In the standard, printed edition or vulgate text of the Suśrutasaṃhitā, chapter ten of the Sūtrasthāna is dedicated to the topic of becoming a professional physician . The title of the chapter is interesting: “how to enter the roadway,” (विशिखानुप्रवेशनीयमध्यायम्). Commentators and dictionaries interpret the word विशिखा to mean “path, road.” This sense is not common in Sanskrit literature although it is known to lexicographers and also in Pāli (Vinayapiṭaka, Jātaka) and in Sinhalese . (See also SS 3.10.9 for viśikhāntaram “interior of the road,” i.e., vaginal passage. The lexeme śikhā is a loan word in Sanskrit .)
The fourth passage of the chapter, describes how a physician takes note of omens on the way to a patient’s home, and then how he diagnoses the patient:
Then he should approach the house of the sick person according to the favourableness of the messenger, the reason given, omens, and good-luck signs. After sitting down, he should have a good look at the sick person, he should palpate them and interrogate them. Diseases are mostly understandable through these three means of gaining knowledge. That is what some people say, but it is not correct. There are six means of gaining knowledge about diseases, i.e., by the five senses, hearing etc., and by interrogation.
दूतनिमित्तशकुनमङ्गलानुलोम्येनातुरगृहमभिगम्य, उपविश्य, आतुरमभिपश्येत्स्पृशेत्पृच्छेच्च; त्रिभिरेतैर्विज्ञानोपायै रोगाः प्रायशो वेदितव्या इत्येके; तत्तु न सम्यक्, षड्विधो हि रोगाणां विज्ञानोपायः, तद्यथा — पञ्चभिः श्रोत्रादिभिः प्रश्नेन चेति ।। ४ ।।|
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As we see, the text first proposes a three-part method of diagnosis and then immediately distances itself from that statement and provides a different six-part procedure. One has the sense of hearing two voices.
Who were the “some people” being referred to? The three-part diagnostic procedure is found in the Carakasaṃhitā (Ca.ci.25.22 ) . For that reason, this passage has been taken as evidence that the authors of the Suśrutasaṃhitā knew the Carakasaṃhitā and were responding to it . This is one of the pieces of evidence that is used to argue that the Suśrutasaṃhitā is chronologically later than the Carakasaṃhitā.
In the Nepalese version of the Suśrutasaṃhitā, however, the passage is much simpler and omits this second, distancing, voice:
Then, arriving at the house of the sick person according to the favourableness of the messenger, the reason given, omens, and good-luck signs, he should sit down. Then, he should have a good look at the sick person, he should palpate them and interrogate them. Through these three means of gaining knowledge it can be known whether life will be long or life will be short.
ततो दूतनिमित्तशकुनमङ्गलानुलोम्येनातुरगृहमागम्योपविश्यातुरमभिपश्येत्स्पृशेच्च त्रिभिरेतैर्विज्ञानोपायैः दीर्घमायुषोल्पायुषो वेदितव्यः।
Thus, the passage referring to the Carakasaṃhitā is absent.
Luckily, for this part of the Suśrutasaṃhitā, the learned commentary of Cakrapāṇidatta (fl. 1075) survives. It was edited and published in 1939 by Yādavaśarman T. Ācārya. Commenting on the passage, Ācārya stated that this extra passage was not known to Cakrapāṇidatta (अयं पाठश्च चक्रासंगतः) . Thus, we can say that it was added to the text of the Suśrutasaṃhitā some time between the oldest Nepalese manuscript (878 CE) and Cakrapāṇidatta’s time, i.e., the eleventh century.
The fact that this reference to the Carakasaṃhitā is not present in the early Nepalese version of the Suśrutasaṃhitā means that this argument about the Carakasaṃhitā‘s chronological priority cannot be sustained.