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|title=Mahachatushpada Adhyaya

|title=Mahachatushpada Adhyaya

|titlemode=append

|titlemode=append

|keywords=Prognosis of diseases, types of prognosis, importance of prognosis in therapeutics, curable, incurable, palliable diseases

|keywords=Prognosis of diseases, types of prognosis, the importance of prognosis in therapeutics, curable, incurable, palliable diseases

|description=Sutra Sthana Chapter 10. The four important components of Therapeutics

|description=Sutra Sthana Chapter 10. The four important components of Therapeutics

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=== Introduction ===

== Introduction ==

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This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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We shall now expound a detailed chapter on the four important components of therapeutics. Thus, said Lord Atreya.[1-2]

We shall now expound a detailed chapter on the four important components of therapeutics. Thus, said Lord Atreya.[1-2]

==== Four components of therapeutics ====

=== Four components of therapeutics ===

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According to physicians, therapeutics has four components which have sixteen qualities. The same has been stated in the preceding chapter, therapeutics with these sixteen qualities have the capacity to eliminate diseases, so said Lord Punarvasu Atreya.[3]

According to physicians, therapeutics has four components which have sixteen qualities. The same has been stated in the preceding chapter, therapeutics with these sixteen qualities have the capacity to eliminate diseases, so said Lord Punarvasu Atreya.[3]

==== Maitreya’s Observation and Query ====

=== Maitreya’s Observation and Query ===

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==== Reply by Atreya ====

=== Reply by Atreya ===

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==== General Principles of Management ====

=== General Principles of Management ===

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And we see with our own eyes that we cure a patient by taking a recourse to curative therapeutic measures- the depleted body elements by increasing them. We give nourishment to those who are weak and emaciated. We administer reducing therapy to the one who is obese. We treat patients afflicted by heat with cooling measures and the one afflicted by cold with heating measures. We adopt proper measures to replenish the deficient ''dhatus'' (tissue elements, ''doshas'' and ''malas'') and deplete those that are in excess. We thus bring back the physiological state by treating the diseases with those having opposite properties of causative factors. Thus the group of therapeutic measures gives us the best result in the management of diseases. [6]

And we see with our own eyes that we cure a patient by taking a recourse to curative therapeutic measures- the depleted body elements by increasing them. We give nourishment to those who are weak and emaciated. We administer reducing therapy to the one who is obese. We treat patients afflicted by heat with cooling measures and the one afflicted by cold with heating measures. We adopt proper measures to replenish the deficient ''dhatus'' (tissue elements, ''doshas'' and ''malas'') and deplete those that are in excess. We thus bring back the physiological state by treating the diseases with those having opposite properties of causative factors. Thus the group of therapeutic measures gives us the best result in the management of diseases. [6]

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==== Importance of Determination of Prognosis ====

==== Consequences of treatment after knowing prognosis ====

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# The disease having bad prognostic signs. [19-20]

# The disease having bad prognostic signs. [19-20]

==== Importance of prognosis ====

=== Importance of prognosis ===

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A wise physician should examine the distinctive features of the diseases first and then start his treatment (only) of the curable diseases. So a physician who can distinguish between curable and incurable diseases, and who possesses the right applications, will not subscribe to the wrong notions prevailing among pseudo- physicians like Maitreya, and say that he will certainly succeed in curing diseases. [21-22]

A wise physician should examine the distinctive features of the diseases first and then start his treatment (only) of the curable diseases. So a physician who can distinguish between curable and incurable diseases, and who possesses the right applications, will not subscribe to the wrong notions prevailing among pseudo- physicians like Maitreya, and say that he will certainly succeed in curing diseases. [21-22]

==== Summary ====

=== Summary ===

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Thus ends the tenth “Detailed chapter on four important components of the Therapeutics” chapter of Sutra section of Agnivesha’s work as redacted by Charak.[10]

Thus ends the tenth “Detailed chapter on four important components of the Therapeutics” chapter of Sutra section of Agnivesha’s work as redacted by Charak.[10]

=== ''Tattva Vimarsha'' / Fundamental Principles ===

== ''Tattva Vimarsha'' / Fundamental Principles ==

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# Proper administration of therapeutic measures hastens the process of cure in case of curable diseases. Therefore, correct diagnosis and prognosis at the earliest by the physician is important for getting better results with treatment. [5]

# Proper administration of therapeutic measures hastens the process of cure in case of curable diseases. Therefore, correct diagnosis and prognosis at the earliest by the physician is important for getting better results with treatment. [5]

A wise physician should always consider above factors to determine prognosis of a disease and then start treatment. [21]

A wise physician should always consider above factors to determine prognosis of a disease and then start treatment. [21]

=== ''Vidhi Vimarsha'' / Applied Inferences ===

== ''Vidhi Vimarsha'' / Applied Inferences ==

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In contemporary medical system, the curable and incurable signs and symptoms of diseases are well understood but the criteria for deciding the prognosis are different than [[Ayurveda]]. There is availability of advanced technology in the form of imaging, biochemical, immunological, molecular and genetic studies etc. for diagnosis and assessment of prognostic factors of diseases.

In contemporary medical system, the curable and incurable signs and symptoms of diseases are well understood but the criteria for deciding the prognosis are different than [[Ayurveda]]. There is availability of advanced technology in the form of imaging, biochemical, immunological, molecular and genetic studies etc. for diagnosis and assessment of prognostic factors of diseases.

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=== Future Scope for Research ===

== Future Scope for Research ==

#Research studies should be conducted to assess the impact of modern medical facilities , geared with sophisticated medical infrastructure, skilled nursing staff, and features to handle emergency services,  in controlling the mortality and morbidity of a disease.  

#Research studies should be conducted to assess the impact of modern medical facilities , geared with sophisticated medical infrastructure, skilled nursing staff, and features to handle emergency services,  in controlling the mortality and morbidity of a disease.  

#Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

#Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

=== Glossary of Technical Terms ===

== Glossary of Technical Terms ==

#चतुष्पादं catuShpAdaM- Four limbs(four essential components) of therapeutics viz, Physician, Medicine, Attendant and  Patient.

#चतुष्पादं catuShpAdaM- Four limbs(four essential components) of therapeutics viz, Physician, Medicine, Attendant and  Patient.

#Leenadoshävasthä- Concealed and Opportunistic dosha. The abnormal state of the vitiated dosha in they become concealed in the body channels and remain opportunistic to cause abnormality in the body in presence of a favorable condition.

#Leenadoshävasthä- Concealed and Opportunistic dosha. The abnormal state of the vitiated dosha in they become concealed in the body channels and remain opportunistic to cause abnormality in the body in presence of a favorable condition.

=== Reference ===

== Reference ==

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