J Appl Physiol 104: 1553–1556, 2008.
First published March 20, 2008; doi:10.1152/japplphysiol.00925.2007.
Historical Perspective
Susruta of India, an unrecognized contributor to the history
of exercise physiology
Charles M. Tipton
Department of Physiology, University of Arizona, Tucson, Arizona
Archeological excavations during the 1920s in the Indus
Valley pertaining to Mohenjo-Daro (in Sind of now west
Pakistan) and Harappa (in Punjab of India) revealed the existence of an ancient Indus civilization that noted historians and
archeologists (15, 25, 32, 43) believe existed millenniums
earlier than a carbon dated value of 3300 B.C. (41). These
findings support the view that these cities existed during the
pre-Susruta era (32) (4000 –900 B.C.) while being contemporary with civilizations in Egypt, Mesopotamia, and China
(1). Excavation results and evaluations of skeletal remains
indicated Hindus living in these regions were focused on
matters of personal hygiene, public health, and sanitation
and had experienced arteriosclerosis, osteomyelitis, cancer,
metal poisoning, and infectious diseases (10). The excavations also included statues with positions that suggested the
inhabitants were familiar with the practice of yoga. With the
Aryan invasion of ⬃2000 B.C. (42), the Indus Civilization
ended but the interest in health and the concern for disease
remained.
The oldest literature in the world is found in the 1,028
sacred hymns of the Rgveda (Rig-Veda) (50 –56). Written in
Sanskrit, it includes a history of the Aryans, a view of
prehistoric times, requests for benevolence and blessings
from various mythological gods and goddesses, and divine
remedies for disease and disorders. Within select hymns was
the belief that disease occurred because of evil spirits that
originated from either a god or goddesses or from a living or
deceased enemy (53). When health was mentioned, it was
not related to disease or recovery from disease, rather it was
a condition that reflected the pleasure or displeasure of the
gods (56). It is known that a hymn in the Rgveda makes
reference to the existence of the three humors (50, p. 95)
that influence health. The dates cited for the Rgveda range
from 4000 B.C to 2500 B.C. to 1500 B.C., with the latter
date being most frequently mentioned by historians (21).
When the era of the Vedas or the Vedic Period is discussed,
a range of dates is also listed with 3000 B.C. to 1000 B.C.
being frequently recorded (19).
Of the sacred texts of India, the Atharvaveda (AtharvaVeda) contains the most detailed information dealing with
medicine, health, and disease (15, 16, 48, 49). It includes 20
books by multiple authors with 731 hymns and considered by
the Sanskrit scholar Macdonell (26, p. 185) to be a “a heterogenous collection of spells” directed against diseases, demons, foes, wizards, noxious animals, and oppressors of
Brahmns. Although all authorities agree it appeared after the
Rgveda, uncertainty reigns as to the date of origination with
1000 B.C. being selected by the majority of authors. As in the
Rgveda, diseases were associated with supernatural forces and
as a punishment for evil deeds or for sins against the gods by
individuals, their parents, or by their enemies.
During the late Vedic period (circa 1500 – 800 B.C.) the
tridosa doctrine (also known as the trihautu doctrine and
considered to be the Indian humoral theory) was formulated
and developed (3, 23). This doctrine was introduced to help
explain the meaning of life, death, health, and disease while
describing how the elements of water, fire, air, earth, and ether
contributed to the formation of the human body. Interacting
within the body were nutrient particles that were derived from
the wind, sun, and moon that became transformed into air, bile,
and phlegm and were regarded by Susruta as dosas (humors)
Address for reprint requests and other correspondence: C. M. Tipton, Dept.
of Physiology, Ina Gittings Bldg., Univ. of Arizona, Tucson, AZ 85704
(e-mail: [email protected]).
The costs of publication of this article were defrayed in part by the payment
of page charges. The article must therefore be hereby marked “advertisement”
in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
ancient history; health; humors, antiquity
LIKE PHYSIOLOGY (40), the history of exercise physiology begins
with contributions from ancient Greece and Rome (2, 29, 45).
Unfortunately, this approach ignores the information from
ancient India and the tenets of Susruta (Sushruta, an Indian
physician) concerning exercise physiology and exercise influences on human health and disease. The purpose of this
Historical Perspective is to acquaint the exercise physiology
community with India’s and Susruta’s contributions while
indicating similarities to present day concepts.
BACKGROUND INFORMATION ON ANCIENT INDIA AND THE
EXISTENCE OF SUSRUTA
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Tipton CM. Susruta of India, an unrecognized contributor to the
history of exercise physiology. J Appl Physiol 104: 1553–1556, 2008.
First published March 20, 2008; doi:10.1152/japplphysiol.00925.2007.—
When considering the history of exercise physiology, authors begin with
Hippocrates and the “Golden Age” of Greece before mentioning Galen
and the contributions from Rome. However, this approach has omitted
the information from the ancient civilizations of India which flourished
before and during the emergence of Mycenaen cultures. Specifically
ignored have been 1) the tridosa doctrine (humoral theory), which as
early as 1500 B.C., emphasized that disease occurred because of a
displacement of one or more of the three humors, with health being
achieved when the humors were in equilibrium and 2) the perspective of
Susruta (Sushruta) who was a 600 B.C. physician who included exercise
in his prescriptions to prevent and treat diseases. Susruta not only
advocated exercise to maintain equilibrium among the humors, notably
kapha, he promoted exercise to minimize the consequences of obesity
and diabetes. To be effective, exercise had to be daily and moderate in
intensity and never excessive or to exceed the half-maximum limit for
exhaustion, because disease or even death could ensue. It is concluded
that Susruta’s concepts pertaining to chronic exercise and to the health
benefits of exercise were “remarkably modern” and that future authors on
the history of exercise physiology should include contributions from
ancient India.
Historical Perspective
1554
SUSRUTA AND THE HISTORY OF EXERCISE PHYSIOLOGY
SUSRUTA AND HIS CONCEPTS PERTAINING
TO EXERCISE PHYSIOLOGY
He defined exercise as a “sense of weariness from bodily
labour and it should be taken every day” (5, p. 485). When he
J Appl Physiol • VOL
described exercise he was referring to movements associated
with walking, running, jumping, swimming, diving, or riding
and participating in sports such as archery, wrestling, and
javelin throws (5). When prescribed (he was the first physician to prescribe exercise), exercise should be moderate in
nature or to an intensity that will cause labored breathing.
However, before exercise was to be prescribed, the age,
strength, physique, and diet of the individual was to be
considered as well as the season of the year and the terrain
of the area (5).
Susruta advocated moderate exercise for ancient Indians
because it improved the growth of limbs; enhanced muscle
stoutness (mass), strength, endurance, tautness (tone), and
development; reduced corpulence; increased digestion; increased the resistance against fatigue; elevated temperatures
and thirst while improving appearances and complexions.
Moderate exercise was also advocated because it “gives the
desirable mental qualities of alertness, retentive memory, and
keen intelligence” (5, p. 40).
SUSRUTA AND HIS CONCEPTS PERTAINING TO EXERCISE,
HEALTH, AND DISEASE
Susruta believed medical practice should direct as much
effort to the prevention of disease as it devoted to curative
remedial procedure and included physical exercise within his
recommended hygienic practices. He felt regular moderate
exercise provided resistance to disease(s) and “against physical
decay” and stated “Diseases fly from the presence of a person,
habituated to regular physical exercise . . .” (5, p. 486). He
strongly opposed excessive exercises, which was interpreted to
mean continued heavy or maximal exercise (46), because it
would cause diseases and disorders such as consumption, thirst
phthisis, asthma, cachexia, hemorrhaging, vomiting, coughing,
and fever (5). It is of interest that the concept of excessive
exercise being responsible for a disease state has similarities to
a current concept that repeated bouts of strenuous exercise will
suppress the immune system leading to transient disorders of
the upper respiratory tract (34). Moreover, professional societies who advocate exercise for health reasons should incorporate this cautionary concern in their 21st century pronouncements.
Susruta was a strong advocate for the tridosa doctrine and
for the concepts that 1) disease occurred when the humors were
not in equilibrium and 2) health was present when the displaced humors had returned to resting levels. He was convinced a sedentary lifestyle that included physical inactivity,
sleeping through the day, and consuming excessive food and
fluids would sufficiently elevate the kapha humor to a level that
could disrupt humoral equilibrium resulting in a disease state
and potential death. Consequently, he included exercise in his
recommendations to prevent the occurrence of kapha diseases
(5, 22, 38).
Frequently discussed by historians is whether the tridosa
doctrine of India influenced the humoral theory of Greece
attributed to Hippocrates (460 –370 B.C.). Although Alexander the Great conquered Greece in 326 B.C. after the
death of Hippocrates and had Greek physicians within his
Army, the possibility exists but the issue remains unresolved
(15, 43).
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and identified as vayu, pitta (pittam), and kapha (kaphah),
respectably (12, 23, 38). However, Susruta considered blood to
be a fourth humor that was capable of influencing interactions
between the other humors (38).
According to the tridosa doctrine or the Indian humoral
theory, vayu, pitta, and kapha humors controlled and regulated
all functions of the body (38). When they were in equilibrium,
health was present, but if one or more humors were displaced
or deranged, health was impaired and illness and death could
occur (23, 38). In addition to disease, conditions that could
alter the equilibria between the humors were climatic changes,
select foods, fatigue, psychic changes, poisons, sedentary living, and exercise (6, 38).
Susruta’s existence is shrouded in mythology and controversy. One version has Dhanwantari, the physician to the gods
and reputed Vedic father of medicine, coming to earth to
minister to the misery and disease of mankind while extolling
them in the science of life (21). He subsequently migrates to
Benares (Varanasi) and meets Susruta as the son of Saint
Vishvamitra, a disciple of Dhanwantari, and instructs him on
the science of life and the surgery of medicine. Later, Susruta
writings were compiled into a Samhita. Another version has
Susruta being trained by Divodasa, a physician king of Varanasai (1, 4). However, this version creates more confusion
because select authorities consider Divodasa and Dhanwantari
to be the same entity.
Regardless, Susruta was a physician who taught surgery and
medicine at the university in Benares (19). With ancient India,
there is certainty in the existence of their sacred texts and of the
samhitas associated with Atreya, the world’s oldest record of
medical practice (15, 43). However, uncertainty prevails concerning their dates and whether the samhita attributed to
Susruta was from a historical figure or from different physicians using a prominent name to give credence to their views
(12, 22). When dates are listed for him, they include 1000 B.C.
(21, 32), 800 – 600 B.C. (37), 600 B.C. (27), 600 –200 B.C. (1),
200 B.C. (15), 1–100 A.D. (33), and 500 A.D. (14). Partial
resolution of these uncertainties has been achieved by findings
that 1) several Vedic hymns were dedicated to him (21), 2) his
description of the human skeleton was very similar to the one
described in the Atreya samhita (21), 3) his comments on the
skeleton were nearly identical to the words included in the
creation of man within Hymn X of the Atharvaveda (17, p.
1– 4), and 4) a critical analysis of the ancient Bower Manuscript by Hoernle demonstrated Susruta was a historical figure
during 600 B.C. (20). After commenting on what he considered
to be “absurd and amusing theories” that denied the existence
of Susruta, Professor N. H. Keswani of Anatomy at the AllIndia Institute of Medical Sciences in New Delhi wrote (4, p.
7), “Considering all the evidence available today, one comes to
the conclusion that ’the lowest limit of Sushruta’s death is fixed
as the sixth and seventh Century B.C., this being the date of the
Satapatha Brahmana, while nothing can be said about the upper
limit.” Therefore, 600 B.C. has been selected for the era of
Susruta.
Historical Perspective
SUSRUTA AND THE HISTORY OF EXERCISE PHYSIOLOGY
WHY HAVE EXERCISE PHYSIOLOGIST OMITTED
THE CONTRIBUTIONS OF SUSRUTA?
Susrutra’s contributions to medicine have been extensively
acknowledged by historians on the history of medicine (15, 35,
36, 43) and by authors of articles pertaining to urology, plastic
surgery, and ophthalmology (11, 19, 37). When the History of
Physiology (40) was published, Rothschuh began with the
contributions from Greece. However, in the United States,
exercise physiology did not evolve from physiology; rather, it
began in the classrooms and laboratories of physical educators
during the late decades of the 19th century. Even so, physical
education historians have been careful to note the contributions
from Persia, India, and China before discussing those from
Greece and Rome (18, 39, 47). Insights can be gleaned from
the publication in 1553 of the first text devoted to exercise
physiology entitled the Book of Bodily Exercise (33) by the
Spanish physician Cristobal Mendez (1500 –1541) in that only
Greek and Roman concepts were used to discuss the four
treatises emphasized within the book. Sixteen years later
(1569), the Italian physician Girolamo Mercuriale (Hieronymus Mercuralis, 1550 –1606 B.C.) published in Latin the first
text devoted to sports medicine in which sections were devoted
to exercise and its physiological concepts; but, only those that
had originated from Greece and Rome with the most coming
from Galen (31). Several hundred years later in England, or in
1807, John Sinclair discussed aspects of chronic exercise
(training) for humans and animals (45). Like others, he followed Mendez’s approach by using observations and concepts
from individuals who lived in ancient Greece and Rome
(Herodicus, Asclepiades, Celsus, Galen) plus those from the
17th century as Sir Francis Bacon and Byran Robinson (45).
Since the time of Sinclair there have been ⬃40 first edition
texts published in North America devoted to the science of
exercise physiology. Of those that contain ancient historical
J Appl Physiol • VOL
information, all begin with the contributions from Greece and
Rome.
CONCLUSION
Unlike their history of medicine counterparts, authors on the
history of exercise physiology have omitted the achievements
from ancient India. In doing so, they have missed the contributions of a 600 B.C. physician named Susruta (Sushruta;
Fig. 1) who was an ardent advocate of the tridosa doctrine
(humoral theory), which stated disease was a resultant when
one or more of the three bodily humors (dosas) was displaced
and that health occurred when they were in equilibrium. The
antiquity of the tridoasa doctrine is that it was included within
the oldest of the sacred books of India (The Rig-Veda, circa
1500 B.C.) while its importance to exercise physiology was
established by Susruta’s belief that exercise could help
prevent the diseases caused by the elevation in the kapha
humor because of lifestyles that included inactivity and
excessive consumption of food and fluid. His idea that
inactivity could lead to a disease state has similarities to the
20th century concept of the Sedentary Death Syndrome. He
was the first physician to prescribe exercise (moderate) for
health reasons and preceded Greek physicians in discouraging individuals from performing “excessive exercise” because of the propensity for health disorders. Susruta regarded diabetes and obesity as diseases and included moderate exercise within his treatment regimens. When he
described the physiological effects of chronic exercise, they
had marked similarities to those currently listed in elementary exercise physiology textbooks.
The collective conclusion is that Susruta was remarkably
modern with his ancient concepts.
Fig. 1. Susruta (Sushruta) of ancient India (circa 600 B.C.) who advocated
exercise to restore the equilibria between the dosas. Reprinted, with permission
from Ref. 41a.
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Susruta considered obesity to be a disease that was caused
by an increase in the humor vayu because of an elevation in
lymph chyle. Obesity was attributed to a sedentary lifestyle
which included “pampering his belly”; sleeping during the day,
and being adverse to taking “any sort of physical exercise” (5,
p. 135–136). As with other diseases, death could result if his
recommendations were not followed. Treatment consisted of
removing the fat that was obstructing the internal channels and
by preventing the growth of abnormal fat, which was accomplished by providing assorted medications and by prescribing
“physical exercise” (5, p. 137).
Diabetes was regarded by Susruta as a disease of the urinary
tract (prameha) and as an incurable condition (mahu-meha).
When diagnosed as prameha, its causes were either congenital
or the result of an injudicious diet, with obesity being a major
characteristic of the disease (6). Treatment included dietary
changes and participation in an exercise program that included
long walks, engaging in sports such as wrestling, and riding on
a horse or an elephant (5, p. 377).
Susruta’s sixth century B.C. concept that sedentary living
could cause obesity, diabetes, disease, and death has similarities to the 20th century concept of the Sedentary Death Syndrome of Professor Frank Booth (9, 24) in that both identified
inactivity with disease and both included physical activity
within their prevention regimens (7, 8).
1555
Historical Perspective
1556
SUSRUTA AND THE HISTORY OF EXERCISE PHYSIOLOGY
ACKNOWLEDGMENTS
With permission, this is to acknowledge that information pertaining to
ancient India and to the samhitas of Susruta were included in the APS Orr
Reynolds Award manuscript entitled “The antiquity of exercise, exercise
physiology, and the exercise prescription for health” (46a).
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