Changes

This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

This chapter describes four types of diseases on the basis of prognosis and emphasizes the importance of knowledge of prognosis for successful management of disease. It is important to assess the prognosis of a patient before initiating treatment. Lord Atreya responds to the queries of Maitreya regarding the role of therapeutics in the eradication of disease and prescribes the four components of Healthcare Management. He suggests that even the most wise physician and the most efficient therapeutic measure cannot prevent or cure an ailment without knowing its prognosis. The chapter gives details of all the factors that are helpful in deciding the prognosis of a disease including ''prakriti'' (body type). Some fundamental principles of management like nourishment therapy, fasting therapy, treating the root cause of disease, hot therapy and cold therapy are mentioned to exemplify the principle of ''dhatu samyata'' (maintenance of stable equilibrium or concept of homeostasis).

===Sanskrit text, transliteration and english translation===

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

अथातोमहाचतुष्पादमध्यायंव्याख्यास्यामः||१||

अथातोमहाचतुष्पादमध्यायंव्याख्यास्यामः||१||

catuShpAdaMShoDashakalaMbheShajamitibhiShajobhAShante,yaduktaMpUrvAdhyAyeShoDashaguNamiti, tadbheShajaMyuktiyuktamalamArogyAyetibhagavAnpunarvasurAtreyaH||3||

catuShpAdaMShoDashakalaMbheShajamitibhiShajobhAShante,yaduktaMpUrvAdhyAyeShoDashaguNamiti, tadbheShajaMyuktiyuktamalamArogyAyetibhagavAnpunarvasurAtreyaH||3||

According to physicians, therapeutics has four components which have sixteen qualities. The same has been stated in the preceding chapter, therapeutics with these sixteen qualities have the capacity to eliminate diseases, so said Lord PunarvasuAtreya.[3]

According to physicians, therapeutics has four components which have sixteen qualities. The same has been stated in the preceding chapter, therapeutics with these sixteen qualities have the capacity to eliminate diseases, so said Lord Punarvasu Atreya.[3]

==== Maitreya’s observation and query ====

==== Maitreya’s observation and query ====

kAntatamobhavati||6||

kAntatamobhavati||6||

And we see with our own eyes that we cure a patient by taking a recourse to curative therapeutic measures- the depleted [body elements] by increasing them. We give nourishment to those who are weak and emaciated. We administer reducing therapy to the one who is obese. We treat patients afflicted by heat with cooling measures and the one afflicted by cold with heating measures. We adopt proper measures to replenish the deficient dhatus (tissue elements, doshas and malas) and deplete those that are in excess. We thus bring back the physiological state by treating the diseases with those having opposite properties of causative factors. Thus the group of therapeutic measures gives us the best result in the management of diseases. [6]

And we see with our own eyes that we cure a patient by taking a recourse to curative therapeutic measures- the depleted body elements by increasing them. We give nourishment to those who are weak and emaciated. We administer reducing therapy to the one who is obese. We treat patients afflicted by heat with cooling measures and the one afflicted by cold with heating measures. We adopt proper measures to replenish the deficient ''dhatus'' (tissue elements, ''doshas'' and ''malas'') and deplete those that are in excess. We thus bring back the physiological state by treating the diseases with those having opposite properties of causative factors. Thus the group of therapeutic measures gives us the best result in the management of diseases. [6]

==== Importance of determination of prognosis ====

==== Importance of determination of prognosis ====

The following are the factors that determine the nature of the diseases which are easily curable:

The following are the factors that determine the nature of the diseases which are easily curable:

# Causes, premonitory symptoms, and other signs and symptoms that are mild,

# Causes, premonitory symptoms, and other signs and symptoms that are mild,

# Qualities of dhatus involved are not in common with those of the doshas,

# Qualities of ''dhatus'' involved are not in common with those of the ''doshas'',

# Doshas constituting the prakriti (physical and mental constitution) of the patient are not similar

# ''Doshas'' constituting the ''prakriti'' (physical and mental constitution) of the patient are not similar

# The season is not conducive to the growth of the disease

# The season is not conducive to the growth of the disease

# The geographical and bodily positions are not conducive to the growth of the disease

# The geographical and bodily positions are not conducive to the growth of the disease

# Recently originated (not chronic)

# Recently originated (not chronic)

# Having no complications

# Having no complications

# Only one dosha is involved in the pathogenesis of the disease

# Only one ''dosha'' is involved in the pathogenesis of the disease

# The body is amenable to all kinds of the medicaments and

# The body is amenable to all kinds of the medicaments and

# Fourfold therapeutic measures are available. [11-13]

# Fourfold therapeutic measures are available. [11-13]

# Causes, premonitory symptoms and other signs and symptoms are of slightly serious nature

# Causes, premonitory symptoms and other signs and symptoms are of slightly serious nature

# The qualities of any one of the kala (season), prakriti (physical including mental constitution) and dhatus (tissue elements) are favorable to the disease (doshas)

# The qualities of any one of the ''kala'' (season), ''prakriti'' (physical including mental constitution) and ''dhatus'' (tissue elements) are favorable to the disease (''doshas'')

# The person suffering from the disease is a pregnant woman, old, or child

# The person suffering from the disease is a pregnant woman, old, or child

# There are moderate types of complications

# There are moderate types of complications

# The diseases in which treatment, surgery, application of alkalis and cauterization are involved

# The diseases in which treatment, surgery, application of alkalis and cauterization are involved

# The diseases that are not new could we say chronic disease or diseases not of recnt onset?

# The diseases that are not new could we say chronic disease or diseases not of recent onset?

# The diseases occurring in vital parts and joints

# The diseases occurring in vital parts and joints

# Diseases involving only one system but not fully supported by the four fold therapeutic measures. Not clear

# Diseases involving only one system but not fully supported by the four fold therapeutic measures. '''Not clear'''

# Diseases extending to two systems but not very chronic, and

# Diseases extending to two systems but not very chronic, and

# Diseases that are caused by the vitiation of two doshas. [14-16]

# Diseases that are caused by the vitiation of two ''doshas''. [14-16]

==== Prognostic criteria for palliable diseases ====

==== Prognostic criteria for palliable diseases ====

The palliable group of diseases are characterized as follows:

The palliable group of diseases are characterized as follows:

# As pre-ordained, the patient has survived for a certain period by following a wholesome regimen and as such has enjoyed a little relief, but even a slightest carelessness might quickly aggravate the condition

# As preordained, the patient has survived for a certain period by following a wholesome regimen and as such has enjoyed a little relief, but even a slightest carelessness might quickly aggravate the condition

# The disease has affected deep seated dhatus

# The disease has affected deep seated ''dhatus''

# The disease involves a number of dhatus

# The disease involves a number of ''dhatus''

# It affects the vital organs and joints  

# It affects the vital organs and joints  

# It affects the patient continuously for a long time (chronic), and

# It affects the patient continuously for a long time (chronic), and

# The disease is caused by the vitiation of the two doshas. [17-18]

# The disease is caused by the vitiation of the two ''doshas''. [17-18]

==== Prognostic criteria for incurable diseases ====

==== Prognostic criteria for incurable diseases ====

Likewise, the following factors would determine the absolute incurability of the disease:

Likewise, the following factors would determine the absolute incurability of the disease:

# Disease caused by the vitiation of all the three doshas

# Disease caused by the vitiation of all the three ''doshas''

# Disease that transcend all therapeutic measures

# Disease that transcend all therapeutic measures

# Diseases that involves all the systems

# Diseases that involves all the systems

# Disease which affects the sense organs

# Disease which affects the sense organs

# The affected person is usually weak and the disease is sufficiently advanced, and

# The affected person is usually weak and the disease is sufficiently advanced, and

# The disease having bad prognostic signs. What prognostic signs? [19-20]

# The disease having bad prognostic signs. '''What prognostic signs?''' [19-20]

==== Importance of prognosis ====

==== Importance of prognosis ====

ityagniveshakRutetantrecarakapratisaMskRuteshlokasthAnemahAcatuShpAdonAmadashamo~adhyAyaH||10||

ityagniveshakRutetantrecarakapratisaMskRuteshlokasthAnemahAcatuShpAdonAmadashamo~adhyAyaH||10||

Thus ends the tenth “Detailed chapter on four important components of the Therapeutics” chapter of Sutra section of Agnivesa’s work as redacted by Charaka.[10]

Thus ends the tenth “Detailed chapter on four important components of the Therapeutics” chapter of Sutra section of Agnivesha’s work as redacted by Charaka.[10]

=== Tattva vimarsha ===

=== Tattva vimarsha ===