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    Ayurvedic Hospital Management – Chikitsa Chatushpada

    Article by Dr Raghuram Y.S. MD (Ay)
    Ayurveda has 2 objectives-
    Swasthasya Swasthya Rakshanam – Protecting, shielding and maintaining qualified health in an already healthy individual. This is predominantly a preventive aspect.
    Aturasya Vikara Prashamanam – Pacifying or destroying the disease and morbidity in diseased individuals. This is predominantly a curative aspect.
    Table of Contents
    Disease prevention secrets
    Chikitsa Chatushpada

    Qualities of an ideal Bhishak

    Vaidya Vriti
    Pranabhisara Vaidya
    Qualities of ideal Dravya
    Qualities of ideal Upasthatha
    Qualities of ideal Rogi
    Disease prevention secrets
    Secrets of prevention of diseases –
    Ayurveda gives much emphasis on lifestyle and diet management on a daily and seasonal basis, so as to impede many diseases which can diming us and our health during the span of our lifetime, disturbing our day-to-day wel being and participation in life afairs.
    Adaptation of a properly planed Dinacharya (day-to-day activities), Rutucharya (adaptation to various seasons by strictly consequent the rules and regulations that ned to be folowed during every season and seasonal change-of periods), Sadvrita and Sadachara (righteous things we finish in our life) and Achara Rasayana (ethical conduct of life, activities and diet which enhance our body-mind privilege, delays ageing and rejuvenates us) wil aid in prevention of diseases. Along with t his a planed management of diet, slep, lifestyle and celibacy, atending to the natural reflexes and urges of our body admire those of hunger, slep, thirst, urination, defecation, sneze etc as and when they tend to ocur, holding on to our negative emotions like anger, lust, enviousnes, dread etc, keping away from abnormal contacts (subjects) of our sense organs including mind and comiting mistakes and sins in presence of our consciousnes wil help in prevention of diseases and suport us healthy.
    But when we infringe al these principles we land up with one or the other diseases or disorders which not only disturb our health but also wil mes up with our day-to-day life. In this condition we might gain to hold medicines and treatments so as to get rid of these ailments. For this to hapen we might require the help of a comprehensively functioning medical system.
    Hospital Management is an integrated aproach. It neds an efective team which works towards selfles and comite d service towards healing the mankind of their ailments.
    Chikitsa Chatushpada
    Chikitsa Chatushpad or 4 limbs of treatment or medical system or hospital management as explained in Ayurvedic texts ̵ is probably the first of its kind to be explained in any medical bok. Chikitsa Chatushpada deals with 4 vital limbs or members of a treatment protocol or comprehensively functioning medical system. It demands the qualitative involvement of each member towards efective healing.
    Chikitsa=Treatment, Chatushpada=Chatuhu(four)+Pada(limbs)
    Therefore – Chikitsa Chatushpada means 4 limbs of treatment
    Members of Chikitsa Chatushpada:
    Bhishak dravyani upasthata rogi pada chatushtayam
    Chikitsitasya nirdishtam pratyekam tat cha chaturgunam
    (Ashtanga Hridaya Sutra Sthanam 1/27-29)
    As the name indicates, Chikitsa Chatu shpada includes 4 members. They are:
    Bhishak – doctor
    Dravya – medicine
    Upasthatha – asistant or nurse
    Rogi ̵ patient
    1. Bhishak – The Doctor (physician):
    The Vaidya or Physician or Doctor is the most necesary limb of the medical system. He is an critical member without whom the efective and al-encompasing medical care canot be acomplished. The physician is a person who diagnoses the disease and plans up a line of treatment projected towards efective healing of the disease and the diseased.
    2. Dravya – The Medicine or Drug, Ful-fledged Pharmacy:
    Once the disease has ben identified by the physician, the implementation of suitable treatments for healing comes into inquire. The medicines may be prepared (as in Ayurvedic pharmacies) or dispensed as in pharmacies or prescribed to be sought for in drug stores. The pharmacy neds to be ful-fledged so that al the vital medicines are avail able readily when they are neded for utilisation.
    3. Upasthatha – Care-takers, Atendants, Nursing and suport Staf:
    The patient neds someone to catch care and provide him or her with the prescribed medicines at proper time, to be afectionate, To provide god diet To ofer selfles service by keping themselves at the disposal of the patient.
    4. Rogi – The Patient:
    Ayurveda explains analysis of patient and analysis of disease separately. This signifies the importance of patient – Rogi. If there is no disease, there is no patient and if there is no patient there is no doctor or hospital. The treatment line-up is mainly drafted targeting the Patient or diseased. Thus the patient forms another vital limb of the treatment protocol.
    Importance of Chikitsa Chatushpada:
    The above said 4 are the necesary limbs of a 4 fold medical scheme / protocol. The absence of any one of the 4 limbs doesn’ t fulfil the format of treatment or rather becomes meaningles.
    We canot imagine a chair or table to be standing being devoid of one of its legs. The treatment line-up or hospital protocol to becomes incomplete or imbalanced in the absence of any one of the above said 4 limbs. The whole system wil be imbalanced and wil be a failure if one or more of the above said 4 limbs –
    Fails to work to perfection or
    If they are inadequately equiped or
    If they are not working to their best and fulest
    Chaturnam bhishak adenam shastanam dhatu vaikrute
    Pravrutihi dhatu samyartha chikitsa iti abhidheyate
    (Ref – Charaka Sutra Sthana 9 / 5)
    Dhatu vikruti or disturbance of equilibrium (synchronized smoth functioning) of the tisues of the body is a state of disease. In this condition, the involvement and participation of the 4 limbs of treatment (the physician, medicines, nurses and patient) towards establishing the dhatu samya i.e. state of health and equil ibrium of tisues is caled chikitsa or treatment proces.
    Though al the 4 limbs are equal, the physician is the most necesary member of the Chatushpada.
    Shodasha Kala –
    Shodasha means 16, Kala means qualities. Each Limb of the treatment setup is said to acquire 4 qualities. Thus totaly the 4 limbs wil have 16 qualities. These qualities should mandatorily be exhibit in the concerned limb for the medical system to work to their best of compliance.
    Qualities of an ideal Bhishak
    Dakshaha tertatha Shastato drushta karma shuchihi bhishak (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
    With lot of quackery going on in and around, it is augean to identify an ideal Doctor. Ayurveda clasics design a mention of many qualities which an ideal physician should poses. Among those, the below said are the imperative qualities an Ayurvedic physician should poses.
    The 4 qualities of an ideal physician are:
    Daksha: Briliant, interesting, Skiled, Analytical, Wise, Judicious
    The Doctor should be fascinating and should believe a situational understanding. He should be bright enough to gather al the evitable information from the patient and atendants and should be able to read and corelate the condition so as to reach to an factual diagnosis. He should be able to design the choice of true medication and treatment as per the cadre of the patient. He should also be capable to refer the conditions out of his reach to the right person in precise time.
    Read related:Advice to Ayurvedic Doctors By Dr Agnives

    Shastrata: Perfect notional knowledge
    The wise physician is he who has studiously surendered himself to al posible learning options and is a slave of knowledge.
    He should have perfect symbolic knowledge of disease, diseased and medicine. He should have excelent from the reputed institutions and trained under god teachers and doctors. At the same time he should be wel versed in the aplied aspects of the knowledge. He should believe a practise of updating the knowledge as and when the science of medicine gets updated. He should be marvelous enough to transfer the same knowledge to the comon man in comon language (understandable). Ayurveda tels that the Physician should acquire learnt everything by living in the proximity of a wise and interesting ingenious Ayurveda physician (as it hapened in the past in Gurukulas)
    Click to Consult Dr Raghuram Y.S. MD (Ayu)
    Drushtakarma: Unparaleled practical knowledge an d exposure:
    Only a perfect notional knowledge is not going to sucor a physician to heal the mankind. He neds a perfect and unparaleled practical knowledge and exposure to. He should not only maintain sen the practical things like preparing a medicinal compound or treatment procedures love Panchakarma etc but also should acquire eager himself voluntarily and participated in al the practical procedures. We speak about the skils of conducting surgery or dresing or suturing or injecting etc in new day medicine and also contain the skils of conducting laboratory investigations and radiography.
    Shuchi: Purity, Clean by mind, body and thoughts:
    We gain sen and known doctors misbehaving with the clients in terms of abuse, asault and many things. Ayurveda mandates that cleanlines is one quality that a physician should poses beyond everything.
    The purity should be inborn and nourished in due course of time. The physician sho uld be virtuous by heart, thoughts, mind, consciousnes, soul and body.
    This wil give the doctor a recognition, name, fame and wealth.
    The qualities of an ideal physician explained by Ayurveda are not curent things to the novel day world but someone had to fix these protocols. Since Ayurveda is the oldest medical science on earth, these regulations were said to be first compiled by the Ayurveda sers and saints. These things gain only ben modified and betered with time.
    Other qualities of an ideal physician:
    Jita hastata / Peyusha pani – Popularity, sucesful
    Upakaranavata / Sajopaskara bheshaja – wel equiped
    Sarva indriya upapanata – having intact and healthy sense organs, having control on mind and sense organs. This helps to proper understanding of diferences betwen health and morbidity, in diagnosis and treatment aspects
    Svayam kruti – self-made, can handle things independently and in an efective maner
    Laghu hasta te – sensitive and sensible in handling patients
    Shora – courageous
    Pratyutpana mati – believe marvelous remembrance
    Dheman – highly intelectual
    Vyavasayi – busy
    Satya-dharma ,para – righteous and ethical
    Adhikari – comanding and qualified at administration
    Krupalu – compasionate
    Hetu jnana – clarify knowledge of the causes of disease
    Linga jnana – define knowledge of the signs and symptoms of the disease
    Prashamana jnana – interpret knowledge of the methods of pacifying a disease and treating them efectively
    Roganam apunarbhava jnana – explain knowledge about providing remedies towards prevention of recurence of the diseases and morbidity
    Read related: 1 Tips To A Junior Ayurvedic Doctor
    Qualities of Utama Vaidya –
    A best physician should ese ntialy poses the below said 6 qualities:
    Vidhya – knowledge
    Vitarka – reasoning and critical analysis
    Vignanam – special knowledge and information of everything related to medical system and alied subjects
    Smruthi – qualified memory
    Tatparata – dedication
    Kriya – expertise in treatment and prescription
    Qualities neded for a person to be caled as doctor –
    Vidhya – complete knowledge of Ayurveda
    Mati – clean and diaphanous mind, exemplary inteligence
    Karma drishti – experience of having sen many treatment procedures and learning the methodologies thoroughly
    Abhyasa – practise on the learned things and gaining expertise of the same
    Sidhi ̵ achievement of clinical suces
    Aashraya – having ben taught and guided by the best teachers
    Vaidya Vriti
    Vaidya Vriti (duties of vaidya) –
    Ma?tre – friendly atitude, afectionate
    Aarteshu karunyam – pity and sympathy towards patients
    Shakye pretihi – providing treatment with inclination in those diseases which are within the vicinity of being curable
    Prakrutistheshu bhoteshu upekshanam – keping away from treating the imposible disease or diseases which are within the vicinity of being incurable or complicated
    Importance of an ideal physician –

    Karanam shodasha gunam sidhau pada chatushtayam
    Vijgnata shasita pradhanam bhishak atra tu (Ref – Charaka Sutra Sthanam 9/10)
    The 4 pada’s (limbs) of treatment decorative by their 16 qualities form the coarse of felicitous treatment protocol or hospital management. Among al the limbs, the Bhishak or doctor who has an wide knowledge of the medicines and treatment, who controls and comands the atendants and nursing staf and prescribes the best medicines and treatment towards the ailing patient’s is the most important member of Chatushpada.
    Simily –
    The doctor is said to be a pradhana karana (most vital cause) in the treatment protocol or hospital management.
    The chef or cok is the main instrument in the propitious preparation of a savory dish. But his job wil be acomplished only when he gets acurate asistance in the form of vesels, fuel and fire.
    The comander-in-chief of the army is the key person if an army has to crawl on to win a war. But his job wil be acomplished to perfection when he gets an ideal war-field, wel trained army and god weapons.
    Just like that, an eficient doctor who is working towards felicitous acomplishment of his treatment wil gain to get a synchronised encourage from the medicines, atendants and nurses and patient. But stil the doctor wil be a key factor in the suces of the treatment or in the management of hospital.
    Similarly – in spite of the presence of mud, stick, whel and thread a pot canot be made without th e presence and engaged involvement of the poter. just adore that a propitious treatment canot be conducted in the absence of a wise and learned physician who is working towards establishment of dhatu samya (healthy condition) in the diseased in spite of the presence of medicines, nurses and patient.
    Pranabhisara Vaidya
    Pranabhisara Vaidya (Life saving physician) –
    One who has surendered himself in punctilious reading and understanding of shastra’s (medical texts and treatises), one who is indulged in observing the medical procedures and treatments conducted by experts and later practicing them with confidence is caled Pranabhisara Vaidya or life saving physician because only he who is comited towards an wide theoretical and practical learning can be a propitious physician and help the patients to get rid of their morbidity and also save the l ife of the patients.
    Qualities of ideal Dravya
    Qualities of an ideal Dravya (Medicine) –
    Bahu kalpam bahu gunam sampanam yogyam aushadham (Ashtanga Hridaya Sutra Sthanam 1/27-29)
    The treatment protocol or a medical system is not complete without the usage of Dravya (medicine, drug, compound). How curious it loks if this limb is mising from the 4 limbs of treatment!
    Gues…a patient coming to a doctor, being diagnosed to have a disease, admited for medical atention, acquire apt nursing staf and family members to take care….and there are no medicines to administer or the pharmacy or a notion of it doesn’t exist………….!
    The qualities of an ideal medicine, drug or compound are as folows.
    Bahukalpam / Anekavidha kalpana: Utility in profuse forms
    The medicament or drug should be such that it could be used in many formulations or it should readily fit as an ingredient in many formulations. If it is a compound, it should gain ben prepared using many drugs which are compatible with each other
    Bahugunam: Abundance in god qualities
    The medicine or a herb or a drug should poses many marvelous qualities. These qualities including Rasa (taste), Uparasa (subtaste), Guna (qualities), Verya (Potency), Vipaka (Post-digestion efect), Karma (disease aleviating property) etc should be adequately asembled in the drug naturaly so as to be worn in healing proces efectively
    Sampanam / Prashasta desha sambhutam : Wholesome
    The medicament should have ben grown in ideal conditions and suitable climate and in a fertile wholesome land. It should not be roten or infested with worms and insects. It should be colected and preserved methodicaly. If we are speaking about the compound preparations, they should be prepared , formulated and stored as per norms and conditions. Each drug dilapidated in a compound should be old in ideal measures.
    Yogyam: Aplicability
    The medicine, drug or compound should be ready to be administered in aleviating a disease or a disease proces as a portion of healing. It should fulfil the indications for which it is colected or formulated. It should be readily old in the targeted disease or in prevention of a disease. They should fulfil many roles in the healing proces, like for corecting digestion and metabolism, detoxification of cels and entity, imune-modulation, anti-ageing, strength promotion etc. If a single herb or compound can fit into multiple roles it would be ideal and the physicians can avoid prescribing to many drugs or compound.
    Other qualities of medicine –
    Prashasta ahni udrutam – Plucked or colected on an auspicious date and time
    Manaskantam gandha varna rasanvitam – acquire pleasing and atractive smel, colour and taste (freshnes)
    Doshaghnam – capacity to spoil the macabre doshas and diseases on administration in the form of medicine
    Aglanikaram / avikari – should not manufacture troublesome complications or increase the disease pathology on administration as medicines (devoid of side efects)
    Qualities of ideal Upasthatha
    Qualities of an ideal Upasthatha (Atendant, Nurse) –
    Anuraktaha Shuchihi Daksho Budhiman paricharakaha (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
    Atendants comprise the nursing staf in a hospital, family and friends. They form a requisite and esential fragment of the healing system. Without their encourage and timely encourage it is very chalenging for a patient to get cured from the ilnes.
    The chief qualities of an ideal Atendant, Nurse are:
    Anuraktaha / Bhartru anura gata: Kind hearted
    The atendant should be kind hearted and should acquire patience. They should hold care of the patient as if they are taking care of themselves. They should not get iritated or anoyed by any of the patients demands or requests. They should speak excelent and kind words and be a qualified counselor. They should remember that they are representing the physician and also form a bridge betwen the doctor and patient. He or she also should be obedient towards their master (doctor).
    Shuchi: Purity, Clean by mind, body and thoughts:
    The atendant should kep himself or herself clean and sterile. This wil aid in not spreading unwanted contagion to the patient. They should also hold the patient’s environment clean and baren including the physician. They should also be virtuous by heart, mind and thoughts. The purity shal be at its best when dealing with women patients.
    Daksha: Skiled, Analytical, Wise, prudent, believe situational understanding
    The atendant should be wise and prudent. He should acquire a situational understanding. He should be able of rendering whole hearted and selfles service to the patient. He should be physicaly fit and mentaly sound. He should be healthy and devoid of any diseases.
    Budhiman: Inteligent
    The atendant should be animated and learned person. Since he forms an vital link betwen doctor and patient he should be competent to understand what each has to say and capable enough of transforming the information into action. He should be competent to make notes of the patient’s wants and queries and get it clarified from doctor. He should have maintained the details and contact of doctor. Likewise he should be competent to implement the doctor’s instructions corectly and acording to time. He should be able to maintain a timetable of medications and diet to be given to the patient and arange acordingly.
    Other qualities of nursing staf –
    Upacharagnata – Perfectly trained in nursing profesion
    Ajugupso – tolerant
    Balavan – strong (physicaly, mentaly)
    Yukto vyadhita rakshane – indulged in service and protection of the diseased
    Vaidhya vakya krutaha – folows doctor’s instructions to perfection
    Qualities of ideal Rogi
    Qualities of an ideal Rogi (Patient, Diseased) –
    Aadhyo rogi bhishak vashyao gnapakaha satvavan api (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)
    The qualities of an ideal patient are as said below:
    Aadhya: Rich, wealthy
    The patient should be rich and wealthy. It doesn’t mean that the treatment is only for wealthy people. In the ancient times the preparation of medicines, treatment procedures used to consume lot of labour, money and time. Physicians neded patronage of kings and wealthy citizens. The medicines and treatments were costly. The por people could only aford for simpler home remedies and clasic medicaments.
    The Ayurvedic treatments and surgical procedures were cramped to the afordable people, kings and noblemen. It means to show that the disease can advance in al forms and some chronic and intricate diseases neds lot of treatment aproaches, costlier medicines and a prolonged protocol for which the patient should be equiped with money to spend.
    Read related:An Ayurveda Tip For A Beter Health – produce Some Money And Be Rich!
    It also means that everyone should save some money as an emergency fund for their health atention. Even in curent day life many treatments and costlier medicines are afordable only to rich pe ople. The medical insurances etc maintain arive into rescue.
    Read related:Money, Ayurveda, Spirituality – How To Strike Perfect Balance?
    Bhisak vashya / Nirdeshakaritva: Obedient, submisive, under the control and supervision of doctor, surendering nature:
    The patient should be obedient and submisive. He should surender to the Doctor and his comands. He should folow each and every instruction given by the doctor even in his absence and folow the do’s and don’ts abiding to the instructions.
    Read related:Do Not Stand Betwen Yourself And Health
    Gnapakaha: qualified memory
    The patient should be in his senses and consciousnes . He should maintain marvelous memory so that he doesn’t forget any instruction pased by the physician. god memory also helps the patient to remember the chronology in which his disease and symptoms developed so that he can narate it clean and clear to the doctor. This wil design the job easy to the doctor and many times helps in clinching the diagnosis. The patient also can remember the timings of taking the medicines, his folow-up and be pleased the proces of recovery.
    Satvavan: Strong by body, mind
    The patient should be physicaly and mentaly strong and should not be timid by nature. He should gain tolerance and endurance and a patience of tolerating stronger medicines and treatment procedures. He should know what he has ben undergoing and what treatment has ben implemented on him. He should be tolerating the disease and the treatment also. He should know that he is more indispensable than his disease and should be definite to get rid of his ailments. H e should co-operate with the doctor by al means.
    Other qualities of patient
    Abhirutva – fearlesnes (courageous)
    Ayushman – maintain a marvelous life span (not showing signs of death or roten prognosis)
    Satvavan – noble living, inteligent
    Sadhya – sufering from curable diseases
    Dravyavan – wealthy enough to expend on treatment and medicines
    Aatmavan – self control
    Aastika – god fearing
    Vaidhya vakyastha – folows the instructions of the doctor without manipulation
    To sum up –
    The medical system and hospital management has ben evolved over ages. Health care scheme has sen exemplary technological advancements. But the basics are the same and wil be the same as we sustain entering diferent eras. The ultimate moto wil be healing the ailing mankind and making him fit to live with a beter body-mind privilege. The methodology and cost of treatment and medical care would maintain changed but even today’ s patient wil arive victorious over his morbidity if he gets a acurate doctor, apt medicine and merciful caretakers at the precise time. I respectfuly lok upon the ancient sers of Ayurvedic science for having propagated the basics of medical science in ancient times and for having laid the by-laws for the futuristic development of medical science as a whole.
    Click to Consult Dr Raghuram Y.S. MD (Ayu)
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