Shuddha Chikitsa Meaning, Importance In Clinical Practice

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
The wisdom of Master Charaka should be highly regarded and respected because he has touched upon such minute and subtle aspects of clinical practice and medical ethics that are highly valued even today and will be done in future too. In Nidana Sthana, Master Charaka puts forth a valid point in the form of a verse which will hold value forever in clinical practice, be it Ayurveda or any other medical science. Here he tries to explain ‘Shuddha Chikitsa – pure and safe form of treatment’ and justifies its importance in clinical practice and for every physician.

Shuddha = clean, unadulterated, pure, safe; Chikitsa = treatment
Read – Chikitsa: Treatment Types, Ayurvedic classification

It is the responsibility of each and every physician to provide not only a comprehensive treatment to patients but also to see that the treatment, medicine or therapy administered would not produce any untoward effects, complications or harm to the patient. This in actual terms is safe treatment.

Let us see what Master Charaka has to say about it –
That treatment which when administered would pacify / cure a disease but on the other hand causes yet another disease/complication is not a vishuddha / shuddha chikitsa i.e. pure treatment. The treatment which is opposite of this is considered as shuddha chikitsa i.e. pure treatment.

Therefore shuddha chikitsa should have the below mentioned characteristic features –

• Treatment should be capable of pacifying / curing the disease
• Treatment should not be causing yet another disease / complication

Master Charaka has touched upon this aspect immediately after having explained the concept of ‘vyadhi sankara’, in the same chapter. Vyadhi / Roga Sankara means many diseases getting manifested at the same time.
Read – Vyadhi (Disease) Definition, Meaning And Explanation

Charaka quotes –
Roga Sankara i.e. simultaneous manifestation of many ‘difficult to cure’ or incurable diseases are manifested when

• Proper medicines are not administered
• One disease is manifested as a complication of another disease

Here Master Charaka mentions ‘improperly treating the diseases or improper administration of medicines in curing diseases’ as one of the causes for new disease / diseases to be manifested. These treatments / medicines are considered as ‘ashuddha chikitsa’ i.e. impure or improper treatment, the opposite of which is ‘shuddha chikitsa’ i.e. pure or proper treatment.

In the very next verse Master Charaka clarifies that a properly administered treatment i.e. pure treatment (shudha chikitsa) should cure a disease and should not cause a new disease or complication.
Read – Classification of Vyadhi (diseases) according to Ayurveda

Roga Anutpattikara Chikitsa

Roga = disease, Anutpattikara = not allowing to manifest, Chikitsa = treatment
Roga anutpattikara chikitsa or bhavas are the treatments which do not allow the diseases to get manifested. Basically, they are preventive medicine or treatments. Here the intention of the treatment is to prevent the manifestation of the disease. It is correct to call them as practices or measures rather than treatment. If practiced regularly, these practices act like treatment in spite of not actually being treatments. They would act like shield and not allow the diseases to get manifested. It is important to make a practice of practicing them regularly. It is a good habit since the diseases can be kept at bay.
Read – Factors That Prevent Disease Manifestation – Roga Anutpattikara Bhava

Shuddha Chikitsa

Shuddha = pure, unadulterated Chikitsa = treatment
Shuddha Chikitsa includes comprehensive treatment for a manifested disease. In shuddha chikitsa case the disease is manifested. The aim of treatment is two fold –

• to cure the disease
• to see that no complication or new disease is formed during or after the treatment process

Shuddha Chikitsa demands proper planning and execution of treatment for a given disease. This also increases the responsibility of the physician to script the blueprint of the treatment cautiously and also see that it is executed to perfection. In Roga anutpattikara chikitsa the disease has not formed and the measures have already been taken to prevent the disease.
Read – Shuddha Chikitsa Meaning, Importance In Clinical Practice

Apunarbhava Chikitsa

A = no, Punah = again, Bhava = manifest / form, Chikitsa = treatment
Apunarbhava Chikitsa is another form of treatment wherein the treatment is planned and fortified in such a way that the disease which has been cured doesn’t manifest once again. Even in this case, the disease is manifested. The aim of this treatment is to prevent recurrence of disease. It will also provide long standing immunity against the disease. Therefore, immunity medicines and therapies are also included in this form of treatment.

Panchakarma treatments and Rasayana therapy can be included in this type of treatment. Rasayanas, pre-planned dietetic regimen and lifestyle practices are generally recommended in the follow-up treatment of almost all the diseases after those diseases have been treated comprehensively administering the treatment principles of those related diseases. In these cases, Rasayanas will act like apunarbhava chikitsa methods.
Read – Rasayana Therapy (Anti Ageing, Rejuvenation) Benefits, Meaning, Medicines

So, in a nutshell –

• Roga anutpattikara chikitsa is a treatment or preventive measures used to prevent the diseases before their manifestation. It can be considered as preventive medicine.
• Shuddha Chikitsa is a comprehensive treatment given for a manifested disease by taking utmost caution to keep away new disease or complication from forming during or after the treatment. This can be considered as methodical and skillfully planned treatment plan.
• Apunarbhava Chikitsa is also a preventive treatment just like roga anutpattikara chikitsa but is done to prevent the recurrence of a cured disease. This can be considered as ‘prevention of relapses or rejuvenation and immunity modulating treatment modalities’.

Benefits of Pure Treatment  

Administering a proper / pure or improper / impure treatment is under the control of the physician and his skills. Pure / proper treatment leads to clinical success and cure of diseases for which it has been administered, leading to establishment of health in the patient. On the other hand, administering an impure / improper treatment leads to failure in clinical practice, aggravation of diseases and symptoms, formation of new diseases or complications and continued illness and grief in the patient.
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