E-ISSN:2456-3110

Review Article

Charaka Samhita

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 6 June
Publisherwww.maharshicharaka.in

Importance of physician in healthcare system from the perspective of Charaka Samhita

Ray Paul S.1*
DOI: http://dx.doi.org/10.21760/jaims.8.6.20

1* Sumana Ray Paul, Department of Ayurved Samhita & Siddhanta, Institute of Post Graduate Ayurvedic Education and Research, Shyamadas Vaidya Sastra Pith Hospital, Govt. of West Bengal, Kolkata, West Bengal, India.

According to Ayurveda, a healthcare system is like a table which is stood upon four factors i.e., Bhishaka (physician), Dravya (medicaments), Upasthata (attendant) and Rogi (patient), among which physician is considered to be the most principal factor among others. Charaka Samhita being the foremost compendium of Ayurveda has given much emphasis on various characteristic of an ideal physician along with his duties, functions and other essential aspects. By studying all these textual information one can draw a distinct idea about the importance and role of an ideal physician in the healthcare system as conceptualised by Charaka Samhita. A physician by virtue of his erudite knowledge, commanding capability and rational approach drives the entire healthcare system to its successful accomplishment. Without physician, none of the other three factors can function properly and leads to collapse. It is only the physician who is capable of bringing the other three factors, viz. the patient, the attendant and the medicament to right usage. Even if, these three factors are deficient in certain qualities, the physician can by virtue of his imagination; knowledge and concentration render them useful. The three factors (even if otherwise useful) may turn out to be completely useless in the absence of a well-qualified physician. Thus a physician holds the most important place in a healthcare system by virtue of his textual knowledge, extensive experience, noble character, skill and many other qualities.

Keywords: Bhishaka, Vaidya, Chikitsa Chatuspada, Kaarana, Charaka Samhita

Corresponding Author How to Cite this Article To Browse
Sumana Ray Paul, , Department of Ayurved Samhita & Siddhanta, Institute of Post Graduate Ayurvedic Education and Research, Shyamadas Vaidya Sastra Pith Hospital, Govt. of West Bengal, Kolkata, West Bengal, India.
Email: 		Sumana Ray Paul, Importance of physician in healthcare system from the perspective of Charaka Samhita. J Ayu Int Med Sci. 2023;8(6):119-125.
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https://jaims.in/jaims/article/view/2466

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-04-29 2023-05-01 2023-05-08 2023-05-15 2023-05-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2023by Sumana Ray Pauland Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

In Ayurveda, the term ‘Chikitsa’ has been used to denote both management of diseases and medicaments as well as to denote the healthcare system.[1] A healthcare system is stood upon the four pillars - together known as “Chikitsa Chatuspada”. Chikitsa Chatuspada is comprised of - Bhishaka (physician), Rogi (patient), Upasthata (attendant) and Dravya (medicaments).[2] According to various Ayurvedic compendiums, these four aspects are outmost essential for successful diagnosis of disease as well as its management, execution of different therapeutic procedures, application of different medicaments and prevention of diseases also. According to Charaka Samhita, the four aspects of healthcare system are responsible for the cure of diseases, provided they have the requisite qualities.[3] Among the different fundamental textual resources of Ayurveda, Charaka Samhita is regarded as one of the most important resources along with the other two - Sushruta Samhita and Ashtanga Hridayam. The original author of Charaka Samhita has been regarded as Maharshi Agnivesha who had written this treatise on the basis of the teachings of his preceptor Atreya Punarvasu - so both the personalities thought to be contemporary and lived around 1000 B.C.[4] Later this treatise was edited by Acharya Charaka who lived around 300 - 200 B.C.[5] The final shape has been given by Acharya Drirhavala who redacted this compendium around 4th century C.E. and revised this treatise completely according to the need of time and introduced 41 chapters into it, which was part of the original compendium but got lost with the passage of time and was unavailable at the time of him.[6] Charaka Samhita being the most ancient and important compendium of Ayurveda has given much emphasis on the various aspects of a physician like his essential qualities, advanced qualities, duties and his role in health care system. Among the four essential aspects of a healthcare system, Acharya Charaka has given physician the most important place, so he has enumerated Bhishaka or the physician the first place among these four aspects ; then comes, in order of merit, the medicament followed by attendant and lastly the patient. The great commentator of Charaka Samhita, Acharya Chakrapani Dutta has pointed out - “apparently, a patient, being the object of treatment should have been enumerated first (among the four

essential factors of healthcare system). But as a matter of fact, these four factors are enumerated here from the point of view of actions leading to the cure of diseases and in that the patient does not play such an important role. So the patient comes last in the order of importance (and the physician comes first in the order of importance as the most essential factor among these four)”.[7] Acharya Charaka has often referred Chikitsa Chatuspada (four pillars of healthcare system) as Bhishakadi[8] - that is ‘Bhishaka et al.’ or we can say ‘Bhishaka and others’, which indicates the supremacy of Bhishaka among all the four pillars of healthcare system. While discussing the Dashavidha Parikshya Bhava (ten important topics for examination of patient) Bhishaka has been referred as Kaarana or the principal causative factor for achievement of maintenance of the equilibrium of Dhatus[9] - by which maintaining the healthy state of body as well as alleviation of diseases can be achieved, both of which are considered to be the chief objectives of Ayurveda[10]; that is to say, Acharya Charaka has considered physician as the root cause of achieving the objectives of Ayurveda which is also the goal of any healthcare system. Thus it can be said that, Charaka Samhita has considered physician as the most important factor for successful accomplishment of any healthcare system. To evaluate the role and importance of physician in healthcare system, we have to consider various views expressed by Acharya Charaka regarding physician’s quality, various functions, different categories etc. Acharya Charaka has used different terminologies like Bhishaka[11], Vaidya[12], Chikitsaka[13], Parikshaka[14] etc. referring a physician among which Bhishaka and Vaidya are most frequently used. The supreme importance of a physician in healthcare system can be assumed by one statement by Acharya Charaka where he has opined that, among all the factors of healthcare system, physician should be considered as foremost and supreme. Hence, the present study has been undertaken keeping the below mentioned aims and objectives.

Aims and Objectives

1. To evaluate the different aspect of physician’s character based on his qualities.

2. To evaluate the role of a physician in successful accomplishment of any healthcare system.


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3. To evaluate the importance of physician in healthcare system based on his qualities and actions.

Materials and Methods

The present literary study has been conducted based on various textual information related with different aspect of physician available in Charaka Samhita mainly in Sutrasthana, Vimanasthana and Chikitsasthana. Different classical commentaries of Charaka Samhita have also been studied in multiple contexts, among which Ayurveda Dipika commentary of Acharya Charkrapani Dutta & Jalpakalpataru commentary of Kaviraj Gangadhar Roy should be mentioned especially. All the literary information has been verified and validated through this study.

Discussion

The role of a physician in providing healthcare facilities can be discussed under the few points like:

1. Physician has been considered as the most important aspect of healthcare system. Acharya Charaka has opined that, though quadruped of therapeutics in all, equipped with sixteen qualities are responsible for successful accomplishment of healthcare system yet the physician, by virtue of his knowledge, administrative position and by decision making as well as prescribing capacity, occupies the most important position among them.[15] Physician is the highest source of knowledge in any healthcare system. This knowledge about different aspect of diagnosis, management, medicaments and prevention of diseases are the most essential factor for successful accomplishment of all healthcare system. Acharya Charaka has categorically mentioned in different places of Charaka Samhita about the importance of knowledge of a physician in treatment procedure.

2. Also, the physician should also be a good administrator who is capable to run the entire healthcare system. As mentioned earlier, this healthcare system is comprised of various other factors like medicaments, attendants and patients - which need a strict organizational force to run smoothly and harmonically. So, one of the principal role of a physician is as administrator of the whole system.[16]


3. Along with these two aforesaid qualities, Acharya Charaka has given emphasis on a third quality which is Yokta.[17] Yokta is a person who is accomplished with the ability to make proper Yukti. Yukti is the rational approach in any decision making which is based on the law of causality (Karya Karana Vada) and has been considered as the most important method of attaining objective knowledge (known as Pramana) by Acharya Charaka. This decision making capacity of a physician can be attributed to ability of constructing Yukti - which can be applied in many practical aspect right from diagnosis of diseases, framing line of managements, preparing prescriptions and methods of prevention as well as eradication of any disease. So, by virtue of these three factors i.e., knowledge, administrative capacity and decision making ability the physician has been considered as the most prime factor among all the others for smooth operation of a healthcare system.

4. To make understand the importance of a physician as supreme factor in healthcare system, Acharya Charaka has given two classical examples like “as the vessel (related to patient), fuel (related to attendant) and fire (related to medicament) are the helping factors for the cook in the process of cooking and for the victory, a conqueror needs favourable topographical position (related with patient), army (related with attendant) and weapons (related with medicaments) ; similarly in the success of treatment the patient, attendant and medicament are helpers only to the physician. Thus, the physician plays the most prominent role in the management of diseases”.[18]

5. Being the principal factor in healthcare system, all other factors like medicaments, attendant and patient are fully dependent on physician for their proper functioning. These three factors cannot operate independently unless until a physician commands themselves for doing so. Medicaments being an insentient object needed to be operated by any sentient being and the proper usage of the medicaments are only to be known to a physician only because of his essential qualities like medical knowledge, extensive practical experience, skill etc. Similarly, an attendant can skilfully function under the guidance of a physician and a patient cannot make his own treatment without the help from a physician. Thus it can be said that, the entire healthcare system is driven by the physician in driver’s seat along with other three factors being his


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support. To denote this phenomenon Acharya Charaka has given another beautiful example: “as the clod of earth, the wheel, the thread etc. are of no use (in making of a pitcher) without the help of the potter, so without physician, other factors do not serve the purpose”.[19]

6. Success of a healthcare system providing eradication of diseases depends on a qualified physician in absence of whom the healthcare system may miserably collapse. As Acharya Charaka has mentioned: “the remaining three factors being similar, the most difficult diseases, required to be treated may soon vanish or it may quickly aggravate like the city of Gandharvas (an epic character) depending upon the quality of the physician”.[20] Acharya Chakrapani while commenting on the supremacy of physician among the four aspects of healthcare system opined that, “it is only the physician who is capable of bringing the other three factors, viz. the patient, the attendant and the medicament to right usage. Even if, these three factors are deficient in certain qualities, the physician can by virtue of his imagination, knowledge and concentration render them useful. The three factors (even if otherwise useful) may turn out to be completely useless in the absence of a well-qualified physician”.[21]

7. As we have discussed earlier that, Acharya Charaka has given physician the most important place in a healthcare system, so he has given much emphasis on different qualities of a physician. Acharya Charaka has described different qualities of each of the factors of healthcare system i.e. physician, medicaments, attendant and patient, among them physician has the most number of qualities mentioned. This indicates how much it is crucial to be a physician having all the essential and desirable qualities for successful accomplishment of any healthcare system. As we have seen earlier, how Acharya Charaka has compared physician with a potter or the supreme doer without whom all the other factors cannot function properly, so he has elaborately discussed about various qualities of physician. Analysis of all these qualities is very essential to understand the true role of a physician in healthcare system as conceptualised by Acharya Charaka.

8. The four essential qualities of a physician as described by him are: 1. Shrute Paryavadatwam - excellence in medical knowledge 2.

Vahusho Drishtakarmata - an extensive practical experience 3. Dakshyam - dexterity and 4. Shoucha - purity of mind and character.[22] While commenting on the above qualities of a physician the great commentator of Charaka Samhita, Acharya Chakrapani Dutta opined that, “excellence in knowledge can be had by attending on preceptors and studying scriptures. Purity in a physician helps the patient by dint of its spiritual force. Reputation as infallible in prescribing medicines is also one of the qualities of a physician which is included in the four qualities mentioned above”.[23]

9. Further while referring Bhishaka or the physician as the Kaarana or the principal cause for the achievement of the maintenance of the equilibrium of Dhatus, Acharya Charaka has emphasised more on some elaborate qualities of a physician like - 1. Paryavadatshrutata - knowledge of medical texts in their entirety 2. Paridrishtakarmata - practical experience 3. Dakshyam - skill or dexterity 4. Shoucha - purity 5. Jitahastata - infallibility of prescriptions 6. Upakaranavatta - all the requisite equipment 7. Sarvaindriyaupapannata - possession of normal sense faculties 8. Prakritijnanata - knowledge of various natural manifestations and 9. Pratipattijnata - presence of mind.[24] Apart from these essential qualities, Acharya Charaka has also mentioned several other qualities which are also crucial to make oneself a true physician. These are - 1. Vidya - knowledge 2. Vitarka - critical and rational approach 3. Vijnan - insight into other allied sciences 4. Smriti - good memory 5. Tatparata - promptness in duty and 6. Kriya – perseverance.[25] A physician equipped with all these qualities never misses his target i.e. cure of diseases.[26] So, by analysing all the aforesaid qualities we can say that, a true physician has to lend his duty to any healthcare system by virtue of his vast textual knowledge as well as clinical experience, along with his capacity of decision making, unbiased character and authoritative nature.

10. Another important aspect of a physician’s role in a healthcare system is his role the saviour of life. Physician has been regarded as the supreme saviour of life and given the place only next to king. While describing various categories of physician, Acharya Charaka has described two categories namely Pranabhisara Vaidya and Jivitabhisara Vaidya - both of which refers to the same optimum qualified physician who is capable to protect life of a diseased person. According to Sutrasthana 29th


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chapter the person who possess the knowledge of 1. Pranayatana (ten important sit of Prana or life) 2. Indriyani (sensory organs) 3. Vijanana (technical knowledge of Ayurveda) 4. Chetana (soul) and 5. Amaya Hetu (causative factors of diseases) should be referred as Pranabhisara Bhishaka[27] and according to Sutrasthana 9th chapter the physician who is Pravritta (duly engaged) in following four objects like 1. Shastra (study of the scriptures) 2. Sastrartha Vijnanane (mastering the actual implication of knowledge) 3. Karma (the right application of therapy) and 4. Darshana (practical experience by observing others) should be referred as Pranabhisara Bhishaka.[28] Again those who are accomplished in the Prayoga (administration of therapies), Jnana (knowledge of texts) and Vijnana (knowledge of therapeutics) are endowed with Siddhisiddha (infallible success) and can bring out Sukha (happiness) to the patients are often referred as Jivitabhisara.[29] So, it can be said from above descriptions that, on the basis of above qualities a physician acts as the supreme saviour of life in a healthcare system.

11. If we consider the healthcare system as a pyramid structure, then it can be said that the base is formed by population based health care services, thereafter the next level is built by primary health care services, followed by secondary health care services at the next level where as apex of such pyramid is formed by tertiary health care services. The first two levels of services may be provided by the attendants, but the last two levels should be provided by physician with the help of other three factors of quadrupeds of healthcare system. To explore the role of a physician at the tertiary level, we should consider the description of court physicians as given by Acharya Charaka. A court physician to the king should be regarded as the most expert in the profession as he is bestowed with the responsibility to save the king and should be capable of handling all the life threatening conditions and should bring out the king from the grip of death. As a provider of the most tertiary level of healthcare, a physician should be possessed with authentic knowledge about four essential aspects of a disease like - Hetu (causes of disease), Linga (clinical manifestation of disease), Prashamana (alleviation of disease) and Apunrabhava (prevention of disease).[30] Again a physician who is Sarva Roga Viseshajna (expert in knowledge of all the diseases), Sarva

Karya Viseshavit (expert in all the therapeutic procedures) and Sarva Bheshaja Tatwajna (expert in knowledge of all the drugs) should be entitled to be the provider of tertiary healthcare to highest personalities in the society”.[31]

12. At last we should remember the fact that, although Acharya Charaka has regarded physician as the most principal factor of healthcare system and given much emphasis of his various roles, it should be remembered that, the act of treatment is a collective effort of all the four aspects of Chikitsa Chatuspada rather than be a solitary capability of a physician. This aspect should be understood by the very definition of Chikitsa (treatment) as described by Acharya Charaka: “all the efforts of the four factors like physician, medicaments, attendant and the patient, possessing requisite qualities, for the revival of the equilibrium of Dhatus in the event of their equilibrium being disturbed, is known as treatment”.[32]

Conclusion

Ayurveda has accepted the fact that a healthcare system is stood upon the four pillars namely physician, attendant, medicaments and patient. Among these factors, Acharya Charaka has considered physician as the most principal aspect. Depending upon the various descriptions about different aspect of an ideal physician as given in Charaka Samhita we can assume the ideal role of a physician in a healthcare system as conceptualised by Acharya Charaka. A physician lends his services in this healthcare system by virtue of his textual knowledge, extensive experience, noble character, skill and many other qualities. Being equipped with so many such qualities, a physician acts as the supreme knower of medical knowledge, the principal doer or driver of the entire healthcare system, a decision making authority in any crucial situation, a competent administrator of the whole healthcare system under whose guidance all the other three factors functions properly, provider of healthcare services from primary level to tertiary level, a person capable of both eradication and prevention of diseases and ultimately the supreme saviour of life. Analysis of a physician’s role in healthcare system as described by Charaka Samhita gives us much understanding about the utility of physician in today’s modern era in a whole new light.


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12. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 26, page no. 190

13. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 11, Verse no. 50, page no. 230

14. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 28, Verse no. 37, page no. 581

15. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 10, page no. 187

16. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 10, page no. 187

17. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 10, page no. 187

18. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 11 & 12, page no. 187 & 188

19. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary


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Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 13, page no. 188

20. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 14, page no. 188

21. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Chakrapani Dutta’s commentary on verse no. 21-23, page no. 189 - 190

22. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 6, page no. 186

23. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Chakrapani Dutta’s commentary on verse no. 26, page no. 186

24. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 2. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Vimanasthan, Chapter 8, Verse no. 86, page no. 255

25. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 21, page no. 189

26. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 21, page no. 189

27. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 29, Verse no. 4, page no. 585

28. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 18, page no. 189

29. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 11, Verse no. 53, page no. 230

30. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 9, Verse no. 19, page no. 129

31. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 2. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Vimanathan, Chapter 6, Verse no. 19, page no. 196

32. Sharma R.K., Dash Bhagwan, editor. Charaka Samhita of Agnivesh: commentary Ayurveda Dipika of Chakrapani Dutta. Reprint Ed. Vol. 1. Varanasi: Chowkhamba Sanskrit Series Office, 2004, Sutrasthan, Chapter 09, Verse no. 5, page no. 186.


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