Chikitsa Sthana

Chikitsa in Sanskrit means treatment and this section is about therapeutics in Ayurveda. Since the objective of Ayurveda is the prevention and treatment of disease, the first two chapters viz. Rasayana and Vajikarana deal with the preservation and promotion of physical, mental, and sexual health of a healthy person and the remaining chapters deal with therapeutics for the cure of diseases.

Charaka Samhita being primarily a treatise of kayachikitsa (medicine) , most of the chapters in the Chikitsa Sthana deal with kayachikitsa while chapter 25 pertains to surgical disorders (shalya) and chapter 23 on the management of poisoning (visha) deals with agada-tantra (toxicology). In Ayurveda, psychiatry is dealt with under the heading of bhuta-vidya and two chapters - 9th and 10th - deal with unmada and apasmara focus on this aspect of medicine. Finally, the 30th chapter describes miscellaneous matters including the gynecological disorders and pediatrics (kaumarabhritya).

It is important to note here that thoughChikitsa Sthana relates with therapeutics, each chapter provides a brief etio-pathogenesis along with symptomatology, prognosis and classification of the disease before delving into its detailed treatment. In therapeutic chapters a general pattern is adopted to describe the management: The first principle of treatment (chikitsa sutra) of that particular disease is given in terms of langhana or brimhana, snehana or rukshana, svedana or stambhana and concerned measures of shodhana followed by their judicious use in particular state and stage of the disease. It is followed by description of single or compound preparations along with their constituents, method of preparation and indications. The drugs are mentioned in the form of fresh juice and paste, powder, tablet, decoctions, avaleha (jam), asava (fermented preparations mainly from juices), arishta (fermented preparations mainly from decoctions), medicated ghee and oil etc.

Eight groups of major diseases were described in Nidana sthana, each representing one specific clinical feature from diagnostic point of view. Management of those eight diseases is explained in detail from third to tenth chapter.

There are thirty chapters:

First chapter is on rasayana (rejuvenation therapy) having four subchapters and it describes number of drugs and preparations through which one can prevent and retard aging and live longer happier life. Rasayana drugs promote physical and mental health and provide general immunity to prevent diseases as well as strength to the tissues to be able to fight diseases effectively. Second chapter on vajikarana also comprises of four subchapters and deals with promotion of sexual health of healthy persons, healthy progeny as well as male sexual problems.

Management of jwara (fever) associated diseases are described in the 3rd chapter. It includes therapeutic measures for acute and chronic fever; continuous, intermittent, malarial and seasonal fevers; mild, moderate and severe fevers; fever with or without ama, fevers occurring from one, two or three combination of dosha; fever occurring in dhatu and so on. All the aspects affecting treatment and prognosis of various types of fever are also described. Fourth chapter deals with the management of bleeding disorders under the heading of raktapitta, which is of two types i.e. bleeding from the upper and lower channels.

Fifth chapter describes protuberance of abdomen under two headings, local and generalized. Local enlargement of belly is gulma and is of five types which includes simple gas phantom to new growth and their treatment.

Urinary diseases are described according to the presenting symptoms of excessive urine or scanty urine with difficulty/pain. Sixth chapter deals with the treatment of urinary problems with presenting sign of excessive urine under the heading of prameha which is of twenty types and includes madhumeha (diabetes mellitus).

The management of eighteen types of kushtha (skin diseases including leprosy) is described in 7th chapter. Chronic non-purulent bacterial, fungal and allergic skin disorders are described under this heading. These disorders are further divided into two groups viz. 11 types of kshudra kushtha (minor skin diseases) and 7 types of mahakushtha (major skin disorders).

Rajayakshma (Tuberculosis) has been a problem since time immemorial and according to its etio-pathogenesis it is classified into four types and its detailed treatment is described in the 8th chapter.

Bhuta-vidya (psychological diseases); Ninth chapter describes the management of unmada (insanity/psychotic disorders).

Tenth chapter deals with the management of epilepsy described under the heading of apasmara.

Kshata-kshina occurs by indulgence in activities beyond one’s strength or cruel activities such as bull fighting leading to ulcer in chest, bleeding and cachexia is described in 11th chapter.

Three groups of diseases with swelling (utsedha), edema and inflammation occurring in the skin and glands are described under the heading of shotha in the 12th chapter.

The conditions leading to generalized enlargement of abdomen such as ascites, splenomegaly are described in 13th chapter under the heading of udara roga.

Various types of hemorrhoids and warts etc. are described along with their treatment in the 14th chapter.

Grahani (mal-absorption) and its management is explained in the 15th chapter. Various processes of digestion, metabolism leading to the formation of dhatu and mala are also described.

Two diseases caused mainly by involvement of rakta viz. pandu roga (anemia) and kamala (jaundice) are described in 16th chapter.

Five types of disorders having presentation of dyspnea are explained in 17th chapter along with five types of hiccough.

Other diseases of respiratory system viz. cough (Kasa) is described in 18th chapter and

Diarrheal disorders (atisara) are described in 19th chapter.

Vomiting (chhardi) has been devoted a full 20th chapter.

Various types of inflammatory skin conditions such as erysipelas are described under the heading of visarpa in chapter 21st .

Various conditions manifested in the form of thirst (trishna) are described in chapter 22nd . The twenty third chapter is on the management of poisoning (visha) relating with agada-tantra (toxicology).

Alcoholism was a major problem in ancient India and the management of its various acute and chronic stages and complications are tackled in 24th chapter under the heading of madatyaya.

The twenty fifth chapter pertains to vrana chikitsa (wound management) and surgical disorders (shalya)

Twenty sixth chapter describes other gastrintestinal diseases such as udavarta, annha (distension of abdomen), aruchi (anorexia) etc. The urinary problems with scanty urine occurring with difficulty and accompanied with burning sensation or pain are also described under the heading of mutra-kricchra and ashmari. Management of other diseases, pertaining to five types of heart diseases and ear, nose, throat and scalp diseases with passing reference to eye diseases.

Disorders of spinal neuro muscular degeneration or Urustambha are described in 27th chapter.

Various nervous system and related disorders including joints (sandhi-gata-vata, avabahuka etc), stroke and their managements are described in 28th chapter under the caption of vata-vyadhi.

The 29th chapter under the heading of vatarakta mainly deals with gout but other joint disorders and condition resembling thrombo angitis obliterans is described. The 30th chapter describes miscellaneous matters including the gynecological disorders and children diseases (kaumarabhritya).

It is obvious from the foregoing that Chikitsa sthana is a treasure of therapeutic knowledge and by mastering this part one can become expert physician who can tackle all types of acute and chronic disease successfully.