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{{#seo:

{{#seo:

|title=Mahachatushpada Adhyaya

|title=Mahachatushpada Adhyaya

|type=article

|type=article

}}

}}

<big>'''Sutra Sthana Chapter 10. The four important components of Therapeutics '''</big>

<big>'''Sutra Sthana Chapter 10. The four important components of Therapeutics '''</big>

{{Infobox

{{Infobox

|data7  = Gujarathi R., Godatwar P.

|data7  = Gujarathi R., Godatwar P.

|label8 = Editor  

|label8 = Editor  

|data8  = Dixit U., Deole Y.S., Basisht G.

|data8  = Dixit U., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication  

|label9 = Year of publication  

|data9 =  2020

|data9 =  2020

}}

}}

<big>'''Abstract'''</big>

<big>'''Abstract'''</big>

 

<p style="text-align:justify;">In the preceding chapter, four important aspects of healthcare including the standard qualities of physician, nursing staff, medicine and the patient were described. This chapter deals with guidelines for therapeutic management based on four types of prognosis of diseases. It is important to determine prognosis of a disease before starting the treatment to decide the quality of life of patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of therapeutic management of diseases. </br>

<div style="text-align:justify;">In the preceding chapter, four important aspects of healthcare including the standard qualities of physician, nursing staff, medicine and the patient were described. This chapter deals with guidelines for therapeutic management based on four types of prognosis of diseases. It is important to determine prognosis of a disease before starting the treatment to decide the quality of life of patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of therapeutic management of diseases. </div>

'''Keywords''':  Prognosis of diseases, types of prognosis, importance of prognosis in therapeutics, curable, incurable, palliable diseases

'''Keywords''':  Prognosis of diseases, types of prognosis, importance of prognosis in therapeutics, curable, incurable, palliable diseases

</div>

</p>

== Introduction ==

== Introduction ==

[[Ayurveda]] holds the view that some diseases are incurable right from the beginning and also provides the details of the factors that cause such diseases. Therefore, it is irrational to apply therapeutic measures for such diseases. However, research shows that incurable diseases such as  type-1 Diabetes mellitus (resembling with Vataja prameha) can become less severe with treatment factoring in all prognosis outcomes.  

[[Ayurveda]] holds the view that some diseases are incurable right from the beginning and also provides the details of the factors that cause such diseases. Therefore, it is irrational to apply therapeutic measures for such diseases. However, research shows that incurable diseases such as  type-1 Diabetes mellitus (resembling with Vataja prameha) can become less severe with treatment factoring in all prognosis outcomes.  

Type-1 diabetes meets all the criteria described above for incurability, like vitiation of all three ''doshas'', affliction of ten ''dushyas'' with the nature of involved ''dosha'' and ''dushya'' are same (''kapha dosha'' and ''meda dushya'') along with ''prakriti'' compatibility of patient (predominance in ''kaphaja prakriti'', like in an obese patient). Again due to genetic predisposition, ''kapha'' loses its natural characteristics, becoming liquefied and  losing its usual properties. There is vitiation of ''vata dosha'' due to depletion of all ''dhatus'', especially ''oja'' (the ultimate resultant of all seven ''dhatu'' metabolism). The pathogenesis of the disease starts with the admixture of vitiated ''kapha'' and ''meda'' and progression successively to involve other ''dhatus'' like ''mamsa, kleda'' etc. The ''dhatus'' are depleted so quickly that the body is unable to replenish it, ultimately leading to death. Thus, Diabetes Mellitus, is not merely a disease but a syndrome, proves to be fatal due to many complications like diabetic neuropathy, nephropathy, microangiopathy, cardiomyopathy, retinopathy, skin complications, as well as emergency crises such as hypoglycemic shock and diabetic ketoacidosis. There is successive involvement of all body tissues involving connective tissues, nerve tissues, muscle tissue etc, leading to severe depletion of insulin due to autoimmune degeneration of beta pancreatic cells. Genetic abnormalities cause impaired glucose, lipid and protein metabolism. Type-1 diabetes mellitus is an autoimmune disorder and destruction of body tissues by autoantibody is very fast causing loss of immune- intolerance and immune-component (''oja'') thus impairing body defense mechanism. There is disturbance in production and clearance of lipoprotein causing hampered functioning of insulin resulting in hyperglycemia and producing microvascular complications like retinopathy and nephropathy. However, for macrovascular complications, including neuropathy, pathogenesis starts before the onset of diabetes i.e. at the stage of lipid abnormalities. These factors make Type 1 Diabetes mellitus difficult to treat. The treatment consists of life-long insulin replacement by exogenous insulin. This is an example of an incurable disease although there is a lot of research work going on to find an effective remedy for this ailment.  

Type-1 diabetes meets all the criteria described above for incurability, like vitiation of all three ''[[dosha]]s'', affliction of ten ''[[dushya]]s'' with the nature of involved ''[[dosha]]'' and ''[[dushya]]'' are same (''[[kapha]] [[dosha]]'' and ''[[meda]] [[dushya]]'') along with ''[[Prakriti]]'' compatibility of patient (predominance in ''kaphaja [[prakriti]]'', like in an obese patient). Again due to genetic predisposition, ''[[kapha]'' loses its natural characteristics, becoming liquefied and  losing its usual properties. There is vitiation of ''[[vata dosha]]'' due to depletion of all ''[[dhatu]]s'', especially ''[[oja]]'' (the ultimate resultant of all seven ''[[dhatu]]'' metabolism). The pathogenesis of the disease starts with the admixture of vitiated ''[[kapha]]'' and ''[[meda]]'' and progression successively to involve other ''[[dhatu]]s'' like ''[[mamsa]], [[kleda]]'' etc. The ''[[dhatu]]s'' are depleted so quickly that the body is unable to replenish it, ultimately leading to death. Thus, Diabetes Mellitus, is not merely a disease but a syndrome, proves to be fatal due to many complications like diabetic neuropathy, nephropathy, microangiopathy, cardiomyopathy, retinopathy, skin complications, as well as emergency crises such as hypoglycemic shock and diabetic ketoacidosis. There is successive involvement of all body tissues involving connective tissues, nerve tissues, muscle tissue etc, leading to severe depletion of insulin due to autoimmune degeneration of beta pancreatic cells. Genetic abnormalities cause impaired glucose, lipid and protein metabolism. Type-1 diabetes mellitus is an autoimmune disorder and destruction of body tissues by autoantibody is very fast causing loss of immune- intolerance and immune-component (''[[oja]]'') thus impairing body defense mechanism. There is disturbance in production and clearance of lipoprotein causing hampered functioning of insulin resulting in hyperglycemia and producing microvascular complications like retinopathy and nephropathy. However, for macrovascular complications, including neuropathy, pathogenesis starts before the onset of diabetes i.e. at the stage of lipid abnormalities. These factors make Type 1 Diabetes mellitus difficult to treat. The treatment consists of life-long insulin replacement by exogenous insulin. This is an example of an incurable disease although there is a lot of research work going on to find an effective remedy for this ailment.  

Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. ''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) ''Kutaki'' (Picrorrhiza kurroa)<ref>Joy KL, Kuttan R. Anti-diabetic activity of Picrorrhiza kurroa extract.J Ethnopharmacol. 1999 Nov 1;67(2):143-8. </ref>,''Kiratatikta'' (Swertia chirata (Roxb.) Buch.-Hum <ref>Bajpai M, Asthana RK, Sharma NK, et al. Hypoglycemic effect of swerchirin from the hexane fraction of Swertia chirayita. Plant Med 1991; 57: 102-104. </ref>  <ref>Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK. Swerchirin induced  blood sugar lowering of streptozotocin treated hypoglycemic rats. Indian J Exp Biol 1993; 31:178-181.</ref>, ''Mamejjaka'' (Enicostema littorale Blume)<ref>Upadhyay UM, Goyal RK. Efficacy of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235. </ref>  <ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367. </ref>and Pterocarpus marsupium <ref>Kirana Halagappa, H.N. Girish,  B.P. Srinivasan. The study of aqueous extract of Pterocarpus marsupium Roxb. on cytokine TNF-α in type 2 diabetic rats.  Indian J Pharmacol. 2010; 42(6): 392–396. </ref>  <ref>Ahmad, F., Khalid, P., Khan, M.M., Rastogi, A.K., Kidwai J.R. Insulin-like activity in epicatechin. Acta. Diabetol. Lat. 1989. 26; 291-300. </ref>have proven to reduce blood glucose levels by modifying the prognostic factors of type 1 diabetes in experimental animals. Thus yearly detection and treatment of an incurable disorder like diabetes mellitus, by means of addressing prognostic factors at an early stage of disease, may prevent the progression of the ailment further into becoming incurable.  

Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. ''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) ''Kutaki'' (Picrorrhiza kurroa)<ref>Joy KL, Kuttan R. Anti-diabetic activity of Picrorrhiza kurroa extract.J Ethnopharmacol. 1999 Nov 1;67(2):143-8. </ref>,''Kiratatikta'' (Swertia chirata (Roxb.) Buch.-Hum <ref>Bajpai M, Asthana RK, Sharma NK, et al. Hypoglycemic effect of swerchirin from the hexane fraction of Swertia chirayita. Plant Med 1991; 57: 102-104. </ref>  <ref>Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK. Swerchirin induced  blood sugar lowering of streptozotocin treated hypoglycemic rats. Indian J Exp Biol 1993; 31:178-181.</ref>, ''Mamejjaka'' (Enicostema littorale Blume)<ref>Upadhyay UM, Goyal RK. Efficacy of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235. </ref>  <ref>Prince PS, Srinivasan M. Enicostemma littorale Blume aqueous extract improves the antioxidant status in alloxan induced diabetic rat tissues. Acta Pol Pharm 2005; 62: 363-367. </ref>and Pterocarpus marsupium <ref>Kirana Halagappa, H.N. Girish,  B.P. Srinivasan. The study of aqueous extract of Pterocarpus marsupium Roxb. on cytokine TNF-α in type 2 diabetic rats.  Indian J Pharmacol. 2010; 42(6): 392–396. </ref>  <ref>Ahmad, F., Khalid, P., Khan, M.M., Rastogi, A.K., Kidwai J.R. Insulin-like activity in epicatechin. Acta. Diabetol. Lat. 1989. 26; 291-300. </ref>have proven to reduce blood glucose levels by modifying the prognostic factors of type 1 diabetes in experimental animals. Thus yearly detection and treatment of an incurable disorder like diabetes mellitus, by means of addressing prognostic factors at an early stage of disease, may prevent the progression of the ailment further into becoming incurable.  

#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.

== References ==

== References ==