Principles of treatment (chikitsa sutra)

The introduction says the aim of Ayurvedic treatment is to bring about lasting health (dhruva ārogya), and that treatment relies on daivavyapāśraya, yuktivyapāśraya and sattvāvajaya. Treatment is of two kinds: with substances (dravyabhūta), in which medicines and diets are used by rule, and without substances (adravyabhūta), in which no medicine or food is given directly but the patient is given the necessary instructions and mantra, bali, homa and the like are used externally.

Dharma is said to be the internal cause of the calming of disease and external treatment only an auxiliary cause, which is what the book describes; hence all treatment is of two kinds, external and internal.

Therapeutic action is divided into four kinds, caustic, fire, knife and medicine; one of them done well can cure a disease, while some diseases need two, harder ones three and the hardest all four.

The introduction says the secret of treatment is to perform the particular action by which the body's dhātus return to balance (a footnote quotes Caraka Sūtra to this effect); the whole range of medicine, its many procedures and methods, rests on this one principle, which the Kalyāṇakāraka sets out in great detail. Destroying the imbalance of the dhātus and re-establishing balance is the aim of treatment and the physician's duty, and giving up the causes of imbalance while resorting to the causes of balance is the main principle of treatment (a second footnote from Caraka Sūtra).

It says that in treatment the physician must consider the dūṣya, the land (deśa), strength (bala), time (kāla), digestive fire (anala), constitution (prakṛti), age (vaya), mind (sattva), suitability (sātmya), diet and the particular states of the disease, quoting Aṣṭāṅgasaṅgraha Sūtra 12 that one who examines these closely in deciding on doṣa and medicine never errs in treatment. Dūṣya means the gross dhātus such as rasa and rakta, which the doṣas vitiate; age is of three kinds, childhood, youth and old age; sattva means the mind and endurance; and treatment must take into account the diet and the stages of disease, such as unripe (āma), ripe (pakva) and ripening (pacyamāna).

The introduction says Ayurveda uses many different procedures in nourishing (bṛṁhaṇa) and lightening (laṅghana) therapy, and that both treatment with and without substances rest on the method of opposing the doṣas (doṣa-pratyanīka): removing the vitiation of the doṣas and restoring the balance of the dhātus is the core of treatment, and Ayurvedic principles and method developed around this fixed principle. It says that treatment according to the doṣas lets the patient recover well and quickly, with balance of the dhātus, strength and flesh returning soon and illness not lasting long, and it urges all vaidyas and doctors to study and spread this method.

The verse says physicians treat the (righteous) patients daily after knowing, in due order, life span, age, digestive strength, vigour, a good land, suitability, the well-known constitution, medicine, body, disease and the sequence of seasons.

The commentary lists these as the patient's life span, age, digestive power, strength, land, suitability, constitution (vāta and the others), the medicine suited to it, body, disease and the cold and other seasons, all to be known in order before treating.

A faultless medicine used after considering the patient's digestive fire, age, strength, land, season and the nature of the disease is said to destroy even terrible diseases quickly; if the medicine is faulty or is used without such consideration, it fails.

The diligent, virtuous physician, knowing the distinctions of time, place and the rest as the texts teach, should determine the relative strength of the doshas in two-dosha and three-dosha disorders and respectfully use medicines rich in good qualities that oppose the aggravated dosha, that is, which calm (śamana) or purge (śodhana) it.

After understanding the forms and types of these diseases, the physician is told to pacify them by skilfully applying the best fitting medicines, attending to the types, sub-types, mixed forms and greater or lesser predominance of the doshas.

The learned physician is described as considering which dosha produced the disease and which is strong or weak, understanding the merits and faults of good medicines and the signs of the major diseases, and then treating with suitable medicines.

If not all the medicines of a stated group can be obtained, the text says to treat with half of them, or half of that, or finally with as many as are available, and the diseases are said to subside.

The soul, the disease, the medicine and time are to be held in such a way that they are usable in practice in some relative respect; nothing should be asserted absolutely, as only permanent or only impermanent, because absolute assertion contradicts reason and scripture.

Because disease arises from karma, the wise are said to call the practice that calms one's karma, such as worship of the deity and meditation, the real treatment that calms disease.

A skilled, qualified physician approved by the king should begin treatment on a suitable lunar day, weekday, lunar mansion (nakṣatra), yoga, karaṇa and muhūrta, while the strength of the stars and moon holds, noting favourable messengers, portents and auspicious omens, and should report his findings to the king before treating.

Depleted doshas are to be built up, agitated doshas pacified, doshas in their normal state protected, and greatly increased doshas expelled at once by purification.

The text says treatment for calming all the diseases of all beings proceeds through four means, poison, alkali, instruments and fire, and quotes a verse that some disorders are cured by one procedure, some by two, some by three and some by all four.

The text attributes this rule to Siddhasena, whom the commentary calls a yati (ascetic).

Treating the sick is said to be a cause of the destruction of sin and of the growth of dharma, to bring happiness in this world and the next, and to be the highest austerity of all.