Karma Purusha: The Sushruta Samhita's Six-Part Person

📖 26 min read  |  Sushruta Samhita, Sharira Sthana, Chapter 1

Sarva Bhuta Chinta Shariram: An Anatomy Volume That Opens With a Universe

The Sushruta Samhita is organised into six divisions. The Sutra Sthana holds the general principles, the Nidana Sthana the classification of disease, the Chikitsa Sthana the management of it, the Kalpa Sthana the handling of poisons, and the Uttara Tantra the long appendix that carries the eye, ear, nose and throat material. The third of the six is the Sharira Sthana, and it is the anatomy volume — the place where the text describes what a body is and how it is put together. Our article on Asthi Sharira and the enumeration of three hundred bones works through the counting chapters of this same volume.

Given that, the opening of Sushruta Samhita, Sharira Sthana, Chapter 1 is a surprise. The chapter is titled Sarva Bhuta Chinta Shariram, which the standard English rendering gives as the section concerned with "the science of Being in general". Not the science of the body. The science of Being. Before Sushruta will tell you how many bones there are, he wants to settle what a thing is, what any thing is, and where things come from at all.

Verse 1 begins where the Samkhya tradition begins: with Prakriti, described as the latent or unmanifest supreme nature, self-begotten, carrying the three primary qualities of Sattva, Rajas and Tamas. She is called the progenitor of all created things and "the sole and primary factor in working out the evolution of the universe". This is not a medical claim. It is a metaphysical premise, stated openly as a premise, at the top of a surgical manual.

One shoreless ocean; tank and river differ only in their banks.

Why would a surgeon do this? The chapter answers the question itself, though not until much later. Medicine, on Sushruta's account, works by putting matter into contact with matter. If that is what a physician does, then the physician needs a defensible account of what matter is, where it comes from, and what its properties are — otherwise the whole discipline rests on nothing. The cosmology is not decoration prefixed to the anatomy. It is the load-bearing argument that makes the anatomy mean something.

There is a second reason, and it is the one that makes this chapter worth reading closely rather than skimming. A text that begins by describing everything has to decide, at some point, how much of everything it is going to claim jurisdiction over. Chapter 1 makes that decision explicitly, in public, with reasons given. Very few technical texts of any period do that.

Avyakta and the Eight: Sushruta's Two-Verse Account of Prakriti

Sushruta compresses into a few lines what other schools spend books on. Avyakta — the unmanifest — is said to be imaged or embodied in eightfold categories: Avyakta itself, Mahan (intellection), Ahamkara (the sense of I-ness), and the five Tanmatras, the subtle sensibles behind sound, touch, sight, taste and smell.

Then comes one of the finest similes in the classical corpus. The original nature, verse 1 says, is the stone house of materials out of which the bodies of all self-conscious working agents have been evolved — "in the same manner as all water, whether confined in a tank or a reservoir, or coursing free through the channels of streams and of mighty rivers, have been welled up from the one and shoreless primordial ocean."

Read that again for what it is actually doing. It is not saying that a tank and a river are the same. It is saying that the difference between them is a difference of confinement, not of substance. Two bodies, two temperaments, two diseases — on this model they differ in arrangement and in boundary, and not in what they are ultimately made of. That single premise is what later permits an Ayurvedic physician to regard a mineral, a plant and a person as commensurable things, subject to the same vocabulary of quality.

The order of evolution follows. From Avyakta comes Mahan, intellection; from Mahan comes Ahamkara. Ahamkara then forks into three, and this is the hinge of the whole scheme: Vaikarika (the sattvika form), Taijasa (the rajasika form), and Bhutadi (the tamasika form). From the Vaikarika working together with the Taijasa come the eleven organs. From the Bhutadi, again with the Taijasa as instrument, come the five Tanmatras, and from those, the five kinds of gross matter — ether, air, fire, water and earth. Our guide to the Pancha Mahabhuta follows that second branch in detail, element by element.

Verse 5 then closes the arithmetic: "These twenty four categories combinedly form what is technically known as the twenty four elements." Verse 6 divides them into producers and produced. Avyakta, Mahan, Ahamkara, the five Tanmatras and the five gross principles in their nascent stage are grouped under Prakriti; the remaining sixteen are her Vikara, her modifications. Eight that generate. Sixteen that are generated.

Verse 7 adds a clarification that is easy to skip and worth pausing on: Mahan, Ahamkara and the five Tanmatras are themselves modifications of the original nature, yet they are still counted within the category of Prakriti, because they form the immediately antecedent conditions of everything that follows. Something can be both a product and a producer. The scheme is not a ladder of pure kinds; it is a sequence in which most rungs do double duty.

The Eleven Indriyas and the Gods Who Preside Over Them

Verse 3 names the eleven organs of cognition and action: the ears, skin, eyes, tongue, nose, speech, hands, genitals, anus, feet, and the mind, Manas. The first five are the Buddhi Indriyas, the organs of knowing. The next five are the Karma Indriyas, the organs of doing. Manas is listed eleventh and given a peculiar status: it "partakes of the character of both the intellectual and operative organs alike". It is on both lists, which is to say it belongs cleanly to neither.

Verse 6 pairs each organ with its function with almost bureaucratic flatness. Hearing, touch, sight, taste and smell are the subjects of the five intellectual organs. Speech, handling, pleasure, evacuation and locomotion belong to the five operative ones. There is no rhetoric here at all — it reads like a table, and that is the point. This is a text establishing a register.

Sound, and the organ built to read it.

And then verse 7 does something a modern anatomy would never do. It assigns each faculty a presiding deity.

It is tempting to read this as ornament bolted onto a physiology, and it is worth resisting that reading for a moment. Look at which deity gets which organ. The sun presides over the eyes and the moon over the mind, and those two assignments are consistent with everything else the tradition says about light: the sun is the hot luminary, sight is the faculty that depends on light, and the moon is the cool one, which is why it draws the faculty that the same tradition repeatedly describes as needing to be settled rather than heated. Water presides over taste and earth over smell, which is exactly the pairing that verse 19 goes on to give in material terms — taste is the property of water, smell the property of earth.

In other words, the deity list is not a second, incompatible theory laid over the material one. It is the same mapping expressed in the older idiom. A reader in Sushruta's period would have found the two mutually reinforcing rather than in tension.

Manas keeps its odd position throughout. It is the eleventh organ, it is on both sides of the knowing-and-doing divide, and it gets the moon. Later chapters of the tradition put a great deal of weight on that ambiguity, because a faculty that both receives and acts is exactly what you need if you want to explain how a person can notice something and then respond to it — and, for a physician, how a disturbance in one direction can produce a change in the other.

A Flower With the Eyes, Not With the Nose: The Rule of the Proper Object

Verses 12 to 14 are marked in the text as a memorable verse, which in the classical convention means: commit this one. It reads: "A man by a particular organ of his body perceives the same matter which forms the proper object of that sense organ, in as much as the perceiving sense organ and the perceived sensible are produced by the same material cause."

And then, immediately, the illustration that makes it stick: "The matter which specifically forms the object of a particular sense organ cannot be perceived by the other. We see a flower with the eyes and not with the nose."

We see a flower with the eyes and not with the nose.

This is the like-perceives-like principle, and Sushruta gives it a material argument rather than an assertion. The eye can register form and colour because the eye is itself built predominantly of the same element whose property form and colour are. The tongue can register taste because taste is the property of water and the tongue is watery in its constitution. The nose reads smell because smell is the property of earth. Perception is not a mysterious bridge between two unlike kinds of thing. It is a meeting between two portions of the same stuff, one of which happens to be organised as an organ.

Verse 19 supplies the material half of that pairing directly. It gives the distinctive traits of the five kinds of matter, beginning with Akasha: its properties are sound, the sense of hearing, porosity, and the differentiation of the veins and ligaments into their proper kinds. Note that a single element is credited with a quality, a faculty that reads that quality, and a structural role in the body, all in one breath. That is the compression this chapter works in.

The consequence for a physician is practical. If every faculty is confined to its proper object, then examination has to be plural. No one sense will give you the whole picture of a person, because no one sense is capable of registering more than its own share of the world. The elaborate multi-sense examination protocols that appear elsewhere in the classical literature — look, touch, ask — are not an arbitrary checklist. They follow from this verse. You need every organ because each one can only bring back one kind of report.

It is also worth noticing what this rules out. A model in which perception is a shared material event has no room for a faculty that perceives everything, and no room for a sense that perceives at a distance without contact. The chapter is quietly closing doors as it goes.

Svabhava, Kala, Yadrichchha, Niyati: The Causes Sushruta Refuses

Between the cosmology and the definition of the person, Sushruta stops to clear the ground. The passage is short and unusually sharp in tone. It asserts that "only the gross-sighted ones, who confound, observing only the superficial appearances," mistake six other things for the original Nature.

The six are named, and each was a live position held by a real school in the period:

Sushruta's objection is precise, and it is worth stating carefully because it is easy to caricature. He is not saying that time does not exist, or that nothing ever happens by chance, or that there is no God — the same chapter has just finished handing out presiding deities, and Ishvara is given charge of Ahamkara a few verses earlier. The objection is that these six are being confounded with Prakriti. They are being promoted from modes into materials. Time is real; time is not the stuff anything is made of. Chance describes how an event arrived; it is not a substance that arrived.

Time is real. Time is not what anything is made of.

Having cleared the ground, the chapter states its own position with unusual bluntness: "The five different forms of matter, such as ether etc., are nothing but the modifications or transformed states of the original nature and are characterised by the three universal qualities of Sattva, Rajas and Tamas, and all created things, whether mobile or immobile, should be considered as alike exponented by the same."

And then the sentence that, more than any other in the chapter, explains why the book is written the way it is:

Read that as a boundary being drawn, because that is what it is. Sushruta is not claiming that matter is all there is. He is claiming that matter is all a book like his is entitled to discuss. The reasoning runs: a physician's means are material, a physician's target is a material cause, therefore a physician's text confines itself to the properties of matter. Anything past that line belongs to a different kind of book.

This is a discipline defining its own competence. It is the same instinct that, twelve verses later, will hand the physician a person with six parts instead of twenty-four.

Karma Purusha: The Six-Part Person Medicine Is Given

Verses 16 and 17 are the centre of the chapter, and they are startlingly economical. The argument arrives in three steps.

First, the material origin of the body: "the immediately prior cause of the human organism is a proper and congenial admixture of the sperm and ovum". The starting point of a person, for medical purposes, is a material event with a material product.

Second, the material nature of the apparatus: "the sense organs are the resultants of phenomenal evolution of matter, and the objects of sense perception are equally material or phenomenal in their nature". The instruments are matter, and so is everything they report on.

Third, the definition itself: "Purusha (individual) is nothing but a combination of a self-conscious self and the five kinds of matter (Mahabhutas) formed into an organic body. This Purusha or individual, which is called Individual of action (Karma Purusha), falls within the scope of the science and art of medicine."

Five kinds of matter and one self, folded into a body.

Count it. Five Mahabhutas, and one conscious self. Six.

The chapter has just spent its opening verses building a being of twenty-four categories, with eleven organs, three forks of Ahamkara, five subtle sensibles and a full complement of presiding gods. And then, at the moment it turns to the physician, it puts almost all of that aside and hands over a person made of six things.

The narrowing is not carelessness and it is not an abridgement for beginners. It follows directly from the scope declaration a few verses earlier. A physician acts on matter with matter. The five Mahabhutas are what the physician can reach. The conscious self has to be included because without it there is no patient — only a body — but it is included as a single term, not as a subject to be operated on. Everything between those two, the whole elegant middle of the Samkhya scheme, is real on Sushruta's account and simply not the physician's business.

The name carries the argument. Karma Purusha is the Individual of Action: the person considered as something that acts, that has acted, and that can be acted upon. Not the person as pure witness. Not the person as a metaphysical absolute. The person as an agent with a history and a body, which is precisely the only version of a person a physician ever meets.

There is one more detail worth catching. Sushruta writes that the self is "eternally subject to the process of being evolved out into a finite, organic individual through the dynamics of the combined sperm and ovum". The self is not described as descending into a ready-made body, nor as being manufactured along with it. It is described as being drawn into finitude by a material process. That is a careful, and rather strange, middle position — and it is the position that lets the same text speak about a soul in one clause and about tissue in the next without changing register.

Kshetrajna: Where Ayurveda Parts Company With Samkhya

Verse 15 contains the chapter's one open disagreement, and it is aimed at the school Sushruta has been borrowing from for the previous fourteen verses.

"The Science of medicine does not lay down that self-conscious Selves (Kshetrajna) are all pervading, but on the contrary it asserts that they are real and eternal and are born in the planes of divine, human or animal existence according to their good or evil deeds."

To see how sharp this is, you have to know what it is refusing. In classical Samkhya the Purusha is vibhu — all-pervading, without location, without action, a witness that does not do anything and to which nothing happens. It is the still term in the system, and everything that appears to happen to it is really happening to Prakriti while the Purusha looks on.

Sushruta declines the whole picture. His Kshetrajna is real and eternal, yes — but it is individual, it is somewhere, and it is born into one plane or another according to what it has done. It is a self with an address and a record.

The edition consulted for this article notes the divergence in a footnote of its own, observing that where Samkhya discourses on the immaterial character of the soul, Ayurveda instead takes up the question of how the material environment the soul is said to inhabit comes to be evolved, and how the spiritual within the material organism is effected. It adds that Sushruta's physiology, like Charaka's, is in the strictest sense of the word molecular, and that the soul in Sushruta is individual — "it is not everywhere the same."

There is a fine epistemological note attached. Sushruta says the existence of these self-conscious entities "can be ascertained duly by inference inasmuch as they are extremely subtle in their essence." Not by perception — by inference. Having just built a theory in which knowing means one material thing meeting a like material thing, he is consistent enough to admit that the self cannot be known that way, and to say plainly which instrument he is using instead. He then cites a dictum of the Shruti in support, so the claim is placed as a reasoned inference backed by received authority, rather than as something observed.

For readers who want to see how the two frameworks are usually presented as continuous rather than divergent, our overview of the Sushruta Samhita sets out the text's general character and place in the tradition.

The Marks of a Living Individual: Blinking Among the Great Faculties

Verse 18 gives the attributes of an organic individual — the observable marks by which you can tell that what you are looking at is one. The list is worth reproducing in the order the text gives it, because the order is the interesting part:

There is no hierarchy in it. Intellect sits next to flatus. Memory sits four places from blinking. A modern list would almost certainly separate the mental from the mechanical and rank them; this one does not, and the refusal is deliberate.

The reason is the definition that has just been given. If the Karma Purusha is a conscious self combined with five kinds of matter into an organic body, then any evidence that the combination is intact counts equally. Eyelids that open and close are as good a sign that a self is joined to a body as a memory is. Both are things the combination does and a mere heap of matter does not.

The inclusion of Prana and Apana by name is the point at which this chapter connects to the rest of the physiology. These are two of the five vayus that the tradition works with in far more detail elsewhere; our guide to the five pranas follows the full set. Here they appear in their simplest role: as movement you can observe from outside, offered as evidence.

Sattvika, rajasika, tamasika: described, and left there.

Sattvika, Rajasika, Tamasika: Sushruta's Three Mental Temperaments

Verse 19 closes the chapter's account of the person with what it calls the distinctive features of the different classes of mental temperament. The three gunas that opened the chapter as cosmic constituents return at the end as a description of character.

The Sattvika temperament is marked by: an absence of all killing or hostile propensities; a judicious regimen of diet; forbearance; truthfulness; piety; a belief in God; spiritual knowledge; intellect; a good retentive memory; comprehension; and the doing of good deeds irrespective of consequences.

The Rajasika temperament is marked by: feeling much pain and misery; a roving spirit; non-comprehension; vanity; untruthfulness; non-clemency; pride; an overweening confidence in one's own excellence; lust; anger; and hilarity.

The Tamasika temperament is marked by: despondency; stupidity; disbelief in God; impiety; stupefaction and perversity of intellect; lethargy in action; and sleepiness.

Two things about these lists reward a second look.

The first is the last item on the sattvika list: the doing of good deeds irrespective of consequences. Every other entry names a quality a person has. This one names a structure the person's action takes — specifically, action that is not transactional. It is the only entry in the three lists that describes a relationship between a deed and its expected return, and putting it at the end of the sattvika column, as the culminating mark, is a considered choice.

The second is the placement of "feeling much pain and misery" at the head of the rajasika list. A modern reader expects the rajasika column to open with restlessness or ambition. Instead it opens with suffering. The implication is that the rajasika temperament is characterised first by the experience of friction, and only afterwards by the vanity, anger and hilarity that the rest of the list records. That is a considerably more sympathetic reading than the word "rajasic" usually carries in casual use today.

It is also worth being clear about what the chapter does not do with these three categories. It does not attach an intervention to any of them. No regimen follows, no correction is proposed, and nothing is recommended for moving a person from one column to another. They are given as a way of describing what is in front of you, and the chapter ends. For the constitutional schemes that the later tradition did build out in detail, see our article on Prakriti and the seven constitutions in the Ashtanga Hridaya, and our guide to the tridosha.

On Our Shelf: Things With a Stated Scope

The chapter above is history, and we sell none of what it describes. But there is one habit in it worth borrowing, and it is the habit of saying up front what a thing is for. An eye is for one thing and a nose for another. Sushruta says so, and then says the same about his own book — here is its subject, and here is where its subject ends.

We make ordinary bath and hair items. So the most useful thing we can copy is that plainness. Below, each item is described only by what surface it is meant for and how long it is meant to stay there. Every line is read off that item's own pack and its own product page, so every line is something you can check rather than take on trust. None of these is a medicine, and none is offered as one.

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