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Apamarga tanduliya or the “dehusked seeds of Apamarga”, is the second chapter within Bheshaja (medicinal treatment) Chatushka (tetrad constituting four chapters) of Sutra Sthana. After reading this chapter, the student of Ayurveda would understand the practical application of bio-purificatory drugs and dietary preparations for purificatory measures suggested for the preservation of health and treatment of diseases.
Apamarga tanduliya or the “dehusked seeds of Apamarga”, is the second chapter within Bheshaja (medicinal treatment) Chatushka (tetrad constituting four chapters) of Sutra Sthana. After reading this chapter, the student of Ayurveda would understand the practical application of bio-purificatory drugs and dietary preparations for purificatory measures suggested for the preservation of health and treatment of diseases.
=== Sutra Sthana Chapter 3. Aragvadha(purging cassia) and other medicines - [[Aragvadhiya Adhyaya]] ===
=== Chapter 3. Aragvadha(purging cassia) and other medicines - [[Aragvadhiya Adhyaya]] ===
While the preceding chapter (Apamarga Tanduliya) dealt with internal application of therapies in the form of Panchakarma, yavagu etc, this chapter deals with the external application of medications. Skin diseases such as kushtha are systemic disorders and considered a maharoga (major disease). They require internal cleansing and detoxification treatments prior to external treatments – and hence, the sequence of the chapters. Without prior internal treatment, local treatments have limited efficacy.
While the preceding chapter (Apamarga Tanduliya) dealt with internal application of therapies in the form of Panchakarma, yavagu etc, this chapter deals with the external application of medications. Skin diseases such as kushtha are systemic disorders and considered a maharoga (major disease). They require internal cleansing and detoxification treatments prior to external treatments – and hence, the sequence of the chapters. Without prior internal treatment, local treatments have limited efficacy.
=== Chapter 4. The Classification of Six Hundred Types of Evacuatives - [[Shadvirechanashatashritiya Adhyaya]] ===
=== Chapter 4. The Classification of Six Hundred Types of Evacuatives - [[Shadvirechanashatashritiya Adhyaya]] ===
The fourth chapter, titled Shadavirechana Shatashritiyam, provides comprehensive information about herbs and their classification by their specific activity and utility, medicinal preparations for evacuation (or evacuatives), and specific therapeutic regimen such as samshodhana (cleansing regimen) and samashamana (pacification regimen). Ayurveda emphasizes upon removing body impurities, like metabolic waste products, toxins, and undigested foods from various tissues and organs before treating any disease or applying measures for preservation, protection, and rejuvenation of health. There are six hundred preparations used for cleansing the body by vamana (therapeutic emesis) and virechana (therapeutic purgation), five hundred herbs, and (fifty) mahakashayas (classes with similar activity profile) of herbs used in their preparations. An Ayurvedic physician should have complete knowledge of special/selective actions of various preparations meant for removal of impurities from the body. The fifty mahakashayas comprise of ten herbs in each of five classes of drugs. It also includes six virechana ashraya (types of plant-based evacuatives), five kashaya yoni (original sources as per tastes), and five kashaya kalpana (forms of medicine preparations).
The fourth chapter, titled Shadavirechana Shatashritiyam, provides comprehensive information about herbs and their classification by their specific activity and utility, medicinal preparations for evacuation (or evacuatives), and specific therapeutic regimen such as samshodhana (cleansing regimen) and samshamana (pacification regimen). Ayurveda emphasizes upon removing body impurities, like metabolic waste products, toxins, and undigested foods from various tissues and organs before treating any disease or applying measures for preservation, protection, and rejuvenation of health. There are six hundred preparations used for cleansing the body by vamana (therapeutic emesis) and virechana (therapeutic purgation), five hundred herbs, and (fifty) mahakashayas (classes with similar activity profile) of herbs used in their preparations. An Ayurvedic physician should have complete knowledge of special/selective actions of various preparations meant for removal of impurities from the body. The fifty mahakashayas comprise of ten herbs in each of five classes of drugs. It also includes six virechana ashraya (types of plant-based evacuatives), five kashaya yoni (original sources as per tastes), and five kashaya kalpana (forms of medicine preparations).
=== Chapter 5. The proper quantity of food and daily regimen for preserving health -[[Matrashiteeya Adhyaya]] ===
=== Chapter 5. The proper quantity of food and daily regimen for preserving health -[[Matrashiteeya Adhyaya]] ===
This chapter describes how humans perceive the world surroundings by means of five senses (Hear, see, smell, taste, and touch), how a system of five senses called Indriya Pancha-Panchaka works and communicates with mind to perceive the surroundings and how a person can maintain health by using his/her senses properly (and therefore leading a tempered, ethical life) or suffer from disease by not using their senses properly. It also explains the role of mind, intellect and soul in the entire process of perception. This chapter describes the qualities of the mind based on the predominance of the three fundamental qualities, the triguna (sattva, rajas and tamas), including the illusions created by the mind that makes a common observer perceive through his/her senses, say, multiple minds instead of one. It further describes the spiritual elements (Adhyatma dravya guna sangraha) & their action. The principles of psycho-pathogenesis based on the excessive, deficient and perverted association of five senses with their objects along with the principles of preventing psychic disturbances and preserving the physical, mental and socio-spiritual health in the form of the principles of sadvritta has been elaborately described. This involves a broad range of ethical observances & moral practices for preventing psychosomatic disturbances. Broadly, the practices regarding code of general ethics, diet, natural urges, relationship with women, study, regarding self-control & related to worship have been elaborately described. General ethical practices related to individual, inter- personal & about maintenance of social relations have been included, which are extremely valuable for personal & social health.
This chapter describes how humans perceive the world surroundings by means of five senses (Hear, see, smell, taste, and touch), how a system of five senses called Indriya Pancha-Panchaka works and communicates with mind to perceive the surroundings and how a person can maintain health by using his/her senses properly (and therefore leading a tempered, ethical life) or suffer from disease by not using their senses properly. It also explains the role of mind, intellect and soul in the entire process of perception. This chapter describes the qualities of the mind based on the predominance of the three fundamental qualities, the triguna (sattva, rajas and tamas), including the illusions created by the mind that makes a common observer perceive through his/her senses, say, multiple minds instead of one. It further describes the spiritual elements (Adhyatma dravya guna sangraha) & their action. The principles of psycho-pathogenesis based on the excessive, deficient and perverted association of five senses with their objects along with the principles of preventing psychic disturbances and preserving the physical, mental and socio-spiritual health in the form of the principles of sadvritta has been elaborately described. This involves a broad range of ethical observances & moral practices for preventing psychosomatic disturbances. Broadly, the practices regarding code of general ethics, diet, natural urges, relationship with women, study, regarding self-control & related to worship have been elaborately described. General ethical practices related to individual, inter- personal & about maintenance of social relations have been included, which are extremely valuable for personal & social health.
=== Chapter 9.The four fundamental components of Healthcare [[Khuddakachatushpada Adhyaya]] ===
After completing the Swastha chatushka(tetrad on health), Charak draws attention of the student/reader to the components of Healthcare Management. Four components necessary for providing optimum healthcare are described in this chapter. These components are: Physician, Medicine, Attendant and the Patient. Further, qualities of these components are described in brief. Definitions of disorder, health, treatment etc, along with different types of physicians have also been described.
=== Chapter 10. The Four Important Components of Therapeutics - [[Mahachatushpada Adhyaya]] ===
In the preceding chapter, four important aspects of healthcare including the best 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 remaining life of the patient, and whether it will be diseased or disease free. Therefore, as the title suggests, the chapter is about four important components of management of diseases.
=== Chapter 11.The Three Desires of Life and important triads - [[ Tistraishaniya Adhyaya ]] ===
Having or expressing desires is a human trait, and only human beings aspire to fulfill them. This chapter, Tistraishaniya Adhyaya, tries to explain three basic desires in human beings, and the mode to fulfill them during one’s life – longevity, wealth (or material comforts), and a blissful afterlife. This chapter is described under Nirdesha Chatushka since it gives instructions to lead a healthy and righteous life. It also guides to treat a patient with physical and/or mental disease and describes a triad of eight vargas, or ashtatrikas, explaining the theories of reincarnation and creation of universe. Four parikshas (aptopadesha, pratyaksha, anumana and yukti) or means for getting correct knowledge and their role in establishing the theory of reincarnation are described in detail. Using these methods, a physician can get knowledge about roga (disease) and rogi (patient) and can choose appropriate courses of treatment, with suitable drugs.
=== Chapter 12.The merits and demerits of Vata - [[Vatakalakaliya Adhyaya]] ===
This last chapter of the Nirdesha Chatushka is based on the findings of an assembly of expert practitioners of Ayurveda, headed by Atreya, that analyzed the normal and abnormal functions of tridosha. Among the three doshas, the vata dosha has been discussed in more detail, considering its supremacy as the initiator of all functions in the body. The important normal and abnormal functions of Vata in environment are also mentioned. Consequently, shorter descriptions of pitta and kapha dosha’s normal and abnormal functions have been provided.
=== Chapter 13. Oleation therapies - [[Snehadhyaya]] ===
Thirteenth chapter of Charak Samhita describes details of oleation therapy including the sources of lipids, types, properties, administration method, time, dose, alternative methods of administration in the form of recipe (vicharana), indications, contraindications, symptoms of proper, inadequate and excess oleation. Lipids are essential components of body as the meda dhatu (lipids) provides lubrication to all viscera and other interstetial spaces due to its snigdha (unctuous) qualities. Meda dhatu (lipids) is an integral part of cell membrane that allows entry of lipid soluble substances/drugs into the cells. The selection of lipids for oleation therapy depends upon the specific integrity of gut, severity of the disease, and specific indications of lipids. Those contra-indicated for use of natural fat as in diabetes or skin diseases, can consume medicated lipids. Properly done oleation results in proper downward movement of vata, increase in digestive power, softening of (hard) feces, and making the body supple and soft. Improper implementation of methods or violation of guidelines results in complications such as skin diseases, itching, haemorrhoids, ascitis, fainting, indigestion etc. Oleation and sudation are pre-requisites or pre-treatment procedures for shodhana (purification) therapies to aid in moving vitiated dosha to gut (for an eventual expelling out of the body and achieve purification). The present chapter can be considered as a first step in purification therapies described.
=== Chapter 14. Sudation Therapies - [[Swedadhyaya]] ===
Swedana (sudation) is a process in which the individual is subjected to therapeutic sweating. It is considered an essential prerequisite to Panchakarma (purification therapy involving five procedures) in Ayurveda and is secondary to snehana (oleation) in importance. When done without snehana, it is called ruksha sweda (dry fomentation). Swedana is intended to remove excessive vata and kapha dosha and is contraindicated in pitta disorders. The extent and severity of swedana depends upon various factors such as physical strength, amount of dosha, season, site, age etc. There are specific indications and contraindications for swedana karma and the optimal signs should be strictly followed for the procedure. There are many agents to induce sweating which can be broadly divided into sagni sweda (sweating induced with the help of fire) and niragni sweda (induced without using fire). Bolus fomentation, steam fomentation, tub fomentation and poultice fomentation are some of the very common types of swedana procedures. There are thirteen varieties of fomentations (prevalent in the olden days) that involve direct usage of heat derived from fire, and ten methods without fire. Swedana is an effective therapeutic method in Ayurveda and is the focus of study in this chapter.
=== Chapter 15. The Guidelines for Hospital Management and Purification Treatment- [[Upakalpaniya Adhyaya]] ===
The fifteenth chapter, Upakalpaniya Adhyaya continues the discussion on purification procedures (samshodhana karmas) from the preceding sections, but also focuses on the pre-requisites for construction of a well-equipped hospital facility suitable for administration of Panchakarma therapies. Pre-procedure, main procedure and post-procedure guidelines have been described in detail in this chapter, along with descriptions of dosages of drugs for vamana and virechana therapies as well as signs and symptoms of inadequate, proper and excess purification. Dosha afflictions, complications, dietetic regimen during the therapy and after the therapy (samsarjana karma) have also been clearly elaborated.
=== Chapter 16. Duties and Responsibilities of a Qualified Physician - [[Chikitsaprabhritiya Adhyaya]] ===
Chikitsaprabhritiya Adhyaya is the last chapter of the Kalpana Chatushka tetrad and describes the traits of a physician proficient in therapeutics, besides the consequences of appropriate as well as incorrect administration of therapeutic procedures, along with corrective interventions wherever applicable. This chapter also describes various indications for therapeutic intervention and their benefits, and questions and answers related the applicability of svabhavaparamvada (i.e. theory of natural destruction of causative factors of disease).