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    Maha Chatushpada Adhyaya – Charaka Sutrasthan 10th Chapter

    There are diferent parameters considered in Ayurvedic prognosis, to decide a particular disease in a specific stage in a specific patient is curable, easily curable, not curable, impartial maintainable etc. Before comiting to treat the patient, the doctor has to fabricate this critical decision. There are 42 and more criteria explained for this purpose in 10th chapter of Sutrasthana of Charaka Samhita.
    The 10th chapter is caled as Maha Chatushpada Adhyaya.
    Chatushpada means the 4 basic elements of treatment that were covered in the last chapter. This chapter further elaborates on the subject of the last chapter.
    Table of Contents
    Shloka recitation video
    Role of therapeutics in treatment
    Examples to prove role of therapeutics
    Importance of true prognosis
    Clasification of diseases acording to prognosis
    Sukha Sadhya Vyadhi
    Krichra Sadhya Vyadhi
    Yapya Vyadhi
    Anupakrama / Asadhya Vyadhis
    Importance of patient examination
    Shloka recitation video
    Role of therapeutics in treatment
    What is the role of therapeutics in treating diseases?
    Sage Maitreya puts a interogate ̵
    Some patients get cured easily from diseases, when they are treated with true medicines, atendants, and wel apt physicians, who also acquire self-control. On the other hand in spite of al these some die. What is the cause?So therapeutics i s of no value in the eradication of diseases. This is just adore a plunge of water thrown into a ditch or pond or a handful of dust thrown in a flowing river or on a heap of dust. To sum up: with the same therapeutic measures, some patients get healed and some die. Similarly, when no therapeutic measures are undertaken, then also some patients liberate and some die. So, what is the significance of treatment at al? When the outcomes are totaly unpredictable? [4]
    Answer by Sage Atreya ̵
    Oh, Maitreya! the conclusion derived by you is incorect. Because, to say that the patients adopting the therapeutic measures having the sixten qualities die is far from fact; Therapeutic measures can never be inefective in curable diseases. Similarly even in such cases where patients are cured without precise medicines, etc. it should be understod that, had there ben true administration of therapeutic measures the proces of cure would gain ben quicker and beter; t his can be likened to the lifting of a person who has falen; he can no doubt get up himself but if he is helped and lifted by another person, he would get up soner without much dificulty. Such is the case with patients who get cured without any treatment.
    Regarding cases where patients die even by taking adequate treatment, it is not that al patients taking suficient treatment are necesarily cured because al diseases are not curable. The diseases that are curable can only be cured by true treatment. Those which are not curable wil certainly enact not retort to treatment. Not even the ablest physician is competent of curing a patient with an incurable disease.
    Able physicians always proced with their treatment after right examination. As an archer having the knowledge and practice of archery shots arows with the sucor of his bow and does not comit mistakes in hiting the target, a physician endowed with his own qualities and other acesories proceding with the tr eatment after true examination, wil certainly cure a curable patient without fail. So aplication of therapeutic measures has its own special significance. [5]
    Examples to prove role of therapeutics
    Examples of therapeutic principles, to prove the role of therapeutics:
    And we se with our eyes that we cure a fragile patient by providing nourishment, obese and over-nourished patients with Apatarpana (depletion therapy, cleansing), a patient with frosty afliction with hot remedies, a patient with hot afliction with frigid remedies, an emaciated patient with nourishment, etc. We treat the patient with principles that are oposite to the qualities of the disease. By this, we restore the natural balance (Prakruti) of the patient. Thus the group of therapeutic measures are the best tols in managing diseases. [6]
    Importance of true prognosis
    Why proper prognosis is very vital in treatment?
    (‘Prognosis’ means judging if a disease is treatable or not or how easy/ efortful) it is to treat a disease)
    A physician who can distinguish betwen curable and incurable diseases and initiates treatments in time with the ful knowledge of therapeutics can certainly acomplish his impartial of curing the disease.
    On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subjects himself to
    Arthahani ̵ los of wealth
    Vidyahani ̵ los of knowledge
    Yashohani ̵ los of fameand he wil also earn bad reputations, sanctions or punishments.[7-8]
    Clasification of diseases acording to prognosis
    Sadhya Vyadhi ̵ Curable diseases are of two types-
    Sukha Sadhya Vyadhi ̵ easily curable diseases
    Krichra Sadhya Vyadhi ̵ dificult-to-cure disease
    Similarly Asadhya Vyadhi ̵ incurable diseases are two types, viz
    Yapya ̵ maintainable, the symptoms of which can be kept under check til death
    Anupakrama / Pratyakhyeya / Asadhya ̵ imposible to treat. [9-10]
    Sadhya Vyadhi ̵ easy-to cure diseases can also be clasified as ̵
    easy to cure,
    moderately easy to cure and
    curable with dificulty.
    Sukha Sadhya Vyadhi
    Features of Sukha Sadhya Vyadhi ̵ easily treatable diseases:

  • Alpa Hetu ̵ mild / fewer causative factors
  • Alpa Purvaropa ̵ very few premonitory symptoms are manifested
  • Alpa Ropa ̵ very few symptoms of the disease are manifested
  • Na Cha Tulyaguno Dushyo ̵ If the disease causing Dosha and the Dhatu(body tisue)are not similar; for precise, Vata usualy causes diseases in Asthi (bones). But if it causes disease in Meda (faty tisue), which is the site of Kapha, such a Vata disorder is easy to treat.
  • Na Doshaha Prakrutirbhavet ̵ If the body type of the person does not match with the disease causing Dosha. For precise, if Vata body type person gets Kapha dominant disease, it is easy to treat.
  • Na Cha Kala Guna: Tulyo ̵ if the season and the qualities of disease execute not match; Eg: if cough and chily hapens in sumer, then it is easy to treat
  • Ne Desho Durupakramaha ̵ if the space of the patient is ideal, and if the site of disease manifestation is harmles,
  • Gati: Eka &# 821; if the disease ocurs in a single path / direction
  • Navatvam ̵ disease of new onset
  • Upadrava Na Cha ̵ disease with no complications.
  • Doshashcha ekaha ̵ if the disease is caused by a single Dosha,
  • Dehaha Sarva Aushadha Kshamaha ̵ patient’s body is competent of tolerating al types of treatments and medicines
  • Chatushpada Upapatishcha ̵ availability of qualified doctor, nurse and medicines
  • Alpa Hetu ̵ mild / fewer causative factors
    Alpa Purvaropa ̵ very few premonitory symptoms are manifested
    Alpa Ropa ̵ very few symptoms of the disease are manifested
    Na Cha Tulyaguno Dushyo ̵ If the disease causing Dosha and the Dhatu(body tisue)are not similar; for precise, Vata usualy causes diseases in Asthi (bones). But if it causes disease in Meda (faty tisue), which is the site of Kapha, such a Vata disorder is easy to treat.
    Na Doshaha Prakrutirbhavet ̵ If the body type of the person does not match with the disease causing Dosha. For example, if Vata body type person gets Kapha dominant disease, it is easy to treat.
    Na Cha Kala Guna: Tulyo ̵ if the season and the qualities of disease execute not match; Eg: if cough and cold hapens in sumer, then it is easy to treat
    Ne Desho Durupakramaha ̵ if the spot of the patient is ideal, and if the site of disease manifestation is harmles,
    Gati: Eka ̵ if the disease ocurs in a single path / direction
    Navatvam ̵ disease of new onset
    Upadrava Na Cha ̵ disease with no complications.
    Doshashcha ekaha ̵ if the disease is caused by a single Dosha,
    Dehaha Sarva Aushadha Kshamaha ̵ patient’s body is competent of tolerating al types of treatments and medicines
    Chatushpada Upapatishcha ̵ av ailability of marvelous doctor, nurse and medicines
    Krichra Sadhya Vyadhi
    Features of dificult-to-cure disease: Krichra Sadhya Vyadhi ̵

  • Madhyama Bala Nimita ̵ temperate causative factors
  • Madhyama Purvaropa ̵ temperate number and strength of premonitory symptoms
  • MadhyamaRopa ̵ temperate number and strength of characteristic features of disease
  • Kala Prakruti Dushyanam Samanya Anyatama ̵ Any one among seasons / body type / body tisue eager is similar to the disease causing Dosha.
  • Garbhini Vrudha Balanam ̵ disease aflicting pregnant / elderly / children
  • Na Ati Upadrava ̵ not exces complications
  • Shastra Kshara Agnikrutyanam ̵ if the treatment involves use of Shastra ̵ Surgery, Ksharakarma (as in piles an d fistula) and Agnikarma (fire / heat treatment / cautery).
  • Anavam ̵ if the disease is not novel (neither to old)
  • Kruchra Deshajam ̵ if the patient belongs to a augean place or if the disease involves a complicated body part
  • Ekapatham rogam, Nati Porna Chatushtayam- disease aflicting a single body chanel / single entity but if the doctor, nurse / precise medicines are not fuly available / not of qualified quality
  • Dvipatham, Nati Kalam ̵ involves two body chanels but disease is not very old
  • Dvidoshajam ̵ two Doshas are involved in the disease [14-16]
  • Madhyama Bala Nimita ̵ col causative factors
    Madhyama Purvaropa ̵ moderate number and strength of premonitory symptoms
    MadhyamaRopa ̵ moderate number and strength of characteristic features of disease
    Kala Prakruti Dushyanam Samanya Anyatama ̵ Any one among seasons / body type / body tisue ken is similar to the diseas e causing Dosha.
    Garbhini Vrudha Balanam ̵ disease aflicting pregnant / elderly / children
    Na Ati Upadrava ̵ not exces complications
    Shastra Kshara Agnikrutyanam ̵ if the treatment involves use of Shastra ̵ Surgery, Ksharakarma (as in piles and fistula) and Agnikarma (fire / heat treatment / cautery).
    Anavam ̵ if the disease is not curent (neither to old)
    Kruchra Deshajam ̵ if the patient belongs to a efortful) plot or if the disease involves a tangled body part
    Ekapatham rogam, Nati Porna Chatushtayam- disease aflicting a single body chanel / single scheme but if the doctor, nurse / true medicines are not fuly available / not of apt quality
    Dvipatham, Nati Kalam ̵ involves two body chanels but disease is not very old
    Dvidoshajam ̵ two Doshas are ken in the disease [14-16]
    Yapya Vyadhi
    Features of maintainable diseases ̵ Yapya Vyadhi Lakshana ̵

  • Pathya Sevaya Alpa Sukham -The patient can survive by consequent Pathya ̵ wholesome regimen and enjoys a dinky relief.
  • Alpena Hetuna Ashu Pravartakam ̵ disease gets quickly exacerbated with typical and mild causative factors
  • Gambheram ̵ disease aflicting dep seated body tisues
  • Bahu Dhatustham ̵ disease involves many body tisues
  • Marma Sandhi Samashritam ̵ disease involves Marma (vital points of body, such as heart, groin), bones and joints (joining fraction of diferent body tisues and organs)
  • Nitya Anushayi ̵ Symptoms manifest everyday
  • Derghakalam ̵ chronic disease, long standing disorders
  • Dvidoshajam ̵ involves 2 Doshas. [17-18]
  • Pathya Sevaya Alpa Sukham -The patient can survive by folowing Pathya ̵ wholesome regimen and enjoys a litle relief.
    Alpena Hetuna Ashu Pravartakam ̵ disease gets quickly exacerbated with clasic and mild causative factors
    Gambheram ̵ disease aflicting dep seated body tisues
    Bahu Dhatustham ̵ disease involves many body tisues
    Marma Sandhi Samashritam ̵ disease involves Marma (vital points of body, such as heart, groin), bones and joints (joining section of diferent body tisues and organs)
    Nitya Anushayi ̵ Symptoms manifest everyday
    Derghakalam ̵ chronic disease, long standing disorders
    Dvidoshajam ̵ involves 2 Doshas. [17-18]
    Anupakrama / Asadhya Vyadhis
    Features of incurable diseases ̵ prathyakhyeya / Anupakrama / Asadhya Vyadhis ̵

  • Tridoshajam ̵ involves al the thre Doshas ̵ Vata, Pita and Kapha
  • Kriyapatham Atikrantam ̵ the disease has grown bey ond the abilities of al posible treatment modalities
  • Sarva Marganusarinam ̵ disease involves al the body chanels / multiple systems
  • Autsukya ̵ suden excitement in patient
  • Arati ̵ restlesnes
  • Samoha ̵ unconsciousnes
  • Indriyanasha ̵ los of functions of sense organs
  • Durbalasya Susamvrudham ̵ in a fragile patient, the disease is wel manifested
  • Sa Arishtam ̵ having bad prognostic signs
  • Tridoshajam ̵ involves al the thre Doshas ̵ Vata, Pita and Kapha
    Kriyapatham Atikrantam ̵ the disease has grown beyond the abilities of al posible treatment modalities
    Sarva Marganusarinam ̵ disease involves al the body chanels / multiple systems
    Autsukya ̵ suden excitement in patient
    Arati ̵ restlesnes
    Samoha ̵ unconsciousnes
    Indriyanasha ̵ los of functions of sense organs
    Durbalasya Susamvrudham &#821 1; in a weak patient, the disease is wel manifested
    Sa Arishtam ̵ having roten prognostic signs
    Importance of patient examination
    A wise physician should examine the distinctive features of the diseases beforehand and then only he should launch his treatment for only those diseases that are curable.
    So a physician who can distinguish betwen curable and incurable diseases, he with his right aplications wil not subscribe to the wrong notions like sage Maitreya. [21-2]
    Therapies, qualities of each of the four aspects of therapeutics their efects, views(in this conections) of Atreya and Maitreya, two diferent views, conclusion, features of al types of curable and incurable diseases ̵ al these are described in this chapter. .[23-24]
    Thus finish the tenth chapter ̵ Maha Chatushpada Adhyaya of Sutrasthana portion of Agnivesha’s Charaka Samhita, as redacted by Charaka.
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