics, toxicology, psychiatry, rejuvenation therapy, and reproductive health. This classification reflects an attempt to organize medical knowledge into a coherent system. For the modern reader, it suggests a curriculum rather than a manual, a structured approach to medical education.

The Concept of Shalya

The Sanskrit word śhalya refers to a sharp instrument (spear, javelin, arrow or a thorn) foreign body or anything that must be removed from the body. From this comes Śhalyatantra, the branch of medicine dealing with surgery. Vagbhata adopts this classical concept and describes a range of conditions requiring surgical intervention foreign bodies, abscesses, calculi, dead tissue, and traumatic wounds.

The surgeon’s role was therefore defined not only by cutting but by removal: removing pus, removing foreign material, removing devitalized tissue. The idea is strikingly close to what we would now call debridement.

Wound Care and Healing

One of Vagbhata’s most practical contributions lies in his descriptions of wounds (vrana). He classifies wounds by cause traumatic, surgical, and inflammatory and also by their condition. Clean wounds, contaminated wounds, and infected wounds are described in different terms, each with its own management.

The principles of treatment are logical and sequential. A wound must first be cleaned. Any foreign or dead material must be removed. Only then can healing proceed properly. Vagbhata repeatedly emphasizes that retained debris or devitalized tissue interferes with healing, a principle that remains fundamental in modern surgery.

Suppuration is described as a stage in the evolution of certain wounds. The surgeon is advised to recognize the signs of abscess formation swelling, pain, warmth, and fluctuation and to intervene when pus has formed. Premature incision is discouraged, but so is delay once suppuration is evident.

Drainage of abscesses is described in straightforward mechanical terms. The incision must be adequate, and the cavity must be allowed to empty fully. After drainage, dressings are applied to promote healing from within. The emphasis on adequate drainage reflects long practical experience with soft tissue infections.

Chronic wounds receive special attention. Vagbhat describes methods to stimulate healing in wounds that fail to close, including cleaning, scraping, and the application of medicinal substances. The idea that a wound might need to be “refreshed” before it can heal is familiar to any modern surgeon dealing with chronic ulcers.

Debridement

Although the modern term does not exist in the text, the concept of debridement is clearly present. Dead or unhealthy tissue is described as an obstacle to healing and must be removed. This may be done with cutting instruments or by other means. The wound is then treated so that healthy tissue can form.

This principle appears repeatedly in classical Indian surgery and remains one of its most enduring contributions.

Bandaging

Bandaging is discussed in considerable detail. Vagbhat describes a variety of bandage types, each suited to a different region of the body. The bandage must be firm enough to support the tissues but not so tight as to impair circulation.

Special bandaging techniques are described for the limbs, joints, and trunk. The importance of maintaining the correct position during healing is emphasized. The surgeon is advised to check bandages regularly and adjust them as needed.

The descriptions suggest a practical familiarity with postoperative care and the management of injuries.

Original lithographic print of the book Aṣṭāṅgahṛdayasaṃhitā written by Vagbhata printed in 1860s

Fractures and Dislocations

Fractures are described in terms of displacement and instability. The basic principles of treatment are recognizable: reduction, alignment, and immobilization.

The injured limb is first brought back into proper position. It is then supported with splints and bandages. Movement is restricted until healing has occurred. Vagbhata emphasizes that improper alignment leads to deformity and impaired function.

Dislocations are treated by manipulation followed by immobilization. Careful handling is advised, and excessive force is discouraged. The emphasis on gentle but effective reduction suggests a developed understanding of musculoskeletal injuries.

Surgical Instruments

Like Sushruta, Vagbhata describes a range of surgical instruments, though in less detail. These include cutting instruments, probes, forceps, and needles. Instruments are to be kept clean and in good condition.

The surgeon is expected to be familiar with the proper use of each instrument. Precision and control are emphasized over force.

Though the descriptions are brief, they reflect an established operative practice in which specialized tools were used for specific purposes.

Cautery

Cautery occupies an important place in Vagbhat’s surgical practice. Two forms are described: thermal cautery (agnikarma) and chemical cautery (kṣhārakarma) (akin to ksharasutra).

Thermal cautery is used to control bleeding, destroy diseased tissue, and treat certain growths. Chemical cautery uses caustic substances to achieve similar ends. Each method has specific indications, and improper use is warned against.

Cautery is presented not as a last resort but as a standard surgical tool. Its careful and controlled application suggests considerable experience.

Bloodletting

Bloodletting is described as a therapeutic procedure in selected conditions. Methods include venesection and the use of leeches. Though based on the humoral theories of the time, the techniques themselves required practical skill.

The descriptions include guidance on patient selection and technique, indicating that these procedures were performed with some regularity.

The Surgeon

Vagbhata’s description of the surgeon is worth noting. The surgeon must be steady-handed, observant, and disciplined. Cleanliness is emphasized, both in the person and in the instruments. The surgeon must understand the disease before attempting treatment.

Vagbhata’s Place in Surgical History

Vagbhata does not describe rhinoplasty with the detail found in Sushruta, nor does he present dramatic new operations. His importance lies elsewhere. He preserved the principles of surgery at a time when they might otherwise have faded.

Through his writings, the essential elements of surgical practice wound care, drainage, debridement, fracture management, and operative technique were organized into a coherent system and transmitted to later generations.

For modern surgeons, Vagbhata offers a glimpse of a tradition in transition. The bold experimental phase of early surgery had passed, but the craft itself remained alive. The operating surgeon was still present, treating wounds, draining abscesses, setting fractures, and managing injuries much as surgeons would for centuries afterward.

If Sushruta represents the birth of Indian surgery, Vagbhata represents its continuity.

From a historical perspective, Vagbhata represents a bridge between worlds. Behind him lie the great surgical traditions of ancient India. Ahead lies the long medieval period, during which medical knowledge was preserved in monasteries, courts, and teaching lineages. Without authors like Vagbhata, much of the earlier tradition might have been lost or scattered.

If Sushruta can be imagined as the master surgeon, then Vagbhata might be seen as the professor who ensured that the knowledge endured. His contribution was not dramatic, but it was essential. He gathered what was known, organized it, and presented it in a form that could be taught and remembered.

References

1. Vagbhata. Ashtanga Hridayam. Translated by K.R. Srikantha Murthy. Varanasi: Chaukhambha Krishnadas Academy.
2. Vagbhata. Ashtanga Sangraha. Translated by K.R. Srikantha Murthy. Varanasi: Chaukhambha Orientalia.
3. Meulenbeld GJ. A History of Indian Medical Literature. Groningen: Egbert Forsten; 1999.
4. Filliozat J. The Classical Doctrine of Indian Medicine. Delhi: Munshiram Manoharlal; 1964.
5. Wujastyk D. The Roots of Ayurveda. London: Penguin Classics; 2003.
6. Sharma PV. History of Medicine in India. New Delhi: Indian National Science Academy; 1992.
7. Menon, I (2010). "The Ashtavaidya physicians of Kerala: A tradition in transition". Journal of Ayurveda and Integrative Medicine.

Footnote

In addition to textual and scholarly study, Vagbhat is associated with a number of regional traditions in India, particularly in Kerala, where classical Ayurveda developed distinctive institutional lineages. These traditions form part of the cultural history of Ayurveda but are generally treated by historians as legendary or devotional accounts rather than established historical biography.

In Kerala, hereditary families of Ayurvedic physicians known as Ashtavaidyas (literally, “masters of the eight branches of Ayurveda”) preserved classical texts and clinical practices connected to the Aṣṭāṅga system described in Vagbhat’s works. Ethnographic and historical surveys of Kerala Ayurveda note that these families often traced their intellectual lineage to classical authors such as Vagbhat, Charaka, and Sushruta, though such links are understood as traditional affiliations rather than direct teacher–disciple relationships.

One such Ashtavaidya lineage is the Pulamanthole Mooss family of present-day Malappuram district, Kerala. Local family histories and community narratives maintained by the Pulamanthole Mooss tradition state that Vagbhat spent his final years in the Pulamanthole region and that a memorial site (samādhi) associated with him exists there. This association is referenced in institutional histories and regional cultural accounts but is not supported by epigraphic, archaeological, or contemporaneous textual evidence accepted by mainstream historians

The legacy of Vagbhata written by Dr. MS Valiathan

Digital Rare Book:
Astanga Hrdaya of Vagbhata (500-600 CE)

Quiz time

Which of Vagbhata’s texts is written mainly in concise poetic verses and became widely popular among physicians?

Answer – Ashtanga Hridaya

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

King Bhoja

King Bhoja was a 11 century Parmar king who ruled in the area of present-day Madhya Pradesh. His ‘country’ extended from just east of Bhopal in the east to Sabarmati River in the west, and from Chittor in present day Rajasthan in the north to Konkan in the South.

Statue of King Bhoja in Bhopal

His life is chronicled in Bhoja Prabhanda authored by Ballaladeva in the 16th century. King Bhoja was a prolific writer with around 84 literary works attributed to him. The legends surrounding him match those surrounding King Vikramaditya. King Bhoja also fought many wars and was considered a hero by his citizens.

He was troubled by chronic headaches. Medications by his regular court doctors seemed to have no effect. Two Brahmins from Ujjain are credited with curing his headache through neurosurgery. They used anaesthesia, put him into a stupor, made trephinations in his skull and took out a tumour – and this cured him.

Trephination

Trephination or Trepanation involves making a ‘hole’ in the skull. These words are used interchangeably now. But the names are probably derived from the original names of the instruments used in the process.

The process involves scraping, cutting or drilling a hole in the skull. The process was practices as far back as the neolithic period. Trepanation has been documented in excavations of skulls from across the globe. The first ‘proper’ documentation was in mid 1800s from a skull excavated from Peru. Regularly shaped circular or rectangular holes suggest that it is man made. Scarring and ‘healing’ seen in the edges of these holes suggest that the holes were made in a live human and that he/she survived the procedure for a good length of time.

Different methods of trephining: (1) scraping; (2) grooving; (3) boring and cutting; (4) rectangular intersecting cuts. Reference: Gross CG. A Hole in the Head: More Tales in the History of Neuroscience. Cambridge (Massachusetts): MIT Press; 2009

In India, similar skulls with trepanations have been excavated from the Harappan sites (4500 years ago), Kashmir and Karnataka.

Trepanations were carried out for many indications including head trauma (to let the ‘bad blood’ out), headaches, epilepsy and psychiatric disturbances. That the patients survived the procedure has been mentioned. But there is no clear evidence about the patients getting better from the malady. But the fact that the procedure itself survived for such a long time suggests that it had some salutary effect.

A surgeon removing ‘the Stone of Madness’ by Trepanation; A 15th century Painting

Sushruta (600 BCE), the Father of Indian Surgery is credited with neurosurgical procedures in addition to the famous Rhinoplasty and several other surgical procedures. Sushruta designed and used more than 120 surgical instruments. He described methods of trepanation, extraction of foreign bodies, closure of wounds and application of dressings. Sushruta used some alcoholic potions as a form of anaesthesia.

Jivaka (5th Century BCE) is another well known physician of ancient India. His claim to fame was that he was the personal Physician of Gautama Buddha. Several neurosurgical procedures have been attributed to Jivaka as well.

Jivaka, Gautama Buddha’s physician
 

By the time of King Bhoja (11th Century), with 1500 years of experience, the science of neurosurgery had progressed. The improvement came in the form of anaesthesia. The Brahmin surgeons who operated on King Bhoja used a herbal mixture called Sammohini (probably a combination of cannabis and opium) to induce anaesthesia to the king. After the procedure, they used another herb called Sanjivini to wake him. Botanical equivalents of the herbs matching the descriptions have now been identified.

Thus, it can be seen that ancient Indian Surgeons were in the know of basic neurosurgical procedures. They had sophisticated anaesthetic protocols, designed and used proper instruments and clearly, the patients survived these procedures.

Bronze Age Harappan Trepanation skull (4300 years old)

Further reading:

https://journals.lww.com/armh/fulltext/2022/10010/history_of_trepanation_and_the_indian_connection.26.aspx

https://en.wikipedia.org/wiki/Bhoja

https://tamilandvedas.com/2015/06/17/brain-surgery-in-ancient-india-bhoja-and-indus-valley/
 

Quiz time

Who was the Father of Modern Neurosurgery in India?

Answer – Dr. B. Ramamurthi (who established the first neurosurgical department in Madras in 1950).

History of Surgery ASI team

Dr Kaushik Bhattacharya (Head of the team)
Dr Pratap Varute
Dr Patta Radhakrishna
Dr Surajit Bhattacharya
Dr Clement Rajan
Dr K Lakshman
Dr Mahesh Prabhu

ASICON—the Annual Conference of The Association of Surgeons of India—remains one of the most anticipated events in the surgical community, offering a dynamic platform for surgeons across the country to engage, collaborate, and exchange scientific knowledge.

Under the esteemed leadership of Dr. D.Maruthu Pandian, President of ASI, and the Executive Committee of The Association of Surgeons of India, we are pleased to officially announce ASICON 2026, scheduled to be held in Ahmedabad and Call for various academic engagements for ASICON 2026.

In addition, we are now inviting applications for the following:

I. Orations 2027
II. Endowment Lectures 2027
III. Travelling Fellowships 2027
IV. Symposia for ASICON 2027.

Click Here for Detailed Information About Announcement of ASICON 2026 & Awards for ASICON 2027

We kindly request you to submit your nominations in accordance with the guidelines outlined in the notice, ensuring they are submitted within the stipulated deadlines.

We look forward to your active participation and valuable contributions to the upcoming conferences.

With warm regards and best wishes,

The MRCS Part B OSCE is a practical examination that assesses the essential surgical skills, clinical competence and professional behaviours expected of a surgeon in training.

MRCS Part B OSCE – 2026

Dates: 6-8 September 2026
Location: Trivandrum, India
Booking Link : https://rcpsg.ac.uk/exams/mrcs-part-b