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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 ===

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This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

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

==Sanskrit text, Transliteration and English Translation==

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अथातोमहाचतुष्पादमध्यायंव्याख्यास्यामः||१||

अथातोमहाचतुष्पादमध्यायंव्याख्यास्यामः||१||

इति ह स्माहभगवानात्रेयः||२||

इति ह स्माहभगवानात्रेयः||२||

athAtomahAcatuShpAdamadhyAyaMvyAkhyAsyAmaH||1||

athAtomahAcatuShpAdamadhyAyaMvyAkhyAsyAmaH||1||

iti ha smAhabhagavAnAtreyaH||2||

iti ha smAhabhagavAnAtreyaH||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 ===

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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 Punarvasu Atreya.[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 Punarvasu Atreya.[3]

==== Maitreya’s Observation and Query ====

=== Maitreya’s Observation and Query ===

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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

yatashcapratikurvansidhyati, pratikurvanmriyate; apratikurvansidhyati,

yatashcapratikurvansidhyati, pratikurvanmriyate; apratikurvansidhyati,

apratikurvanmriyate; tatashcintyatebheShajamabheShajenAvishiShTamiti ||4||

apratikurvanmriyate; tatashcintyatebheShajamabheShajenAvishiShTamiti ||4||

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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]

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==== Reply by Atreya ====

=== Reply by Atreya ===

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

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

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

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||5||

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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]

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]

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

=== General Principles of Management ===

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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||

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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, ''doshas'' 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, ''doshas'' 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]

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==== Importance of Determination of Prognosis ====

==== Consequences of treatment after knowing prognosis ====

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भवन्तिचात्र-  

भवन्तिचात्र-  

अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्|  

अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्|  

प्राप्नुयान्नियतंवैद्योयोऽसाध्यंसमुपाचरेत्||८||

प्राप्नुयान्नियतंवैद्योयोऽसाध्यंसमुपाचरेत्||८||

bhavanticAtra-  

bhavanticAtra-  

arthavidyAyashohAnimupakroshamasa~ggraham|

arthavidyAyashohAnimupakroshamasa~ggraham|

prApnuyAnniyataMvaidyoyo~asAdhyaMsamupAcaret||8||

prApnuyAnniyataMvaidyoyo~asAdhyaMsamupAcaret||8||

<div style="text-align:justify;">

<div style="text-align:justify;">

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|

साध्यानांत्रिविधश्चाल्पमध्यमोत्कृष्टतांप्रति|  

साध्यानांत्रिविधश्चाल्पमध्यमोत्कृष्टतांप्रति|  

विकल्पो, न त्वसाध्यानांनियतानांविकल्पना||१०||

विकल्पो, न त्वसाध्यानांनियतानांविकल्पना||१०||

sukhasAdhyaMmataMsAdhyaMkRucchrasAdhyamathApi ca| dvividhaMcApyasAdhyaMsyAdyApyaMyaccAnupakramam||9||  

sukhasAdhyaMmataMsAdhyaMkRucchrasAdhyamathApi ca| dvividhaMcApyasAdhyaMsyAdyApyaMyaccAnupakramam||9||  

sAdhyAnAMtrividhashcAlpamadhyamotkRuShTatAMprati|  

sAdhyAnAMtrividhashcAlpamadhyamotkRuShTatAMprati|  

vikalpo, natvasAdhyAnAMniyatAnAMvikalpanA||10||

vikalpo, natvasAdhyAnAMniyatAnAMvikalpanA||10||

<div style="text-align:justify;">

<div style="text-align:justify;">

Curable diseases are of two types- one that can be cured easily and the other with some difficulty. Similarly, incurable diseases are of two types, viz., one which is palliable and the other which is absolutely irreversible.

Curable diseases are of two types- one that can be cured easily and the other with some difficulty. Similarly, incurable diseases are of two types, viz., one which is palliable and the other which is absolutely irreversible.

</div>

</div>

==== Prognostic Criteria for Easily Curable Diseases ====

==== Prognostic criteria for easily curable diseases ====

हेतवःपूर्वरूपाणिरूपाण्यल्पानियस्य च|  

हेतवःपूर्वरूपाणिरूपाण्यल्पानियस्य च|  

दोषश्चैकःसमुत्पत्तौदेहःसर्वौषधक्षमः|  

दोषश्चैकःसमुत्पत्तौदेहःसर्वौषधक्षमः|  

चतुष्पादोपपत्तिश्चसुखसाध्यस्यलक्षणम्||१३||

चतुष्पादोपपत्तिश्चसुखसाध्यस्यलक्षणम्||१३||

hetavaHpUrvarUpANirUpANyalpAniyasya ca|  

hetavaHpUrvarUpANirUpANyalpAniyasya ca|  

DoshashcaikaHsamutpattaudehaHsarvauShadhakShamaH| catuShpAdopapattishcasukhasAdhyasyalakShaNam||13||

DoshashcaikaHsamutpattaudehaHsarvauShadhakShamaH| catuShpAdopapattishcasukhasAdhyasyalakShaNam||13||

The following are the factors that determine the nature of the diseases which are easily curable:

The following are the factors that determine the nature of the diseases which are easily curable:

==== Prognostic criteria for curable diseases with difficulty ====

==== Prognostic criteria for curable diseases with difficulty ====

निमित्तपूर्वरूपाणांरूपाणांमध्यमेबले|  

निमित्तपूर्वरूपाणांरूपाणांमध्यमेबले|  

विद्यादेकपथंरोगंनातिपूर्णचतुष्पदम्|  

विद्यादेकपथंरोगंनातिपूर्णचतुष्पदम्|  

द्विपथंनातिकालंवाकृच्छ्रसाध्यंद्विदोषजम्||१६||

द्विपथंनातिकालंवाकृच्छ्रसाध्यंद्विदोषजम्||१६||

nimittapUrvarUpANAMrUpANAMmadhyame bale| kAlaprakRutidUShyANAMsAmAnye~anyatamasya ca||14||garbhiNIvRuddhabAlAnAMnAtyupadravapIDitam|

nimittapUrvarUpANAMrUpANAMmadhyame bale| kAlaprakRutidUShyANAMsAmAnye~anyatamasya ca||14||garbhiNIvRuddhabAlAnAMnAtyupadravapIDitam|

nAtipUrNacatuShpadam|  

nAtipUrNacatuShpadam|  

dvipathaMnAtikAlaMvAkRucchrasAdhyaMdviDoshajam||16||

dvipathaMnAtikAlaMvAkRucchrasAdhyaMdviDoshajam||16||

Following are the factors that determine the nature of the diseases which are difficult to get cured:

Following are the factors that determine the nature of the diseases which are difficult to get cured:

# The diseases that are not new could we say chronic disease or diseases not of recent onset?

# The diseases that are not new could we say chronic disease or diseases not of recent onset?

# The diseases occurring in vital parts and joints

# The diseases occurring in vital parts and joints

# Diseases involving only one system but not fully supported by the four fold therapeutic measures. '''Not clear'''

# Diseases involving only one system but not fully supported by the four fold therapeutic measures.

# Diseases extending to two systems but not very chronic, and

# Diseases extending to two systems but not very chronic, and

# Diseases that are caused by the vitiation of two ''doshas''. [14-16]

# Diseases that are caused by the vitiation of two ''doshas''. [14-16]

==== Prognostic criteria for palliable diseases ====

==== Prognostic criteria for palliable diseases ====

शेषत्वादायुषोयाप्यमसाध्यंपथ्यसेवया|  

शेषत्वादायुषोयाप्यमसाध्यंपथ्यसेवया|  

विद्याद्द्विदोषजं,...|१९|

विद्याद्द्विदोषजं,...|१९|

sheShatvAdAyuShoyApyamasAdhyaMpathyasevayA| labdhAlpasukhamalpenahetunA~a~ashupravartakam||17||

sheShatvAdAyuShoyApyamasAdhyaMpathyasevayA| labdhAlpasukhamalpenahetunA~a~ashupravartakam||17||

vidyAddviDoshajaM,...|19|

vidyAddviDoshajaM,...|19|

The palliable group of diseases are characterized as follows:

The palliable group of diseases are characterized as follows:

==== Prognostic criteria for incurable diseases ====

==== Prognostic criteria for incurable diseases ====

   

  <div class="mw-collapsible mw-collapsed">

 

...तद्वत्प्रत्याख्येयंत्रिदोषजम्|  

...तद्वत्प्रत्याख्येयंत्रिदोषजम्|  

क्रियापथमतिक्रान्तंसर्वमार्गानुसारिणम्||१९||  

क्रियापथमतिक्रान्तंसर्वमार्गानुसारिणम्||१९||  

औत्सुक्यारतिसम्मोहकरमिन्द्रियनाशनम्|  

औत्सुक्यारतिसम्मोहकरमिन्द्रियनाशनम्|  

दुर्बलस्यसुसंवृद्धंव्याधिंसारिष्टमेव च||२०||

दुर्बलस्यसुसंवृद्धंव्याधिंसारिष्टमेव च||२०||

...tadvatpratyAkhyeyaMtriDoshajam|  

...tadvatpratyAkhyeyaMtriDoshajam|  

autsukyAratisammohakaramindriyanAshanam| durbalasyasusaMvRuddhaMvyAdhiMsAriShTameva ca||20||

autsukyAratisammohakaramindriyanAshanam| durbalasyasusaMvRuddhaMvyAdhiMsAriShTameva ca||20||

Likewise, the following factors would determine the absolute incurability of the disease:

Likewise, the following factors would determine the absolute incurability of the disease:

==== Importance of prognosis ====

==== Importance of prognosis ====

भिषजाप्राक्परीक्ष्यैवंविकाराणांस्वलक्षणम्|  

भिषजाप्राक्परीक्ष्यैवंविकाराणांस्वलक्षणम्|  

साध्यासाध्यविभागज्ञोयःसम्यक्प्रतिपत्तिमान्|  

साध्यासाध्यविभागज्ञोयःसम्यक्प्रतिपत्तिमान्|  

न स मैत्रेयतुल्यानांमिथ्याबुद्धिंप्रकल्पयेत्||२२||

न स मैत्रेयतुल्यानांमिथ्याबुद्धिंप्रकल्पयेत्||२२||

bhiShajAprAkparIkShyaivaMvikArANAMsvalakShaNam|  

bhiShajAprAkparIkShyaivaMvikArANAMsvalakShaNam|  

sAdhyAsAdhyavibhAgaj~joyaHsamyakpratipattimAn|

sAdhyAsAdhyavibhAgaj~joyaHsamyakpratipattimAn|

nasamaitreyatulyAnAMmithyAbuddhiMprakalpayet||22||

nasamaitreyatulyAnAMmithyAbuddhiMprakalpayet||22||

A wise physician should examine the distinctive features of the diseases first and then start his treatment (only) of the curable diseases. So a physician who can distinguish between curable and incurable diseases, and who possesses the right applications, will not subscribe to the wrong notions prevailing among pseudo- physicians like Maitreya, and say that he will certainly succeed in curing diseases. [21-22]

A wise physician should examine the distinctive features of the diseases first and then start his treatment (only) of the curable diseases. So a physician who can distinguish between curable and incurable diseases, and who possesses the right applications, will not subscribe to the wrong notions prevailing among pseudo- physicians like Maitreya, and say that he will certainly succeed in curing diseases. [21-22]

==== Summary ====

=== Summary ===

<div class="mw-collapsible mw-collapsed">

तत्रश्लोकौ-  

तत्रश्लोकौ-  

चतुर्विधविकल्पाश्चव्याधयःस्वस्वलक्षणाः|  

चतुर्विधविकल्पाश्चव्याधयःस्वस्वलक्षणाः|  

उक्तामहाचतुष्पादेयेष्वायत्तंभिषग्जितम्||२४||

उक्तामहाचतुष्पादेयेष्वायत्तंभिषग्जितम्||२४||

tatrashlokau-  

tatrashlokau-  

caturvidhavikalpAshcavyAdhayaHsvasvalakShaNAH| uktAmahAcatuShpAdeyeShvAyattaMbhiShagjitam||24||

caturvidhavikalpAshcavyAdhayaHsvasvalakShaNAH| uktAmahAcatuShpAdeyeShvAyattaMbhiShagjitam||24||

In brief, therapies, prognostic criteria of the disease and its importance in therapeutics, two different views (in this connection) of Atreya and Maitreya,  the conclusion, four types of prognosis of diseases and its characteristics are described in this “Detailed chapter on Therapeutics”. Treatment of diseases depends upon these considerations. [23-24]

In brief, therapies, prognostic criteria of the disease and its importance in therapeutics, two different views (in this connection) of Atreya and Maitreya,  the conclusion, four types of prognosis of diseases and its characteristics are described in this “Detailed chapter on Therapeutics”. Treatment of diseases depends upon these considerations. [23-24]

इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेश्लोकस्थानेमहाचतुष्पादोनामदशमोऽध्यायः||१०||

इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेश्लोकस्थानेमहाचतुष्पादोनामदशमोऽध्यायः||१०||

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]

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

== Tattva Vimarsha (Fundamental Principles) ==

<div style="text-align:justify;">

<div style="text-align:justify;">

# 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]

# 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]

</div>

</div>

{| class="wikitable"

{| class="wikitable"

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) ==

<div style="text-align:justify;">

<div style="text-align:justify;">

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]  

 

 

 

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> 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 the 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 address 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>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>

   

   

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 ancient times remain the same even today. A step ahead of the contemporary classification of diseases, [[Ayurveda]] advocates the 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.

 

 

 

 

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

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 contemporary medicine researchers to work together.

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.

</div>

</div>

=== Future Scope for Research ===

== Future scope for research ==

#Research studies should be conducted to assess the impact of modern medical facilities , geared with sophisticated medical infrastructure, skilled nursing staff, and features to handle emergency services,  in controlling the mortality and morbidity of a disease.  

#Research studies should be conducted to assess the impact of modern medical facilities , geared with sophisticated medical infrastructure, skilled nursing staff, and features to handle emergency services,  in controlling the mortality and morbidity of a disease.  

#Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

#Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

=== Glossary of Technical Terms ===

== References ==

 

#चतुष्पादं catuShpAdaM- Four limbs(four essential components) of therapeutics viz, Physician, Medicine, Attendant and Patient.

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=== Reference ===

 

#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.

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

#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.

#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.

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