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Chikitsaprabhritiya Adhyaya (view source)

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|title=Chikitsaprabhritiya Adhyaya

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|titlemode=append

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|keywords=Chikitsaprabhrita (equipped physician), bahudosha (signs of aggravated dosha), samshodhana (purification therapy), vishuddha koshtha (purified bowel), svabhavoparamavada (theory of natural destruction),Panchakarma, patient care, assessment criteria of purification,Ayurveda, Indian system of medicine, charak samhita.

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|description=Sutra Sthana Chapter 16. Assessment and care in Panchakarma therapies

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=carak samhita

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|type=article

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}}

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<big>'''Sutra Sthana Chapter 16. Assessment and care in [[Panchakarma]] therapies'''</big>

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

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<div style="text-align:justify;">Meaning of title of this chapter describes its subject about approaching the conditions arise during therapies. The assessment of correct and incorrect administration of therapeutic procedures, along with its treatment interventions are described in this chapter. It also enlists indications for therapeutic intervention and their benefits with details of post therapeutic dietary management. The applicability of svabhavoparamvada (i.e. theory of natural destruction of causative factors of disease) is discussed in this chapter, that emphasizes need of therapeutic interventions for fast recovery to health. </div>

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'''Keywords''': ''Chikitsaprabhrita'' (equipped physician), ''bahudosha'' (signs of aggravated ''dosha''), ''samshodhana'' (purification therapy), ''vishuddha koshtha'' (purified bowel), ''svabhavoparamavada'' (theory of natural destruction),[[Panchakarma]], patient care, assessment criteria of purification.

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~~</div>~~

{{Infobox

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|label5 = Other Sections

|data5 = [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|data6 = Murthy A.R.V., Magare R.

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|label7 = Reviewer

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|data7 = Galib, Sabnis M.

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|label8 = Editors

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|data8 = Mangalasseri P., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s01.018 10.47468/CSNE.2020.e01.s01.018]

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}}

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

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<div style="text-align:justify;">This chapter describes the management of conditions arising during therapies. The assessment of correct and incorrect administration of therapeutic procedures, along with its treatment interventions are described. It also enlists indications for therapeutic intervention and their benefits with details of post therapeutic dietary management. The applicability of the theory of natural destruction of causative factors of disease (svabhavoparamvada) is discussed, that emphasizes need of therapeutic interventions for fast recovery to health. </div>

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'''Keywords''': Chikitsaprabhrita(equipped physician), bahudosha (signs of aggravated [[dosha]]), samshodhana (purification therapy), vishuddha koshtha (purified bowel), svabhavoparamavada (theory of natural destruction),[[Panchakarma]], patient care, assessment criteria of purification.

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</div>

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}}

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=== Introduction ===

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== Introduction ==

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A continuation of the preceding [[Upakalpaniya Adhyaya]] ~~and elaboration~~ on the remaining aspects of purification processes and their prerequisites which were not fully dealt there.The word ''prabhrita'' is derived from the verbal root ''bhr'' which suggests the sense of supporting, nourishing and offering. ~~Thus~~, ''chikitsaprabhrita'' is applied to mean that physician who is well equipped in terms of qualities and instruments and who can play proper supporting role in the management of diseases. The chapter emphasizes upon the need for a proficient and well equipped physician to ensure flawless treatment. The patient is also expected to be intelligent enough to be able to identify a good physician. The word ''virechana'' is used often for ''vamana'' and ''samshodhana'' as well. Clinical features of ''samyak yoga'' (appropriate application of a procedure), ''ayoga'' (under application) and ''atiyoga'' (over application), and their management, have also been described. Diseases, their therapeutic response (so that they do not reoccur) and management of post-therapy cachexia have also been addressed in this chapter. ''Svabhavaparamavada'' is a phenomenon of natural destruction of health and disease. There is a continuous process of degeneration and regeneration of body tissues. The process of regeneration is known to great extent but the cause of degeneration and death is not known.

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In continuation of the preceding [[Upakalpaniya Adhyaya]] this chapter elaborates on the remaining aspects of purification processes and their prerequisites which were not fully dealt there.The word ''prabhrita'' is derived from the verbal root ''bhr'' which suggests the sense of supporting, nourishing and offering. The term, ''chikitsaprabhrita'' is applied to mean that physician who is well equipped in terms of qualities and instruments and who can play proper supporting role in the management of diseases. The chapter emphasizes upon the need for a proficient and well equipped physician to ensure flawless treatment. The patient is also expected to be intelligent enough to be able to identify a good physician. The word [[virechana]] is used often for [[vamana]] and ''samshodhana'' as well. Clinical features of ''samyak yoga'' (appropriate application of a procedure), ''ayoga'' (under application) and ''atiyoga'' (over application), and their management, have also been described. Diseases, their therapeutic response (so that they do not reoccur) and management of post-therapy cachexia have also been addressed in this chapter. ''Svabhavaparamavada'' is a phenomenon of natural destruction of health and disease. There is a continuous process of degeneration and regeneration of body tissues. The process of regeneration is known to great extent but the cause of degeneration and death is not known.

</div>

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

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==Sanskrit text, Transliteration and English Translation==

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अथातश्चिकित्साप्राभृतीयमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaścikitsāprābhr̥tīyamadhyāyaṁ vyākhyāsyāmaḥ||1||

Line 43: Line 69:

iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

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Now, we shall expound the chapter ~~on the “Duties of a qualified physician~~.” [1-2]

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Now we shall expound the chapter "Chikitsaprabhritiya" (Assessment and care in [[Panchakarma]] therapies).” Thus said Lord Atreya.[1-2]

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चिकित्साप्राभृतो धीमान् शास्त्रवान् कर्मतत्परः|

Line 51: Line 79:

यं वैद्यमानी त्वबुधो विरेचयति मानवम्|

सोऽतियोगादयोगाच्च मानवो दुःखमश्नुते||४||

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cikitsāprābhr̥tō dhīmān śāstravān karmatatparaḥ|

Line 63: Line 92:

yaM vaidyamAnI tvabudho virecayati mAnavam|

so~atiyogAdayogAcca mAnavo duHkhamashnute||4||

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</div></div>

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A qualified physician is the one who is well acquainted with the principles of treatment, is learned and skilled in the practice of Ayurveda, and is known for promptness of action. A patient obtaining treatment in the form of emesis or purgation from such a physician, becomes healthy and attains happiness. On the other hand, if the patient receives treatment from a pretentious & ignorant physician, he subjects himself to potential complications because of excessive or inadequate treatment. [3-4]

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A qualified physician is the one who is well acquainted with the principles of treatment, is learned and skilled in the practice of [[Ayurveda]], and is known for promptness of action. A patient obtaining treatment in the form of emesis or purgation from such a physician, becomes healthy and attains happiness. On the other hand, if the patient receives treatment from a pretentious & ignorant physician, he subjects himself to potential complications because of excessive or inadequate treatment. [3-4]

</div>

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==== Signs of proper purification ====

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=== Signs of proper purification ===

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दौर्बल्यं लाघवं ग्लानिर्व्याधीनामणुता रुचिः|

Line 73: Line 105:

बुद्धीन्द्रियमनःशुद्धिर्मारुतस्यानुलोमता|

सम्यग्विरिक्तलिङ्गानि कायाग्नेश्चानुवर्तनम् ||६||

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daurbalyaṁ lāghavaṁ glānirvyādhīnāmaṇutā ruciḥ|

Line 85: Line 118:

buddhIndriyamanaHshuddhirmArutasyAnulomatA|

samyagviriktali~ggAni kAyAgneshcAnuvartanam ||6||

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</div></div>

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Weakness, lightness, fatigue, attenuation of diseases, improved taste perception, restoration of the functioning of heart, improved complexion, proper appetite and thirst, timely passage of natural urges, feeling of cleanliness in intellect, sense organs and mind, proper movement of ''vata'', and proper digestion (including metabolic activities) are the signs and symptoms of correctly administered purification therapy. [5-6]

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Weakness, lightness, fatigue, attenuation of diseases, improved taste perception, restoration of the functioning of heart, improved complexion, proper appetite and thirst, timely passage of natural urges, feeling of cleanliness in intellect, sense organs and mind, proper movement of [[vata]], and proper digestion (including metabolic activities) are the signs and symptoms of correctly administered purification therapy. [5-6]

</div>

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==== Signs of inadequate purification ====

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=== Signs of inadequate purification ===

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ष्ठीवनं हृदयाशुद्धिरुत्क्लेशः श्लेष्मपित्तयोः|

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जङ्घोरुसदनं तन्द्रा स्तैमित्यं पीनसागमः|

लक्षणान्यविरिक्तानां मारुतस्य च निग्रहः||८||

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ṣṭhīvanaṁ hr̥dayāśuddhirutklēśaḥ ślēṣmapittayōḥ|

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ja~gghorusadanaM tandrA staimityaM pInasAgamaH|

lakShaNAnyaviriktAnAM mArutasya ca nigrahaH||8||

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</div></div>

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Spitting or drooling, abnormal functioning of heart, precipitation (''utklesha'') of ''shleshma'' and ''pitta'', distension of abdomen , anorexia, vomiting, debility, absence of lightness (heaviness or sluggishness), laxity in calf muscles and thighs, drowsiness , feeling as if covered with a wet hide (''staimitya''), onset of rhinitis and impediment to the function of ''vata'' are the signs and symptoms of inadequate purification. [7-8]

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Spitting or drooling, abnormal functioning of heart, precipitation (''utklesha'') of ''shleshma'' and [[pitta]], distension of abdomen , anorexia, vomiting, debility, absence of lightness (heaviness or sluggishness), laxity in calf muscles and thighs, drowsiness , feeling as if covered with a wet hide (''staimitya''), onset of rhinitis and impediment to the function of [[vata]] are the signs and symptoms of inadequate purification. [7-8]

</div>

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==== Signs of excess purification therapy ====

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−

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=== Signs of excess purification therapy ===

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विट्पित्तकफवातानामागतानां यथाक्रमम्|

परं स्रवति यद्रक्तं मेदोमांसोदकोपमम्||९||

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निःश्लेष्मपित्तमुदकं शोणितं कृष्णमेव वा|

तृष्यतो मारुतार्तस्य सोऽतियोगः प्रमुह्यतः||१०||

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viṭpittakaphavātānāmāgatānāṁ yathākramam|

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niHshleShmapittamudakaM shoNitaM kRuShNameva vA|

tRuShyato mArutArtasya so~atiyogaH pramuhyataH||10||

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</div></div>

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Elimination of feces, ''pitta, kapha,'' and ''vata'' in succession, excessive discharge of blood that looks like fat and flesh (washed), supernatant water or watery excretion of black colored blood without ~~''shleshma''~~ and ''pitta'', excessive thirst affliction with vitiated ''vata'' and fainting are the signs and symptoms of overpurgation. [9-10]

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Elimination of feces, [[pitta]], [[kapha]], and [[vata]] in succession, excessive discharge of blood that looks like fat and flesh (washed), supernatant water or watery excretion of black colored blood without [[kapha]] and [[pitta]], excessive thirst affliction with vitiated [[vata]] and fainting are the signs and symptoms of overpurgation. [9-10]

</div>

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वमनेऽतिकृते लिङ्गान्येतान्येव भवन्ति हि|

ऊर्ध्वगा वातरोगाश्च वाग्ग्रहश्चाधिको भवेत्||११||

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चिकित्साप्राभृतं तस्मादुपेयाच्छरणं नरः|

युञ्ज्याद् य एनमत्यन्तमायुषा च सुखेन च||१२||

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vamanē'tikr̥tē liṅgānyētānyēva bhavanti hi|

Line 149: Line 197:

cikitsAprAbhRutaM tasmAdupeyAccharaNaM naraH|

yu~jjyAd ya enamatyantamAyuShA ca sukhena ca||12||

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</div></div>

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In case of excessive administration of emesis, the symptoms are identical to that observed in the case of purgation. In addition, overemesis may result in diseases of ''vata'', affecting the upper part of the body and also causing impediment of speech. One should therefore approach such a qualified and well-versed physician for the administration of any purification therapy. [11-12]

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In case of excessive administration of emesis, the symptoms are identical to that observed in the case of purgation. In addition, overemesis may result in diseases of [[vata]], affecting the upper part of the body and also causing impediment of speech. One should therefore approach such a qualified and well-versed physician for the administration of any purification therapy. [11-12]

</div>

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==== Signs of excess aggravated ''dosha'' and indications of purification therapy ====

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=== Signs of excess aggravated [[dosha]] and indications of purification therapy ===

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अविपाकोऽरुचिः स्थौल्यं पाण्डुता गौरवं क्लमः|

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बहुदोषस्य लिङ्गानि तस्मै संशोधनं हितम्|

ऊर्ध्वं चैवानुलोमं च यथादोषं यथाबलम्||१६||

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avipākō'ruciḥ sthaulyaṁ pāṇḍutā gauravaṁ klamaḥ|

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bahudoShasya li~ggAni tasmai saMshodhanaM hitam|

UrdhvaM caivAnulomaM ca yathAdoShaM yathAbalam||16||

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</div></div>

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Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (''utklesha'') of ''kapha'' and ''pitta'', sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion in spite of taking nourishing diet and right therapy are the signs and symptoms of patients having excess of morbid ~~doshas~~. An experienced, skilled physician would advise and administer purification therapy taking into consideration the ''dosha'' status and strength of the patient . [13-16]

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Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (''utklesha'') of [[kapha]] and [[pitta]], sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion in spite of taking nourishing diet and right therapy are the signs and symptoms of patients having excess of morbid [[dosha]]. An experienced, skilled physician would advise and administer purification therapy taking into consideration the [[dosha]] status and strength of the patient . [13-16]

</div>

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==== Benefits of purification therapy ====

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=== Benefits of purification therapy ===

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एवं विशुद्धकोष्ठस्य कायाग्निरभिवर्धते|

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जरां कृच्छ्रेण लभते चिरं जीवत्यनामयः|

तस्मात् संशोधनं काले युक्तियुक्तं पिबेन्नरः||१९||

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ēvaṁ viśuddhakōṣṭhasya kāyāgnirabhivardhatē|

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jarAM kRucchreNa labhate ciraM jIvatyanAmayaH|

tasmAt saMshodhanaM kAle yuktiyuktaM pibennaraH||19||

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</div></div>

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Administration of therapies, leading to elimination of vitiated ~~''doshas''~~, results in the following effects: enhancement of digestion / metabolism, pacification of diseases, restoration of normal health, improvement in clarity of sense organs, mind, intellect and complexion, promotion of strength, plumpness, progeny and virility, delayed ageing, and longevity. Therefore, one should take recourse to a skillfully administered purificatory therapy at an appropriate time. [17-19]

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Administration of therapies, leading to elimination of vitiated [[dosha]], results in the following effects: enhancement of digestion / metabolism, pacification of diseases, restoration of normal health, improvement in clarity of sense organs, mind, intellect and complexion, promotion of strength, plumpness, progeny and virility, delayed ageing, and longevity. Therefore, one should take recourse to a skillfully administered purificatory therapy at an appropriate time. [17-19]

</div>

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==== Prevention of recurrence of disease ====

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=== Prevention of recurrence of disease ===

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दोषाः कदाचित् कुप्यन्ति जिता लङ्घनपाचनैः|

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दोषाणां च द्रुमाणां च मूलेऽनुपहते सति|

रोगाणां प्रसवानां च गतानामागतिर्ध्रुवा||२१||

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dōṣāḥ kadācit kupyanti jitā laṅghanapācanaiḥ|

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doShANAM ca drumANAM ca mUle~anupahate sati|

rogANAM prasavAnAM ca gatAnAmAgatirdhruvA||21||

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</div></div>

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Morbid ~~''doshas''~~ relieved by fasting and digestive drugs may sometimes get aggravated again, but those that are evacuated by purification therapies do not recur. ~~''Doshas''~~, like plants, if not uprooted completely, would recur or relapse almost certainly. [20-21]

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Morbid [[dosha]] relieved by fasting and digestive drugs may sometimes get aggravated again, but those that are evacuated by purification therapies do not recur. [[Dosha]], like plants, if not uprooted completely, would recur or relapse almost certainly. [20-21]

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==== Post purification measures ====

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=== Post purification measures ===

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भेषजक्षपिते पथ्यमाहारैरेव बृंहणम्|

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अभ्यङ्गोत्सादनैः स्नानैर्निरूहैः सानुवासनैः|

तथा स लभते शर्म युज्यते चायुषा चिरम्||२३||

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bhēṣajakṣapitē pathyamāhārairēva br̥ṁhaṇam|

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abhya~ggotsAdanaiH snAnairnirUhaiH sAnuvAsanaiH|

tathA sa labhate sharma yujyate cAyuShA ciram||23||

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</div></div>

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For those weakened by purification therapy, restoration of one’s health could be done by prescribing a nourishing diet regimen that would include ''ghee'', relishing soup (including preparations with meat), and milk. The patient should also be advised massage, bath, and evacuative and unctuous enema. This process of purification followed by rejuvenation or restoration of one’s health bestows happiness and longevity to the patient. [22-23]

</div>

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==== Treatment of excess and inadequate purification therapy ====

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=== Treatment of excess and inadequate purification therapy ===

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अतियोगानुबद्धानां सर्पिःपानं प्रशस्यते|

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स्नेहने स्वेदने शुद्धौ रोगाः संसर्जने च ये|

जायन्तेऽमार्गविहिते तेषां सिद्धिषु साधनम्||२६||

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atiyōgānubaddhānāṁ sarpiḥpānaṁ praśasyatē|

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snehane svedane shuddhau rogAH saMsarjane ca ye|

jAyante~amArgavihite teShAM siddhiShu sAdhanam||26||

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</div></div>

For those suffering from symptoms of excessive administration or application of purification activities, ingestion of ''ghee'' and oil processed with sweet drugs or ''anuvasana'' type of enema is prescribed.

Line 301: Line 371:

In cases of inadequate administration or application, one should be given oleation therapy followed by evacuative therapy again, considering the dose, time, strength of the patient and factors responsible for inadequate cleansing earlier. Management of disorders arising out of improper oleation, fomentation and purification therapies as well as post- purification dietetic regimen program is described subsequently in [[Siddhi Sthana]] (i.e., the Siddhi section of this treatise). [24-26]

</div>

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===~~= ''~~Swabhavoparama vada'' (theory of natural destruction) ====

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=== Swabhavoparama vada (theory of natural destruction) ===

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जायन्ते हेतुवैषम्याद्विषमा देहधातवः|

हेतुसाम्यात् समास्तेषां स्वभावोपरमः सदा||२७||

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jāyantē hētuvaiṣamyādviṣamā dēhadhātavaḥ|

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jAyante hetuvaiShamyAdviShamA dehadhAtavaH|

hetusAmyAt samAsteShAM svabhAvoparamaH sadA||27||

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</div></div>

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−

Discordance of the causative factors results in disequilibrium of the tissue elements (~~''dhatus''~~) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors. However, the resolution / destruction of the existing always happens naturally in the course of time. [27]

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Discordance of the causative factors results in disequilibrium of the tissue elements ([[dhatu]]) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors. However, the resolution / destruction of the existing always happens naturally in the course of time. [27]

</div>

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प्रवृत्तिहेतुर्भावानां न निरोधेऽस्ति कारणम्|

केचित्तत्रापि मन्यन्ते हेतुं हेतोरवर्तनम्||२८||

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pravr̥ttihēturbhāvānāṁ na nirōdhē'sti kāraṇam|

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pravRuttiheturbhAvAnAM na nirodhe~asti kAraNam|

kecittatrApi manyante hetuM hetoravartanam||28||

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</div></div>

There is always a cause for the manifestation of beings but none exists for their annihilation. However, some scholars are of the opinion that the noncontinuance of their causative factors is the very cause of their annihilation. [28]

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==== Query by Agnivesha ====

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=== Query by Agnivesha ===

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एवमुक्तार्थमाचार्यमग्निवेशोऽभ्यभाषत|

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भेषजैर्विषमान् धातून् कान् समीकुरुते भिषक्|

का वा चिकित्सा भगवन्! किमर्थं वा प्रयुज्यते||३०||

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ēvamuktārthamācāryamagnivēśō'bhyabhāṣata|

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bheShajairviShamAn dhAtUn kAn samIkurute bhiShak|

kA vA cikitsA bhagavan! kimarthaM vA prayujyate||30||

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</div></div>

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The master having thus given his version Agnivesha inquired- if the natural resolution (of disorders) be in the very nature of things then what is the necessity of a qualified physician? Which discordant body elements are harmonized by the physician by means of therapy? After all what does the treatment amount to? And what is its objective? [29-30]

</div>

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==== Explanation by Punarvasu ====

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=== Explanation by Punarvasu ===

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तच्छिष्यवचनं श्रुत्वा व्याजहार पुनर्वसुः|

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न नाशकारणाभावाद्भावानां नाशकारणम्|

ज्ञायते नित्यगस्येव कालस्यात्ययकारणम्||३२||

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tacchiṣyavacanaṁ śrutvā vyājahāra punarvasuḥ|

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na nAshakAraNAbhAvAdbhAvAnAM nAshakAraNam|

j~jAyate nityagasyeva kAlasyAtyayakAraNam||32||

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Hearing these words from his disciple, Punarvasu responded, “Hear, oh gentle one! The rationale the great sages have given in this respect is that the cause of destruction of entities cannot be comprehended, because no such cause exists, just as in case of time, which is always in the process of swift movement automatically gets destroyed. Being transitory by nature, things perish even as they are born. [31-32]

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शीघ्रगत्वाद्यथा भूतस्तथा भावो विपद्यते|३३||

निरोधे कारणं तस्य नास्ति नैवान्यथाक्रिया||३३||

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śīghragatvādyathā bhūtastathā bhāvō vipadyatē|33||

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nirodhe kAraNaM tasya nAsti naivAnyathAkriyA||33||

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There is neither a cause for things to perish nor there is a possibility of bringing out a change in the innate tendency of destruction. [33]

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==== Definition of ''chikitsa'' and the duty of a physician ====

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=== Definition of ''chikitsa'' and the duty of a physician ===

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याभिः क्रियाभिर्जायन्ते शरीरे धातवः समाः|

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कथं शरीरे धातूनां वैषम्यं न भवेदिति|

समानां चानुबन्धः स्यादित्यर्थं क्रियते क्रिया||३५||

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yābhiḥ kriyābhirjāyantē śarīrē dhātavaḥ samāḥ|

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kathaM sharIre dhAtUnAM vaiShamyaM na bhavediti|

samAnAM cAnubandhaH syAdityarthaM kriyate kriyA||35||

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</div></div>

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Therapeutics therefore consists of measures or operations by way of which concordance of the tissue elements can be sustained and this (achieving concordance of tissue elements) constitutes the duty of the physician. Therapy is administered with the sole objective of ensuring that no discordance prevails in tissue elements and that there is sustenance of continued concordance. [34-35]

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त्यागाद्विषमहेतूनां समानां चोपसेवनात्|

विषमा नानुबध्नन्ति जायन्ते धातवः समाः||३६||

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धर्मस्यार्थस्य कामस्य नृलोकस्योभयस्य च|

दाता सम्पद्यते वैद्यो दानाद्देहसुखायुषाम्||३८||

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tyāgādviṣamahētūnāṁ samānāṁ cōpasēvanāt|

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dharmasyArthasya kAmasya nRulokasyobhayasya ca|

dAtA sampadyate vaidyo dAnAddehasukhAyuShAm||38||

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</div></div>

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By abstaining from factors that give rise to discordance and practicing those that promote concordance, the discordant elements do not persist and concordance is maintained. As the well-equipped physician effects the production of balanced tissue elements by means of his expertise, he is regarded as the bestower of bodily health, happiness and longevity. By virtue of his aptitude to bestow physical happiness and longevity the physician is regarded as the donor of virtue, wealth and desires belonging to this mundane world and the world eternal. [36-38]

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==== Summary ====

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=== Summary ===

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तत्र श्लोकाः-

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या च युक्तिश्चिकित्सायां यं चार्थं कुरुते भिषक्|

चिकित्साप्राभृतेऽध्याये तत् सर्वमवदन्मुनिः||४१||

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tatra ślōkāḥ-

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yA ca yuktishcikitsAyAM yaM cArthaM kurute bhiShak|

cikitsAprAbhRute~adhyAye tat sarvamavadanmuniH||41||

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</div></div>

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Benefits that accrue from the treatment received through a qualified physician as against that received through an unqualified one, the signs and symptoms of adequate, inadequate and excessive administration of evacuative therapies, the signs and symptoms of excessive morbidity, advantages of evacuative therapy, principles of treatment in successful and complicated conditions, the rationale of therapeutics and the intent with which the physician administers the therapy -all this has been described by the sage in this chapter on the “duties of a qualified physician.” [39-41]

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Here also ends the fourth tetrad on the “Therapeutical Processes.”

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==~~= ''~~Tattva Vimarsha~~'' =~~==

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== Tattva Vimarsha (Fundamental Principles) ==

*A skillful physician is critical to the successful administration of a [[Panchakarma]] therapy and a patient who can identify such a physician is of equal importance.

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*The proper administration of purification therapy is important to ~~achive~~ positive health benefits, uprooting the disease and preventing recurrence.

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*The proper administration of purification therapy is important to achieve positive health benefits, uprooting the disease and preventing recurrence.

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*Discordance of the causative factors results in disequilibrium of the tissue elements (~~''dhatus''~~) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors.

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*Discordance of the causative factors results in disequilibrium of the tissue elements ([[dhatu]]) of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors.

*The resolution / destruction of the existing always happen naturally in the course of time.

*There is always a cause for the manifestation of beings, but there is no cause for their annihilation.

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*Ayurvedic treatment is aimed towards creating balance in ''dosha'' and ~~''dhatus''~~ and sustaining it.

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*Ayurvedic treatment is aimed towards creating balance in [[dosha]] and [[dhatu]] and sustaining it.

*The skilled physician should make all efforts to normalize the tissues of the body.

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==~~= ''~~Vidhi Vimarsha~~'' =~~==

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== Vidhi Vimarsha (Applied Inferences) ==

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*The physician should be especially skilled in ''vamana'' and ''virechana'' procedures.

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*The physician should be especially skilled in therapeutic emesis [[vamana]] and therapeutic purgation [[virechana]] procedures.

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*If the patient develops weight loss and debility after purification therapy, he should be given a rejuvenation treatment in the form of a nourishing dietary regimen that includes ~~''ghrita'' (clarified butter)~~, meat soup, milk, appetizing broth, massage and medicated enema.

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*If the patient develops weight loss and debility after purification therapy, he should be given a rejuvenation treatment in the form of a nourishing dietary regimen that includes ghee, meat soup, milk, appetizing broth, massage and medicated enema.

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*Treatment for ''atiyoga'' involves a regimen of medicated ~~''ghrita''~~ and an oleation enema with oil prepared from ~~''jeevaniya dravya'' (~~vitality enhancer drugs).

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*Treatment for condition of excess purification (atiyoga) involves a regimen of medicated ghee and an oleation enema with oil prepared from vitality enhancer drugs (jeevaniya dravya).

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*Treatment for ''ayoga'' considers ~~analysing~~ mistakes made in the earlier procedure and repeating the procedure with correct doses or measures of drugs, while factoring in seasonal effects, and the physical constitution of the patient.

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*Treatment for condition of insufficient/less purification (ayoga) considers analyzing mistakes made in the earlier procedure and repeating the procedure with correct doses or measures of drugs, while factoring in seasonal effects, and the physical constitution of the patient.

*Details of the procedures are given in [[Siddhi Sthana]].

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*The purpose of understanding ''svabhaavaparamavada'' is to understand the cause and effect relationship between health and disease. The factors that cause abnormality in tissues, when removed, lead to a healthy state. ''Ahara~~'' (diet~~) with the same qualities as those of the tissues enhance or strengthen the qualities of the tissues, while diet with opposite qualities will decrease it. Regeneration and degeneration of body tissues is a continuous process. ~~Healthy~~ diet and other ~~regimen~~ help in maintaining longevity. However, the cause of death is unknown.

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*The purpose of understanding the theory of natural destruction of causative factors of disease (svabhaavaparamavada) is to understand the cause and effect relationship between health and disease. The factors that cause abnormality in tissues, when removed, lead to a healthy state. Diet ([[Ahara]]) with the same qualities as those of the tissues enhance or strengthen the qualities of the tissues, while diet with opposite qualities will decrease it. Regeneration and degeneration of body tissues is a continuous process. A healthy diet and other regimens help in maintaining longevity. However, the cause of death is unknown.

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*~~At the end of the chapter, qualities of a physician~~ skilled ~~in therapeutics are described. Such a~~ physician helps in maintaining the normal tissues and provides a healthy life with longevity ~~so that a person can achieve ''~~dharma, artha, kama'' and ''moksha''.

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*A skilled physician helps in maintaining the normal tissues and provides a healthy life with longevity. This helps in attaining four objectives of life viz. virtue(dharma), wealth (artha), gratification(kama) and emancipation(moksha).

</div>

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=== Further reading ===

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#~~Charak~~, ~~[[Charak~~ Samhita]], ~~[[Sutra Sthana]] 16, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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#Sushruta, Sushruta Samhita, Nibadha Samgraha commentary by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997 quotations from Sutra Sthana chapter 41/6, chapter 21, chapter 6/13

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~~#Charak, [[Charak Samhita]], [[Sutra Sthana]] 16/34, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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#Kashyapa, Kashyapa Samhita, Khila Sthana 5/6-7, Chaukhamba Orientalia, Varanasi

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~~#Charak, [[Charak Samhita]], [[Sutra Sthana]] 16/12, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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#Vagbhata, Ashtanga Hridaya, , Chaukhamba Amarabharati Prakashan, 2nd edition, Varanasi Sutra Sthana 12/ 24

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~~#Susruta, Susruta Samhita, Sutrasthana 41/6, Nibadhasangraha commentry~~ by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997

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~~#Charak, [[Charak Samhita]], [[~~Sutra Sthana~~]] 16~~/16, ~~Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya~~, ~~Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Charak, Charak Samhita, Vimana Sthana 8~~/~~89-90, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Susruta, Susruta Samhita, Sutrasthana 21, Nibadhasangraha commentry by Dalhana, Chaukhamba Orientelia, 6th edition, Varanasi, 1997~~ #Kashyapa, Kashyapa Samhita, ~~Khilasthana~~ 5/6-7, Chaukhamba ~~Orientelia, Varanasi~~

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~~#Charak, Charak Samhita, Sutra Sthana 16, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Charak, Charak Samhita, Sutra Sthana 16/21 YN , Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Charak, Charak Samhita, Sutra sthana 16/22, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Charak, Charak Samhita, Sutra sthana 16/28, Ayurveda Deepika Commentry of Chakrapani edited by Vd. Jadavji Trikamji Acharya, Chaukhamba Surbharati Prakashan, Varanasi~~

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~~#Susruta, Susruta Samhita, Sutrasthana 6/13, Nibadhasangraha commentry by Dalhana, Chaukhamba Orientelia, 6th edition~~, Varanasi~~, 1997~~

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#Vagbhata, Ashtanga Hridaya, ~~Sutrasthana 12/ 24~~, Chaukhamba Amarabharati Prakashan, 2nd edition, Varanasi

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~~=== Glossary ===~~

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<big>'''[[Special:ContactMe|Send us your suggestions and feedback on this page.]]'''</big>

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~~#cikitsāprābhr̥t ( chikitsAprAbhRut ; चिकित्साप्राभृत ) :- A fully equipped physician.~~

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~~#bhēṣajakṣapitē (bheShajakShapite; भेषजक्षपिते ) :- Weakened by purifactory medication.~~

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~~#bahudōṣasya (bahudoShasya; बहुदोष ) :- Signs of excessive morbidity.~~

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~~#mēdōmāṁsōdakōpamam ( medomAMsodakopamam ; मेदोमांसोदकोपमम् ) :- Just like the water washed after flesh & fat.~~

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~~#viśuddhakōṣṭh (vishuddhakoShTh ; विशुद्धकोष्ठ ) :- Purified.~~

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~~#vaidyamānī ( vaidyamAnI ; वैद्यमानी ) :- The badly lit who considers him as a Vaidya ; pretentious & ignorant physician.~~

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~~#kāyāgnēścānuvartanam (kAyAgneshcAnuvartanam ; कायाग्नेश्चानुवर्तनम् ) :- Regular peristalsis & restoration of body temperature.~~

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~~#vyājahāra ( vyAjahAra ; व्याजहार ) :- Said.~~

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~~#saṁśōdhanaṁ (saMshodhanaM ; संशोधनं ) :- Purification.~~

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~~#svabhāvōparamaḥ ( svabhAvoparamaH ; स्वभावोपरमः ) :- Natural Resolution.~~

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~~#hētōravartanam (hetoravartanam ; हेतोरवर्तनम् ) :- Non continuance of causative factors.~~

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