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{{#seo:

|title=Chikitsaprabhritiya Adhyaya

|title=Chikitsaprabhritiya Adhyaya

|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.  

|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.  

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

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

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

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

|image_alt=carak samhita

|image_alt=carak samhita

|type=article

|type=article

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Galib, Sabnis M.

|data7  = Galib, Sabnis M.

|label8 = Editor

|label8 = Editors

|data8  = Mangalasseri P.

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

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10  =  

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

|label11 = DOI

}}

}}

<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>

<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>

'''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.

'''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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== Introduction ==

== Introduction ==

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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.

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.

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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]

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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=== Signs of inadequate purification ===

=== Signs of inadequate purification ===

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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]

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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=== Signs of excess purification therapy ===

=== Signs of excess purification therapy ===

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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]

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]

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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]

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

 

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

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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]

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]

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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]

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]

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=== Prevention of recurrence of disease ===

=== Prevention of recurrence of disease ===

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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]

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]

=== Post purification measures ===

=== Post purification measures ===

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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]

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]

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*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.

*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.

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

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

*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.  

*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.  

*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.  

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

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

*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.

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

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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).

*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).

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=== Further reading ===

=== Further reading ===

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