Chikitsa (चिकित्सा)

In Ayurveda, the word ‘Chikitsa (Samskrit: चिकित्सा)’ means treatment of a Roga (रोगः) or Vyadhi (व्याधिः Illness or disease). Naturally, this word is used frequently in Ayurveda literature. Other terms like Bheshajam (भेषजम्), Aushadham (औषधम्), Upachara (उपचाराः), Karyam (कार्यम्), Kriya (क्रिया), Prashamanam (प्रशमनम्), Vyadhiharam (व्याधिहरम्), Pathyam (पथ्यम्) and Sadhanam (साधनम्) are synonymously used with the word ‘Chikitsa’.

परिचयः॥ Introduction

Ayurveda offers the precious knowledge on use of various measures to preserve health and life. Therefore, at most of the places in classics, one can find that, various herbs, minerals, food items and even lifestyle measures are suggested to get free from the presenting illness. Cure of diseases is one of the aims of Ayurveda. Thus, various management protocols are recommended to treat the diseases and re-establish the disturbed balance of body elements to confer health. All these measures are known as the Chikitsa of the disease or illness. Since the methods suggested to obtain health are numerous and change on the basis of cause of illness as well as use of a particular medicinal substance, material or activity; Chikitsa is of various types.

व्युत्पत्तिः॥ Etymology

The word ‘Chikitsa’ is derived from root word ‘Kit’ (कित्)

In Samskrit, Kit means eradication or elimination (of diseases)

कित् रोगापनयने।

Thus, the word ‘Chikitsa’ means eliminaitno or separation or destruction of a diseases from the body As per Amarakosha,

चिकित्सा रुक् प्रतिक्रिया।

Hence, Chikitsa is called as the action taken against a disease Or eradicating pain or disease

चिकित्सा परिभाषा॥ Definition of Chikitsa

Ayurveda classics precisely define the word 'Chikitsa' through which the chief aim and subsequent outcome is clearly stated. Acharya Charaka says that, Chikitsa (therapeutics) is an act which establishes the disturbed equilibrium of vital body elements and maintains this balance without causing any new impairment.

याभिः क्रियाभिर्जायन्ते शरीरे धातवः समाः| सा चिकित्सा विकाराणां कर्म तद्भिषजां स्मृतम्|

कथं शरीरे धातूनां वैषम्यं न भवेदिति| समानां चानुबन्धः स्यादित्यर्थं क्रियते क्रिया||- (Char. Samh. 16.34-35)

yābhiḥ kriyābhirjāyantē śarīrē dhātavaḥ samāḥ| sā cikitsā vikārāṇāṁ karma tadbhiṣajāṁ smr̥tam|

kathaṁ śarīrē dhātūnāṁ vaiṣamyaṁ na bhavēditi| samānāṁ cānubandhaḥ syādityarthaṁ kriyatē riya||

Meaning: Therapeutics therefore consists of measures or operations by way of which concordance of the tissue elements can be sustained and this (achieving concordance of tissue elements) constitutes the duty of the physician. Therapy is administered with the sole objective of ensuring that no discordance prevails in tissue elements and that there is sustenance of continued concordance.

शुद्ध चिकित्सा॥ Shuddha Chikitsa

Ayurveda advocates the use of not just effective but safe measures to eradicate the disease. Thus, in addition to use of the plain term 'chikitsa', another word 'Shuddha chikitsa' can also be found in Ayurveda literature. The concept goes very close to the idea of 'zero side effect therapy'. This means, if any treatment that is employed to combat a disease eliminates that particular diseases but at the same time damages some other parts of body or creates a background for development of some new disease should not be considered the right treatment. Ayurveda has always stressed upon the use of such measures to combat disease that do not cause any advrse untoward effects and therefore Ayurveda treatments are recognised since ages as the safer and natural remedies. The principle behind this nature of Ayurveda treatments lies in the word 'Shuddha chikitsa' which is another example of outstanding intellect and wisdom of ancient Ayurveda scholars.

Acharya charaka in Nidanasthanam has defined 'Shuddha Chikitsa' as follows,

प्रयोगः शमयेद्व्याधिं योऽन्यमन्यमुदीरयेत्| नासौ विशुद्धः, शुद्धस्तु शमयेद्यो न कोपयेत्|| (Cha. Samh. 8.23)

prayogaḥ śamayedvyādhiṁ yo'nyamanyamudīrayet| nāsau viśuddhaḥ, śuddhastu śamayedyo na kopayet||

वैद्यानां सुसिद्धा वृत्तिः॥ Right Attitude of a Physician

Ayurveda is a part of vedic literature. Although it is a system of medical knowledge, it maintains its sacred nature by advising a vaidya to always maintain the purity of his mind, body and emotions while treating any rogi (patient). Acharya Bhvamishra in Bhavaprakasha samhita dedicates few lines of verses to dictate how an attitude of a vaidya should be during chikitsa. He says that, a vaidya should never make a business of his service.

नैव कुर्वीत लोभेन चिकित्सापुण्यविक्रयम् | ईश्वराणां वसुमतां लिप्सेतार्थं तु वृत्तये ||

चिकित्सितं शरीरं यो न निष्क्रीणाति दुर्मतिः | स यत्करोति सुकृतं सर्वं तद्भिषगश्नुते ||

न देशो मनुजैर्हीनो न मुनष्या निरामयाः | ततः सर्वत्र वैद्यानां सुसिद्धा एव वृत्तयः || (Bhav. Samh. 1.38-40)

Meaning:

चिकित्सा चतुष्पादाः॥ Four Components of Chikitsa

This is the unique concept in theory of Ayurveda medicine. This concept highlights the critical role of 4 components for being any appropriately administered treatment a success. A Vaidya, Paricharaka, Rogi and Dravyam are those 4 components which when possess all desired qualities, become the 4 pillars of a successful treatment. Their importance is such recognized that, the word 'Chikitsa' is also defined on this basis and these 4 components are called 'Chikitsa Chatushpadas' i.e. 4 pillars of chikitsa.

चतुर्णां भिषगादीनां शस्तानां धातुवैकृते| प्रवृत्तिर्धातुसाम्यार्था चिकित्सेत्यभिधीयते||

caturṇāṁ bhiṣagādīnāṁ śastānāṁ dhātuvaikr̥tē| pravr̥ttirdhātusāmyārthā cikitsētyabhidhīyatē|

Meaning: 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”

चिकित्साभेदाः॥ Types of chikitsa

Understanding the various types of chikitsa described in Ayurveda, is important in a way that, one can realise the in-depth thinking of ancient Ayurveda scholars regarding what all modalities can be used to combat the diseases. It is interesting to know that, Ayurveda scholars have also listed a method wherein no medicinal substance is used but some other element or activity works as a medicine. Also, use of chanting vedic mantras, fasting and holding a precious gem is considered as treatment for certain diseases affecting the union of body, mind, senses and consciousness. Ayurveda chikitsa can be classified in numerous ways. In depth description is available in classical Ayurveda treatises. To name the few, some classifications are listed below based on the following criteria,

1. Use of medicinal substance- Dravya and adravya chikitsa (द्रव्य चिकित्सा- अद्रव्य चिकित्सा)
2. Type of modality used- Shodhan and Shaman chikitsa (शोधन तथा शमन)
3. Fundamental cause of pathogenesis and chief protocol- Santarpan and Apatarpan chikitsa (संतर्पण- अपतर्पण चिकित्सा)
4. 3 basic types of disease- Daivavyapashraya, Yuktivyapashraya & Satvavajaya (दैवव्यपाश्रया, युक्तिव्यपाश्रया तथा सत्त्वावजय चिकित्सा)
5. Mode of administration of a drug- Anta parimarjana, Bahiparimarjana and Shastrapranidhana (अन्तःपरिमार्जन बहिपरिमार्जन तथा शस्त्रप्रणिधान चिकित्सा)

Three Basic Types of Chikitsa

दैवव्यपाश्रया चिकित्सा॥ Daiva Vyapashraya Chikitsa

Daivavyapashraya chikitsa (Divine therapy) includes chanting of mantras, wearing the Aushadha and performances of homas. Daivavyapashraya chikitsa largely revives normal functioning of Sattva and removes obstacles of Rajas. It is not in common use now a days.

(TBE)The term „Daiva‟ essentially refers to, belonging to divine, celestial, to the action of past life. So this therapy is designed to exhaust evil acts of the past to combat Daivikruta diseases. The word „Vyapashraya‟ refers to depending on taking refugewith, having recourse. Daivavyapashraya is literally translated to mean any therapy that depends on or linked to Daiva or unknown. As a matter of fact, Daivavyapashraya is concerned with all the unknown circumstance, which is beyond the purview of reasoning. Hence this treatment is often referred to as spiritual therapy. Some of the measures are concerned with religious rituals like benedictions and offerings. Hence the term magicoreligious practice has aptly been applied. „Occult practice‟, „Faith practices‟ are terms which are generally employed to suggest this “Daiva Vyapashraya‟ treatment. In Atharvaveda and Kousitski Sutra, the two authentic sources of this therapy, many „occult‟ method have been described to deal with demons and with crafts because Atharvans were the first to establish relation between demons and diseases.

The methods adopted by Charaka as a part of Daiva Vyapashraya treatment are 1. Mantra (Hymns) 2. Aushadha (Amulets, Talisman) 3. Mani (Wearing of gems) 4. Mangala (Auspicious ceremony) 5. Bali (Offering to god) 6. Upahara (Gift) 7. Homa(Oblations) 8. Niyamana (Observance of scriptural rules) 9. Prayascita (Atonement) 10. Upavasa (Fasting) 11. Svastyayana (Chanting of auspicious, Hymns) 12. Pranipata (Observance to the god) 13. Gamana (Going to pilgrimage).

सत्त्वावजय चिकित्सा॥ Sattvavajaya Chikitsa

It is specially useful for the mental diseases and it consists of Manonigraha i.e. control of mind.

(TBE)Satwavajaya chikitsa (Trance therapy or psychotherapy) is aimed at regaining the normal mental activity by conducting practice of yama, niyama, asana and pranyama. These remedies ensure free circulation of prana vayu (oxygen) throughout the body resulting in removal of blockage of channels of circulation linked to mind.

It was Acharya Charaka, who introduced Satwavajaya Chikitsa for mental disorders, which is a non-pharmacological approach equivalent to modern psychotherapy. The word Satwavajaya comprises of „Satwa‟ and „Avajaya‟. The word „Satwa‟ is derived from the Sanskrit root „Sat‟ by adding suffix „Ktva‟. The word „Avajaya‟- Ava + Ji - Achaparajaye „Yenendralokhavajayaya‟ means overcoming, victory, conquer and the word „Satwavajaya‟ refers to self-command, strength of mind or character. In other words, Satwavajaya literally means overcoming of mind or victory over mind or control of mind. Satwavajaya therapy aims at the control of mind by restraining the mind from desires for wholesome objects. Acharya Charaka was the first person to use the word Satwavajaya but only once. No further description of Satwavajaya is available in Charaka Samhita. Even, this word is never mentioned anywhere else in the ancient literature. It seems that Acharya Charaka used the word to name the treatment of the diseases where Satwa‟s balance is interfered with. Hence, he has defined it as a method of controlling or restraining the mind from unwholesome objects. It can be achieved by increasing Satwa to subdue the exaggerated Rajas and Tamas.

Uses of Satwavajaya Chikitsa Satwavajaya is an approach which prevents the impairment of intellect, patience and memory and brings them back to normal state. There by all the measures included under Satwavajaya i.e. Jnanam, Vijnanam, Dhairya, Smriti, Harshana, Ashwasana, helps, 1. Individual to discriminate between thoughts and actions. 2. To divert mind and makes the patients to involve with commitment in other (or) next activity. 3. To regulate thought process. To take out phobic nucleus by making awareness of subject knowledge and true facts. 5. Retraining of ideas. 6. For proper guidance and advice for taking right decisions. 7. They initiate Bhakti (or) regard (or) strengthen his belief in god. These measures convey the idea of health to subconscious mind through scientific imagination. There by Satwavajaya Chikitsa uplift the Satva of the patients

युक्तिव्यपाश्रया चिकित्सा॥ Yukti-Vyapashraya Chikitsa

It is being widely used for the prevention and elimination of diseases by the Ayurvedic physicians since time immemorial. This type of treatment consists of planning (Yojana) of dietetic regimen (Pathya) and medication.

The main object of Yukti-Vyapashraya Cikitsa is Yukti or Yojana which means planning. In this type of treatment the physician plans the Ahara, Vihara, Aushadha, Matra, Kala etc. by taking into consideration, Desha, Kala, and causes, symptoms, signs, stage, complications, curability etc. of the disease. Taking all these points in view, a physician whatever plans (by Yukti) for prevention or elimination of a disease is known as Yukti-Vyapashraya Cikitsa.

शोधन तथा शमन॥ Shodhana and Shamana

Taking the different Yukti into consideration, the physician plans two types of treatment depending upon the condition of the patient. These are Shodhana and Shamana.

शोधन चिकित्सा॥ Shodhana Chikitsa

The treatment planned for the elimination of increased and morbid Doṣa from the body is known as Śodhana therapy. It is also termed as Pañca Karma (five fold therapy). It consists of Vamana, Virecana, Anuvāsana Basti, Āsthāpana Basti and Śirovirecana (Nasya).

Before undertaking the above five purificatory processes some treatment is to be given, which is called Pūrva-Karma meaning ‘pre-treatment steps.’ It consists of Snehana and Svedana. In the after-treatment steps the patient is taken to normal diet gradually and this is called Saṁsarjana Krama.

शमन चिकित्सा॥ Shamana Chikitsa

The treatment in which the Kupita Doṣa is pacified without eliminating it from the body is defined as Śamana Cikitsā. It is classified in two groups viz. Apatarpaṇa and Santarpaṇa. Apararpaṇa Cikitsā consists of three measures viz. Laṅghana, Rūkṣaṇa and Svedana; and Santarpaṇa Cikitsā is divided in Bṛṁhaṇa, Snehana and Stambhana.

This type of treatment is indicated in the diseases of Pitta, Agnidagdha, Atisāra, Vamana etc. The drugs having Śīta, Manda, Mṛdu, Ślakṣṇa, Rūkṣa, Sūkṣma, Drava, Sthira and Laghu properties are used for this treatment.

The above mentioned treatment is done through Auṣadha (medicine), Āhāra (diet) and Vihāra (treatment with other means excluding medicines and diet e.g. exercise, rest, etc.).

Antah parimarjana, Bahiparimarjana and Shastrapranidhana (अन्तःपरिमार्जन बहिपरिमार्जन तथा शस्त्रप्रणिधान चिकित्सा)

Antahparimarjana (internal cleasing), Bahirparimarjana (external cleansing) and Shastra Pranidhana (surgical methods).