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→Tattva Vimarsha
=== Tattva Vimarsha ===
=== Tattva Vimarsha ===
* Four components i.e. Physician, Medicine, Caretaker/nursing staff and patient are essential pillars for any healthcare system.[3]
* Disease is a state of unhappiness due to disequilibrium of body elements. Health is a state of happiness due to equilibrium of these elements. [4]
* The management by all four components leading to equilibrium of body elements is called “chikitsa”.[5]
* There are four qualities of an ideal vaidya [learned knowledgeable physician]: Shrute paryavadatatvam [good listener, clear understanding and knowledge of science], bahusha drishtakarmata [maximum practical experience], dakshya [dexterity, alertness and devotion towards duties], and shaucham [purity of body and mind, hygiene]. [6]
* The four qualities of ideal medicine include bahuta [easy and abundant in availability], yogyatwam [efficacy with good pharmacological properties], anekavidha kalpana [preparations in various pharmaceutical forms] and sampat [intact properties without getting affected by insects, moisture etc.] [7]
* The four qualities of a nursing staff/caretaker of patients includes upacharadnyata [knowledge of taking care of patient (nursing) as well as preparation, dispensing, administration of medicines and healthy recipes], dakshyam [dexterity, alert to perform duties quickly], bhartari anuraga [affectionate towards patient like he/she is treating his/her brother] and shaucham [purity of body and mind and hygiene]. [8]
* The four qualities of a patient include smriti [good memory to remember treatment guidelines], nirdeshakaritwam [obedience to follow given instructions], abhirutwam [fearlessness or courage to handle complex procedures or face adversities of disease], and dnyapakatwam [ability to provide all information about the disease, giving proper history]. [9]
* The Ayurvedic physician should know the processing methods in pharmaceutics as the cook knows the recipes. He/she should be brave like a warrior to face adversities in disease management. As like a potter, the physician should think creatively and innovatively to manage disease with advances skills, newer techniques and new formulations. [11-12]
* The physician without proper knowledge [quack] can destroy a patient’s life. Therefore quacks should be strictly prohibited from clinical practice. [14-17]
* The pranabhisara vaidya [life saviour physician] should be updating his/her scientific knowledge continuously, possess clear understanding of Ayurvedic principles and practices (including the correct and timely application of drugs and procedures), and continuous practical experience. [18]
* The aptitude for being royal physician includes knowledge of etiology, symptomatology, therapeutics and prevention of diseases. [19]
* The physician should always try to remove lacunae and update his knowledge and wisdom to improve clinical practice. [20]
* Continuous learning, rationality or capacity for innovative thinking, specific scientific knowledge, good memory, devotion to perform timely duties and action [clinical practice] are the attributes of a successful vaidya [knowledgeable, learned physician]. [21]
* For attaining the qualification of a vaidya, one of the following quality or skill is sufficient: Vidya [the desire to learn continuously], mati [pure prodigious intellect or wisdom acquired by scientific studies], karma drishti [practical knowledge], abhyasa [repeated practice or clinical experience], siddhi [ability to successfully manage most of diseases], and ashraya [residence with or continual guidance from eminent mentors]. One who possesses all these six qualities gives immense happiness [freedom from disease] to all living beings.[22-23]
* The behaviour of a physician towards patients should be friendly and compassionate to share the unhappiness of disease. The wise physician should affectionately manage the curable disease and be neutral towards the patients tending towards natural death. One should know the limitation that he/she can’t extend the life of a patient in case of natural death. These are the four attitudes while dealing with the patients.[26]
Vidhi Vimarsha:
=== Vidhi Vimarsha ===
Chart 1: Four components of health care
Chart 1: Four components of health care
Of the four components of healthcare management, the role of the physician is of utmost importance because he/she is the person who is responsible for the planning of medicine, management of disease and the patient, and for all the instructions to the nursing staff. To establish a new healthcare facility, physicians should be appointed first. Then all necessary medicines (or ingredients required to formulate Ayurvedic preparations), including emergency medicines should be made available. Finally, able nursing staff should be appointed. If all these prerequisites are planned and provided for, then patients will come. Instead if one believes that physicians, medicines and nursing staff could be acquired once patients start coming, it would be wrong thinking.[3]
Of the four components of healthcare management, the role of the physician is of utmost importance because he/she is the person who is responsible for the planning of medicine, management of disease and the patient, and for all the instructions to the nursing staff. To establish a new healthcare facility, physicians should be appointed first. Then all necessary medicines (or ingredients required to formulate Ayurvedic preparations), including emergency medicines should be made available. Finally, able nursing staff should be appointed. If all these prerequisites are planned and provided for, then patients will come. Instead if one believes that physicians, medicines and nursing staff could be acquired once patients start coming, it would be wrong thinking.[3]
Disease and health:
==== Disease and health ====
Dhatu is a collective term signifying all the constituents of a body that sustain its existence. Seven dhatu (rasa, rakta, mamsa, meda, asthi, majja & shukra), upadhatu like raja etc , three doshas (vata, pitta and kapha) and mala like pureesha etc. Perfect health is achieved when all the seven dhatu , three doshas, upadhatu, and mala function properly (i.e. are in equilibrium or harmony). Health is not mere the absence of disease. Certain diseases like tilakalaka (moles) do not cause any physical discomfort or pain, but they hurt the mind of that person. Therefore here it is specifically mentioned that vikara (disease) is termed as dukkha (unhappiness or source of unhappiness). Any disequilibrium of dhātu and dosha (according to the time of the day, stage of digestion etc.) that does not affect the happiness of a person cannot be considered a disorder. Establishment of equilibrium of dhatu is the objective of chikitsa. [4]
Dhatu is a collective term signifying all the constituents of a body that sustain its existence. Seven dhatu (rasa, rakta, mamsa, meda, asthi, majja & shukra), upadhatu like raja etc , three doshas (vata, pitta and kapha) and mala like pureesha etc. Perfect health is achieved when all the seven dhatu , three doshas, upadhatu, and mala function properly (i.e. are in equilibrium or harmony). Health is not mere the absence of disease. Certain diseases like tilakalaka (moles) do not cause any physical discomfort or pain, but they hurt the mind of that person. Therefore here it is specifically mentioned that vikara (disease) is termed as dukkha (unhappiness or source of unhappiness). Any disequilibrium of dhātu and dosha (according to the time of the day, stage of digestion etc.) that does not affect the happiness of a person cannot be considered a disorder. Establishment of equilibrium of dhatu is the objective of chikitsa. [4]
Therapeutics:
==== Therapeutics ====
Physician:
The process of re-establishing the equilibrium of dhatu and dosha by a qualified physician is known as chikitsa [therapeutics]. Thus a physician and his team work together towards curing the pathology and bringing back homeostasis of the dhatu and dosha. For example for treating kamala roga (jaundice), if virechana therapy is advised by the physician, if the potency of prescribed drugs is correct, if the nursing staff is trained to do the procedure, and if the patient is not afraid of the course of treatment prescribed, then an equilibrium of dosha and dhatu could be realized. [5]
====Physician ====
Shruta (listening or being a listener) has been mentioned as the first and foremost quality of a physician, implying that it is critical for an aspiring practitioners to listen attentively to the teacher, and understanding the exact meaning of the topic being taught. In ancient India, knowledge passed down from generation to generation by oral tradition. Therefore this quality is specifically termed as shruta ( knowledge acquired by listening). Paryavadatatvam means divine knowledge acquired from authentic guru (mentors) and passed down from generation to generation in the purest form, without a shade of misunderstanding. Dakṣyaṁ means skillfulness or dexterity, ever-alertness and also sincerity. Shaucham indicates clarity and cleanliness of thoughts, mind and body to get or receive the maximum understanding of a subject.
Shruta (listening or being a listener) has been mentioned as the first and foremost quality of a physician, implying that it is critical for an aspiring practitioners to listen attentively to the teacher, and understanding the exact meaning of the topic being taught. In ancient India, knowledge passed down from generation to generation by oral tradition. Therefore this quality is specifically termed as shruta ( knowledge acquired by listening). Paryavadatatvam means divine knowledge acquired from authentic guru (mentors) and passed down from generation to generation in the purest form, without a shade of misunderstanding. Dakṣyaṁ means skillfulness or dexterity, ever-alertness and also sincerity. Shaucham indicates clarity and cleanliness of thoughts, mind and body to get or receive the maximum understanding of a subject.
Today, the qualities of an ideal physician include possession of relevant knowledge, professionalism, strong credentials, good reputation, sincerity, empathy, responsiveness, humility, strong communication skills, timeliness/punctuality, and thoroughness. All these qualities are addressed in Shrute paryavadatatvam, bahusho drruṣhṭakarmata, dakshyam and Shaucham. [6]
Today, the qualities of an ideal physician include possession of relevant knowledge, professionalism, strong credentials, good reputation, sincerity, empathy, responsiveness, humility, strong communication skills, timeliness/punctuality, and thoroughness. All these qualities are addressed in Shrute paryavadatatvam, bahusho drruṣhṭakarmata, dakshyam and Shaucham. [6]
Medicines:
==== Medicines ====
Bahuta means that the drug should be available in abundance or wherever the patient needs it. Yogyatvam means drugs should have adequate potency to cure diseases. Also it should be appropriate for the patient. Anekavidhakalpana means a single drug could be prepared in different forms, such as decoctions, tablets, medically fermented preparations, etc. This is necessary because certain formulations of a good drug may not be suitable for certain diseases or conditions of diseases or for certain patients. If a drug can be used in multiple formulations, then it gets wide applicability. Various available forms might be palatable to the patients as per their need in today’s era. Sampat means intact qualities of drugs i.e. drugs should not lose the potency due to time factor or contamination, adulteration or affected by insects or moisture etc. [7]
Bahuta means that the drug should be available in abundance or wherever the patient needs it. Yogyatvam means drugs should have adequate potency to cure diseases. Also it should be appropriate for the patient. Anekavidhakalpana means a single drug could be prepared in different forms, such as decoctions, tablets, medically fermented preparations, etc. This is necessary because certain formulations of a good drug may not be suitable for certain diseases or conditions of diseases or for certain patients. If a drug can be used in multiple formulations, then it gets wide applicability. Various available forms might be palatable to the patients as per their need in today’s era. Sampat means intact qualities of drugs i.e. drugs should not lose the potency due to time factor or contamination, adulteration or affected by insects or moisture etc. [7]
Nursing staff/ attendant/care taker:
==== Nursing staff/ attendant/care taker ====
Patient:
Among the qualities of nursing staff, Upacharajnata means knowledge of preparing different forms of medicine, healthy recipes, dispensing, administration of various purification procedures etc. The staff should be skilled to handle a situation, compassionate towards the patient, possess hygiene, and should be able to understand the prescription of the physician. In modern era, an ideal attendant (nurse) should possess the relevant knowledge , skills and credentials required for nursing, with excellent communication skills, empathy for patients and their families, flexible working, attentiveness, responsiveness, and problem-solving skills. These characteristics have been examined further in the fifteenth chapter of the Sutra Sthana, titled “Upakalpaneeya Adhyaya”. [8]
==== Patient ====
The patient should follow the instructions of the doctor, be intelligent enough to understand his disease, and should be able to express his condition openly with the physician. Smriti [memory] is an important character of the patient for him/her to explain the course of disease. Nirdeshakaritvam [ability to follow instructions] is also an important characteristic, because some drug must be taken at specific time. If the patient does not follow the physician’s instructions, adverse reactions may occur and desired effects cannot be obtained. Rogaṇam jnapakatvam [information about the disease] is important. If patient is unable to pinpoint the location of pain or other symptoms properly, then diagnosis of disease would be difficult or not accurate. He should openly convey all the details about his ailment to the physician. If he does not do this, the physician may not be able to properly decide the line of treatment. He should not have fear. He should trust his physician and be ready to undergo any treatment prescribed. If he is scared and not ready for surgery or [[Panchakarma]], for instance, it will be difficult for the physician to manage as there may not be a suitable alternative always. Depression and anxiety in patients are the foremost factors that worsen disease conditions[Cha.Su.25/40]. [9]
The patient should follow the instructions of the doctor, be intelligent enough to understand his disease, and should be able to express his condition openly with the physician. Smriti [memory] is an important character of the patient for him/her to explain the course of disease. Nirdeshakaritvam [ability to follow instructions] is also an important characteristic, because some drug must be taken at specific time. If the patient does not follow the physician’s instructions, adverse reactions may occur and desired effects cannot be obtained. Rogaṇam jnapakatvam [information about the disease] is important. If patient is unable to pinpoint the location of pain or other symptoms properly, then diagnosis of disease would be difficult or not accurate. He should openly convey all the details about his ailment to the physician. If he does not do this, the physician may not be able to properly decide the line of treatment. He should not have fear. He should trust his physician and be ready to undergo any treatment prescribed. If he is scared and not ready for surgery or [[Panchakarma]], for instance, it will be difficult for the physician to manage as there may not be a suitable alternative always. Depression and anxiety in patients are the foremost factors that worsen disease conditions[Cha.Su.25/40]. [9]
Good clinical practice:
==== Good clinical practice ====
Research has shown that patients who feel that their physician has made a genuine empathetic connection - an attempt to understand how they feel and how their condition is affecting their everyday life - will actually experience a reduction in pain. A vaidya should be a friend of the whole society. The society can be divided into apparently healthy persons and the ailing community and the vaidya should have compassion towards the ailing. The patients can be divided into curable and incurable. The vaidya should devote himself to the curable. For the patients who are incurable, he/she should have the approach of upeksha which means to observe or monitor closely. Many of these patients may not respond to the treatment and approach death (terminal patients). He/she should have a sense of detachment towards such patients. If the vaidya is too attached to the patient, he is likely not going to pay proper attention to the patients who are curable , and may neglect them as a result.
Research has shown that patients who feel that their physician has made a genuine empathetic connection - an attempt to understand how they feel and how their condition is affecting their everyday life - will actually experience a reduction in pain. A vaidya should be a friend of the whole society. The society can be divided into apparently healthy persons and the ailing community and the vaidya should have compassion towards the ailing. The patients can be divided into curable and incurable. The vaidya should devote himself to the curable. For the patients who are incurable, he/she should have the approach of upeksha which means to observe or monitor closely. Many of these patients may not respond to the treatment and approach death (terminal patients). He/she should have a sense of detachment towards such patients. If the vaidya is too attached to the patient, he is likely not going to pay proper attention to the patients who are curable , and may neglect them as a result.
Similar four-fold approach can be found in various other Indic philosophies as well. For instance, the Vedanta Darshana, Baudha Darshana and Patanjal Yoga Sutra also describe such a four-fold approach. It is the uniqueness and strength of Ayurveda, however, that this philosophical aspect has been presented and supported with practical applications. [26]
Similar four-fold approach can be found in various other Indic philosophies as well. For instance, the Vedanta Darshana, Baudha Darshana and Patanjal Yoga Sutra also describe such a four-fold approach. It is the uniqueness and strength of Ayurveda, however, that this philosophical aspect has been presented and supported with practical applications. [26]
Reference books:
=== Reference books ===
1. Kushwahavd. Harish Chandra Singh. 2011. The Caraka Samhita. Reprint edition. Varanasi. Chaukhambha Orientalia.
1. Kushwahavd. Harish Chandra Singh. 2011. The Caraka Samhita. Reprint edition. Varanasi. Chaukhambha Orientalia.
2. Sharma. P. 2011. Caraka Samhita. Reprint edition. Varanasi. Chaukhambha Orientalia.
2. Sharma. P. 2011. Caraka Samhita. Reprint edition. Varanasi. Chaukhambha Orientalia.