Ayurvedic Hospital Management – Chikitsa Chatushpada

Article by Dr Raghuram Y.S. MD (Ay)
Ayurveda has 2 objectives-
Swasthasya Swasthya Rakshanam – Protecting, shielding and maintaining good health in an already healthy individual. This is predominantly a preventive aspect.

Aturasya Vikara Prashamanam – Pacifying or destroying the disease and morbidity in diseased individuals. This is predominantly a curative aspect.

Table of Contents

Disease prevention secrets

Secrets of prevention of diseases –
Ayurveda gives much emphasis on lifestyle and diet management on a daily and seasonal basis, so as to prevent many diseases which can eclipse us and our health during the span of our lifetime, disturbing our day-to-day well being and participation in life affairs.

Adaptation of a properly planned Dinacharya (day-to-day activities), Rutucharya (adaptation to various seasons by strictly following the rules and regulations that need to be followed during every season and seasonal change-off periods), Sadvritta and Sadachara (righteous things we do in our life) and Achara Rasayana (ethical conduct of life, activities and diet which enhance our body-mind immunity, delays ageing and rejuvenates us) will help in prevention of diseases. Along with this a planned management of diet, sleep, lifestyle and celibacy, attending to the natural reflexes and urges of our body like those of hunger, sleep, thirst, urination, defecation, sneeze etc as and when they tend to occur, holding on to our negative emotions like anger, lust, enviousness, fear etc, keeping away from abnormal contacts (subjects) of our sense organs including mind and committing mistakes and sins in presence of our consciousness will help in prevention of diseases and keep us healthy.

But when we violate all these principles we land up with one or the other diseases or disorders which not only disturb our health but also will mess up with our day-to-day life. In this condition we might have to take medicines and treatments so as to get rid of these ailments. For this to happen we might require the help of a comprehensively functioning medical system.

Hospital Management is an integrated approach. It needs an effective team which works towards selfless and committed service towards healing the mankind of their ailments.

Chikitsa Chatushpada

Chikitsa Chatushpad or 4 limbs of treatment or medical system or hospital management as explained in Ayurvedic texts – is probably the first of its kind to be explained in any medical book. Chikitsa Chatushpada deals with 4 important limbs or members of a treatment protocol or comprehensively functioning medical system. It demands the qualitative involvement of each member towards effective healing.

Chikitsa=Treatment, Chatushpada=Chatuhu(four)+Pada(limbs)
Therefore – Chikitsa Chatushpada means 4 limbs of treatment

Members of Chikitsa Chatushpada:
Bhishak dravyaani upasthaataa rogi paada chatushtayam
Chikitsitasya nirdishtam pratyekam tat cha chaturgunam
(Ashtanga Hridaya Sutra Sthanam 1/27-29)

As the name indicates, Chikitsa Chatushpada includes 4 members. They are:

Bhishak – doctor
Dravya – medicine
Upasthatha – assistant or nurse
Rogi – patient

1. Bhishak – The Doctor (physician):
The Vaidya or Physician or Doctor is the most important limb of the medical system. He is an important member without whom the effective and comprehensive medical care cannot be accomplished. The physician is a person who diagnoses the disease and plans up a line of treatment projected towards effective healing of the disease and the diseased.

2. Dravya – The Medicine or Drug, Full-fledged Pharmacy:
Once the disease has been identified by the physician, the implementation of suitable treatments for healing comes into question. The medicines may be prepared (as in Ayurvedic pharmacies) or dispensed as in pharmacies or prescribed to be sought for in drug stores. The pharmacy needs to be full-fledged so that all the necessary medicines are available readily when they are needed for utilisation.

3. Upasthatha – Care-takers, Attendants, Nursing and Support Staff:
The patient needs someone to take care and provide him or her with the prescribed medicines at proper time, to be affectionate, To provide good diet To offer selfless service by keeping themselves at the disposal of the patient.

4. Rogi – The Patient:
Ayurveda explains analysis of patient and analysis of disease separately. This signifies the importance of patient – Rogi. If there is no disease, there is no patient and if there is no patient there is no doctor or hospital. The treatment line-up is mainly drafted targeting the Patient or diseased. Thus the patient forms another important limb of the treatment protocol.

Importance of Chikitsa Chatushpada:
The above said 4 are the important limbs of a 4 fold medical system / protocol. The absence of any one of the 4 limbs doesn’t fulfill the format of treatment or rather becomes meaningless.

We cannot imagine a chair or table to be standing being devoid of one of its legs. The treatment line-up or hospital protocol too becomes incomplete or imbalanced in the absence of any one of the above said 4 limbs. The whole system will be imbalanced and will be a failure if one or more of the above said 4 limbs –

Fails to work to perfection or
If they are inadequately equipped or
If they are not working to their best and fullest

Chaturnaam bhishak aadeenaam shastaanaam dhatu vaikrute
Pravruttihi dhatu saamyaarthaa chikitsaa iti abhidheeyate
(Ref – Charaka Sutra Sthana 9 / 5)

Dhatu vikruti or disturbance of equilibrium (synchronized smooth functioning) of the tissues of the body is a state of disease. In this condition, the involvement and participation of the 4 limbs of treatment (the physician, medicines, nurses and patient) towards establishing the dhatu samya i.e. state of health and equilibrium of tissues is called chikitsa or treatment process.

Though all the 4 limbs are equal, the physician is the most important member of the Chatushpada.

Shodasha Kala –
Shodasha means 16, Kala means qualities. Each Limb of the treatment setup is said to have 4 qualities. Thus totally the 4 limbs will have 16 qualities. These qualities should mandatorily be present in the concerned limb for the medical system to work to their best of compliance.

Qualities of an ideal Bhishak

Dakshaha teertaattha Shastatto drushta karma shuchihi bhishak (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)

With lot of quackery going on in and around, it is difficult to identify an ideal Doctor. Ayurveda classics make a mention of many qualities which an ideal physician should possess. Among those, the below said are the mandatory qualities an Ayurvedic physician should possess.

The 4 qualities of an ideal physician are:
Daksha: Brilliant, Intelligent, Skilled, Analytical, Wise, Judicious
The Doctor should be intelligent and should have a situational understanding. He should be intelligent enough to gather all the evitable information from the patient and attendants and should be able to read and correlate the condition so as to reach to an accurate diagnosis. He should be able to make the choice of right medication and treatment as per the cadre of the patient. He should also be able to refer the conditions out of his reach to the right person in right time.
Read related: Advice to Ayurvedic Doctors By Dr Agnives

Shastratta: Perfect theoretical knowledge
The wise physician is he who has studiously surrendered himself to all possible learning options and is a slave of knowledge.
He should have perfect theoretical knowledge of disease, diseased and medicine. He should have qualified from the reputed institutions and trained under good teachers and doctors. At the same time he should be well versed in the applied aspects of the knowledge. He should have a practise of updating the knowledge as and when the science of medicine gets updated. He should be good enough to transfer the same knowledge to the common man in common language (understandable). Ayurveda tells that the Physician should have learnt everything by living in the proximity of a wise and intelligent experienced Ayurveda physician (as it happened in the past in Gurukulas)

Click to Consult Dr Raghuram Y.S. MD (Ayu)

Drushtakarma: Unparalleled practical knowledge and exposure:
Only a perfect theoretical knowledge is not going to help a physician to heal the mankind. He needs a perfect and unparalleled practical knowledge and exposure too. He should not only have seen the practical things like preparing a medicinal compound or treatment procedures like Panchakarma etc but also should have involved himself voluntarily and participated in all the practical procedures. We speak about the skills of conducting surgery or dressing or suturing or injecting etc in modern day medicine and also include the skills of conducting laboratory investigations and radiography.

Shuchi: Purity, Clean by mind, body and thoughts:
We have seen and known doctors misbehaving with the clients in terms of abuse, assault and many things. Ayurveda mandates that cleanliness is one quality that a physician should possess beyond everything.

The purity should be inborn and nourished in due course of time. The physician should be pure by heart, thoughts, mind, consciousness, soul and body.
This will give the doctor a recognition, name, fame and wealth.

The qualities of an ideal physician explained by Ayurveda are not new things to the modern day world but someone had to fix these protocols. Since Ayurveda is the oldest medical science on earth, these regulations were said to be first compiled by the Ayurveda seers and saints. These things have only been modified and bettered with time.

Other qualities of an ideal physician:

Jita hastata / Peeyusha paani – Popularity, successful
Upakaranavatta / Sajjopaskara bheshaja – well equipped
Sarva indriya upapannata – having intact and healthy sense organs, having control on mind and sense organs. This helps to accurate understanding of differences between health and morbidity, in diagnosis and treatment aspects
Svayam kruti – self-made, can handle things independently and in an effective manner
Laghu hastate – sensitive and sensible in handling patients
Shoora – courageous
Pratyutpanna mati – have good remembrance
Dheemaan – highly intellectual
Vyavasaayi – busy
Satya-dharma ,para – righteous and ethical
Adhikari – commanding and good at administration
Krupaalu – compassionate
Hetu jnana – elaborate knowledge of the causes of disease
Linga jnana – elaborate knowledge of the signs and symptoms of the disease
Prashamana jnana – elaborate knowledge of the methods of pacifying a disease and treating them effectively
Rogaanaam apunarbhava jnana – elaborate knowledge about providing remedies towards prevention of recurrence of the diseases and morbidity

Qualities of Uttama Vaidya –
A best physician should essentially possess the below said 6 qualities:

Vidhya – knowledge
Vitarka – reasoning and critical analysis
Vignanam – special knowledge and information of everything related to medical system and allied subjects
Smruthi – good memory
Tatparata – dedication
Kriya – expertise in treatment and prescription

Qualities needed for a person to be called as doctor –

Vidhya – complete knowledge of Ayurveda
Mati – clean and transparent mind, exemplary intelligence
Karma drishti – experience of having seen many treatment procedures and learning the methodologies thoroughly
Abhyasa – practise on the learned things and gaining expertise of the same
Siddhi – achievement of clinical success
Aashraya – having been taught and guided by the best teachers

Vaidya Vritti

Vaidya Vritti (duties of vaidya) –
Maître – friendly attitude, affectionate
Aarteshu kaarunyam – pity and compassion towards patients
Shakye preetihi – providing treatment with affection in those diseases which are within the vicinity of being curable
Prakrutistheshu bhooteshu upekshanam – keeping away from treating the impossible disease or diseases which are within the vicinity of being incurable or complicated

Importance of an ideal physician –

Kaaranam shodasha gunam siddhau paada chatushtayam
Vijgnaataa shaasitaa pradhaanam bhishak atra tu (Ref – Charaka Sutra Sthanam 9/10)

The 4 pada’s (limbs) of treatment adorned by their 16 qualities form the base of successful treatment protocol or hospital management. Among all the limbs, the Bhishak or doctor who has an extensive knowledge of the medicines and treatment, who controls and commands the attendants and nursing staff and prescribes the best medicines and treatment towards the ailing patient’s is the most important member of Chatushpada.

Simily –
The doctor is said to be a pradhana karana (most important cause) in the treatment protocol or hospital management.
The chef or cook is the main instrument in the successful preparation of a delicious dish. But his job will be accomplished only when he gets proper assistance in the form of vessels, fuel and fire.
The commander-in-chief of the army is the key person if an army has to go on to win a war. But his job will be accomplished to perfection when he gets an ideal war-field, well trained army and good weapons.

Just like that, an efficient doctor who is working towards successful accomplishment of his treatment will have to get a synchronised help from the medicines, attendants and nurses and patient. But still the doctor will be a key factor in the success of the treatment or in the management of hospital.

Similarly – in spite of the presence of mud, stick, wheel and thread a pot cannot be made without the presence and active involvement of the potter. Just like that a successful treatment cannot be conducted in the absence of a wise and learned physician who is working towards establishment of dhatu samya (healthy condition) in the diseased in spite of the presence of medicines, nurses and patient.

Pranabhisara Vaidya

Pranabhisara Vaidya (Life saving physician) –
One who has surrendered himself in thorough reading and understanding of shastra’s (medical texts and treatises), one who is indulged in observing the medical procedures and treatments conducted by experts and later practicing them with confidence is called Pranabhisara Vaidya or life saving physician because only he who is committed towards an extensive theoretical and practical learning can be a successful physician and help the patients to get rid of their morbidity and also save the life of the patients.

Qualities of ideal Dravya

Qualities of an ideal Dravya (Medicine) –
Bahu kalpam bahu gunam sampannam yogyam aushadham (Ashtanga Hridaya Sutra Sthanam 1/27-29)

The treatment protocol or a medical system is not complete without the usage of Dravya (medicine, drug, compound). How weird it looks if this limb is missing from the 4 limbs of treatment!!

Guess…a patient coming to a doctor, being diagnosed to have a disease, admitted for medical attention, have good nursing staff and family members to take care….and there are no medicines to administer or the pharmacy or a concept of it doesn’t exist………….!!!!

The qualities of an ideal medicine, drug or compound are as follows.

Bahukalpam / Anekavidha kalpana: Utility in various forms
The medicament or drug should be such that it could be used in many formulations or it should readily fit as an ingredient in many formulations. If it is a compound, it should have been prepared using many drugs which are compatible with each other

Bahugunam: Abundance in good qualities
The medicine or a herb or a drug should possess many good qualities. These qualities including Rasa (taste), Uparasa (subtaste), Guna (qualities), Veerya (Potency), Vipaka (Post-digestion effect), Karma (disease alleviating property) etc should be adequately assembled in the drug naturally so as to be used in healing process effectively

Sampannam / Prashasta desha sambhutam : Wholesome
The medicament should have been grown in ideal conditions and suitable climate and in a fertile wholesome land. It should not be contaminated or infested with worms and insects. It should be collected and preserved methodically. If we are speaking about the compound preparations, they should be prepared, formulated and stored as per norms and conditions. Each drug used in a compound should be used in ideal measures.

Yogyam: Applicability
The medicine, drug or compound should be ready to be administered in alleviating a disease or a disease process as a part of healing. It should fulfil the indications for which it is collected or formulated. It should be readily used in the targeted disease or in prevention of a disease. They should fulfil many roles in the healing process, like for correcting digestion and metabolism, detoxification of cells and system, immune-modulation, anti-ageing, strength promotion etc. If a single herb or compound can fit into multiple roles it would be ideal and the physicians can avoid prescribing too many drugs or compound.

Other qualities of medicine –
Prashasta ahni udrutam – Plucked or collected on an auspicious date and time
Manaskantam gandha varna rasaanvitam – Have pleasing and attractive smell, colour and taste (freshness)
Doshaghnam – capacity to destroy the morbid doshas and diseases on administration in the form of medicine
Aglanikaram / avikari – should not produce troublesome complications or increase the disease pathology on administration as medicines (devoid of side effects)

Qualities of ideal Upasthatha

Qualities of an ideal Upasthatha (Attendant, Nurse) –
Anuraktaha Shuchihi Daksho Buddhimaan paricharakaha (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)

Attendants include the nursing staff in a hospital, family and friends. They form a mandatory and essential part of the healing system. Without their help and timely aid it is very difficult for a patient to get cured from the illness.

The chief qualities of an ideal Attendant, Nurse are:
Anuraktaha / Bhartru anuragata: Kind hearted
The attendant should be kind hearted and should have patience. They should take care of the patient as if they are taking care of themselves. They should not get irritated or annoyed by any of the patients demands or requests. They should speak good and kind words and be a good counsellor. They should remember that they are representing the physician and also form a bridge between the doctor and patient. He or she also should be obedient towards their master (doctor).

Shuchi: Purity, Clean by mind, body and thoughts:
The attendant should keep himself or herself clean and sterile. This will help in not spreading unwanted infection to the patient. They should also keep the patient’s environment clean and sterile including the physician. They should also be pure by heart, mind and thoughts. The purity shall be at its best when dealing with women patients.

Daksha: Skilled, Analytical, Wise, Judicious, Have situational understanding
The attendant should be wise and judicious. He should have a situational understanding. He should be capable of rendering whole hearted and selfless service to the patient. He should be physically fit and mentally sound. He should be healthy and devoid of any diseases.

Buddhiman: Intelligent
The attendant should be intelligent and learned person. Since he forms an important link between doctor and patient he should be able to understand what each has to say and capable enough of transforming the information into action. He should be able to make notes of the patient’s wants and queries and get it clarified from doctor. He should have maintained the details and contact of doctor. Likewise he should be able to implement the doctor’s instructions correctly and according to time. He should be able to maintain a timetable of medications and diet to be given to the patient and arrange accordingly.

Other qualities of nursing staff –
Upacharagnata – Perfectly trained in nursing profession
Ajugupso – tolerant
Balavan – strong (physically, mentally)
Yukto vyaadhita rakshane – indulged in service and protection of the diseased
Vaidhya vaakya krutaha – follows doctor’s instructions to perfection

Qualities of ideal Rogi

Qualities of an ideal Rogi (Patient, Diseased) –
Aadhyo rogi bhishak vashyao gnaapakaha satvavaan api (Ref – Ashtanga Hridaya Sutra Sthanam 1/27-29)

The qualities of an ideal patient are as said below:
Aadhya: Rich, wealthy
The patient should be rich and wealthy. It doesn’t mean that the treatment is only for wealthy people. In the ancient times the preparation of medicines, treatment procedures used to consume lot of labour, money and time. Physicians needed patronage of kings and wealthy citizens. The medicines and treatments were costly. The poor people could only afford for simpler home remedies and simple medicaments.

The Ayurvedic treatments and surgical procedures were limited to the affordable people, kings and noblemen. It means to tell that the disease can come in all forms and some chronic and complicated diseases needs lot of treatment approaches, costlier medicines and a prolonged protocol for which the patient should be equipped with money to spend.
Read related: An Ayurveda Tip For A Better Health – Make Some Money And Be Rich!

It also means that everyone should save some money as an emergency fund for their health attention. Even in modern day life many treatments and costlier medicines are affordable only to rich people. The medical insurances etc have come into rescue.
Read related: Money, Ayurveda, Spirituality – How To Strike Perfect Balance?

Bhisak vashya / Nirdeshakaritva: Obedient, submissive, under the control and supervision of doctor, surrendering nature:
The patient should be obedient and submissive. He should surrender to the Doctor and his commands. He should follow each and every instruction given by the doctor even in his absence and follow the do’s and don’ts abiding to the instructions.
Read related: Do Not Stand Between Yourself And Health

Gnaapakaha: Good memory
The patient should be in his senses and consciousness. He should have good memory so that he doesn’t forget any instruction passed by the physician. Good memory also helps the patient to remember the chronology in which his disease and symptoms developed so that he can narrate it clean and clear to the doctor. This will make the job easy to the doctor and many times helps in clinching the diagnosis. The patient also can remember the timings of taking the medicines, his follow-up and appreciate the process of recovery.

Satvavan: Strong by body, mind
The patient should be physically and mentally strong and should not be timid by nature. He should have tolerance and endurance and a patience of tolerating stronger medicines and treatment procedures. He should know what he has been undergoing and what treatment has been implemented on him. He should be tolerating the disease and the treatment also. He should know that he is more important than his disease and should be determined to get rid of his ailments. He should co-operate with the doctor by all means.

Other qualities of patient –
Abhirutva – fearlessness (courageous)
Ayushman – have a good life span (not showing signs of death or bad prognosis)
Satvavan – noble living, intelligent
Sadhya – suffering from curable diseases
Dravyavan – wealthy enough to expend on treatment and medicines
Aatmavan – self control
Aastika – god fearing
Vaidhya vakyastha – follows the instructions of the doctor without manipulation

To sum up –
The medical system and hospital management has been evolved over ages. Health care system has seen exemplary technological advancements. But the basics are the same and will be the same as we keep entering different eras. The ultimate motto will be healing the ailing mankind and making him fit to live with a better body-mind immunity. The methodology and cost of treatment and medical care would have changed but even today’s patient will come victorious over his morbidity if he gets a right doctor, good medicine and compassionate caretakers at the right time. I respectfully look upon the ancient seers of Ayurvedic science for having propagated the basics of medical science in ancient times and for having laid the by-laws for the futuristic development of medical science as a whole.
Click to Consult Dr Raghuram Y.S. MD (Ayu)