Prognosis simply means, how easy or how difficult it is to treat a disease in patient.A disease with good prognosis means, it is quite easy to cure. A disease with poor prognosis is difficult to cure.
The prognosis of disease depends on many different factors. We have learnt about that in a nutshell, while reading the 1st chapter of Ashtanga Hrudaya. Let us explore further on this and learn how to make prognosis of disease as per Ayurveda.
Qualities of diseases in Ayurveda, which can be cured easily, which accounts for good prognosis
Sarvaushadha kshame dehe – The body of patient is able to tolerate all types of medicines – If the patient can tolerate strong dose of medicines, and if patient is co-operative to treatment procedures, then the doctor will have wide range of medicines and treatments to chose from. Hence, this feature accounts for good prognosis. If the patient is intolerant to certain types of medicines, For example, if patient can not tolerate bitter taste, then the physician is restricted to avoid most of the Kashaya (herbal decoctions), and certain Churnas (herbal powders). So, physician has a very small range of medicines to chose from. Hence the prognosis will not be very good.
Yunaha – Young patient – While at young age, the tolerance is more and body readily responds positively to medicines. Hence it is a desirable characteristic in patients.
Jitatmanaha – Patient having good control over sense organs, who follows abstinence. If the patient has a good control over his sense organs, he is more like to follow the dietary and lifestyle changes advised by the doctor. This will immensely help the Ayurvedic doctor to treat the disease very efficiently.
Amarmaga – If the disease does not affect sensitive areas like brain, heart, kidney – Naturally, these spots are very sensitive and if these organs are affected, it makes doctor’s job very difficult.
Alpahetu – If the cause for disease is mild – As per Ayurveda, the extent of worsening of symptoms is directly proportional to the extent of exposure to causitive factor.
For example, more the ice creams you eat, more severe will be the tonsillitis. Hence, lesser the causitive factors, easier the disease to treat.
Alparoopa – Mild symptoms – Lesser the number of symptoms, easier the disease to treat.
Anupadrava – no complications – self explanatory.
Atulya dushya desha rutu prakruti – If the Dosha involved, Dhatu (body tissue) involved, Desha (place), Rutu (season) and Prakruti (body type) are not influenced by one particular Dosha, then that disease is easy to treat.
This demands some explanation.
Atulya Dushya – Different Dosha and its natural habitat – As per Ayurveda, Vata is situated in Bones and cartilages, Pitta in blood, and kapha in rest of the tissues like – lymph, muscles, fat, bone marrow and reproductory system.
If Vata disease manifests in bone, it is relatively hard to cure. Because, Vata is naturally dominant in bones. If further Vata imbalance occurs there, then Vata will be very highly imbalanced.
Similarly, Pitta disorders in blood, and kapha disorders in rest of tissues is difficult to cure.
Going by this theory, if Vata imbalance affects Muscles, it is easier to treat. Because, muscles are dominated naturally by kapha. Kapha, naturally has some qualities opposite to Vata Dosha, hence some bad effects of Vata gets nullified, leading to weakening of disease.
Atulya Desha – different Dosha and place of disease manifestation.
If a person is living in arid region, where Vata is dominant, if he gets Vata imbalance disease, then the disease is difficult to cure. Because, he is surrounded by Vata promoting place, and over that he has Vata imbalance. So, Vata becomes very strong and disease manifestation will be aggressive.
If a person is living in hot humid, Pitta dominant place, and if he gets Vata imbalance, then it is easier to treat. Because, some bad effects of Vata imbalance is nullified by Pitta dominant place.
Atulya Rutu – different Dosha and Season –
We will be learning in future that particular seasons influence Dosha. For example, rainy season influences Vata increase. So, during this season, if there is Vata imbalance disease, then it is difficult to treat. If Vata disease occurs in other seasons, then it is relatively easy to treat.
Pada sampadi – If all the sixteen qualities of Doctor, patient, nurse and medicine are present, then it is easy to cure. We studied about this in the Ashtanga Hrudaya 1st chapter article. This means, if doctor is good, patient is tolerant and obedient, can afford treatment, nurse and hospital infrastructure is good and if medicines are also of good quality, then it is very easy to treat the disease. Prognosis will be usually good.
Graha anuguna – If astrology is in favour of the patient – Ayurveda believes in Astrology, so this factor is mentioned here.
Eka Doshaja – Disease due to only one Dosha. If only one Dosha is involved, only a limited set of symptoms will get manifested, hence it is easy to treat.
Eka Marga – If only one body channel is affected – then it is easy to treat. If multi body channels are affected, it means, many systems are involved, difficult to treat.
Nava – Disease of recent origin / onset. – Earlier the diagnosis of disease, better the prognosis.
Overall, the disease is termed as Sukha Sadhya – easily curable, if
- The disease caused by very few causative factors,
- The disease manifests with very less premonitory symptoms and symptoms,
- The nature of the dushya (tissue) should not be similar to the nature of the dosha (which has caused the disease),
- The dosha causing the disease should not be similar to the dosha forming the prakriti (constitution) of the patient (example, a vata disease occurring in pitta prakriti person), \
- The season and land shouldn’t have similar qualities and nature as that of the dosha causing the disease,
- The disease should not be manifested in the marma (vital body parts),
- The disease should be manifested in only one marga (location of the disease) i.e. the disease should either be in bahya roga marga (tissues) or abhyantara roga marga (viscera),
- The disease should have been newly manifested (acute),
- The disease should not be associated with upadravas (complications),
- The patient having the strength to tolerate stronger treatments like shodhana (cleanising treatments like emesis, purgation etc) and
- The disease being attended by chikitsa chatushpada (4 limbs of treatment – the doctor, the patient, the medicine and the nurse) adorned with best qualities
Features of difficult-to-cure disease:
Moderate causative factors
Moderate number and strength of premonitory symptoms
Moderate number and strength of characteric features of disease
Any one among seasons / body type / body tissue involved is similar to the disease causing Dosha.
Disease afflicting pregnant / elderly / children
Not excess complications
If the treatment involves use of Shastra – Surgery, Ksharakarma (as in piles and fistula) and Agnikarma (fire / heat treatment / cautery).
If the disease is not new (neither too old)
If the patient belongs to a difficult place or if the disease involves a complicated body part
Disease afflicting a single body channel / single system but if the doctor, nurse / proper medicines are not fully available / not of good quality
Involves two body channels but disease is not very old
Two Doshas are involved in the disease
The disease is said to be Krichra Sadhya or difficult to cure if
- The strength of the causes, premonitory symptoms and symptoms of the diseases have moderate strength
- Either of the kala (season), prakriti (constitution of the patient) or dushya (tissues being contaminated by the doshas) should be equal in quality and nature to the causative dosha (disease causing dosha)
- Disease occurring in a child, old aged person or a pregnant woman
- The disease being associated with a few complications
- The disease which could be managed either by surgery, alkali or fire cauterization (not curable by easier remedies like shodhana or cleansing measures, shaman or palliative medicines etc)
- The disease having a chronic nature
- The disease having manifested in the marmas (vital body parts)
- The disease having its course in 2 margas (locations) – bahya roga marga (tissues) and abhyantara roga marga (viscera)
- The disease not being effectively handled by chikitsa chatushpada (4 limbs of treatment – the doctor, the patient, the medicine and the nurse) adorned with best qualities
Features of maintainable diseases –
The patient can survive by following Pathya – wholesome regimen and enjoys a little relief.
Disease gets quickly exacerbated with simple and mild causative factors
Disease afflicting deep seated body tissues
Disease involves many body tissues
Disease involves Marma (vital points of body, such as heart, groin), bones and joints (joining part of different body tissues and organs)
Symptoms manifest everyday
Chronic disease, long standing disorders
Involves 2 Doshas.
Qualities of diseases with bad prognosis
Diseases requiring surgery, which have mixture of causative factors, which is there for long period of time, involving many vital organs.
Involves all the three Doshas – Vata, Pitta and Kapha
Disease has grown beyond the abilities of all possible treatment modalities
Disease involves all the body channels / multiple systems
Sudden excitement in patient
Loss of functions of sense organs
In a weak patient, the disease is well manifested
Having sure-death signs
So, this is a general explanation regarding different criteria that Ayurveda uses in making the prognosis.