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{{Infobox

{{Infobox

|title =  Mahachatushpada Adhyaya

|title =  Mahachatushpada Adhyaya

|data2 = ''Nirdesha Chatushka''

|data2 = ''Nirdesha Chatushka''

|label3 = Preceding Chapter

|label3 = Preceding Chapter

|data3 = [[Khuddakachatushpada]]

|data3 = [[Khuddakachatushpada Adhyaya]]

|label4 = Succeeding Chapter

|label4 = Succeeding Chapter

|data4 = [[Tistraishaniya]]

|data4 = [[Tistraishaniya Adhyaya]]

|label5 = Other Sections

|label5 = Other Sections

}}

}}

=== Introduction ===

=== Introduction ===

</div>

</div>

==== Some Principles of Management ====

==== General 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||

ityagniveshakRutetantrecarakapratisaMskRuteshlokasthAnemahAcatuShpAdonAmadashamo~adhyAyaH||10||

ityagniveshakRutetantrecarakapratisaMskRuteshlokasthAnemahAcatuShpAdonAmadashamo~adhyAyaH||10||

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

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

 

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

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

# The treatment should be aimed at restoring physiological equilibrium. The various ways to bring this equilibrium are to increase the depleted nutrients, nourish those who are weak and emaciated, and reduce the one who are obese, those afflicted by heat with cooling measures and those afflicted by cold with heating measures. Proper measures to replenish the deficient dhatus (tissue elements, doshas and malas) and deplete those that are in excess should be adopted. Thus these therapeutic measures give us the best result in the management of diseases. [6]The diseases can be categorized under four types on the basis of their prognosis viz.  

# The treatment should be aimed at restoring physiological equilibrium. The various ways to bring this equilibrium are to increase the depleted nutrients, nourish those who are weak and emaciated, and reduce the one who are obese, those afflicted by heat with cooling measures and those afflicted by cold with heating measures. Proper measures to replenish the deficient dhatus (tissue elements, doshas and malas) and deplete those that are in excess should be adopted. Thus these therapeutic measures give us the best result in the management of diseases. [6]The diseases can be categorized under four types on the basis of their prognosis viz.  

# Absolutely irreversible or incurable. (9-10)

# Absolutely irreversible or incurable. (9-10)

# The following factors should be considered to determine prognosis of disease [ 11-20]

# The following factors should be considered to determine prognosis of disease [ 11-20]

 

{| class="wikitable"

{| class="wikitable"

! rowspan="1"| Factors/criteria  

! rowspan="1"| Factors/criteria  

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

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

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

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

In 1971, the famous psychiatrist R.D. Laing coined a term ‘Medical model’ in his book “The Politics of the Family and Other Essays”, for the set of procedures in which all doctors are trained. This set includes complaint, history, physical examination, ancillary tests if needed for making diagnosis, treatment, and prognosis. <ref> 1. Laing, Ronald (1971). The Politics of the Family and Other Essays. Routledge. </ref> The medical model has proven highly successful, and even indispensable, in many contexts. The concepts of "disease" and "injury" are central to this model. An important aspect of the medical model is its focus on identification of pathology of disease and an attempt to remove or control it (offense strategy). There is less attention paid to the capability of human body to heal itself or understanding what health is and ways to preserve, protect and rejuvenate health. That is why there is no defense strategy in modern medical system to prevent disease. There are vaccinations to prevent certain known infectious diseases and addressing mitigating factors causing chronic diseases, such as ischemic heart disease. That appears to be the reason for increasing incidences of autoimmune and degenerative diseases.<ref> 2. Basisht GK. Symbiohealth-Need of the hour. AYU [serial online] 2011 [cited 2016 Jun 1];32:6-11. Available from: http://www.ayujournal.org/text.asp?2011/32/1/6/85715 </ref>

 

In 1971, the famous psychiatrist R.D. Laing coined a term ‘Medical model’ in his book “The Politics of the Family and Other Essays”, for the set of procedures in which all doctors are trained. This set includes complaint, history, physical examination, ancillary tests if needed for making diagnosis, treatment, and prognosis. [1] The medical model has proven highly successful, and even indispensable, in many contexts. The concepts of "disease" and "injury" are central to this model. An important aspect of the medical model is its focus on identification of pathology of disease and an attempt to remove or control it (offense strategy). There is less attention paid to the capability of human body to heal itself or understanding what health is and ways to preserve, protect and rejuvenate health. That is why there is no defense strategy in modern medical system to prevent disease. There are vaccinations to prevent certain known infectious diseases and addressing mitigating factors causing chronic diseases, such as ischemic heart disease. That appears to be the reason for increasing incidences of autoimmune and degenerative diseases.[2]  

   

   

The rules and ethics that governed the medical system in the ancient times remain the same even today. A step ahead of the contemporary classification of diseases, [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] advocates classification of diseases on the basis of prognosis before applying therapeutic measures as the basis of treatment for restoration of health.  

The rules and ethics that governed the medical system in the ancient times remain the same even today. A step ahead of the contemporary classification of diseases, [[Ayurveda]] advocates classification of diseases on the basis of prognosis before applying therapeutic measures as the basis of treatment for restoration of health.  

There are many diseases that are still incurable and according to medical ethics it is essential to give proper information to the patient regarding diagnosis, management and prognosis. Withholding the truth or giving wrong assurance is unethical and punishable. Thus, one should ascertain the prognosis of disease before proceeding with any course of treatment and then share the outcome with the patient.

There are many diseases that are still incurable and according to medical ethics it is essential to give proper information to the patient regarding diagnosis, management and prognosis. Withholding the truth or giving wrong assurance is unethical and punishable. Thus, one should ascertain the prognosis of disease before proceeding with any course of treatment and then share the outcome with the patient.

[https://en.wikipedia.org/wiki/Ayurveda 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 or ''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. Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. ''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) [4-7], ''Kutaki'' (Picrorrhiza kurroa)[8],''Kiratatikta'' (Swertia chirata (Roxb.) Buch.-Hum [9-12], ''Mamejjaka'' (Enicostema littorale Blume) [13-14] and Pterocarpus marsupium [15-18] 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.  

[[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 or ''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. Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. ''Meshashringi'' (Gymnema Sylvester (Retz.) R.Br.; Gurmar) <ref>जनपदोद्ध्वंस –janapadoddhvaMsan- Epidemiology </ref>, <ref>परीक्ष्यैवं – Clinical examination </ref>''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.

This chapter has emphasized the importance of understanding the prognosis of diseases and the factors causing them. Recent research in the field of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] has shown that incurable diseases can be controlled by addressing the prognostic factors and there is a need for both [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] and Modern medicine researchers to work together.

Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK.Mechanism of blood sugar lowering by a swerchirin- containing hexane fraction (SWI) of Swertia chirayita. 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.  

This chapter has emphasized the importance of understanding the prognosis of diseases and the factors causing them. Recent research in the field of [[Ayurveda]] has shown that incurable diseases can be controlled by addressing the prognostic factors and there is a need for both [[Ayurveda]] and Modern medicine researchers to work together.

=== Future Scope for Research ===

=== Future Scope for Research ===

=== Reference ===

=== Reference ===

 

<references/>

<div id="BackToTop"  class="noprint" style="background-color:#DDEFDD; position:fixed;

#Basisht GK. Symbiohealth-Need of the hour. AYU [serial online] 2011 [cited 2016 Jun 1];32:6-11. Available from: http://www.ayujournal.org/text.asp?2011/32/1/6/85715

  bottom:32px; left:2%; z-index:9999; padding:0; margin:0;"><span style="color:blue;

#GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet 385: 117–71.

  font-size:8pt; font-face:verdana,sans-serif;  border:0.2em outset #ceebf7;

#Leach MJ. Gymnema sylvestre for diabetes mellitus: A systematic review. J Alter Complement Med 2007; 13: 977-983.

  padding:0.1em; font-weight:bolder; -moz-border-radius:8px; ">

#Shanmugasundaram ER, Gopinath KL, Radha Shanmugasundaram K, Rajendran VM. Possible regeneration of the islets of Langerhans in streptozocin- diabetic rats given Gymnema sylvestre leaf extracts. J Ethnnopharmacol 1990; 30: 265-279.

[[#top| Back to the Top ]]</span></div>

#Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER.Antidiabetic effect  of a leaf extract from Gymnema sylvestre in non-insulin – dependent diabetes mellitus patients. J Ethnnopharmacol 1990; 30: 295-300.

#Shanmugasundaram ER, Rajeswari G, Baskaran K, et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in in insulin- dependent diabetes mellitus. J Ethnnopharmacol 1990; 30: 281-294.

#Joy KL, Kuttan R. Anti-diabetic activity of Picrorrhiza kurroa extract. J Ethnopharmacol. 1999 Nov 1;67(2):143-8.

#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.

#Sekar BC, Mukherjee B, Chakravarti RB, Mukherjee SK. Effect of different fractions of Swertia chirayita on the blood sugar level of albino rats. J Ethnnopharmacol 1987; 21: 175-181.

#Chandrasekar B, Bajpai MB, Mukherjee SK.Hypoglycemic activity of Swertia chirayita (Roxb ex Flem) Karst. Indian J Exp Bio. 1990; 28: 616-618.

#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.

#Saxena AM, Bajpai MB, Murthy PS, Mukherjee SK.Mechanism of blood sugar lowering by a swerchirin- containing hexane fraction (SWI) of Swertia chirayita. Indian J Exp Biol 1993; 31:178-181.

#Upadhyay UM, Goyal RK. Efficacy of Enicostemma littorale in type-2 diabetic patients. Phytother Res 2004; 18:233-235.

#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.

#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.

#Chakravarthy, B.K., Gupta, S., Gambhir, S.S., Gode, K.D. Pancreatic Beta cell regeneration. A novel anti-diabetic mechanism of Pterocarpus marsupium Roxb. Ind. J. Pharmacol. 1980.12; 123-127.

#Jahromi, M.A., Ray, A.B., Chansouria, J.P.N. Antihyperlipidemic effect of flavonoids from Pterocarpus marsupium. J.Nat. Prod. 1993. 56; 989-994.

#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.