Charak Samhita - Sutrasthana - Chapter 10 (Maha Chatuspada Adhyaya)
Four key elements of healthcare were discussed in the chapter before, including the norms for a doctor, nursing staff, medication, and the patient. Guidelines for therapeutic therapy according to four different disease prognosis types are covered in this chapter. Before beginning therapy, it is crucial to ascertain the prognosis of a condition in order to assess the patient's quality of life and whether they will be ill or ailment-free. As implied by the chapter's title, it discusses four crucial elements of the therapeutic management of disorders.
This chapter outlines four disease kinds based on their prognoses and places a strong emphasis on the necessity of prognosis information for effective illness management. Prior to starting a patient's treatment, it's critical to determine their prognosis. The four elements of management of healthcare are suggested by Lord Atreya in response to Maitreya's questions about the role of medicines in eliminating disease. He contends that without understanding the prognosis of a condition, not even the wisest medical professional or the most effective therapeutic approach can prevent or treat it. The chapter provides information on each element, including Prakriti (Body type), that can be used to determine a disease's prognosis. To illustrate the notion of dhatu samyata (Maintenance of a healthy balance or homeostasis), certain essential management methods are listed, including feeding therapy, addressing the disease's primary cause, fasting therapy, cold therapy, and hot therapy.
Four Elements Of Therapeutics
Medical professionals say that therapeutics contain four components with sixteen properties. The same thing was expressed in the chapter before: Lord Punarvasu Atreya said that medicines with these sixteen attributes might cure illnesses.
Observation And Question Of Maitreya
Maitreya disagrees and asks, "What is the cause that certain patients handled by adequate medications, attendants, and well-trained doctors, who are also possessing self-control, quickly heal from the ailments? But what if some people still pass away despite all of these? Therapeutics are therefore useless in the fight against sickness. This is comparable to a little water thrown in a pond or ditch or dropping a handful of dust into a heap of dust or into a river that is running. On the other hand, there are patients who, in spite of the lack of necessary materials, caregivers, skilled medical professionals, patience, recover, while others in similar circumstances also pass away. In conclusion, it can be argued that whether or not therapeutic procedures are taken, the outcomes are the same. Because a person using therapeutic methods occasionally recovers from their illnesses and occasionally passes away as well. Similar circumstances apply to someone who ignores treatment interventions.
Answer From Atreya
Oh Maitreya! says Lord Atreya in response to this. You did not arrive at the right conclusion. Because it is not supported by facts to claim that patients who adopt treatment measures and possess the sixteen traits perish. In disorders that can be cured, therapeutic interventions can never be unsuccessful. Likewise, even in situations where patients recover without the use of adequate medication, it is important to recognize that the healing process would have been sped up and more effective if therapeutic measures had been properly administered. To lift a healthy individual who falls is analogous to doing this. He can undoubtedly stand up on his own, but if someone else lifted and assisted him, he would stand up more quickly and easily. Similar circumstances apply to patients who claim to have recovered despite inadequate therapy interventions. So there is the situation in which people pass away despite receiving proper medical treatment. Because not all ailments are treatable, not all patients who seek out treatment methods are inevitably cured. Only therapeutic techniques can be used to treat conditions that are treatable. A patient who cannot be cured will undoubtedly not react to treatment, and even a talented doctor is not capable of reviving a dead patient. A skilled doctor always starts treatment after a thorough examination. As an archer having theoretical knowledge and practical experience in the art, does not fail when he takes the bow and strikes the arrow to a not distant and big object and thus achieves the desired result, likewise, the physician, endowed with his qualities and equipped with all necessary materials, proceeds with treatment after careful examination, alleviates the curable disease without fall and provides normalcy to the patient. Therefore, it is not correct to say that therapeutics are not different from non-therapeutics.
General Principles For Management
And we witness firsthand how a patient can be healed by using curative therapeutic interventions, which replenish the body's depleted materials. We provide food for individuals who are malnourished and frail. We give lowering therapy to the fat person. We use cooling measures on patients who are suffering from heat, and heating techniques on those who are suffering from cold. We take the necessary steps to reduce the surplus dhatus and refill the inadequate dhatus. As a result, we restore physiological equilibrium by healing diseases with agents that have the opposite causal qualities. Thus, when it comes to the handling of diseases, a team of therapeutic techniques produces the best results.
Effects Of Treatment After Learning The Prognosis
A doctor may definitely achieve his goal (Of curing the condition) if they are able to differentiate between treatable and incurable medical conditions, start therapy on schedule, and are well informed about all therapeutic options. On the other hand, a doctor who attempts to treat an incurable illness will surely suffer a loss of money, expertise, and prestige as well as a negative reputation from censure and unpopularity.
Types Of Prognosis
There are two categories of disorders that can be cured: those that are simple to treat and those that are more challenging. Similar to this, there are two categories of incurable diseases: those that can be reversed somewhat and those that are completely irreversible. Again, there are three variations for ailments that can be cured depending on the good and outstanding treatments needed. However, this option cannot be used in the case of disorders that are categorically incurable.
Prognostic Factors For Disorders That Are Easily Treated
- Causes, prodromal symptoms are a few.
- Dushya is not similar to dosha in quality nor is dosha as in constitution.
- The patient's prakriti (Mental and physical and constitution) is made up of different doshas.
- The season does not favor the spread of the illness.
- Geographical and physical conditions do not favor the spread of the illness.
- The sickness only affects one specific system.
- Recently developed (not ongoing).
- Absence of complications.
- Involvement of one dosha in the disease pathogenesis.
- Body capable of tolerating all therapeutic measures.
- Proper arrangement of four legs (Physician, attendant, drug and patient).
Prognostic Factors For Difficult-To-Cure Diseases
- Causes, prodromal symptoms are of medium severity.
- Any one of the season (Kala), mental, including physical constitution (Prakriti), and tissue elements (Dhatus) characteristics is advantageous to the sickness.
- A pregnant lady, an elderly person, or a youngster is the individual who has the sickness.
- Not afflicted with too many complications.
- Diseases that require treatment, the use of alkalis, surgery, and cauterization.
- Not recently developed.
- Disease located in vital parts.
- Disease involvement of one passage but not equipped fully with fourfolds of therapeutic measures.
- Disease of two passages but not of very long period.
- Disease having causation by two doshas.
Prognostic Factors For Palliable Disease
- The patient has endured for a predetermined amount of time by adhering to a healthy routine, and as a result, has seen some relief. However, even the slightest negligence could immediately aggravate the disease.
- Deep-seated dhatus have been harmed by the illness.
- Several dhatus are involved in the disorder.
- The critical joints and organs are impacted.
- It has a long-lasting (chronic) effect on the patient.
- Disease caused by two doshas.
Prognostic Factors For Incurable Disease
- Disease that is caused by all the three doshas.
- Disease not amenable to any therapy.
- Disease involving all the passages.
- Excitation, restlessness, and confusion-causing illness.
- Disease that impacts the sense organs.
- Typically, the patient has a weak immune system and the sickness has progressed far enough.
- The disease's poor prognostic indicators.
Significance Of Prognosis
A wise doctor will first study the diseases' distinguishing characteristics before beginning to treat those that are treatable. Therefore, a doctor who can tell the difference between treatable and incurable conditions and who has the necessary tools won't agree to the false beliefs held by pseudo-doctors like Maitreya and claim that he will undoubtedly be successful in curing ailments.
In this chapter we read about the great quadruple on which the therapeutics depend. We read about the therapeutics, qualities of four therapeutics, effect of therapeutics, views of Atreya and Maitreya, conclusion of two divergent views, four categories of diseases (According to prognosis) with their respective characters. In order to treat just those ailments that are curable, a knowledgeable doctor should first assess the distinguishing characteristics of the illnesses.