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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 ====

चतुष्पादंषोडशकलंभेषजमितिभिषजोभाषन्ते, यदुक्तंपूर्वाध्यायेषोडशगुणमिति, तद्भेषजंयुक्तियुक्तमलमारोग्यायेतिभगवान्पुनर्वसुरात्रेयः||३||

चतुष्पादंषोडशकलंभेषजमितिभिषजोभाषन्ते, यदुक्तंपूर्वाध्यायेषोडशगुणमिति, तद्भेषजंयुक्तियुक्तमलमारोग्यायेतिभगवान्पुनर्वसुरात्रेयः||३||

catuShpAdaMShoDashakalaMbheShajamitibhiShajobhAShante,yaduktaMpUrvAdhyAyeShoDashaguNamiti, tadbheShajaMyuktiyuktamalamArogyAyetibhagavAnpunarvasurAtreyaH||3||

catuShpAdaMShoDashakalaMbheShajamitibhiShajobhAShante,yaduktaMpUrvAdhyAyeShoDashaguNamiti, tadbheShajaMyuktiyuktamalamArogyAyetibhagavAnpunarvasurAtreyaH||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 PunarvasuAtreya.[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 PunarvasuAtreya.[3]

Maitreya’s observation and query:

 

==== Maitreya’s observation and query ====

 

नेतिमैत्रेयः, किंकारणं? दृश्यन्तेह्यातुराःकेचिदुपकरणवन्तश्चपरिचारकसम्पन्नाश्चात्मवन्तश्चकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताश्चापरेम्रियमाणाः; तस्माद्भेषजमकिञ्चित्करंभवति, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, नद्यांवास्यन्दमानायांपांसुधानेवापांसुमुष्टिःप्रकीर्णइति; तथाऽपरेदृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताम्रियमाणाश्चापरे| यतश्चप्रतिकुर्वन्सिध्यति, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ततश्चिन्त्यतेभेषजमभेषजेनाविशिष्टमिति ||४||

नेतिमैत्रेयः, किंकारणं? दृश्यन्तेह्यातुराःकेचिदुपकरणवन्तश्चपरिचारकसम्पन्नाश्चात्मवन्तश्चकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताश्चापरेम्रियमाणाः; तस्माद्भेषजमकिञ्चित्करंभवति, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, नद्यांवास्यन्दमानायांपांसुधानेवापांसुमुष्टिःप्रकीर्णइति; तथाऽपरेदृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताम्रियमाणाश्चापरे| यतश्चप्रतिकुर्वन्सिध्यति, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ततश्चिन्त्यतेभेषजमभेषजेनाविशिष्टमिति ||४||

NetimaitreyaH, kiMkAraNaM? dRushyantehyAturAHkecidupakaraNavantashca

NetimaitreyaH, kiMkAraNaM? dRushyantehyAturAHkecidupakaraNavantashca

paricArakasampannAshcAtmavantashcakushalaishcabhiShagbhiranuShThitAH

paricArakasampannAshcAtmavantashcakushalaishcabhiShagbhiranuShThitAH

yatashcapratikurvansidhyati, pratikurvanmriyate; apratikurvansidhyati,

yatashcapratikurvansidhyati, pratikurvanmriyate; apratikurvansidhyati,

apratikurvanmriyate; tatashcintyatebheShajamabheShajenAvishiShTamiti ||4||

apratikurvanmriyate; tatashcintyatebheShajamabheShajenAvishiShTamiti ||4||

Maitreya contradicts and puts query – “What is the reason that some patients managed by proper medicaments, attendants, and well qualified physicians, who are also having self control, soon recover from the diseases? On the other hand, in spite of all these, some die? So therapeutics is of no value (in the eradication of diseases). This is just like a drop of water thrown into a ditch or pond or a handful of dust thrown into a flowing river or on a heap of dust. On the contrary, even without proper medicaments, attendants, good physicians, patients having no self control, recover from the diseases, however others in the similar situation also die. To sum up: It may be said that therapeutic measures or no therapeutic measures, results are the same. For one who is taking recourse to therapeutic measures may sometime succeed in recovering from the diseases and may sometimes die as well. Similar is the case with one who does not pay any heed to therapeutic measures”. [4]

Maitreya contradicts and puts query – “What is the reason that some patients managed by proper medicaments, attendants, and well qualified physicians, who are also having self control, soon recover from the diseases? On the other hand, in spite of all these, some die? So therapeutics is of no value (in the eradication of diseases). This is just like a drop of water thrown into a ditch or pond or a handful of dust thrown into a flowing river or on a heap of dust. On the contrary, even without proper medicaments, attendants, good physicians, patients having no self control, recover from the diseases, however others in the similar situation also die. To sum up: It may be said that therapeutic measures or no therapeutic measures, results are the same. For one who is taking recourse to therapeutic measures may sometime succeed in recovering from the diseases and may sometimes die as well. Similar is the case with one who does not pay any heed to therapeutic measures”. [4]

Reply by Atreya:

 

==== Reply by Atreya ====

 

मैत्रेय !मिथ्याचिन्त्यतइत्यात्रेयः; किंकारणं, येह्यातुराःषोडशगुणसमुदितेनानेनभेषजेनोपपद्यमानाम्रियन्तइत्युक्तंतदनुपपन्नं, न हिभेषजसाध्यानांव्याधीनांभेषजमकारणंभवति; येपुनरातुराःकेवलाद्भेषजादृतेसमुत्तिष्ठन्ते, न तेषांसम्पूर्णभेषजोपपादनायसमुत्थानविशेषो[२]

मैत्रेय !मिथ्याचिन्त्यतइत्यात्रेयः; किंकारणं, येह्यातुराःषोडशगुणसमुदितेनानेनभेषजेनोपपद्यमानाम्रियन्तइत्युक्तंतदनुपपन्नं, न हिभेषजसाध्यानांव्याधीनांभेषजमकारणंभवति; येपुनरातुराःकेवलाद्भेषजादृतेसमुत्तिष्ठन्ते, न तेषांसम्पूर्णभेषजोपपादनायसमुत्थानविशेषो[२]

नास्ति; यथाहिपतितंपुरुषंसमर्थमुत्थानायोत्थापयन्पुरुषोबलमस्योपादध्यात्, स क्षिप्रतरमपरिक्लिष्ट

नास्ति; यथाहिपतितंपुरुषंसमर्थमुत्थानायोत्थापयन्पुरुषोबलमस्योपादध्यात्, स क्षिप्रतरमपरिक्लिष्ट

एवोत्तिष्ठेत्, तद्वत्सम्पूर्णभेषजोपलम्भादातुराः; येचातुराःकेवलाद्भेषजादपिम्रियन्ते, न च सर्वएवतेभेषजोपपन्नाःसमुत्तिष्ठेरन्, नहिसर्वेव्याधयोभवन्त्युपायसाध्याः, नचोपायसाध्यानांव्याधीनामनुपायेनसिद्धिरस्ति, न चासाध्यानांव्याधीनांभेषजसमुदायोऽयमस्ति[३] , न ह्यलंज्ञानवान्भिषङ्मुमूर्षुमातुरमुत्थापयितुं; परीक्ष्यकारिणोहिकुशलाभवन्ति, यथाहियोगज्ञोऽभ्यासनित्यइष्वासोधनुरादायेषुमस्यन्नातिविप्रकृष्टेमहतिकायेनापराधवान्भवति, सम्पादयतिचेष्टकार्यं, तथाभिषक्स्वगुणसम्पन्नउपकरणवान्वीक्ष्यकर्मारभमाणःसाध्यरोगमनपराधःसम्पादयत्येवातुरमारोग्येण; तस्मान्नभेषजमभेषजेनाविशिष्टंभवति||५||

एवोत्तिष्ठेत्, तद्वत्सम्पूर्णभेषजोपलम्भादातुराः; येचातुराःकेवलाद्भेषजादपिम्रियन्ते, न च सर्वएवतेभेषजोपपन्नाःसमुत्तिष्ठेरन्, नहिसर्वेव्याधयोभवन्त्युपायसाध्याः, नचोपायसाध्यानांव्याधीनामनुपायेनसिद्धिरस्ति, न चासाध्यानांव्याधीनांभेषजसमुदायोऽयमस्ति[३]

 

न ह्यलंज्ञानवान्भिषङ्मुमूर्षुमातुरमुत्थापयितुं; परीक्ष्यकारिणोहिकुशलाभवन्ति, यथाहियोगज्ञोऽभ्यासनित्यइष्वासोधनुरादायेषुमस्यन्नातिविप्रकृष्टेमहतिकायेनापराधवान्भवति, सम्पादयतिचेष्टकार्यं, तथाभिषक्स्वगुणसम्पन्नउपकरणवान्वीक्ष्यकर्मारभमाणःसाध्यरोगमनपराधःसम्पादयत्येवातुरमारोग्येण; तस्मान्नभेषजमभेषजेनाविशिष्टंभवति||५||

Maitreya! mithyAcintyataityAtreyaH; kiMkAraNaM, ye hyAturAHShoDashaguNasamuditenAnenabheShajenopapadyamAnAmriyantaityuktaMtadanupapannaM, na hi bheShajasAdhyAnAMvyAdhInAMbheShajamakAraNaMbhavati; ye punarAturAHkevalAdbheShajAdRutesamuttiShThante, nateShAMsampUrNabheShajopapAdanAyasamutthAnavisheShonAsti; yathA hi patitaMpuruShaMsamarthamutthAnAyotthApayanpuruShobalamasyopAdadhyAt, sakShiprataramaparikliShTa

Maitreya! mithyAcintyataityAtreyaH; kiMkAraNaM, ye hyAturAHShoDashaguNasamuditenAnenabheShajenopapadyamAnAmriyantaityuktaMtadanupapannaM, na hi bheShajasAdhyAnAMvyAdhInAMbheShajamakAraNaMbhavati; ye punarAturAHkevalAdbheShajAdRutesamuttiShThante, nateShAMsampUrNabheShajopapAdanAyasamutthAnavisheShonAsti; yathA hi patitaMpuruShaMsamarthamutthAnAyotthApayanpuruShobalamasyopAdadhyAt, sakShiprataramaparikliShTa

evottiShThet, tadvatsampUrNabheShajopalambhAdAturAH; ye cAturAHkevalAdbheShajAdapimriyante,na ca sarvaevatebheShajopapannAHsamuttiShTheran, nahisarvevyAdhayobhavantyupAyasAdhyAH, nacopAyasAdhyAnAMvyAdhInAmanupAyenasiddhirasti, nacAsAdhyAnAMvyAdhInAMbheShajasamudAyo~ayamasti, nahyalaMj~jAnavAnbhiSha~gmumUrShumAturamutthApayituM; parIkShyakAriNo hi kushalAbhavanti, yathA hi yogaj~jo~abhyAsanityaiShvAsodhanurAdAyeShumasyannAtiviprakRuShTemahatikAynAparAdhavAnbhavati, sampAdayaticeShTakAryaM, tathAbhiShaksvaguNasampannaupakaraNavAnvIkShyakarmArabhamANaHsAdhyarogamanaparAdhaHsampAdayatyevAturamArogyeNa; tasmAnnabheShajamabheShajenAvishiShTaMbhavati||5||

evottiShThet, tadvatsampUrNabheShajopalambhAdAturAH; ye cAturAHkevalAdbheShajAdapimriyante,na ca sarvaevatebheShajopapannAHsamuttiShTheran, nahisarvevyAdhayobhavantyupAyasAdhyAH, nacopAyasAdhyAnAMvyAdhInAmanupAyenasiddhirasti, nacAsAdhyAnAMvyAdhInAMbheShajasamudAyo~ayamasti, nahyalaMj~jAnavAnbhiSha~gmumUrShumAturamutthApayituM; parIkShyakAriNo hi kushalAbhavanti, yathA hi yogaj~jo~abhyAsanityaiShvAsodhanurAdAyeShumasyannAtiviprakRuShTemahatikAynAparAdhavAnbhavati, sampAdayaticeShTakAryaM, tathAbhiShaksvaguNasampannaupakaraNavAnvIkShyakarmArabhamANaHsAdhyarogamanaparAdhaHsampAdayatyevAturamArogyeNa; tasmAnnabheShajamabheShajenAvishiShTaMbhavati||3-5||

To this Lord Atreya remarks, “Oh Maitreya! The conclusion derived by you is not correct. Because, to say that the patients adopting the therapeutic measures having the sixteen qualities die is not borne out of facts. Therapeutic measures can never be ineffective in curable diseases. Similarly, even in such cases where patients are cured without proper medication, it should be understood that had there been proper administration of therapeutic measures the process of cure would have been quicker and better. This can be likened to the lifting of a healthy person who has fallen. He can no doubt get up himself but if he is helped and lifted by another person, he would get up sooner and without much difficulty. Similar is the case with patients stated to have been cured without adequate therapeutic measures. Then there is the case where patients die even by taking recourse to adequate therapeutic measures. It is not that all patients taking recourse to therapeutic measures are necessarily cured because all diseases are not curable. Diseases that are curable can be cured only by taking recourse to therapeutic measures. Those that are not curable will certainly not respond to the treatment and not even the ablest physician is capable of curing the moribund patient. An able physician always proceeds with their treatment after proper examination. As an archer having the knowledge and practice (of archery) shoots arrows with the help of his bow and does not commit mistakes in hitting a massive body nearby and thus accomplishes his object, so a physician endowed with his own qualities and other accessories proceeding with the act (of treatment) after proper examination will certainly cure a curable patient without fail. So it is not correct to say that there is no difference between the application and non-application of therapeutic measures”. [5]

 

Some principles of management:

To this Lord Atreya remarks, “Oh Maitreya! The conclusion derived by you is not correct. Because, to say that the patients adopting the therapeutic measures having the sixteen qualities die is not borne out of facts. Therapeutic measures can never be ineffective in curable diseases. Similarly, even in such cases where patients are cured without proper medication, it should be understood that had there been proper administration of therapeutic measures the process of cure would have been quicker and better. This can be likened to the lifting of a healthy person who has fallen. He can no doubt get up himself but if he is helped and lifted by another person, he would get up sooner and without much difficulty. Similar is the case with patients stated to have been cured without adequate therapeutic measures. Then there is the case where patients die even by taking recourse to adequate therapeutic measures. It is not that all patients taking recourse to therapeutic measures are necessarily cured because all diseases are not curable. Diseases that are curable can be cured only by taking recourse to therapeutic measures. Those that are not curable will certainly not respond to the treatment and not even the ablest physician is capable of curing the moribund patient. An able physician always proceeds with their treatment after proper examination. As an archer having the knowledge and practice (of archery) shoots arrows with the help of his bow and does not commit mistakes in hitting a massive body nearby and thus accomplishes his object, so a physician endowed with his own qualities and other accessories proceeding with the act (of treatment) after proper examination will certainly cure a curable patient without fail. So it is not correct to say that there is no difference between the application and non-application of therapeutic measures”. [3-5]

 

==== Some principles of management ====

 

इदं चनःप्रत्यक्षं- यदनातुरेणभेषजेनातुरंचिकित्सामः , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, स्थूलंमेदस्विनमपतर्पयामः, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, व्याधीन्मूलविपर्ययेणोपचरन्तःसम्यक्प्रकृतौस्थापयामः; तेषांनस्तथाकुर्वतामयंभेषजसमुदायःकान्ततमोभवति||६||

इदं चनःप्रत्यक्षं- यदनातुरेणभेषजेनातुरंचिकित्सामः , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, स्थूलंमेदस्विनमपतर्पयामः, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, व्याधीन्मूलविपर्ययेणोपचरन्तःसम्यक्प्रकृतौस्थापयामः; तेषांनस्तथाकुर्वतामयंभेषजसमुदायःकान्ततमोभवति||६||

idaM ca naHpratyakShaM- yadanAtureNabheShajenAturaMcikitsAmaH, kShAmamakShAmeNa, kRushaM ca durbalamApyAyayAmaH, sthUlaMmedasvinamapatarpayAmaH, shItenoShNAbhibhUtamupacarAmaH, shItAbhibhUtamuShNena, nyUnAndhAtUnpUrayAmaH, vyatiriktAnhrAsayAmaH, vyAdhInmUlaviparyayeNopacarantaHsamyakprakRutausthApayAmaH; teShAMnastathAkurvatAmayaMbheShajasamudAyaH

idaM ca naHpratyakShaM- yadanAtureNabheShajenAturaMcikitsAmaH, kShAmamakShAmeNa, kRushaM ca durbalamApyAyayAmaH, sthUlaMmedasvinamapatarpayAmaH, shItenoShNAbhibhUtamupacarAmaH, shItAbhibhUtamuShNena, nyUnAndhAtUnpUrayAmaH, vyatiriktAnhrAsayAmaH, vyAdhInmUlaviparyayeNopacarantaHsamyakprakRutausthApayAmaH; teShAMnastathAkurvatAmayaMbheShajasamudAyaH

kAntatamobhavati||6||

kAntatamobhavati||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, dosas 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, dosas 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]

Importance of determination of prognosis:

 

==== Importance of determination of prognosis ====

 

भवन्तिचात्र-  

भवन्तिचात्र-  

साध्यासाध्यविभागज्ञोज्ञानपूर्वंचिकित्सकः|  

साध्यासाध्यविभागज्ञोज्ञानपूर्वंचिकित्सकः|  

कालेचारभतेकर्मयत्तत्साधयतिध्रुवम्||७||  

कालेचारभतेकर्मयत्तत्साधयतिध्रुवम्||७||  

अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्|  

अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्|  

प्राप्नुयान्नियतंवैद्योयोऽसाध्यंसमुपाचरेत्||८||

प्राप्नुयान्नियतंवैद्योयोऽसाध्यंसमुपाचरेत्||८||

bhavanticAtra-  

bhavanticAtra-  

sAdhyAsAdhyavibhAgaj~joj~jAnapUrvaMcikitsakaH|

sAdhyAsAdhyavibhAgaj~joj~jAnapUrvaMcikitsakaH|

kAlecArabhate karma yattatsAdhayatidhruvam||7||  

kAlecArabhate karma yattatsAdhayatidhruvam||7||  

arthavidyAyashohAnimupakroshamasa~ggraham|

arthavidyAyashohAnimupakroshamasa~ggraham|

prApnuyAnniyataMvaidyoyo~asAdhyaMsamupAcaret||8||

prApnuyAnniyataMvaidyoyo~asAdhyaMsamupAcaret||8||

A physician who can distinguish between curable and incurable diseases and initiates treatment in time with the full knowledge (about the various aspects of the therapeutics) can certainly accomplish his objective (of curing the disease). On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of wealth, knowledge and fame and will also earn bad reputation and other royal sanctions or punishments. [7-8]

A physician who can distinguish between curable and incurable diseases and initiates treatment in time with the full knowledge (about the various aspects of the therapeutics) can certainly accomplish his objective (of curing the disease). On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of wealth, knowledge and fame and will also earn bad reputation and other royal sanctions or punishments. [7-8]

Types of prognosis:

 

==== Types of prognosis ====

 

सुखसाध्यंमतंसाध्यंकृच्छ्रसाध्यमथापिच|

सुखसाध्यंमतंसाध्यंकृच्छ्रसाध्यमथापिच|

द्विविधंचाप्यसाध्यंस्याद्याप्यंयच्चानुपक्रमम् ||९||  

द्विविधंचाप्यसाध्यंस्याद्याप्यंयच्चानुपक्रमम् ||९||