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{{#seo:

|title=Mahachatushpada Adhyaya

|titlemode=append

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|keywords=Prognosis of diseases, types of prognosis, the importance of prognosis in therapeutics, curable, incurable, palliable diseases, ~~Ayurveda, Indian system of medicine, charak samhita~~.

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|keywords=Ayurveda, Indian system of medicine, charak samhita, carakasamhitaonline, online ayurveda, sadhya, asadhya, yapya, krichrrasadhya, curability, incurability, management principles, healthcare, Prognosis of diseases, types of prognosis, the importance of prognosis in therapeutics, curable, incurable, palliable diseases, treatment principles.

|description=Sutra Sthana Chapter 10. The four important components of Therapeutics

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|type=article

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<big>'''Sutra Sthana Chapter 10. The four important components of Therapeutics '''</big>

{{Infobox

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|data7 = Gujarathi R., Godatwar P.

|label8 = Editor

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|data8 = Dixit U., Deole Y.S., Basisht G.

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|data8 = Dixit U., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication

|data9 = 2020

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}}

<big>'''Abstract'''</big>

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<p style="text-align:justify;">In the preceding chapter, four important aspects of healthcare including the standard qualities of physician, nursing staff, medicine and the patient were described. This chapter deals with guidelines for therapeutic management based on four types of prognosis of diseases. It is important to determine prognosis of a disease before starting the treatment to decide the quality of life of patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of therapeutic management of diseases. </br>

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<~~div~~ style="text-align:justify;">In the preceding chapter, four important aspects of healthcare including the standard qualities of physician, nursing staff, medicine and the patient were described. This chapter deals with guidelines for therapeutic management based on four types of prognosis of diseases. It is important to determine prognosis of a disease before starting the treatment to decide the quality of life of patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of therapeutic management of diseases. </~~div~~>

'''Keywords''': Prognosis of diseases, types of prognosis, importance of prognosis in therapeutics, curable, incurable, palliable diseases

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</~~div~~>

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</p>

== Introduction ==

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~~अथातोमहाचतुष्पादमध्यायंव्याख्यास्यामः~~||१||

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अथातो महाचतुष्पादमध्यायं व्याख्यास्यामः||१||

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इति ह ~~स्माहभगवानात्रेयः~~||२||

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इति ह स्माह भगवानात्रेयः||२||

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~~चतुष्पादंषोडशकलंभेषजमितिभिषजोभाषन्ते~~, ~~यदुक्तंपूर्वाध्यायेषोडशगुणमिति~~, ~~तद्भेषजंयुक्तियुक्तमलमारोग्यायेतिभगवान्पुनर्वसुरात्रेयः~~||३||

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चतुष्पादं षोडशकलं भेषजमिति भिषजो भाषन्ते, यदुक्तं पूर्वाध्याये षोडशगुणमिति, तद्भेषजं युक्तियुक्तमलमारोग्यायेति भगवान्पुनर्वसुरात्रेयः||३||

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~~नेतिमैत्रेयः~~, ~~किंकारणं~~? दृश्यन्तेह्यातुराःकेचिदुपकरणवन्तश्चपरिचारकसम्पन्नाश्चात्मवन्तश्चकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, ~~तथायुक्ताश्चापरेम्रियमाणाः~~; ~~तस्माद्भेषजमकिञ्चित्करंभवति~~, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, ~~नद्यांवास्यन्दमानायांपांसुधानेवापांसुमुष्टिःप्रकीर्णइति~~; तथाऽपरेदृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, ~~तथायुक्ताम्रियमाणाश्चापरे~~| ~~यतश्चप्रतिकुर्वन्सिध्यति~~, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ~~ततश्चिन्त्यतेभेषजमभेषजेनाविशिष्टमिति~~ ||४||

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नेति मैत्रेयः, किं कारणं? दृश्यन्तेह्यातुराः केचिदुपकरणवन्तश्च परिचारकसम्पन्नाश्चात्मवन्तश्च कुशलैश्चभिषग्भिरनुष्ठिताः समुत्तिष्ठमानाः, तथायुक्ताश्चापरे म्रियमाणाः; तस्माद्भेषजमकिञ्चित्करं भवति, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, नद्यां वा स्यन्दमानायांपांसुधाने वा पांसुमुष्टिः प्रकीर्ण इति; तथाऽपरे दृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्च भिषग्भिरनुष्ठिताः समुत्तिष्ठमानाः, तथायुक्ता म्रियमाणाश्चापरे| यतश्च प्रतिकुर्वन्सिध्यति, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ततश्चिन्त्यते भेषजमभेषजेनाविशिष्टमिति ||४||

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

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मैत्रेय !मिथ्या चिन्त्यत इत्यात्रेयः; किंकारणं, येह्यातुराः षोडशगुणसमुदितेनानेन भेषजेनोपपद्यमानाम्रियन्त इत्युक्तं तदनुपपन्नं, न हि भेषजसाध्यानां व्याधीनां भेषजमकारणं भवति; ये पुनरातुराः केवलाद्भेषजादृते समुत्तिष्ठन्ते, न तेषां सम्पूर्णभेषजोपपादनाय समुत्थानविशेषो नास्ति; यथा हि पतितं पुरुषं समर्थमुत्थानायोत्थापयन् पुरुषो बलमस्योपादध्यात्, स क्षिप्रतरमपरिक्लिष्ट

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एवोत्तिष्ठेत्, तद्वत्सम्पूर्णभेषजोपलम्भादातुराः; ये चातुराः केवलाद्भेषजादपि म्रियन्ते, न च सर्व एव ते भेषजोपपन्नाः समुत्तिष्ठेरन्, नहि सर्वेव्याधयो भवन्त्युपायसाध्याः, न चोपायसाध्यानां व्याधीनामनुपायेन सिद्धिरस्ति, न चासाध्यानां व्याधीनां भेषजसमुदायोऽयमस्ति, न ह्यलं ज्ञानवान्भिषङ्मुमूर्षुमातुरमुत्थापयितुं; परीक्ष्यकारिणो हि कुशला भवन्ति, यथा हि योगज्ञोऽभ्यासनित्य इष्वासो धनुरादायेषुमस्यन्नातिविप्रकृष्टे महति काये नापराधवान्भवति, सम्पादयति चेष्टकार्यं, तथा भिषक्स्वगुणसम्पन्न उपकरणवान्वीक्ष्यकर्मारभमाणः साध्यरोगमनपराधः सम्पादयत्येवातुरमारोग्येण; तस्मान्नभेषजमभेषजेनाविशिष्टं भवति||५||

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नास्ति; ~~यथाहिपतितंपुरुषंसमर्थमुत्थानायोत्थापयन्पुरुषोबलमस्योपादध्यात्~~, स क्षिप्रतरमपरिक्लिष्ट

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एवोत्तिष्ठेत्, तद्वत्सम्पूर्णभेषजोपलम्भादातुराः; ~~येचातुराःकेवलाद्भेषजादपिम्रियन्ते~~, न च ~~सर्वएवतेभेषजोपपन्नाःसमुत्तिष्ठेरन्~~, ~~नहिसर्वेव्याधयोभवन्त्युपायसाध्याः~~, ~~नचोपायसाध्यानांव्याधीनामनुपायेनसिद्धिरस्ति~~, न ~~चासाध्यानांव्याधीनांभेषजसमुदायोऽयमस्ति[३]~~

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

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इदं ~~चनःप्रत्यक्षं~~- ~~यदनातुरेणभेषजेनातुरंचिकित्सामः~~ , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, ~~स्थूलंमेदस्विनमपतर्पयामः~~, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, ~~व्याधीन्मूलविपर्ययेणोपचरन्तःसम्यक्प्रकृतौस्थापयामः~~; ~~तेषांनस्तथाकुर्वतामयंभेषजसमुदायःकान्ततमोभवति~~||६||

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इदं च नः प्रत्यक्षं- यदनातुरेण भेषजेनातुरं चिकित्सामः , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, स्थूलं मेदस्विनमपतर्पयामः, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, व्याधीन्मूलविपर्ययेणोपचरन्तः सम्यक्प्रकृतौ स्थापयामः; तेषां नस्तथाकुर्वतामयं भेषजसमुदायः कान्ततमो भवति||६||

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भवन्तिचात्र-

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~~साध्यासाध्यविभागज्ञोज्ञानपूर्वंचिकित्सकः~~|

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साध्यासाध्यविभागज्ञो ज्ञानपूर्वं चिकित्सकः|

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~~कालेचारभतेकर्मयत्तत्साधयतिध्रुवम्~~||७||

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काले चारभते कर्म यत्तत्साधयति ध्रुवम्||७||

अर्थविद्यायशोहानिमुपक्रोशमसङ्ग्रहम्|

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~~प्राप्नुयान्नियतंवैद्योयोऽसाध्यंसमुपाचरेत्~~||८||

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प्राप्नुयान्नियतं वैद्यो योऽसाध्यं समुपाचरेत्||८||

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~~सुखसाध्यंमतंसाध्यंकृच्छ्रसाध्यमथापिच~~|

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सुखसाध्यं मतं साध्यं कृच्छ्रसाध्यमथापि च|

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~~द्विविधंचाप्यसाध्यंस्याद्याप्यंयच्चानुपक्रमम्~~ ||९||

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द्विविधं चाप्यसाध्यं स्याद्याप्यं यच्चानुपक्रमम् ||९||

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~~साध्यानांत्रिविधश्चाल्पमध्यमोत्कृष्टतांप्रति~~|

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साध्यानां त्रिविधश्चाल्पमध्यमोत्कृष्टतां प्रति|

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विकल्पो, न ~~त्वसाध्यानांनियतानांविकल्पना~~||१०||

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विकल्पो, न त्वसाध्यानां नियतानां विकल्पना||१०||

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~~हेतवःपूर्वरूपाणिरूपाण्यल्पानियस्य~~ च|

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हेतवः पूर्वरूपाणि रूपाण्यल्पानि यस्य च|

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न च ~~तुल्यगुणोदूष्यो~~ न दोषःप्रकृतिर्भवेत्||११||

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न च तुल्यगुणो दूष्यो न दोषःप्रकृतिर्भवेत्||११||

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न च कालगुणस्तुल्यो न ~~देशोदुरुपक्रमः~~|

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न च कालगुणस्तुल्यो न देशो दुरुपक्रमः|

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~~गतिरेकानवत्वं~~ च रोगस्योपद्रवो न च||१२||

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गतिरेका नवत्वं च रोगस्योपद्रवो न च||१२||

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~~दोषश्चैकःसमुत्पत्तौदेहःसर्वौषधक्षमः~~|

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दोषश्चैकः समुत्पत्तौ देहः सर्वौषधक्षमः|

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~~चतुष्पादोपपत्तिश्चसुखसाध्यस्यलक्षणम्~~||१३||

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चतुष्पादोपपत्तिश्च सुखसाध्यस्य लक्षणम्||१३||

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~~निमित्तपूर्वरूपाणांरूपाणांमध्यमेबले~~|

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निमित्तपूर्वरूपाणां रूपाणां मध्यमे बले|

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~~कालप्रकृतिदूष्याणांसामान्येऽन्यतमस्य~~ च||१४||

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कालप्रकृतिदूष्याणां सामान्येऽन्यतमस्य च||१४||

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~~गर्भिणीवृद्धबालानांनात्युपद्रवपीडितम्~~|

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गर्भिणीवृद्धबालानां नात्युपद्रवपीडितम्|

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~~शस्त्रक्षाराग्निकृत्यानामनवंकृच्छ्रदेशजम्~~||१५||

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शस्त्रक्षाराग्निकृत्यानामनवं कृच्छ्रदेशजम्||१५||

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~~विद्यादेकपथंरोगंनातिपूर्णचतुष्पदम्~~|

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विद्यादेकपथं रोगं नातिपूर्णचतुष्पदम्|

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~~द्विपथंनातिकालंवाकृच्छ्रसाध्यंद्विदोषजम्~~||१६||

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द्विपथं नातिकालं वा कृच्छ्रसाध्यं द्विदोषजम्||१६||

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~~शेषत्वादायुषोयाप्यमसाध्यंपथ्यसेवया~~|

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शेषत्वादायुषो याप्यमसाध्यं पथ्यसेवया|

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~~लब्धाल्पसुखमल्पेनहेतुनाऽऽशुप्रवर्तकम्~~||१७||

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लब्धाल्पसुखमल्पेन हेतुनाऽऽशुप्रवर्तकम्||१७||

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~~गम्भीरंबहुधातुस्थंमर्मसन्धिसमाश्रितम्~~|

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गम्भीरं बहुधातुस्थं मर्मसन्धिसमाश्रितम्|

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~~नित्यानुशायिनंरोगंदीर्घकालमवस्थितम्~~||१८||

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नित्यानुशायिनं रोगं दीर्घकालमवस्थितम्||१८||

विद्याद्द्विदोषजं,...|१९|

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...~~तद्वत्प्रत्याख्येयंत्रिदोषजम्~~|

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...तद्वत्प्रत्याख्येयं त्रिदोषजम्|

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~~क्रियापथमतिक्रान्तंसर्वमार्गानुसारिणम्~~||१९||

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क्रियापथमतिक्रान्तं सर्वमार्गानुसारिणम्||१९||

औत्सुक्यारतिसम्मोहकरमिन्द्रियनाशनम्|

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~~दुर्बलस्यसुसंवृद्धंव्याधिंसारिष्टमेव~~ च||२०||

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दुर्बलस्य सुसंवृद्धं व्याधिं सारिष्टमेव च||२०||

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~~भिषजाप्राक्परीक्ष्यैवंविकाराणांस्वलक्षणम्~~|

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भिषजा प्राक्परीक्ष्यैवं विकाराणां स्वलक्षणम्|

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~~पश्चात्कर्मसमारम्भःकार्यःसाध्येषुधीमता~~||२१||

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पश्चात्कर्मसमारम्भः कार्यः साध्येषु धीमता||२१||

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~~साध्यासाध्यविभागज्ञोयःसम्यक्प्रतिपत्तिमान्~~|

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साध्यासाध्यविभागज्ञो यः सम्यक्प्रतिपत्तिमान्|

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न स ~~मैत्रेयतुल्यानांमिथ्याबुद्धिंप्रकल्पयेत्~~||२२||

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न स मैत्रेयतुल्यानां मिथ्याबुद्धिं प्रकल्पयेत्||२२||

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तत्रश्लोकौ-

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~~इहौषधंपादगुणाःप्रभवोभेषजाश्रयः~~|

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इहौषधं पादगुणाः प्रभवो भेषजाश्रयः|

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~~आत्रेयमैत्रेयमतीमतिद्वैविध्यनिश्चयः~~||२३||

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आत्रेयमैत्रेयमती मतिद्वैविध्यनिश्चयः||२३||

−

~~चतुर्विधविकल्पाश्चव्याधयःस्वस्वलक्षणाः~~|

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चतुर्विधविकल्पाश्च व्याधयःस्वस्वलक्षणाः|

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~~उक्तामहाचतुष्पादेयेष्वायत्तंभिषग्जितम्~~||२४||

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उक्ता महाचतुष्पादे येष्वायत्तं भिषग्जितम्||२४||

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इत्यग्निवेशकृतेतन्त्रेचरकप्रतिसंस्कृतेश्लोकस्थानेमहाचतुष्पादोनामदशमोऽध्यायः||१०||

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने महाचतुष्पादो नाम दशमोऽध्यायः||१०||

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# Curable with some difficulty,

# Palliable and

−

# Absolutely irreversible or incurable. (9-10)

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# Absolutely irreversible or incurable. [9-10]

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

'''Table 1: Factors affecting prognosis of disease'''

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In the contemporary medical system, the curable and incurable signs and symptoms of diseases are well understood but the criteria for deciding the prognosis are different than [[Ayurveda]]. There is availability of advanced technology in the form of imaging, biochemical, immunological, molecular and genetic studies etc. for diagnosis and assessment of prognostic factors of diseases.

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Inspite of such sophisticated tools, prognostic criteria are limited to diseases only. Overdependence on these studies has caused enormous increase in the cost of medical care. On the other hand, assessment of prognostic criteria of [[Ayurveda]] based on understanding ''~~prakriti~~'' (body type) with ''dosha, dhatu, mala, agni,'' and ''indriya'' are for both health and disease. These are entirely clinical and fairly accurate depending upon the clinical acumen of Ayurvedic physician. The concept of personalized medicine known to modern medicine is very limited at this time and is helpful in certain cancers and genetic diseases only. In future, it will be helpful to use a combination of prognostic criteria of both systems to provide better care at less expense.

+

Inspite of such sophisticated tools, prognostic criteria are limited to diseases only. Overdependence on these studies has caused enormous increase in the cost of medical care. On the other hand, assessment of prognostic criteria of [[Ayurveda]] based on understanding ''[[Prakriti]]'' (body type) with ''[[dosha]], [[dhatu]], [[mala]], [[agni]],'' and ''[[indriya]]'' are for both health and disease. These are entirely clinical and fairly accurate depending upon the clinical acumen of Ayurvedic physician. The concept of personalized medicine known to modern medicine is very limited at this time and is helpful in certain cancers and genetic diseases only. In future, it will be helpful to use a combination of prognostic criteria of both systems to provide better care at less expense.

=== Medical model and healthcare system ===

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[[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 (resembling with Vataja prameha) can become less severe with treatment factoring in all prognosis outcomes.

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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.

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Type-1 diabetes meets all the criteria described above for incurability, like vitiation of all three ''[[dosha]]s'', affliction of ten ''[[dushya]]s'' 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 ''[[dhatu]]s'', 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 ''[[dhatu]]s'' like ''[[mamsa]], [[kleda]]'' etc. The ''[[dhatu]]s'' 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) ''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.

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#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.

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