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Mini Review | DOI: https://doi.org/10.31579/2690-1897/232
1Jhansipura, Lalitpur-284403 India,
2Professor & Head, Department of Pediatric Surgical Super specialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 U.P. INDIA
*Corresponding Author: Basant Kumar, Professor & Head, Department of Pediatric Surgical Super specialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014 U.P. INDIA.
Citation: Ven S. Thero, Basant Kumar, (2025), Surgeon and Physician of Ancient India: Jivak, J, Surgical Case Reports and Images, 8(1); DOI:10.31579/2690-1897/232
Copyright: © 2025, Basant Kumar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 08 January 2025 | Accepted: 23 January 2025 | Published: 31 January 2025
Keywords: jivaka; ancient; lord buddha; father of medicine; personal physician
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 postsurgical 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. Some treatment methods used by Jivaka are well known to the scholars of ancient Pali texts. For example, he treated some “Disease of the Head” of a patient with Ghee through the nose. He also treated Rectal Fistula of King Bimbisara with some ointment. These texts also mention that Jivaka performed Surgeries on his patients, sometimes even in front of the relatives. But the veracity of these accounts is difficult to verify. One famous Surgery he performed was removing a piece of rock from the foot of the Buddha himself using a knife.
He was the contemporary of Siddhartha Gautama, the founder of Buddhism. His practice of medicine and incorporation of traditional methods into practices is worthy of recounting in present days too. Both of them lived and worked in the same area of Northern India and Sub-Himalayan terrain. Jivaka came across Siddhartha at the juncture of an era which would have been recounted in the following several decades as memorandum of Humanity and Sacrifice. Jivaka, enriched with his talent and wisdom, had taken care of terrestrial body of Lord Buddha and myriads of monks. By his virtue and royal patronage of king Bimbisara, Jivaka Kumarvaccha became a wealthy person in his time. He was a saint in soul and would believe in Sacrifice and Charity. Here appeared Jivaka Kumarbacha as personal Physician of Lord Buddha. Jivaka was considered as the most down trodden person of the Society. His life as a student, trainee and healer was not only exemplary in his time but in modern times also. His devotion to the subject and treating patient earned respect from all walks of the Society. He accomplished many cortical surgeries and stressed on the fact that surgery comprises of three stages. Pre-operative and Postoperative care were of equal importance as procedure of surgery itself. He advised seven months to lie on same side to his wealthy busy patient after surgery knowingly that seven days was enough! After seven days, patient stood up and said that he did enough. He could not do it anymore! After Nirvana of Lord Buddha, Jivaka Kumarbacha was the instrumental on organizing first Buddhist council with the king Ajatashatru. Life and sermon of Lord Buddha were taught and memorized and recited over centuries before these had been texted. Mahabhargav, the early and medicinal part of Vinaya Pitaka was written in Pali language in 4thcentury BC (Chen and Chen, 2005). Other parts had been texted centuries later.
Thangka paintings involve more than artistic skills. To be able to sketch Tibetan Buddhist deities that form the theme of most of the Thangkas, the artist must have expert-level knowledge of measurements and proportions of Buddhas, Bodhisattvas, and other deities as outlined in Buddhist iconography. These deities of Tibetan Buddhism run in thousands. Artists have to rely on a grid of precisely positioned lines to sketch. Sketching involves a basic system of these coordinates having one vertical and two diagonal lines. The center of any Thangka painting is an intersection of these three lines. And where Thangkas have figures other than the central one, there are additional connecting lines and circles contrasting these background figures with the central figure. Since the grid system divides the Thangka painting into parts with different proportions and also lends fluidity to a Thangka painting, should a Thangka painting be done, say twice the original size, the artist need only double the dimensions or distance between all lines. It is hard to surmise the expertise, knowledge, and artistic skill that has gone into a completed, impressive Thangka painting that looks nothing less than divine. We have briefed the process of creating a traditional Thangka painting into the following thirteen steps to give our readers an appreciative view of this sacred Tibetan art or your newly acquired Thangka painting. While certain elements of Thangka paintings stand changed since artists have had to paint in exile, much of Tibet’s traditional styles and techniques were thankfully retained laboriously. We hope the below will interest and enlighten you on this Sacred Art of Tibet (Art Of Thangka Painting). Prologue Ayurveda is the ancient Indian system of medicine literally meaning “the knowledge of healthy long life.” Ayurveda is concerned with “the ‘total way of life,’ and is not just a ‘system of medicine’ that offers to cure diseases through drugs and rituals (Satyavati, 1991).” According to the ancient physicians, in the “knowledge of healthy long life,” medicine was not just the medical drugs used in the treatment of illness. “Medicine in their eyes was not a catalogue of makeshift devices to get over disease and re-establish bodily ease, but it was the synthetic facts underlying and regulating the life of [the hu]man in its varied physical, physiological and psychical aspects and stages, in a word, the science of life as a whole (Ayyar, 1946).” Caraka defines Ayurveda in this way: “The measuring (assessing) of that healthy long life (longevity) on the basis of that which is beneficial and unbeneficial to healthy life, favourable (happy) and unfavourable (sorrowful) to healthy life, the wholesome and the unwholesome to healthy life, is called Ayurveda.” Jivaka is known by Buddhists as the personal physician to the Buddha. His closeness with the Buddhism and early patronage of the faith have made him a great emulation and reverence. His practice of medicine includes some notable contributions to surgery. He was appointed in the court of Bimbisara. Compassion from a health professional is essential, and if medical treatment can decrease suffering without altering the clarity of the mind, then a treatment should not be considered futile. Suffering from illness and death, moreover, is considered by Buddhists a normal part of life and is ever-changing. Jivaka (also spelled Jeevak) was among the greatest surgeons in ancient India and in all the civilized world in antiquity (Fig 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. Birth and Early Life He was born of a courtesan who was called Salavati from the Republic of Rajgir and was the son or grandson of Bimbisara (depending on the source). Prince Abhaya found the newborn alive in unbelievably harsh circumstances and called him “Jivaka” meaning “Life” for his intense will to survive (Pierce, 2009). 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 (Now Pakistan i.e., Pothohar region of Punjab Rawalpindi). 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 (Singh, et al 2012), under the great Guru Atreya Punarvasu- Atri – Atreya - The Great Teachers As in other ancient civilizations, in India the art of healing is said to have divine origin. (Cures and Karma, 1998). 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 (Muley, 2001).” 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 (Zysk, 1998). 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. 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 (Perera,1996). 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 (Cures and Karma, 1998). 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:
1. 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
2. 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
3. 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 (Talim ). These include:
1. Surgery for fistula‑in‑ano performed on Ki Bimbisara. This is the procedure that made him famous (Ayyar, 1946). It is said that surgery for fistula‑in‑a 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
2. 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 (Banerjee, et al, 2011).
3. 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
4. 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”
5. 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 (Salguero, 2009). Massage therapists from Thailand also regard Jivaka to be the father of Thai massage (Salguero, 2011). 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.” (Buswell and Lopez, 2013) The great healer, it seems, is waiting for his own healer. Hundred years before Hippocrates was born Jivaka described the ways to diagnose ‘a patient with disease’ instead of describing a disease a patient could suffer from. Unfortunately, the West was merely aware of this legend who was regarded as one of the sixteen Arahants, who, according to Buddhism, achieved spiritual enlightenment during life time. Much of his early life is known from different religious descriptions written centuries after his death but there is a lack of scientific authentication in most cases. Jivaka is known by the Buddhists as the Personal Physician to Lord Buddha. Jivaka Kumarvaccha had dedicated his life in pursuit of truth; in union with the God in his own ways of serving Humankind. Hundred years before Hippocrates in Greece, he was instrumental to put our profession in highest regarded place (Wright, 1996). The only difference from Hippocrates was his unwillingness to establish a school for the continuation of his teaching. Perhaps this saint thought it was useless to establish his teaching separately from the divine teaching of the Lord Himself. Therefore, as the illegitimate son of a courtesan as well as the greatest Physician and Teacher of his time, Jivaka Kumarvaccha chose to remain an Arahant, or a Protector of Buddha’s physical body, rather than be identified as the Father of Medicine. Thus, Jivaka Kumarvaccha was an esteemed Physician and Surgeon, who not only served as the Personal Physician to Lord Buddha, but also left a legacy of ethical and methodical medical practice. Centuries prior to Hippocrates, Jivaka had already established fundamental principles of treatment and emphasized the separation of religion from medicine. In light of his accomplishments, we remember him as the Father of Medicine and honor his contribution to the field (Ghosh, 2023).
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