How Ancient India Set Bones: The Sushruta Samhita

By Eswar Kumar · 9 August 2026

The Sushruta Samhita, a classical Sanskrit medical treatise from ancient India, contains one of the oldest detailed systems of fracture care that survives anywhere. It names twelve kinds of bone fracture and six kinds of joint dislocation, describes how to recognise each by hand, and sets out a four-step handling sequence — pull, press, appose, bind — that any orthopaedic trainee today would recognise as reduction and immobilisation.

This is history of medicine, not medical advice. Two cautions belong at the top: the text’s date is genuinely contested, and anyone offering a single confident year is overstating the evidence; and a classical text describing something well does not make any modern practice invoking it safe or effective.

Who Sushruta was

Less is known than the confident summaries suggest. The Sushruta Samhita presents itself as the teaching of Divodasa — identified in the text with Dhanvantari, the physician-figure of Indian tradition — received and set down by a student named Sushruta at Kashi, present-day Varanasi. Whether that student was a single historical person is not established. Gerrit Jan Meulenbeld, whose survey of Indian medical literature remains the standard reference, concluded that the attribution to a historical Sushruta is generally assumed but not founded on incontrovertible evidence.

The dating is contested, and should be reported as contested. Proposals span an enormous range — from the second millennium BCE at one extreme to the sixth century CE at the other. Rudolf Hoernle argued for around 600 BCE, on an assumption about the text’s skeletal terminology that later scholarship challenged. The mainstream position, following Meulenbeld, is that the work is layered: composition of the core may have begun in the last centuries BCE, and the text reached its surviving form when a later redactor reworked the first five books and added the final one, the Uttara-tantra, some time before roughly 300–500 CE. Round figures like “600 BC” recur constantly in secondary writing, including in modern orthopaedic journals, but they are picks from a disputed range rather than settled results.

The surviving text runs to roughly 186 chapters across six books, and its scope is far wider than bones. Its anatomy is empirical and its arithmetic unfamiliar: it counts 300 bones, against the 206 of a standard adult skeleton, because it counts differently. It also enumerates 107 marma, junction points of flesh, vessel, ligament, bone and joint where injury was held to carry particular consequence — a scheme discussed in the article on marma points and bonesetting.

Bhagna: how the text classifies fractures and dislocations

Bhagna — literally “broken” — is the umbrella category for skeletal injury, divided in two: kanda-bhagna, breakage of the shaft of a bone, and sandhi-mukta or sandhi-moksha, displacement at a joint. Dislocations are given six types, fractures twelve. That division is reported consistently across translations and peer-reviewed reviews, including a 2009 survey in the Indian Journal of Plastic Surgery.

The six dislocations (sandhi-mukta), in Kaviraj Kunja Lal Bhishagratna’s translation: Utplishta, the articular ends grinding together with swelling on either side; Vishlishta, simple looseness with little swelling and constant pain; Vivartita, lateral displacement with an uneven joint; Adhah-kshipta, the bone dropping or hanging from its joint; Ati-kshipta, the bone carried away from the joint into abnormal projection; and Tiryak-kshipta, oblique displacement to one side.

The twelve fractures (kanda-bhagna) are each defined by what the bone has done, not by what caused it:

Name What the text describes
Karkataka Bulges at the middle into a knot-like shape
Ashvakarna Fragment projecting upward like a horse’s ear
Churnita Shattered into fragments
Piccita Smashed, with great swelling
Asthi-challita Covering of the bone splintered or stripped off
Kanda-bhagna Completely severed, bone projecting through the skin
Majjanugata A fragment driven in as far as the marrow
Atipatita The broken bone droops or hangs down
Vakra Bent into an arch without coming apart
Chinna One articular end severed
Patita Slightly fractured and pierced with many holes
Sphutita Cracked and swollen, painful as if stuffed with bristles

Transliterations vary — Bhishagratna’s Asthi-challita and Adhah-kshipta appear in Ayurvedic reviews as Asthichhallita and Avakshipta — but those are the same items romanised differently. What is not stable is the modern equivalents assigned to them. A 2015 review in AYUSHDHARA maps Karkataka to a depressed fracture; another maps it to a comminuted one; the text describes a knot-like bulge that is neither. The same review pairs both Churnita and Patita with “comminuted,” and both Kandabhagna and Atipatita with “complete compound.” Where you see a tidy table equating each Sanskrit term to a modern fracture category, treat the right-hand column as interpretation, not translation.

The text is frank about limits: cures “are effected with extreme difficulty” in the Churnita, Chinna, Ati-patita and Majjanugata types, and certain pelvic and skull fractures are described as beyond help. The classification carries its own list of cases not to take on.

The four-step treatment principle

The treatment chapter is Bhagna Chikitsita, the third chapter of the Chikitsasthana. Ayurvedic reviews conventionally distil its manipulative instructions into four steps, and the distillation is fair to the text:

  1. Anchhana (also anchana) — traction. Pull above and below the break to disengage and lengthen.
  2. Pidana — pressing. Local pressure to feel out and correct the displacement; the chapter separately names unnamana, raising what is depressed, and avapidana, pressing down what protrudes.
  3. Sankshepana — apposition. Bring separated or overlapping fragments back into contact, so the part is adjusted as it was before.
  4. Bandhana — binding. Immobilise with splint and bandage.

Read plainly, that is traction, manipulation, reduction and immobilisation, in that order and with a logic for the order: you cannot appose fragments you have not first disengaged, and you should not bind until you have apposed. The chapter insists on tension too — the bandage should be sadharana, moderate, neither slack nor tight, because a slack one fails to hold the reduction while a tight one brings pain, burning, ulceration and swelling. That is a recognisable description of a constricting dressing. Assessment is entirely by hand: crepitus on pressure, swelling, inability to bear touch, deformity, pain unrelieved by change of position. There is no imaging anywhere in the system, and no part of the classification substitutes for it.

Splints, bandages and materials

Here the text is unexpectedly specific. The verse on splint material instructs the surgeon to gather bark from a named set of trees — madhuka, udumbara, ashvattha, palasha, kakubha (usually identified as Terminalia arjuna), sarja and vata, the banyan — together with vamsha, bamboo. Reviews of the passage note why bark works: the inner layer is soft and cushions, the outer layer is stiff and holds.

One widely repeated detail needs correcting. The splint in this chapter is called kusha and the technique kushabandha. Kusha is also the name of a sacred grass (Desmostachya bipinnata), so many secondary summaries describe Sushruta’s splints as made of kusha grass. But the chapter’s own verse on what to collect “for the kusha” names barks and bamboo, not grass. I could not confirm grass as a splinting material from any translation of the chapter; the likelier reading is that kusha here is a technical term for the splint itself.

The dressing goes on in a set order: the limb is wrapped in cloth soaked in ghee, the splints laid over the wrapping, the bandage applied over the splints. Pastes and washes accompany it — a decoction of Rubia cordifolia, latex of the banyan, rice flour and ghee among them — with cooled decoctions poured over the part, a procedure called parisheka.

The dressing is then changed on a seasonal schedule: roughly every seven days in the cold season, every five in temperate weather, every three in hot weather, though translations differ over whether the hot-season figure is the third day or the fourth. Change more often when it is hot is a sensible response to a dressing that will macerate and sour, whatever reasoning produced it. Union times are given by age rather than by bone — about a month in the young, twice that in the middle-aged, three times in the elderly. Bandaging elsewhere in the treatise is a discipline in itself: the Sutrasthana describes fourteen named bandage forms, kosha, svastika, anuvellita and panchangi among them, matched to regions of the body, with a cross bandage specified for the dislocated shoulder.

What connects the text to today’s folk bonesetting — and what doesn’t

This is where most writing on the subject goes wrong, by implying that India’s village bonesetters are the living continuation of Sushruta and therefore carry his authority. The evidence does not support that, and the authority would not transfer even if it did.

What is genuinely shared is the shape of the method. A bonesetter who palpates a limb, applies traction, manipulates, wraps the part in a herbal paste, splints it with bamboo and rebandages it a fortnight later is doing something structurally similar to what the chapter describes — close to what the 2011 study of Puttur kattu in the Journal of Ayurveda and Integrative Medicine records Puttur practitioners doing. Both use bamboo, plant pastes and binding cloth, because those were the materials to hand.

What is not established is descent. Traditional bonesetting in India is transmitted within families by apprenticeship, not from books; the 2022 case series of South Indian bone setters in the Kansas Journal of Medicine describes the knowledge simply as “passed down within families generationally,” with no link to classical texts at all. Where a link does appear it reads as a later claim rather than a documented lineage: the Puttur family’s own origin account has its founder discovering a herb by experiment and then turning to the Sushruta Samhita before treating people — a consultation, not an inheritance. That account is set out in full in the history of Puttur kattu.

Put plainly: classical Ayurveda is codified textual medicine with colleges, examinations and state recognition in India; bonesetting lineages are folk practice, mostly unwritten and mostly unstudied. Some borrow Ayurvedic vocabulary, some do not. The relationship between the two is poorly documented — the accurate answer, not a placeholder for one. The variation among the living traditions is covered in the bonesetting traditions of India, and the wider picture in this introduction to Indian bonesetting. And even a proven descent would prove nothing clinically. A 2021 history of Indian orthopaedics in International Orthopaedics notes that bonesetting practices “can have complication rates as high as 40%” while still handling a majority of fractures in India: the antiquity and the harm coexist.

When to see a doctor

Nothing here is a reason to manage an injury yourself or to seek out any particular practitioner. Go to a hospital or a qualified doctor immediately for: a suspected fracture — visible deformity, inability to bear weight, a crack or snap at the moment of injury, severe pain over a bone; a suspected or visible dislocation; any acute trauma, including falls from height, road accidents and blows to the head, neck or spine; numbness, tingling, weakness or loss of function in a limb; a limb that is cold, pale, blue or pulseless, or pain that keeps escalating, which can mean compartment syndrome or vascular compromise, both surgical emergencies; open wounds, bone visible through skin, fever or spreading redness; loss of bladder or bowel control or severe progressive back pain. Fractures and dislocations need imaging and a clinician. A classification made by hand and eye, however sophisticated, cannot tell you what a radiograph can.

What modern orthopaedics kept

The convergence is real and worth stating precisely. Standard teaching summarises fracture management as reduce, hold, rehabilitate: restore alignment, immobilise until union, restore function. Sushruta’s anchhana–pidana–sankshepana–bandhana covers the first two of those in the same order, and closed reduction by manual traction and manipulation, followed by a splint or cast, is still first-line for a large share of fractures.

Other continuities are material. A 2025 review of the orthopaedic splint in Orthopedic Reviews places Sushruta’s bamboo splinting alongside Egyptian wooden splinting as the documented ancient origins of the device, and the design brief has not changed: something rigid, contoured, padded against the skin, secured with a bandage of moderate tension. The instructions to re-dress on a schedule and to avoid a constricting bandage would not be out of place in modern cast care.

What did not survive is as instructive. The 300-bone count is wrong by modern anatomy. The dosha framework explaining why some patients heal slowly has no counterpart in fracture biology. There is no imaging, no internal fixation, no antisepsis, no anaesthesia, and no way to detect the malunion a hands-on classification cannot see. Nothing in the text was tested in the sense that word now carries. Resemblance is not vindication: that a very old text arrived at reduction-then-immobilisation is best read as evidence that the sequence is discoverable by careful observation — several traditions found it independently — not as evidence that the rest of the system was right, and not as a warrant for anything practised in its name today.

Frequently asked questions

How old is the Sushruta Samhita?

Nobody can give a single reliable date. Scholarly proposals range from the second millennium BCE to the sixth century CE. The mainstream view is that the text is layered: the core may have begun to be composed in the last centuries BCE, and it reached its surviving form after a later redactor reworked the first five books and added the Uttara-tantra, likely before about 300–500 CE.

How many types of fracture does the Sushruta Samhita describe?

Twelve types of bone fracture (kanda-bhagna) and six types of joint dislocation (sandhi-mukta) — eighteen in all under the general heading bhagna. The fracture types are Karkataka, Ashvakarna, Churnita, Piccita, Asthi-challita, Kanda-bhagna, Majjanugata, Atipatita, Vakra, Chinna, Patita and Sphutita, each defined by the shape and behaviour of the broken bone rather than by its cause.

What are Sushruta’s four principles of fracture treatment?

Anchhana (traction), Pidana (pressing and manipulation), Sankshepana (apposition of the fragments) and Bandhana (immobilisation by splint and bandage), applied in that order. Modern teaching summarises fracture care as reduce, hold and rehabilitate; the first two stages correspond closely, which is why the sequence is so often described as anticipating modern practice.

What were Sushruta’s splints made of?

Bark and bamboo. The chapter names bark from madhuka, udumbara, ashvattha, palasha, kakubha, sarja and banyan, along with bamboo, laid over a ghee-soaked cloth wrapping and secured with a bandage of moderate tightness. The splint is called kusha in the text; despite widespread claims, the chapter’s own list of materials does not include kusha grass.

Does the Sushruta Samhita prove that traditional bonesetting works?

No, and it cannot. The text is a historical document describing what was taught and done, not evidence of outcomes; no classical text establishes efficacy or safety. There is also no documented line of descent from the treatise to today’s hereditary bonesetters, whose knowledge is transmitted by family apprenticeship rather than from books.

Sources

This article is educational history of medicine and is not medical advice. Bonesetting techniques should only be practised after supervised, in-person training and in line with the laws where you live.