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Ophthalmic surgery: a chapter in the history of Sino-Indian medical contacts1

Published online by Cambridge University Press:  05 February 2009

Vijaya Deshpande
Vijaya Deshpande
Affiliation:
Bhandarkar Oriental Research Institute.
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Extract

Although in Chinese culture surgery has not usually been seen as a major part of medical practice, during the Sui (A.D. 581–618) and the Tang dynasties (A.D. 618–907) it showed a marked flowering in the field of ophthalmology. There are indications that it was closely related to Indian medical and surgical ideas which were transmitted to China. The evidence is found in historical records, popular literature and also in medical works and compilations. Interestingly, the origins of this transmission are seen in Chinese Buddhist canonical literature which emerged during the introduction of Buddhism into China in the late Han period (A.D. 25–220) and the mutual contacts which followed immediately thereafter.

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Articles
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Bulletin of the School of Oriental and African Studies , Volume 63 , Issue 3 , January 2000 , pp. 370 - 388
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Copyright © School of Oriental and African Studies, University of London 2000

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References

2 Ophthalmology. By this word I mean a study of eye diseases and their treatment as a separate field of learning, writing and practice, not necessarily modern in its attitude and content.

3 Deshpande, Vijaya, ‘Indian influences on early Chinese ophthalmology: glaucoma as a case study’, Bsoas 62/2, (June 1999), 306–322CrossRefGoogle Scholar.

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6 Titles of Chinese and Indian medical texts are abbreviated as follows: QJYF—Beiji qianjin yaofang Important prescriptions (worth) a thousand (pieces of) gold, written by Sun Simiao, the famous medical writer of Tang times (A.D. 581–682), first published in A.D. 652. (Beijing: People's Hygiene Publications , 1987).

ZBYHL—Zhu bing yuan hou hun (A.D. 610)—‘A complete discussion of the origin and symptoms of all diseases’, written by Yuanfang, Chao of the Sui dynasty. (Guoli Zhongguo yiyao yanjiusuo Taipei, 1964)Google Scholar.

TZJLY—Tianzhu jing lun yan — An Indian Classic of Ophthalmology in WTMY—Waitai miyao–Medical secrets of an official, compiled in A.D. 752 by Tao, Wang, (Beijing: People's Hygiene Publications, 1996)Google Scholar.

LSPSYL—Longshu pusa yanlun or Bodhisattva Nāgārjuna's Treatise on Ophthalmology, in YFLJ—Yi fang lei ju, compiled in the fourteenth century A.D., first published in Korea in 1445 A.D., reprint by Dong Yang Medical College, Seoul, Korea, 1965Google Scholar.

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YHJW—Yinhai jingwei ‘The exhaustive and comprehensive survey of the silver sea’. It is falsely attributed to Simiao, Sun, and is now recognized as a text compiled sometime between A.D. 1343 and A.D. 1373. (Beijing: People's Hygiene Publications, 1956)Google Scholar; also Kovacs, Jurgen and Unschuld, Paul U. (tr. and annotated)— Essential subtleties on the silver sea: the Yinhai jing-wei: a Chinese classic on ophthalmology (Berkeley, Los Angeles and London: University of California Press, 1998)Google Scholar.

SS—Suśrutasamhitā –a famous traditional Sanskrit work (early first millennium B.C.) of which the final redaction is of the first and second centuries A.D. It deals extensively with ophthalmology in its last chapter viz. Uttaratantra (UT).

Singhal, G. D. and Sharma, K. R., Ophthalmic and Otorhinolaryngological considerations in ancient Indian surgery (Allahabad, India: Singhal Publications, 1976)Google Scholar.

AH—Asldnga Hrdayam—with Vidyotinī bhāṣāṭākā (Chaukhambha Sanskrit series, Banares, 1950)Google Scholar. The last chapter which includes diseases of the eye is Uttarasthdna (US).

7 Nāgārjuna was a famous Buddhist philosopher from South India of the second century A.D. He was the founder of the Madhyamika philosophy of the Mahāyāna school. His works have also been translated into Chinese and form a part of the Chinese Tripitaka. The same name Nāgārjuna is also associated with the expert who revised Suśrutasaṃhitā and added the Uttaratantra chapter which contains the sections on minor surgeries including that of the eye. The question of whether the two are the same person or not is clouded in controversy.

Although the medical Nāgīrjuna is considered as a later figure (fourth or fifth century A.D.) in Indian medicine, the Chinese attributed the ophthalmological works to the philosopher Nagarjuna, who was known to them a little earlier through his translated works. Hence the title ‘Bodhisattva’ in ‘Bodhisattva Nagārjuna's work on ophthalmology’. Further, Buddhist philosopher Nāgīrjuna's articles in the Tripitaka also at times mention eye diseases. See Unschuld, P. U., Medicine in China: a history of ideas (Berkeley, Los Angeles, and London: University of California Press, 1985), 144Google Scholar.

8 Ji Xianlin– Yindu yanke yishu chuanru zhongguo kao Study of the entering of Indian ophthalmological techniques into China, in Guoxue yanjiu –Researches in Chinese Studies (1994), 555.

9 Unschuld, , Medicine in China, 146Google Scholar.

10 Yi xin fang—(Renmin weisheng chubanshe)—(Beijing: People's Hygiene Publications, 1993), chapter v, 128Google Scholar.

11 Sheng ji zong lu—Comprehensive records of sagely help—(A.D. 1111–17), compiled by Xiaozhong, Cao and others (Taibei: Huagang chuban gongsi , 1978)Google Scholar.

12 Zysk, Kenneth G., Asceticism and healing in ancient India: medicine in the Buddhist monastery (Delhi: Oxford University Press, 1991)Google Scholar.

13 Tatz, Mark (tr.), ‘Buddhism and healing’: Demieville's article ‘Byo’ from Hobogirin (Lanham, NY and London: University Press of America, 1985)Google Scholar; see also Birnbaum, Raoul, The healing Buddha (London: Rider, 1980), 3Google Scholar.

14 Deshpande, Vijaya—‘Medieval transmission of alchemical and chemical ideas between India and China’, Indian Journal of the History of Science, 22/1, 1987, 15–28Google ScholarPubMed and Chinese sources for the history of Indian science, Annals of the Bhandarkar Oriental Research Institute, Vols LXXII and LXXIII (1991 and 1992), 1993, 229–242Google Scholar.

15 Takakusu, J. and Watanabe, K. (ed.), The Taishā Shinshū Daizōkyo—The Tripitaka in Chinese (Tokyo: Society for the publication of the Taishō Tripiṭaka, 1968)Google Scholar.

TT.1323—Sarvarogapraśamanidhāraṇī (A classic spell to cure all diseases) by Amoghavajra.

TT.1325—Liao zhi bing jing (A classic on the curing of diseases) Arsaprasamanasutra by Yijing who visited India between A.D. 671–96.

TT.793—Fo yi jing—Buddha's classic on medicine—by Zhu Lüyan and Zhi Yue (Vighna?).

16 TT. 1326—Zhou shi qi bing jing—A classic to exort the Qi (seasonal epidemic) diseases—by Tan Wulan of the fourth century A.D.

TT.1327—Zhou zhi jing— A classic to exort (diseases of) teeth—by Tan Wulan.

TT.1328—Zhou mu jing—A classic to exort (diseases of) eyes—Cakṣurviśodhanavidyā by Tan Wulan.

TT. 1324—Neng jing yiqie yanjibing tuoluoni jing (A classic on a spell to cure all eye diseases)—Cakṣurviśodhanavidyā by Amoghavajra.

TT.1329—Zhou xiao er jing (A classic to exort (diseases of) children)—Tan Wulan.

TT. 1330—Lo fu na shuo jiu liao xiao er ji bing jing—Rāvaṇa's (?) classic on the curing of children's diseases—Faxian, who came from Nalanda and died A.D. 1001.

TT. 131 —(A brahmin classic to avoid death) Po lo men bi si jing by An Shigao, who reached Luoyang in A.D. 147.

TT.554—Nai mu qi po jing—Jāvaka's classic on women's standard diseases—by An Shigao.

TT.620—Zhi tan bing yi yao fa (Pharmaceutical methods to cure the Tan, i.e. phlegm diseases)—Sokokyosho ∼ A.D. 457.

17 Takakusu and Watanabe, Taisho, 99, 100, 101.

18 Mark Tatz, ‘Buddhism and healing’, 90. Vairocanasūtra TT 848:2:12a cites in Chinese translation and its commentary; TT 1796:9 is given in transliterated Sanskrit.

19 See Takakusu and Watanabe, Taishō, xxi TT.1324, 490.

20 This observation makes Zysk's hypothesis somewhat doubtful that ‘Significant growth of Indian medicine took place in early Buddhist monastic establishments’ (Zysk, Asceticism and healing; see the preface and conclusion, 118). In fact, one hardly finds any deeper medical insight with respect to nosology, pathogenesis or treatment in Buddhist literature.

21 Tridosa theory. According to this theory, the body is sustained by the three elements or ‘dhātu’ which are kapha, the phlegm, vata, the wind and pitta, the bile. These are essential for the growth and maintenance of the body. A balance of the three keeps the body in a good, healthy state. An imbalance of the three, on the other hand, causes illnesses. Thus when a dhātu is rendering a n adverse effect due to its being in deficit or excess, it is called a ‘dosa’. Any illness is characterized by either one or more of the dosas. Sometimes all the three dosas together cause a disease in which case it is called as due to sannipāta or concurrence of the dosas. See Carakasaṃhitā: Sūtrasthāna, 7–39 and Vimānasthāna, 6 13. Aṣṭāṅgahṛdaya: Sūtrasthāna, 11–1 to 3, also in Suśrutasamhitā with Ḍalhaṇaṭīkā: Sūtrasthāna, 14–20.

22 Soothill, W. E. and Hodous, L., A dictionary of Chinese Buddhist terms (Delhi: Motilal Banarasidas, 1987)Google Scholar.

23 Polypus or polyp is any growth or mass of tissue projecting, usually on a stalk, from a surface, especially a mucous membrane. Polyp commonly occurs on the lining of the nose, the larynx, the intestine and the cervix of the womb. Most polyps are benign but some become malignant. Surgical removal is generally easy. Youngson, Robert M., Collins dictionary of medicine (Glasgow: Harper Collins, 1992)Google Scholar.

24 Ahmed, E., A textbook of ophthalmology (Calcutta: Oxford University Press, 1993), 181Google Scholar.

25 The brief descriptions are: Prastāri Arma (pterygium) is known to be the condition in which there is thin, spread-out tissue in the white portion of the eye having the lustre of blood with a bluish tinge. SS.UT.4.4. Lohita Arma or Ksalaja Arma (progressive pterygium) is the tissue which overgrows in the white part of the eye and which looks like a lotus. SS.UT.4.

26 Chaudhury, R. C., Netra Cikitsā Vijyana, (Varanasi, Delhi: Chaukhambha Orientalia, 1993), 167Google Scholar.

27 Singhal and Sharma, Ophthalmic and otorhinolaryngological considerations.

28 Lekhyāñjana. This is a kind of Añjana or collyrium made from the mixture of eggs, garlic, dried ginger, black pepper, pippalī (Piper longum L.), the seed of Karañja (Pongamia pinnata L.), and of cardamom, etc. SS.UT.12.25, 26.

29 Ancient Chinese—Nurou qin jing waizhang—An external obstacle due to the spoilt flesh invading the eye or Nurou pan jing— Spoilt flesh spreading over the eye. Modern Chinese—Yi zhuang nurou—Wing-shaped spoilt flesh. Sanskrit—Prastārl arma—Spoilt flesh spreading (over the eye).

30 The parts of the translated text which vividly identify the disease and/or depict parallels with the Sanskrit text, are italicized for quick comparison.

31 ZBYHL—No 11—Mu xirou yin fu hou The case of the eye with polypus (grown) excessively (on the) skin—(early stage of pterygium).

32 ZBYHL—No 38 –Ge mu hou chu tong zhi xue hou — The case of getting rid of ache and stopping the blood after the excision of the eye.

33 QJYF(1987)—Juan liu shang —Qi qiaobing shang , p. 103.

34 Various categories identified in a modern dictionary of TCM are Chi mo —Congestive pterygium, Baimo qinjing —Phlyctenular kerato conjunctivitis, Chimo xia chui —Trachomatous pannus. See Classified dictionary of traditional Chinese medicine, (Beijing: New World Press, 1994), 287Google Scholar.

35 See also Zhongyi yanke fazhan shi in Zhongyi yankexue (Beijing: People's Hygiene Publications, 1985), 1Google Scholar; and ‘A history of t he development of Chinese ophthalmology’, Chinese ophthalmology (Beijing: People's Hygiene Publications, 1985), 1Google Scholar.

36 LSPSYL—Bian zhu ban yanbingji butong sui zhuang suo liao sanshipian, , i.e., ‘To distinguish between different kinds of eye-diseases and treat them according to the symptoms—thirty essays’.

37 Gou , drive away—alleviation—Ydpana

Ge cutting—Chedana

Zhen —piercing or needling—Bhedana

Lian scraping—Lekhana

38 This method is used in SS as well; see SS.UT–15.5.

39 Changing from for ‘day’ to mu for ‘eye’.

40 The characters used are Huo zhen yun , so it appears that it was cautery in this case indeed and not just Yun lao or hot press. For Yun lao see the footnote below.

41 Maṇḍalāgra—SS also suggests the use of a curved knife which reminds one of this roundheaded comb (a needle-like instrument?) mentioned in LSPSYL.

42 LSPSYL—Gou ge ji zhen lian fa, 201.

43 SS.UT.15–8, AH.US.11–18.

44 Huade, Pi and Tao, Li, ‘Ophthalmology in traditional Chinese medicine’, Chinese Medical Journal, 77 (1958), 269Google Scholar.

45 Although Longmu zonglun was written before Sheng ji zong lu (A.D. 1111–17), new material was continuously added to it. This book, Baoguang daoren mizhuan yanke longmu zonglun (BGDRMZYKLMZL) as it is available today, has as its seventh section, San yin zheng zhi , a part from a northern Song text by Chen Yan of 1174 A.D. viz. San yin ji yi bing zheng fang lun . It further contains ‘One hundred and one selected prescriptions (A.D. 1196) by scholars of the southern Song period. Volume VIII describes acupuncture and moxibustion; volumes ix and x are largely occupied with a discussion on the function of medicine. Further, there is material from the northern Song Dynasty, Ben shi fang of A.D. 1132. The earliest material is from Mo Hong (A.D. 261–341), and the latest is from Yu yao yuan fang — ‘Prescriptions of the imperial medicinal plant garden’ (A.D. 1266). This title was first seen in the Wan li period of the Ming Dynasty (A.D. 1575). Thus it gave rise to Michuan yanke longmu zonglun in the sixteenth century A.D. Baoguang daoren yanke longmu ji has material from Taiping sheng hui fang (the contents of which are discussed in northern Song Dynasty' Ben shi fang of A.D. 1132). Thus Baoguang daoren mizhuan yanke longmu lun contains the whole of LMZL as well as Bao guang dao ren yan ke long mu ji and some later additions.

46 Yun lao. These are the characters used to describe the process. Yun fa —Hot compression with rubbing—A therapeutic measure of pressing and rubbing the diseased area with hot medical substances wrapped in cloth. Lao fa cauterization. With yun lao perhaps the author does not mean cautery, but only hot-pressing with medicinal drugs. This interpretation is consistent with the treatment given in the Indian text.

47 LMZL—No 27—Nurou qinjing waizhang —The external obstacle due to the spoilt flesh invading the eye.

48 LMZL—No 31—Jiguan xian rou waizhang .

49 See LSPSYL No 8 in the main text above. Chen Ming ju , Yanke wenxian chukao —A preliminary study of ophthalmological literature, in Journal of Shan Dong Medical Institute (1981), 48.

50 Ahmed, , A textbook of ophthalmology, 145Google Scholar.

51 Tarsal—Pertaining to the fibrous skeleton of the eye lid.

52 SS.UT.16.3–9.

53 WTMY (1996), 583.

54 LSPSYL, No 21.

55 LMZL, No. 44—Daojie quanmao waizhang —An external obstacle (of the eye) with inverted eyelash and inturned hair (of the eyelash)—Entropion.

56 Parker, Peter, ‘First quarterly report (fourth November 1835 to fourth February 1836)’, The Chinese Repository, 4, 461Google Scholar. Cullen, Christopher, ‘Yale on China'Parker and Hume on Chinese medicine’, in Hashimoto Keizo, Catherine Jami and Lowell Skar, East Asian science: tradition and beyond. Papers from the seventh international conference on the history of science in East Asia, Kyoto, 2–7 August 1993 (Osaka: Kansai University Press, 1995), 359Google Scholar.

57 Zhongyi yankexue fazhan jianshi —A simple history of the development of Chinese ophthalmology, in Zhongyi yankexue—A study of Chinese ophthalmology (Beijing: People's Hygiene Publications, 1985), 1Google Scholar.

58 WTMY (1996), 563.

59 It was understood by the Indian doctors that only particular kinds of cataract are easily curable by surgical treatment, and others are not, as indicated in the following verse of SS: ‘I shall now describe the surgical procedure employed for the successful treatment of Kaphaja Liṅganāśa (‘Cataract formed due to the imbalance of kapha or phlegm.’ It appears that the ancient Indians identified mature cataract in this way), which is the case when the affliction situated in the lens does not appear semilunar, or does not resemble a sweat drop or a pearl in appearance. It should neither be fixed, irregular, thin in the middle, striated or excessively shining nor be associated with pain or redness.’ SS.UT–17.55, 56.

The author of Aṣṭāṅgahṙdaya differentiated the mature and immature cataract in the following way:

The Kaphaja Liṅganāśa which has developed and matured well, and which does not have complications like Āvartakī, should be pierced.

If a Liṅganāśa (cataract) has not matured well, then it is irregular, thin and whey-like, it comes up even after being dragged down with a needle, is very painful, and covers the pupil again. AṣṭāngahṛdaỴam (AH.US–14.1, 2, 3).

Further, AH differentiates various kinds of immature cataracts and names them according to their physical appearances:

Āvartaki—moving, slightly red and black.

Śārkara—white and granular

Rājimatī—striated

Chinnāmśuka—broken

Candrakī—moon-shaped and shining like bronze

Chattrakī— umbrella-shaped, multicoloured or bluish AH.US–14.5, 6, 7

60 Cataract opacities which are powdery, ice-like, moon-shaped, etc., are described in the second Nagārjuna text viz. LMZL, which remind one of those in SS/AHS.

61 It is possible that the Sanskrit word kapha is erroneously replaced by medā (fat) by some writer or copier and further by medhā (brain fluid) by the Chinese translator. Thus accumulation of kapha in the eye is replaced by that of ‘brain-fluid’ in Chinese texts.

62 SS.UT.17–71.

63 SS Sārīrasthāna—8–3.

64 LSPSYL, Kai neizhang yan yong zhen fa— .

65 AH.US 14–9.

66 SS.UT. 17–60.

67 SS.UT. 17–58, 59—‘leaving the black pupil and two-third' of the white part of the eye from the pupil side and one-third part from the canthus, leaving out the blood vessels, not much above and not much below, or not at the back, i.e., in the central part, incise the needle in the pore which is natural.’

68 AH.US 14–21.

69 SS.UT. 17–64 to 68; AH.US.14–13 to 21.

70 LSPSYL, Liao yan hou jin ji zhen hu .

71 SS.UT, 19–1 to 8 also: ‘A rough needle produces pain, an uneven one scatters dosha all over, a thick-ended one produces a wider hole, a sharp-pointed one may produce multiple injuries, an irregular one causes watery discharge, and an unstable one causes difficulty in operation. Therefore a śalākā (needle) which is free from these defects is useful. SS.UT. 17–82 to 84.

72 ‘Gently enter the needle, do not let it pass heavily in, also do not let it pass in very lightly, moreover it should be heavy after entering. If the head of the needle is slanted it will cause damage, if the needle harms the blood vein then blood will come out with the needle, if the blood does not stop then it should be looked upon as a big failure’.

73 SS.UT.—17.85–6.

74 LSPSYL Kai neizhang yan yong zhen fa .

75 SS also stresses this point in SS.UT. 17–71.

76 YHJW (1956), 108.

77 YHJW (1956), 109.

78 Unschuld, Medicine in China, 82, 403.

79 LSPSYL—in Kai neizhang yan yong zhen fa, see .

80 Incidentally, it was a little after the time of Amoghavajra, Yijing and Xuanzang mentioned earlier.

81 In Nei jing there were two theories which attempted to explain the working of an eye and the etiology of eye diseases. They were—Wu lun, i.e., five wheels theory and Ba kuo, i.e., eight outer boundaries theory. Various parts of the eye were related to various internal (i.e., the Zang and Fu) organs. Thus it seems that the eye was not considered as an individual organ of the bodybut related to the major organs viz. Wu zang, on which its functioning or health depended. Any kind of imbalance in the Yin and Yang forces and the vital energy Qi was supposed to cause illnesses in the corresponding parts of the eye. Therefore the treatment of eye diseases involved treating the respective organs by counteraction. For example, if the illness is caused by excess heat then cold medicines which expelled heat were prescribed. As a result of the predominance of medical philosophy which explained the evolution of diseases in terms of the malfunctioning of the internal organs, the field of surgery did not develop in early Chinese medicine.

82 Sontag, Susan, Illness as metaphor and Aids and its metaphors (New York and London: Doubleday, 1990)Google Scholar.