Prognosis simply means, how easy or how difficult it is to treat a disease in a 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 easily curable diseases
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 choose 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 choose from. Hence the prognosis will not be very good.
Yunaha – Young patient – While at young age, the tolerance is more and body responds readily and 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 likely 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 causative factor.
For example, more the ice creams you eat, more severe will be your tonsillitis. Hence, lesser the causative factors, easier the disease is 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 reproductive 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 the Pitta dominant place.
Atulya Rutu – different Dosha and Season –
We will be learning in future that particular seasons influence particular Dosha. For example, rainy season causes 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.
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 favor 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 be manifested, hence it is easy to treat.
Eka Marga – If only one body channel is affected – then it is easy to treat. If multiple body channels are affected, it means, many systems are involved and so the treatment will be difficult.
Nava – Disease of recent origin / onset. – Earlier the diagnosis of disease, better the prognosis.
Features of Sukha Sadhya – easily curable diseases
The disease is caused by very few causative factors,
- The disease manifests with very less premonitory symptoms and signs,
- 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 (cleansing 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.
Doshas As Determinants Of Prognosis Of Diseases
By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
All diseases are caused by vitiated doshas. Therefore, the prognosis of a given disease also depends on quality and quantity of dosha vitiation and also on quantity of damage caused by these vitiated doshas in body.
Doshas in relation to prognosis of diseases
On the basis of prognosis, diseases are broadly categorized as –
- Sukha sadhya – easily curable diseases
- Krichra / kashta sadhya – curable with difficulty
- Yapya – not curable but can be managed and
- Asadhya / pratyakhyeya / anupakrama – incurable diseases
There are many criteria to know the prognosis of diseases. One among these criteria which help to know the prognosis of disease is from dosha perspective.
Easily curable diseases from dosha perspective
In an easily curable disease –
Disturbance of dosha will be of small quantity. This can be attributed to exposure to the less number of etiological factors or weaker causative factors which are not capable of vitiating doshas to a larger scale.This leads to formation of a disease with weak strength.
Such diseases will present with less premonitory symptoms and symptoms. This picture of disease will make it easier to treat.
Nature of tissue will not be similar to the nature of dosha which has caused disease. Example, kapha aggravation in bone is easier to treat because bone has predominance of vata in it. Similarly a vata disease occurring in muscle or fat tissue which are kapha tissues are easy to handle.
Dosha causing disease will not be similar to dosha forming constitution of patient. Example – a vata disease occurring in a person of pitta constitution. If vata disease occurs in a vata constitution person, it becomes difficult to treat. But when same disease occurs in a pitta or kapha body type it is easier to treat.
Season will not have similar qualities and nature as that of dosha causing disease. Example – Vata disease occurring in autumn season. This season is antagonistic to vata in terms of qualities and nature. Vata, in fact gets pacified in this season. On the other hand, vata occurring in seasons compatible for its increase i.e. summer and monsoon, vata gets increased. These seasons have identical qualities and nature as that of vata.
Land will not have similar qualities and nature as that of dosha causing disease. Example – Marshy lands do not have similar qualities and nature as that of vata, in fact these lands are antagonistic to vata and subside vata aggravation. Therefore, vata diseases occurring in anupa desha i.e. marshy lands are easily curable.
Disease will be caused by aggravation of a single dosha.
Diseases which are curable with difficulty from dosha perspective
In ‘curable with difficulty’ diseases –
Disturbance of dosha will be of moderate to large quantity. This possibly happens due to consumption of moderate to large quantity of etiological factors which disturb doshas to moderate proportions. This leads to the formation of a disease with moderate strength, stronger than easily curable diseases.
Such diseases will present with moderate premonitory symptoms and symptoms. This picture of disease will make it difficult to treat but these diseases can be cured with constant interventions and efforts.
One among season, constitution of patient or tissues equal in quality and nature to the disease causing dosha will be involved with dosha closely in pathogenesis of disease. Example – in a vata disease, either monsoon season favorable for vata vitiation, vata constitution which is more prone to get vata diseases or bone tissue which is more likely to be afflicted and damaged by vata dosha are associated with vata in causation of disease. If all these factors are involved, disease becomes incurable.
Disease will be caused by aggravation of two doshas. Example – disease is caused by simultaneous vitiation of vata-pitta or vata-kapha or kapha-pitta.
Diseases which are ‘maintainable’ from dosha perspective
In ‘maintainable’ diseases –
Diseases are caused by strong etiological factors.
These diseases are also basically incurable but patient stays alive on virtue of practicing wholesome dietetic and lifestyle regimens.
Disease and disease causing doshas remain latent and deep rooted in deeper tissues. Once person breaches code and conduct of food and lifestyle practices, disease and its symptoms become evident with availability of even mild etiological factors.
Many tissues are involved and immunity is compromised.
Diseases are caused by aggravation of two doshas simultaneously and run chronic course.
Diseases which are ‘incurable’ from dosha perspective
In ‘incurable’ diseases –
Vitiated doshas have caused such intense damage that diseases have gone out of reach of any sort of treatments. They cannot be cured by any means. Diseases are strong and deep rooted, chronic and have developed on damage of multiple organs, tissues and channels of the body. In these patients, there is severe debility and signs of impending death have manifested.
These diseases are caused by vitiation of all three doshas and contamination of many tissues by these doshas.
Importance of having the knowledge of disease prognosis
This gives him a freedom to make a choice of which conditions he can treat and which he can reject or refer to other fields of specialization. With this he can attain good success in clinical practice while guarding his honor, name and reputation because he might have mastered the art of accepting and rejecting the right cases.
The physician who knows the difference between curable and incurable diseases can begin the treatment in proper time with the thorough knowledge of the case and succeed in his efforts without fail.
On the other hand, the physician who undertakes the treatment of incurable diseases also will invariably suffer from –
- Loss of wealth and income
- Misappropriation of his knowledge and the science which he serves
- Loss of reputation and fame
- Gains unpopularity, hatred and abuses
- Reduction in the number of patients coming to his clinic
- Loss of license to practice and punishment by law