Changes

=== Tattva vimarsha ===

=== Tattva vimarsha ===

• Proper administration of therapeutic measures hastens the process of cure in case of curable diseases. Therefore, correct diagnosis and prognosis at the earliest by the physician is important for getting better results with treatment. [5]

# Proper administration of therapeutic measures hastens the process of cure in case of curable diseases. Therefore, correct diagnosis and prognosis at the earliest by the physician is important for getting better results with treatment. [5]

• The treatment should be aimed at restoring physiological equilibrium. The various ways to bring this equilibrium are to increase the depleted nutrients, nourish those who are weak and emaciated, and reduce the one who are obese, those afflicted by heat with cooling measures and those afflicted by cold with heating measures. Proper measures to replenish the deficient dhatus (tissue elements, doshas and malas) and deplete those that are in excess should be adopted. Thus these therapeutic measures give us the best result in the management of diseases. [6]The diseases can be categorized under four types on the basis of their prognosis viz. 1. easily curable, 2. Curable with some difficulty, 3. palliable and 4. Absolutely irreversible or incurable. (9-10)

# The treatment should be aimed at restoring physiological equilibrium. The various ways to bring this equilibrium are to increase the depleted nutrients, nourish those who are weak and emaciated, and reduce the one who are obese, those afflicted by heat with cooling measures and those afflicted by cold with heating measures. Proper measures to replenish the deficient dhatus (tissue elements, doshas and malas) and deplete those that are in excess should be adopted. Thus these therapeutic measures give us the best result in the management of diseases. [6]The diseases can be categorized under four types on the basis of their prognosis viz. 1. easily curable, 2. Curable with some difficulty, 3. palliable and 4. Absolutely irreversible or incurable. (9-10)

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

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

 

Factors/criteria Curable Incurable

Factors/criteria Curable Incurable

Easily curable Curable with difficulty Palliable Absolutely incurable  

Easily curable Curable with difficulty Palliable Absolutely incurable  

Body Can tolerate all medicines Occurred in pregnancy, children, old age Affecting vital organs, major joints Weak body, Affecting vital organs, major joints  

Body Can tolerate all medicines Occurred in pregnancy, children, old age Affecting vital organs, major joints Weak body, Affecting vital organs, major joints  

Nature of treatment Medicines Surgical/ agni/ kshara Continuous treatment needed transcend all therapeutic measures

Nature of treatment Medicines Surgical/ agni/ kshara Continuous treatment needed transcend all therapeutic measures

Four pillars of management /patients nature With all qualities of physician, patient, nurse and medicines available Not with all qualities The patient lives, get relief for some time after following wholesome regimen and the disease gets triggered after a little exposure to causative factors also.  All senses of patients are affected, signs like undue excitement, restlessness, confused state of mind with  bad prognostic signs  

Four pillars of management /patients nature With all qualities of physician, patient, nurse and medicines available Not with all qualities The patient lives, get relief for some time after following wholesome regimen and the disease gets triggered after a little exposure to causative factors also.  All senses of patients are affected, signs like undue excitement, restlessness, confused state of mind with  bad prognostic signs  

A wise physician should always consider above factors to determine prognosis of a disease and then start treatment. [21]

A wise physician should always consider above factors to determine prognosis of a disease and then start treatment. [21]

Vidhi Vimarsha:

 

=== Vidhi Vimarsha ===

 

In 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.

In 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.

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 citeria 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 citeria 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.

In 1971, the famous psychiatrist R.D. Laing coined a term ‘Medical model’ in his book “The Politics of the Family and Other Essays”, for the set of procedures in which all doctors are trained.  This set includes complaint, history, physical examination, ancillary tests if needed for making diagnosis, treatment, and prognosis. [1] The medical model has proven highly successful, and even indispensable, in many contexts. The concepts of "disease" and "injury" are central to this model. An important aspect of the medical model is its focus on identification of pathology of disease and an attempt to remove or control it (offense strategy). There is less attention paid to the capability of human body to heal itself or understanding what health is and ways to preserve, protect and rejuvenate health. That is why there is no defense strategy in modern medical system to prevent disease. There are vaccinations to prevent certain known infectious diseases and addressing mitigating factors causing chronic diseases, such as ishemic heart disease. That appears to be the reason for increasing incidences of autoimmune and degenerative diseases.[2]   

 

In 1971, the famous psychiatrist R.D. Laing coined a term ‘Medical model’ in his book “The Politics of the Family and Other Essays”, for the set of procedures in which all doctors are trained.  This set includes complaint, history, physical examination, ancillary tests if needed for making diagnosis, treatment, and prognosis. [1] The medical model has proven highly successful, and even indispensable, in many contexts. The concepts of "disease" and "injury" are central to this model. An important aspect of the medical model is its focus on identification of pathology of disease and an attempt to remove or control it (offense strategy). There is less attention paid to the capability of human body to heal itself or understanding what health is and ways to preserve, protect and rejuvenate health. That is why there is no defense strategy in modern medical system to prevent disease. There are vaccinations to prevent certain known infectious diseases and addressing mitigating factors causing chronic diseases, such as ishemic heart disease. That appears to be the reason for increasing incidences of autoimmune and degenerative diseases.[2]  

   

The rules and ethics that governed the medical system in the ancient times remain the same even today. A step ahead of the contemporary classification of diseases, Ayurveda advocates classification of diseases on the basis of prognosis before applying therapeutic measures as the basis of treatment for restoration of health.  

The rules and ethics that governed the medical system in the ancient times remain the same even today. A step ahead of the contemporary classification of diseases, Ayurveda advocates classification of diseases on the basis of prognosis before applying therapeutic measures as the basis of treatment for restoration of health.  

There are many diseases that are still incurable and according to medical ethics it is essential to give proper information to the patient regarding diagnosis, management and prognosis. Withholding the truth or giving wrong assurance is unethical and punishable. Thus, one should ascertain the prognosis of disease before proceeding with any course of treatment and then share the outcome with the patient.

There are many diseases that are still incurable and according to medical ethics it is essential to give proper information to the patient regarding diagnosis, management and prognosis. Withholding the truth or giving wrong assurance is unethical and punishable. Thus, one should ascertain the prognosis of disease before proceeding with any course of treatment and then share the outcome with the patient.

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 or Vataja prameha can become less severe with treatment factoring in all prognosis outcomes. 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 ~ 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. Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. Meshashringi (Gymnema Sylvester (Retz.) R.Br.; Gurmar) [4-7], Kutaki (Picrorrhiza kurroa)[8],Kiratatikta (Swertia chirata (Roxb.) Buch.-Hum [9-12], Mamejjaka (Enicostema littorale Blume) [13-14] and Pterocarpus marsupium [15-18] 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.  

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 or Vataja prameha can become less severe with treatment factoring in all prognosis outcomes. 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 ~ 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. Recent research has shown some herbs have effect on beta pancreatic cells to induce endogenous insulin production. Meshashringi (Gymnema Sylvester (Retz.) R.Br.; Gurmar) [4-7], Kutaki (Picrorrhiza kurroa)[8],Kiratatikta (Swertia chirata (Roxb.) Buch.-Hum [9-12], Mamejjaka (Enicostema littorale Blume) [13-14] and Pterocarpus marsupium [15-18] 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.  

This chapter has emphasized the importance of understanding the prognosis of diseases and the factors causing them. Recent research in the field of Ayurveda has shown that incurable diseases can be controlled by addressing the prognostic factors and there is a need for both Ayurveda and Modern medicine researchers to work together.  

This chapter has emphasized the importance of understanding the prognosis of diseases and the factors causing them. Recent research in the field of Ayurveda has shown that incurable diseases can be controlled by addressing the prognostic factors and there is a need for both Ayurveda and Modern medicine researchers to work together.  

Future Scope for Research:

 

=== Future Scope for Research ===

 

1. 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.  

1. 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.  

2. Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

2. Data can be collected to estimate the usefulness as well as limitations of therapeutics in the management of curable and incurable diseases.

Glossary of Technical Terms:

=== Glossary of Technical Terms ===

 

1. चतुष्पादंcatuShpAdaM- Four limbs(four essential components) of therapeutics viz, Physician, Medicine, Attendant and  Patient.

1. चतुष्पादंcatuShpAdaM- Four limbs(four essential components) of therapeutics viz, Physician, Medicine, Attendant and  Patient.

2. उपकरणंupakaraNaM- Measures and means used for the management of diseases (Medicine in present context).

2. उपकरणंupakaraNaM- Measures and means used for the management of diseases (Medicine in present context).