Chikitsa Chatushpada (four factors of treatment)

The verse clearly implies that the Ayurvedic practitioner, the medicine/procedure, the assistant and the patient are required for a complete healing process. When these four factors come together, the treatment naurally takes place, but the quality of the individual factors in the healing process is important. In the subsequent verses, these factors and their qualities are described one by one. It does not mean that they have to be classified exacly like this, but they have to be a part of any treatment, whether for a major or a minor illness.

The treatment process takes place even when one treats oneself, for example when one reads a prescription, or when parents treat children, or when we listen to advice from friends. Each treatment process has to have the main treatment administrator. The main administrator is the Bishak (Ayurvedic practitioner), which does not mean that he has to be educated in Ayurveda, but that there is a professionality to the treatment. This main administrator must have the qualities of a professional even if he or she is, for example, a friend, parent or an acquaintance.

The treatment process also means a sufficient amount of remedies are used. This means medicines verified with the Bishak (main administrator). For example, when parents treat children, they have to know the ingredient they use for treatment well. This verse unequivocally refuses treatment based on trial and error.

Another factor of the treatment process is the assistant. This may be a parent, nurse, massage therapist, or anybody who is authorized by the Bishak to perform this role.

The most important factor of the treatment process is the patient. We may define the patient as a diseased person who wants to be healed. A general maxim applies here: "All diseases are curable, but not all patients are."

Any treatment stands on these four "legs". Like any four-legged animal, it needs all of its legs to function. The treatment will run well when all of the legs are functioning well. The Rogi, the patient, the person who is ill (rog), will have symptoms that are both visible and that can be deduced, and that deviate from the norm. Just as things not working properly are the main subject of the news, dysfunction in the patient is what attracts our attention and is discussed. When the gunas and mahabhutas are normal, there is nothing to discuss. Their imbalance is the disease. For example, a mother whose baby is quiet may even forget to nurse it, but the babies who scream when they are hungry will be fed. When we experience physical pain, we usually want to address it as quickly as possible. 

The second "leg" is the Bishak (Ayurvedic practitioner), the third is the Dravya (medicine/procedure), the fourth is the Upastha (assistant). The Bishak is the main "computer" in the process and the assistant does much of the physical work of it.

If a person does not believe that she is ill, then she is not a patient. Others may believe she is ill and may even offer the person ideas for treatment, but if the person does not believe she is ill, there is no point in making some recommendations. When a person does not want to suffer, says so and seeks treatment, then she is a patient and will do whatever it takes to heal. Similarly, good students know what they know and know what they do not know and want to know what they don't know and will find the answer wherever they can. The Rogi is experiencing suffering and is the main ingredient in the process of healing.

Treatment involves an action and its function. Those who understand the principles underlying these actions are wise. The principles of action were discussed previously (samvaya, nimitta, asamvaya). The Bishak, the practitioner, understands everything in terms of the principles underlying the situation and is able to analyze what is happening in those terms. 

The Dravya (medicine/procedure) are prescribed by the practitioner and then administered by the Upastha (assistant), who is also a navigator for the Bishak. There cannot be any cure if all four "legs" are not functioning. People very often believe they are assisting others with their diseases, but if these four aspects are not present, no cure will take place.

Unfortunately many people today just want prescriptions and are not interested in the underlying principles. The place where principles are discussed and learned is a school, not a marketplace.