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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]

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 ====

नेतिमैत्रेयः, किंकारणं? दृश्यन्तेह्यातुराःकेचिदुपकरणवन्तश्चपरिचारकसम्पन्नाश्चात्मवन्तश्चकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताश्चापरेम्रियमाणाः; तस्माद्भेषजमकिञ्चित्करंभवति, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, नद्यांवास्यन्दमानायांपांसुधानेवापांसुमुष्टिःप्रकीर्णइति; तथाऽपरेदृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताम्रियमाणाश्चापरे| यतश्चप्रतिकुर्वन्सिध्यति, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ततश्चिन्त्यतेभेषजमभेषजेनाविशिष्टमिति ||४||

नेतिमैत्रेयः, किंकारणं? दृश्यन्तेह्यातुराःकेचिदुपकरणवन्तश्चपरिचारकसम्पन्नाश्चात्मवन्तश्चकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताश्चापरेम्रियमाणाः; तस्माद्भेषजमकिञ्चित्करंभवति, तद्यथा- श्वभ्रेसरसि च प्रसिक्तमल्पमुदकं, नद्यांवास्यन्दमानायांपांसुधानेवापांसुमुष्टिःप्रकीर्णइति; तथाऽपरेदृश्यन्तेऽनुपकरणाश्चापरिचारकाश्चानात्मवन्तश्चाकुशलैश्चभिषग्भिरनुष्ठिताःसमुत्तिष्ठमानाः, तथायुक्ताम्रियमाणाश्चापरे| यतश्चप्रतिकुर्वन्सिध्यति, प्रतिकुर्वन्म्रियते; अप्रतिकुर्वन्सिध्यति, अप्रतिकुर्वन्म्रियते; ततश्चिन्त्यतेभेषजमभेषजेनाविशिष्टमिति ||४||

To this Lord Atreya remarks, “Oh Maitreya! The conclusion derived by you is not correct. Because, to say that the patients adopting the therapeutic measures having the sixteen qualities die is not borne out of facts. Therapeutic measures can never be ineffective in curable diseases. Similarly, even in such cases where patients are cured without proper medication, it should be understood that had there been proper administration of therapeutic measures the process of cure would have been quicker and better. This can be likened to the lifting of a healthy person who has fallen. He can no doubt get up himself but if he is helped and lifted by another person, he would get up sooner and without much difficulty. Similar is the case with patients stated to have been cured without adequate therapeutic measures. Then there is the case where patients die even by taking recourse to adequate therapeutic measures. It is not that all patients taking recourse to therapeutic measures are necessarily cured because all diseases are not curable. Diseases that are curable can be cured only by taking recourse to therapeutic measures. Those that are not curable will certainly not respond to the treatment and not even the ablest physician is capable of curing the moribund patient. An able physician always proceeds with their treatment after proper examination. As an archer having the knowledge and practice (of archery) shoots arrows with the help of his bow and does not commit mistakes in hitting a massive body nearby and thus accomplishes his object, so a physician endowed with his own qualities and other accessories proceeding with the act (of treatment) after proper examination will certainly cure a curable patient without fail. So it is not correct to say that there is no difference between the application and non-application of therapeutic measures”. [5]

To this Lord Atreya remarks, “Oh Maitreya! The conclusion derived by you is not correct. Because, to say that the patients adopting the therapeutic measures having the sixteen qualities die is not borne out of facts. Therapeutic measures can never be ineffective in curable diseases. Similarly, even in such cases where patients are cured without proper medication, it should be understood that had there been proper administration of therapeutic measures the process of cure would have been quicker and better. This can be likened to the lifting of a healthy person who has fallen. He can no doubt get up himself but if he is helped and lifted by another person, he would get up sooner and without much difficulty. Similar is the case with patients stated to have been cured without adequate therapeutic measures. Then there is the case where patients die even by taking recourse to adequate therapeutic measures. It is not that all patients taking recourse to therapeutic measures are necessarily cured because all diseases are not curable. Diseases that are curable can be cured only by taking recourse to therapeutic measures. Those that are not curable will certainly not respond to the treatment and not even the ablest physician is capable of curing the moribund patient. An able physician always proceeds with their treatment after proper examination. As an archer having the knowledge and practice (of archery) shoots arrows with the help of his bow and does not commit mistakes in hitting a massive body nearby and thus accomplishes his object, so a physician endowed with his own qualities and other accessories proceeding with the act (of treatment) after proper examination will certainly cure a curable patient without fail. So it is not correct to say that there is no difference between the application and non-application of therapeutic measures”. [5]

==== Some principles of management ====

==== Some Principles of Management ====

इदं चनःप्रत्यक्षं- यदनातुरेणभेषजेनातुरंचिकित्सामः , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, स्थूलंमेदस्विनमपतर्पयामः, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, व्याधीन्मूलविपर्ययेणोपचरन्तःसम्यक्प्रकृतौस्थापयामः; तेषांनस्तथाकुर्वतामयंभेषजसमुदायःकान्ततमोभवति||६||

इदं चनःप्रत्यक्षं- यदनातुरेणभेषजेनातुरंचिकित्सामः , क्षाममक्षामेण, कृशं च दुर्बलमाप्याययामः, स्थूलंमेदस्विनमपतर्पयामः, शीतेनोष्णाभिभूतमुपचरामः, शीताभिभूतमुष्णेन, न्यूनान्धातून्पूरयामः, व्यतिरिक्तान्ह्रासयामः, व्याधीन्मूलविपर्ययेणोपचरन्तःसम्यक्प्रकृतौस्थापयामः; तेषांनस्तथाकुर्वतामयंभेषजसमुदायःकान्ततमोभवति||६||

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 ====

भवन्तिचात्र-  

भवन्तिचात्र-  

A physician who can distinguish between curable and incurable diseases and initiates treatment in time with the full knowledge (about the various aspects of the therapeutics) can certainly accomplish his objective (of curing the disease). On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of wealth, knowledge and fame and will also earn bad reputation and other royal sanctions or punishments. [7-8]

A physician who can distinguish between curable and incurable diseases and initiates treatment in time with the full knowledge (about the various aspects of the therapeutics) can certainly accomplish his objective (of curing the disease). On the other hand, a physician who undertakes the treatment of an incurable disease would undoubtedly subject himself to the loss of wealth, knowledge and fame and will also earn bad reputation and other royal sanctions or punishments. [7-8]

==== Types of prognosis ====

==== Types of Prognosis ====

सुखसाध्यंमतंसाध्यंकृच्छ्रसाध्यमथापिच|

सुखसाध्यंमतंसाध्यंकृच्छ्रसाध्यमथापिच|

Again, the curable diseases have three alternants depending upon the moderate and excellent methods required to cure them. This alternative is, however, not possible with regard to diseases which are absolutely incurable. [9-10]

Again, the curable diseases have three alternants depending upon the moderate and excellent methods required to cure them. This alternative is, however, not possible with regard to diseases which are absolutely incurable. [9-10]

==== Prognostic criteria for easily curable diseases ====

==== Prognostic Criteria for Easily Curable Diseases ====

हेतवःपूर्वरूपाणिरूपाण्यल्पानियस्य च|  

हेतवःपूर्वरूपाणिरूपाण्यल्पानियस्य च|  

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 [https://en.wikipedia.org/wiki/Ayurveda 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 criteria of [https://en.wikipedia.org/wiki/Ayurveda 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 ischemic 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, [https://en.wikipedia.org/wiki/Ayurveda 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.  

[https://en.wikipedia.org/wiki/Ayurveda 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'', like in an 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.