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Khuddakachatushpada Adhyaya (view source)

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

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अथातः खुड्डाकचतुष्पादमध्यायं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaḥ khuḍḍākacatuṣpādamadhyāyaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

Now (I) shall expound the ''Khuddakachatushpada'' (chapter on four components of healthcare in brief) as propounded by Lord Atreya.[1-2]

==== Four components of Healthcare ====

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भिषग्द्रव्याण्युपस्थाता रोगी पादचतुष्टयम्|

गुणवत् कारणं ज्ञेयं विकारव्युपशान्तये||३||

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bhiṣagdravyāṇyupasthātā rōgī pādacatuṣṭayam|

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bhiShagdravyANyupasthAtA rogI pAdacatuShTayam|

guNavat kAraNaM j~jeyaM vikAravyupashAntaye||3||

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</div></div>

Physician, medicine, attendant (nursing staff) and the patient, these are four components which, all in their best of qualities are responsible for the complete cure of disease. [3]

==== Definitions of disease, health, happiness and unhappiness ====

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विकारो धातुवैषम्यं, साम्यं प्रकृतिरुच्यते|

सुखसञ्ज्ञकमारोग्यं, विकारो दुःखमेव च||४||

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vikārō dhātuvaiṣamyaṁ, sāmyaṁ prakr̥tirucyatē|

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vikAro dhAtuvaiShamyaM, sAmyaM prakRutirucyate|

sukhasa~jj~jakamArogyaM, vikAro duHkhameva ca||4||

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</div></div>

Disequilibrium of ''dhatus'' is disease and their equilibrium is health. Health is termed as happiness, while disorder as unhappiness. [4]

==== Definition of ''chikitsa'' (therapeutics/management of disease) ====

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चतुर्णां भिषगादीनां शस्तानां धातुवैकृते|

प्रवृत्तिर्धातुसाम्यार्था चिकित्सेत्यभिधीयते||५||

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caturṇāṁ bhiṣagādīnāṁ śastānāṁ dhātuvaikr̥tē|

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caturNAM bhiShagAdInAM shastAnAM dhAtuvaikRute|

pravRuttirdhAtusAmyArthA cikitsetyabhidhIyate||5||

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</div></div>

Employment of all the excellent four – physician etc. – in case of disorder of ''dhatu'' with the objective of (re-establishing) their equilibrium is called “Therapeutics”. [5]

==== Qualities of the best ''vaidya'' (knowledgeable physician) ====

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श्रुते पर्यवदातत्वं बहुशो दृष्टकर्मता|

दाक्ष्यं शौचमिति ज्ञेयं वैद्ये गुणचतुष्टयम्||६||

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śrutē paryavadātatvaṁ bahuśō dr̥ṣṭakarmatā|

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shrute paryavadAtatvaM bahusho dRuShTakarmatA|

dAkShyaM shaucamiti j~jeyaM vaidye guNacatuShTayam||6||

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</div></div>

A ''vaidya'' should possess the qualities such as proficiency in theoretical knowledge (that is learnt), extensive practical experience, dexterity and purity (of body and mind). [6]

==== Qualities of ''dravya'' (medicine) ====

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बहुता तत्रयोग्यत्वमनेकविधकल्पना|

सम्पच्चेति चतुष्कोऽयं द्रव्याणां गुण उच्यते||७||

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bahutā tatrayōgyatvamanēkavidhakalpanā|

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bahutA tatrayogyatvamanekavidhakalpanA|

sampacceti catuShko~ayaM dravyANAM guNa ucyate||7||

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</div></div>

Abundance (in availability), efficacy (with good pharmacological properties), various pharmaceutical forms and intact qualities of drugs – these are four qualities of the ideal medicine. [7]

==== Qualities of best attendant (caretaker/nursing staff) ====

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उपचारज्ञता दाक्ष्यमनुरागश्च भर्तरि|

शौचं चेति चतुष्कोऽयं गुणः परिचरे जने||८||

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upacārajñatā dākṣyamanurāgaśca bhartari|

śaucaṁ cēti catuṣkō'yaṁ guṇaḥ paricarē janē||8||

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upacAraj~jatA dAkShyamanurAgashca bhartari|

shaucaM ceti catuShko~ayaM guNaH paricare jane||8||

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</div></div>

Knowledge of taking care of patient (nursing) as well as preparation, dispensing and administration of medicines and healthy recipes, dexterity, affectionate towards patient and purity of body and mind – these are four qualities of attendant. [8]

==== Qualities of best patient ====

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स्मृतिर्निर्देशकारित्वमभीरुत्वमथापि च|

ज्ञापकत्वं च रोगाणामातुरस्य गुणाः स्मृताः||९||

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smr̥tirnirdēśakāritvamabhīrutvamathāpi ca|

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smRutirnirdeshakAritvamabhIrutvamathApi ca|

j~jApakatvaM ca rogANAmAturasya guNAH smRutAH||9||

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</div></div>

Good memory (to remember treatment guidelines), obedience (to follow given instructions), fearlessness (courage to face adversities of disease) and ability to provide all information about the disease – these are the qualities of patient. [9]

==== Importance and role of physician ====

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कारणं षोडशगुणं सिद्धौ पादचतुष्टयम्|

विज्ञाता शासिता योक्ता प्रधानं भिषगत्र तु||१०||

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kāraṇaṁ ṣōḍaśaguṇaṁ siddhau pādacatuṣṭayam|

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kAraNaM ShoDashaguNaM siddhau pAdacatuShTayam|

vij~jAtA shAsitA yoktA pradhAnaM bhiShagatra tu||10||

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</div></div>

These four components consist of sixteen qualities, if ideally administered, lead to a successful outcome. But here the physician is most important because of his specific knowledge, administrative capacity and managerial skills . [10]

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पक्तौ हि कारणं पक्तुर्यथा पात्रेन्धनानलाः|

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आतुराद्यास्तथा सिद्धौ पादाः कारणसञ्ज्ञिताः|

वैद्यस्यातश्चिकित्सायां प्रधानं कारणं भिषक्||१२||

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paktau hi kāraṇaṁ pakturyathā pātrēndhanānalāḥ|

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AturAdyAstathA siddhau pAdAH kAraNasa~jj~jitAH|

vaidyasyAtashcikitsAyAM pradhAnaM kAraNaM bhiShak||12||

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</div></div>

As in cooking utensils, fuel and fire are complementary for the cook, the battlefield, soldiers and weapons are supporters to the conqueror, similarly for the healing capabilities of the physician, drugs, attendants and patients are the supporters. [11-12]

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मृद्दण्डचक्रसूत्राद्याः कुम्भकारादृते यथा|

नावहन्ति गुणं वैद्यादृते पादत्रयं तथा||१३||

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mr̥ddaṇḍacakrasūtrādyāḥ kumbhakārādr̥tē yathā|

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mRuddaNDacakrasUtrAdyAH kumbhakArAdRute yathA|

nAvahanti guNaM vaidyAdRute pAdatrayaM tathA||13||

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</div></div>

As the soil, stick, wheel, thread etc. do not serve the purpose (of making pot) without the potter, the other three components are in the same position without the physician. [13]

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गन्धर्वपुरवन्नाशं यद्विकाराः सुदारुणाः|

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सति पादत्रये ज्ञाज्ञौ भिषजावत्र कारणम्|१५|

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gandharvapuravannāśaṁ yadvikārāḥ sudāruṇāḥ|

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sati pAdatraye j~jAj~jau bhiShajAvatra kAraNam|15|

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</div></div>

Very severe disorders vanish like the (imaginary) city of ''gandharvas'' (magician) while even the simplest of disorders aggravated, in spite of the other three components of treatment i.e. drugs, nurse, patient (with all their qualities). Learned and ignorant physicians are responsible for the above two consequences respectively. [14-14½]

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वरमात्मा हुतोऽज्ञेन न चिकित्सा प्रवर्तिता||१५||

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पाणिचाराद्यथाऽचक्षुरज्ञानाद्भीतभीतवत्|

नौर्मारुतवशेवाज्ञो भिषक् चरति कर्मसु||१६||

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varamātmā hutō'jñēna na cikitsā pravartitā||15||

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pANicArAdyathA~acakShuraj~jAnAdbhItabhItavat|

naurmArutavashevAj~jo bhiShak carati karmasu||16||

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</div></div>

It is better to self-immolate than be treated by a quack, as a blind man moves groping with the help of the movement of his hand with fear, as a boat without sailors comes under the storm. The physician who has no knowledge of his area of medicine or science proceeds in the realm of therapeutic management with too much fear and lack of confidence.

Therefore never take treatment from an unknowledgeable physician. [15-16]

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यदृच्छया समापन्नमुत्तार्य नियतायुषम्|

भिषङ्मानी निहन्त्याशु शतान्यनियतायुषाम्||१७||

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yadr̥cchayā samāpannamuttārya niyatāyuṣam|

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yadRucchayA samApannamuttArya niyatAyuSham|

bhiSha~gmAnI nihantyAshu shatAnyaniyatAyuShAm||17||

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</div></div>

Such a person regarding himself as a physician cures by chance a patient whose lifespan is certain (who was destined to survive) but kills hundreds having uncertain lifespan. [17]

==== Qualities of ''pranabhisara'' (life saviour) physician ====

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तस्माच्छास्त्रेऽर्थविज्ञाने प्रवृत्तौ कर्मदर्शने|

भिषक् चतुष्टये युक्तः प्राणाभिसर उच्यते||१८||

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tasmācchāstrē'rthavijñānē pravr̥ttau karmadarśanē|

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tasmAcchAstre~arthavij~jAne pravRuttau karmadarshane|

bhiShak catuShTaye yuktaH prANAbhisara ucyate||18||

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</div></div>

Hence, a physician possessing four qualities - indulgence in scientific knowledge, clear understanding, right application, and practical experience - is known as the one who promotes life i.e. ''pranabhisara''. [18]

==== Qualities of a royal physician ====

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हेतौ लिङ्गे प्रशमने रोगाणामपुनर्भवे|

ज्ञानं चतुर्विधं यस्य स राजार्हो भिषक्तमः||१९||

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hētau liṅgē praśamanē rōgāṇāmapunarbhavē|

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hetau li~gge prashamane rogANAmapunarbhave|

j~jAnaM caturvidhaM yasya sa rAjArho bhiShaktamaH||19||

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</div></div>

The physician, who possesses knowledge of etiology, symptomatology, therapeutics and prevention of diseases, is the best among physicians and is fit for becoming a royal physician. [19]

==== Qualities of ideal ''vaidya'' ====

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शस्त्रं शास्त्राणि सलिलं गुणदोषप्रवृत्तये|

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यस्य त्वेते गुणाः सर्वे सन्ति विद्यादयः शुभाः|

स वैद्यशब्दं सद्भूतमर्हन् प्राणिसुखप्रदः||२३||

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śastraṁ śāstrāṇi salilaṁ guṇadōṣapravr̥ttayē|

pātrāpēkṣīṇyataḥ prajñāṁ cikitsārthaṁ viśōdhayēt||20||

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yasya tvete guNAH sarve santi vidyAdayaH shubhAH|

sa vaidyashabdaM sadbhUtamarhan prANisukhapradaH||23||

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The merits (good effect) and demerits (bad effects) of weapons, scriptures and water depend on their user. So, physician should purify his intellect (to remove the lacunae) before treating.

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==== Importance of scientific studies ====

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शास्त्रं ज्योतिः प्रकाशार्थं दर्शनं बुद्धिरात्मनः|

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चिकित्सिते त्रयः पादा यस्माद्वैद्यव्यपाश्रयः|

तस्मात् प्रयत्नमातिष्ठेद्भिषक् स्वगुणसम्पदि||२५||

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śāstraṁ jyōtiḥ prakāśārthaṁ darśanaṁ buddhirātmanaḥ|

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cikitsite trayaH pAdA yasmAdvaidyavyapAshrayaH|

tasmAt prayatnamAtiShThedbhiShak svaguNasampadi||25||

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</div></div>

Scientific scriptures provide light for illumination (to remove darkness of ignorance or to know things) and one’s own intellect is like eyes. The physician who uses both (scientific knowledge and own intellect) properly, does not commit mistakes during treatment because in treatment, the other three components are dependent on the physician. Hence the physician should make all efforts to enrich his qualities. [24-25]

==== Ideal attitude of physician towards patients ====

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मैत्री कारुण्यमार्तेषु शक्ये प्रीतिरुपेक्षणम्|

प्रकृतिस्थेषु भूतेषु वैद्यवृत्तिश्चतुर्विधेति||२६||

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maitrī kāruṇyamārtēṣu śakyē prītirupēkṣaṇam|

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maitrI kAruNyamArteShu shakye prItirupekShaNam|

prakRutistheShu bhUteShu vaidyavRuttishcaturvidheti||26||

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</div></div>

Friendliness, compassion towards the diseased, attachment to the remediable and indifference to those who are moving towards the end (death) – this is the fourfold attitude of an ideal physician.[26]

==== Summary ====

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तत्र श्लोकौ-

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ज्ञानानि बुद्धिर्ब्राह्मी च भिषजां या चतुर्विधा|

सर्वमेतच्चतुष्पादे खुड्डाके सम्प्रकाशितमिति||२८||

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tatra ślōkau-

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j~jAnAni buddhirbrAhmI ca bhiShajAM yA caturvidhA|

sarvametaccatuShpAde khuDDAke samprakAshitamiti||28||

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</div></div>

Four components of therapeutics, four essential qualities of each component, the reason why the physician is the chief “component”, the qualities of physician, the aspects of knowledge and fourfold attitude of the ideal physician – all this has been described in this chapter of four components of healthcare management. [27-28]

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृते श्लोकस्थाने खुड्डाकचतुष्पादो नाम नवमोऽध्यायः||९||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē ślōkasthānē khuḍḍākacatuṣpādō nāma navamō'dhyāyaḥ||9||

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ityagniveshakRute tantre carakapratisaMskRute shlokasthAne khuDDAkacatuShpAdo nAmanavamo~adhyAyaH||9||

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</div></div>

Thus ends the ninth chapter on small quadruple in ''Shlokasthana'' (i.e., [[Sutra Sthana]]) in the treatise composed by Agnivesha and redacted by Charak.

Agnivesha

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