The Principles of Therapeutics (Cikitsā)

Therapeutics, in modern medicine, is the branch concerned with the treatment of disease and the action of remedial agents. In a broad sense it means serving and caring for the patient in a comprehensive manner, preventing disease as well as managing specific problems. “Cikitsā’, the term for treatment of diseases, implies “taking away the disease”.^[1] Its synonyms are vyādhi-hara (removal of disease), pathya (wholesome or conducive to health), sādhana (means of treatment), auṣadha (drugs), prayaścitta (corrective), prasāmana (alleviator), prakṛti-sthāpana (restoration), hita (one which is beneficial) and bheṣaja (medicament).^[2]

Cakrapāṇidatta’s elucidation on these terms provides a clearer meaning of each:

(a) pathya, in the present context, indicates the channels of circulation (śrotas);

(b) sādhana are the agents that help to achieve to relieve the body from ailments;

(c) auṣadha are the medicinal preparations;

(d) prāyaścitta is a condition which produces miseries almost similar to the effect of fire;

(e) praśamana are the agents responsible for the suppression of disease;

(f) prakṛti-sthāpana, consisting of the two terms prakṛti (natural state) and sthāpana (to place or maintain), means the agents that are responsible for the maintenance of the equilibrium of the doṣas and the dhātus in the body;

(g) hita, derived from the root “dha”, i.e., to “to sustain”, “to carry”, “to maintain”, connotes all agents that are responsible in sustaining or maintaining the body in its natural state of equilibrium.^[3]

All the above terms represent different aspects of treatment. Some of these indicate what they do and some what they achieve; but in the present context they all indicate therapeutic means employed for the treatment of diseases.^[4]

Therapeutics depends on the nature of the disease and its effective use is contingent on accurate diagnosis. Knowledge of etiological factors is useful inasmuch it helps in the selection of a therapy to cure the disease by alleviating that particular vitiated doṣa. It also helps in obtaining knowledge regarding the complications and diseases to be developed in future due to that particular vitiated doṣa.^[5] The examination and analysis of the symptoms is vitally important as the vitiated doṣa/doṣas can ascertained from the manifested signs and symptoms. This is especially important in diseases that are caused by the simultaneous perturbation of the three doṣas such as kuṣṭha. Even then one or two doṣa(s) would be dominant which has to be ascertained by the physician.^[6] The causative factors are determined on the basis of specific manifestation, and from the specific manifestation one can determine the cause.^[7]

According to Caraka, therapies are of three types: (daivavyāpāśraya (ritualistic/spiritual), yuktivyāpāśraya (rational) and sattvāvajaya^[8] (psychotherapy or harnessing of mental faculties and powers).^[9] The first, daivavyāpāśraya consists of incantations (mantra), precious stones and sacred gems (maṇi), auspicious rituals (maṅgala), oblations (bali), gifts (uphāra), sacrifices (homa), penances (prāyaścitta), fasts (upvāsa), benedictions (svastyayana), bowing before elders and divine beings (praṇipāta), and visits to sacred spots (gamana).^[10] Yuktivyāpāśraya consists of administration of drugs with proper diet and regimen, while withdrawal of the mind from harmful objects constitutes psychotherapy or sattvāvajaya.^[11] The vitiated doṣas of the mind are pacified by spiritual and scriptural knowledge (jñāna-vijñāna), patience (dhairya), memory (smṛti) and meditation (samādhi).^[12]

In the event of somatic disorders (śarīradoṣaprakopa), three types of therapies are applied to the body:

1. antaḥparimājana (internal cleansing), which is dietary;
2. bahiḥparimārajana (external cleansing), which consists of massage, fomentation, unction, affusion and kneading;
3. śastrapraṇidhānas urgery.^[13]

Suśruta gives a four-fold classification of therapeutic procedures, which is as follows:^[14]

(i) Saṃśodhana—use of emetics, purgatives, enemata etc. to eliminate vitiated doṣas;

(ii) Saṃśamana—use of drugs for palliation of diseases;

(ii) Āhara—management of ailments through nutritional and dietetic regimen;

(iv) Ācāra—(behaviour) consists of activities relating to body, speech and mind, such as moving up and down, reciting, reading etc. (relating to speech) and meditation, thinking, determination, etc. (mental activities) properly employed after examining age, etc.^[15]

The term daivavyāpāśraya or a similar term does not occur in the text. Nor are rituals and prayers specifically mentioned as ācāra. Nonetheless, they are recommended as a therapeutic measure in several diseases as we shall discuss. Chanting of hymns as a protective measure is evident in surgeries;^[16] in the protection of the wounded^[17] and in cases of mūḍhagarbha (abnormal foetal presentations), and attempts to deliver the foetus alive.^[18]

Footnotes and references:

[1]:

Cakrapāṇidatta on Caraka Saṃhitā Cikitsāsthāna 1(1).3.

[2]:

Caraka Saṃhitā Cikitsāsthāna 1(1).3.

[3]:

Cakrapāṇidatta on Caraka Saṃhitā Cikitsāsthāna 1(1).3.

[4]:

Cakrapāṇidatta on Caraka Saṃhitā Cikitsāsthāna 1(1).3.

[5]:

Cakrapāṇidatta on Caraka Saṃhitā Nidāna-sthāna 1.7.

[6]:

Caraka Saṃhitā Cikitsāsthāna 7.31.

[7]:

Caraka Saṃhitā Cikitsāsthāna 7.33.

[8]:

Caraka Saṃhitā Sūtrasthāna 11.54.

[9]:

S.K.R. Rao, Encyclopaedia of Indian Medicine, Vol. II, p. 49.

[10]:

Caraka Saṃhitā Sūtrasthāna 11.54.

[11]:

Caraka Saṃhitā Sūtrasthāna 11.54.

[12]:

Caraka Saṃhitā Sūtrasthāna 1.58.

[13]:

Caraka Saṃhitā Sūtrasthāna 11.55.

[14]:

Suśruta Saṃhitā Sūtrasthāna 1.27.

[15]:

P.V. Sharma (trans.), Suśruta Saṃhitā, Vol. I, pp.20-21.

[16]:

Suśruta Saṃhitā Sūtrasthāna 5.20-33;

[17]:

Suśruta Saṃhitā Sūtrasthāna 19.25-27.

[18]:

Suśruta Saṃhitā Cikitsāsthāna 15.5-8.