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Chikitsaprabhritiya Adhyaya (view source)

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|title=Chikitsaprabhritiya Adhyaya

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|keywords=Chikitsaprabhrita (equipped physician), bahudosha (signs of aggravated dosha), samshodhana (purification therapy), vishuddha koshtha (purified bowel), svabhavoparamavada (theory of natural destruction),Panchakarma, patient care, assessment criteria of purification

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|description=Sutra Sthana Chapter 16. Assessment and care in Panchakarma therapies

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<big>'''Sutra Sthana Chapter 16. Assessment and care in [[Panchakarma]] therapies'''</big>

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===Sanskrit text, Transliteration and English Translation===

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अथातश्चिकित्साप्राभृतीयमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaścikitsāprābhr̥tīyamadhyāyaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

Now, we shall expound the chapter on the “Duties of a qualified physician.” [1-2]

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चिकित्साप्राभृतो धीमान् शास्त्रवान् कर्मतत्परः|

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यं वैद्यमानी त्वबुधो विरेचयति मानवम्|

सोऽतियोगादयोगाच्च मानवो दुःखमश्नुते||४||

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cikitsāprābhr̥tō dhīmān śāstravān karmatatparaḥ|

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yaM vaidyamAnI tvabudho virecayati mAnavam|

so~atiyogAdayogAcca mAnavo duHkhamashnute||4||

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</div></div>

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A qualified physician is the one who is well acquainted with the principles of treatment, is learned and skilled in the practice of [[Ayurveda]], and is known for promptness of action. A patient obtaining treatment in the form of emesis or purgation from such a physician, becomes healthy and attains happiness. On the other hand, if the patient receives treatment from a pretentious & ignorant physician, he subjects himself to potential complications because of excessive or inadequate treatment. [3-4]

</div>

==== Signs of proper purification ====

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दौर्बल्यं लाघवं ग्लानिर्व्याधीनामणुता रुचिः|

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बुद्धीन्द्रियमनःशुद्धिर्मारुतस्यानुलोमता|

सम्यग्विरिक्तलिङ्गानि कायाग्नेश्चानुवर्तनम् ||६||

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daurbalyaṁ lāghavaṁ glānirvyādhīnāmaṇutā ruciḥ|

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buddhIndriyamanaHshuddhirmArutasyAnulomatA|

samyagviriktali~ggAni kAyAgneshcAnuvartanam ||6||

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</div></div>

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Weakness, lightness, fatigue, attenuation of diseases, improved taste perception, restoration of the functioning of heart, improved complexion, proper appetite and thirst, timely passage of natural urges, feeling of cleanliness in intellect, sense organs and mind, proper movement of ''vata'', and proper digestion (including metabolic activities) are the signs and symptoms of correctly administered purification therapy. [5-6]

</div>

==== Signs of inadequate purification ====

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ष्ठीवनं हृदयाशुद्धिरुत्क्लेशः श्लेष्मपित्तयोः|

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जङ्घोरुसदनं तन्द्रा स्तैमित्यं पीनसागमः|

लक्षणान्यविरिक्तानां मारुतस्य च निग्रहः||८||

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ṣṭhīvanaṁ hr̥dayāśuddhirutklēśaḥ ślēṣmapittayōḥ|

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ja~gghorusadanaM tandrA staimityaM pInasAgamaH|

lakShaNAnyaviriktAnAM mArutasya ca nigrahaH||8||

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</div></div>

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Spitting or drooling, abnormal functioning of heart, precipitation (''utklesha'') of ''shleshma'' and ''pitta'', distension of abdomen , anorexia, vomiting, debility, absence of lightness (heaviness or sluggishness), laxity in calf muscles and thighs, drowsiness , feeling as if covered with a wet hide (''staimitya''), onset of rhinitis and impediment to the function of ''vata'' are the signs and symptoms of inadequate purification. [7-8]

</div>

==== Signs of excess purification therapy ====

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विट्पित्तकफवातानामागतानां यथाक्रमम्|

परं स्रवति यद्रक्तं मेदोमांसोदकोपमम्||९||

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निःश्लेष्मपित्तमुदकं शोणितं कृष्णमेव वा|

तृष्यतो मारुतार्तस्य सोऽतियोगः प्रमुह्यतः||१०||

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viṭpittakaphavātānāmāgatānāṁ yathākramam|

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niHshleShmapittamudakaM shoNitaM kRuShNameva vA|

tRuShyato mArutArtasya so~atiyogaH pramuhyataH||10||

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</div></div>

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Elimination of feces, ''pitta, kapha,'' and ''vata'' in succession, excessive discharge of blood that looks like fat and flesh (washed), supernatant water or watery excretion of black colored blood without ''shleshma'' and ''pitta'', excessive thirst affliction with vitiated ''vata'' and fainting are the signs and symptoms of overpurgation. [9-10]

</div>

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वमनेऽतिकृते लिङ्गान्येतान्येव भवन्ति हि|

ऊर्ध्वगा वातरोगाश्च वाग्ग्रहश्चाधिको भवेत्||११||

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चिकित्साप्राभृतं तस्मादुपेयाच्छरणं नरः|

युञ्ज्याद् य एनमत्यन्तमायुषा च सुखेन च||१२||

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vamanē'tikr̥tē liṅgānyētānyēva bhavanti hi|

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cikitsAprAbhRutaM tasmAdupeyAccharaNaM naraH|

yu~jjyAd ya enamatyantamAyuShA ca sukhena ca||12||

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</div></div>

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In case of excessive administration of emesis, the symptoms are identical to that observed in the case of purgation. In addition, overemesis may result in diseases of ''vata'', affecting the upper part of the body and also causing impediment of speech. One should therefore approach such a qualified and well-versed physician for the administration of any purification therapy. [11-12]

</div>

==== Signs of excess aggravated ''dosha'' and indications of purification therapy ====

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अविपाकोऽरुचिः स्थौल्यं पाण्डुता गौरवं क्लमः|

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बहुदोषस्य लिङ्गानि तस्मै संशोधनं हितम्|

ऊर्ध्वं चैवानुलोमं च यथादोषं यथाबलम्||१६||

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avipākō'ruciḥ sthaulyaṁ pāṇḍutā gauravaṁ klamaḥ|

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bahudoShasya li~ggAni tasmai saMshodhanaM hitam|

UrdhvaM caivAnulomaM ca yathAdoShaM yathAbalam||16||

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</div></div>

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Indigestion, anorexia, corpulence, anemia, heaviness, exhaustion, eruption of pimples and wheals (bumps or itchy sores), pruritis, sluggishness, indolence, weakness, foul smell of the body, lassitude, precipitation (''utklesha'') of ''kapha'' and ''pitta'', sleeplessness or excessive drowsiness, impotency, impediment to intelligence, inauspicious dreams, and loss of strength and complexion in spite of taking nourishing diet and right therapy are the signs and symptoms of patients having excess of morbid doshas. An experienced, skilled physician would advise and administer purification therapy taking into consideration the ''dosha'' status and strength of the patient . [13-16]

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==== Benefits of purification therapy ====

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एवं विशुद्धकोष्ठस्य कायाग्निरभिवर्धते|

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जरां कृच्छ्रेण लभते चिरं जीवत्यनामयः|

तस्मात् संशोधनं काले युक्तियुक्तं पिबेन्नरः||१९||

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ēvaṁ viśuddhakōṣṭhasya kāyāgnirabhivardhatē|

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jarAM kRucchreNa labhate ciraM jIvatyanAmayaH|

tasmAt saMshodhanaM kAle yuktiyuktaM pibennaraH||19||

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</div></div>

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Administration of therapies, leading to elimination of vitiated ''doshas'', results in the following effects: enhancement of digestion / metabolism, pacification of diseases, restoration of normal health, improvement in clarity of sense organs, mind, intellect and complexion, promotion of strength, plumpness, progeny and virility, delayed ageing, and longevity. Therefore, one should take recourse to a skillfully administered purificatory therapy at an appropriate time. [17-19]

</div>

==== Prevention of recurrence of disease ====

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दोषाः कदाचित् कुप्यन्ति जिता लङ्घनपाचनैः|

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दोषाणां च द्रुमाणां च मूलेऽनुपहते सति|

रोगाणां प्रसवानां च गतानामागतिर्ध्रुवा||२१||

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dōṣāḥ kadācit kupyanti jitā laṅghanapācanaiḥ|

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doShANAM ca drumANAM ca mUle~anupahate sati|

rogANAM prasavAnAM ca gatAnAmAgatirdhruvA||21||

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</div></div>

Morbid ''doshas'' relieved by fasting and digestive drugs may sometimes get aggravated again, but those that are evacuated by purification therapies do not recur. ''Doshas'', like plants, if not uprooted completely, would recur or relapse almost certainly. [20-21]

==== Post purification measures ====

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भेषजक्षपिते पथ्यमाहारैरेव बृंहणम्|

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अभ्यङ्गोत्सादनैः स्नानैर्निरूहैः सानुवासनैः|

तथा स लभते शर्म युज्यते चायुषा चिरम्||२३||

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bhēṣajakṣapitē pathyamāhārairēva br̥ṁhaṇam|

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abhya~ggotsAdanaiH snAnairnirUhaiH sAnuvAsanaiH|

tathA sa labhate sharma yujyate cAyuShA ciram||23||

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</div></div>

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For those weakened by purification therapy, restoration of one’s health could be done by prescribing a nourishing diet regimen that would include ''ghee'', relishing soup (including preparations with meat), and milk. The patient should also be advised massage, bath, and evacuative and unctuous enema. This process of purification followed by rejuvenation or restoration of one’s health bestows happiness and longevity to the patient. [22-23]

</div>

==== Treatment of excess and inadequate purification therapy ====

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अतियोगानुबद्धानां सर्पिःपानं प्रशस्यते|

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स्नेहने स्वेदने शुद्धौ रोगाः संसर्जने च ये|

जायन्तेऽमार्गविहिते तेषां सिद्धिषु साधनम्||२६||

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atiyōgānubaddhānāṁ sarpiḥpānaṁ praśasyatē|

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snehane svedane shuddhau rogAH saMsarjane ca ye|

jAyante~amArgavihite teShAM siddhiShu sAdhanam||26||

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</div></div>

For those suffering from symptoms of excessive administration or application of purification activities, ingestion of ''ghee'' and oil processed with sweet drugs or ''anuvasana'' type of enema is prescribed.

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</div>

==== ''Swabhavoparama vada'' (theory of natural destruction) ====

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जायन्ते हेतुवैषम्याद्विषमा देहधातवः|

हेतुसाम्यात् समास्तेषां स्वभावोपरमः सदा||२७||

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jāyantē hētuvaiṣamyādviṣamā dēhadhātavaḥ|

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jAyante hetuvaiShamyAdviShamA dehadhAtavaH|

hetusAmyAt samAsteShAM svabhAvoparamaH sadA||27||

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</div></div>

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Discordance of the causative factors results in disequilibrium of the tissue elements (''dhatus'') of the body. Conversely, concordance of tissue elements is restored by means of restoring the concordance of causative factors. However, the resolution / destruction of the existing always happens naturally in the course of time. [27]

</div>

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प्रवृत्तिहेतुर्भावानां न निरोधेऽस्ति कारणम्|

केचित्तत्रापि मन्यन्ते हेतुं हेतोरवर्तनम्||२८||

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pravr̥ttihēturbhāvānāṁ na nirōdhē'sti kāraṇam|

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pravRuttiheturbhAvAnAM na nirodhe~asti kAraNam|

kecittatrApi manyante hetuM hetoravartanam||28||

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</div></div>

There is always a cause for the manifestation of beings but none exists for their annihilation. However, some scholars are of the opinion that the noncontinuance of their causative factors is the very cause of their annihilation. [28]

==== Query by Agnivesha ====

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एवमुक्तार्थमाचार्यमग्निवेशोऽभ्यभाषत|

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भेषजैर्विषमान् धातून् कान् समीकुरुते भिषक्|

का वा चिकित्सा भगवन्! किमर्थं वा प्रयुज्यते||३०||

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ēvamuktārthamācāryamagnivēśō'bhyabhāṣata|

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bheShajairviShamAn dhAtUn kAn samIkurute bhiShak|

kA vA cikitsA bhagavan! kimarthaM vA prayujyate||30||

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</div></div>

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The master having thus given his version Agnivesha inquired- if the natural resolution (of disorders) be in the very nature of things then what is the necessity of a qualified physician? Which discordant body elements are harmonized by the physician by means of therapy? After all what does the treatment amount to? And what is its objective? [29-30]

</div>

==== Explanation by Punarvasu ====

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तच्छिष्यवचनं श्रुत्वा व्याजहार पुनर्वसुः|

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न नाशकारणाभावाद्भावानां नाशकारणम्|

ज्ञायते नित्यगस्येव कालस्यात्ययकारणम्||३२||

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tacchiṣyavacanaṁ śrutvā vyājahāra punarvasuḥ|

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na nAshakAraNAbhAvAdbhAvAnAM nAshakAraNam|

j~jAyate nityagasyeva kAlasyAtyayakAraNam||32||

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</div></div>

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Hearing these words from his disciple, Punarvasu responded, “Hear, oh gentle one! The rationale the great sages have given in this respect is that the cause of destruction of entities cannot be comprehended, because no such cause exists, just as in case of time, which is always in the process of swift movement automatically gets destroyed. Being transitory by nature, things perish even as they are born. [31-32]

</div>

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शीघ्रगत्वाद्यथा भूतस्तथा भावो विपद्यते|३३||

निरोधे कारणं तस्य नास्ति नैवान्यथाक्रिया||३३||

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śīghragatvādyathā bhūtastathā bhāvō vipadyatē|33||

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nirodhe kAraNaM tasya nAsti naivAnyathAkriyA||33||

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</div></div>

There is neither a cause for things to perish nor there is a possibility of bringing out a change in the innate tendency of destruction. [33]

==== Definition of ''chikitsa'' and the duty of a physician ====

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याभिः क्रियाभिर्जायन्ते शरीरे धातवः समाः|

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कथं शरीरे धातूनां वैषम्यं न भवेदिति|

समानां चानुबन्धः स्यादित्यर्थं क्रियते क्रिया||३५||

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yābhiḥ kriyābhirjāyantē śarīrē dhātavaḥ samāḥ|

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kathaM sharIre dhAtUnAM vaiShamyaM na bhavediti|

samAnAM cAnubandhaH syAdityarthaM kriyate kriyA||35||

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</div></div>

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Therapeutics therefore consists of measures or operations by way of which concordance of the tissue elements can be sustained and this (achieving concordance of tissue elements) constitutes the duty of the physician. Therapy is administered with the sole objective of ensuring that no discordance prevails in tissue elements and that there is sustenance of continued concordance. [34-35]

</div>

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त्यागाद्विषमहेतूनां समानां चोपसेवनात्|

विषमा नानुबध्नन्ति जायन्ते धातवः समाः||३६||

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धर्मस्यार्थस्य कामस्य नृलोकस्योभयस्य च|

दाता सम्पद्यते वैद्यो दानाद्देहसुखायुषाम्||३८||

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tyāgādviṣamahētūnāṁ samānāṁ cōpasēvanāt|

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dharmasyArthasya kAmasya nRulokasyobhayasya ca|

dAtA sampadyate vaidyo dAnAddehasukhAyuShAm||38||

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</div></div>

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By abstaining from factors that give rise to discordance and practicing those that promote concordance, the discordant elements do not persist and concordance is maintained. As the well-equipped physician effects the production of balanced tissue elements by means of his expertise, he is regarded as the bestower of bodily health, happiness and longevity. By virtue of his aptitude to bestow physical happiness and longevity the physician is regarded as the donor of virtue, wealth and desires belonging to this mundane world and the world eternal. [36-38]

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==== Summary ====

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तत्र श्लोकाः-

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या च युक्तिश्चिकित्सायां यं चार्थं कुरुते भिषक्|

चिकित्साप्राभृतेऽध्याये तत् सर्वमवदन्मुनिः||४१||

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tatra ślōkāḥ-

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yA ca yuktishcikitsAyAM yaM cArthaM kurute bhiShak|

cikitsAprAbhRute~adhyAye tat sarvamavadanmuniH||41||

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</div></div>

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Benefits that accrue from the treatment received through a qualified physician as against that received through an unqualified one, the signs and symptoms of adequate, inadequate and excessive administration of evacuative therapies, the signs and symptoms of excessive morbidity, advantages of evacuative therapy, principles of treatment in successful and complicated conditions, the rationale of therapeutics and the intent with which the physician administers the therapy -all this has been described by the sage in this chapter on the “duties of a qualified physician.” [39-41]

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