A Text Book of Kayacikitsa (Vol-I)

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This book is the basic book intended as a course supplements to students, researchers, medical officers, and practitioners of Ayurveda. The text covers principles of treatment including management of jwara. This textbook describes all vital topics related to Kayacikitsa paper I as per CCIM syllabus. It is the unique book written in English by a Vikrti Vijnana and Roga Vijnana specialist and Kayachikitsa specialist. Treatment principles and their elaborate description were described in this book.

Dr. P.S. Byadgi is working as a teacher in the area of Roga Nidan (Ayurvedic diagnostics) since 11 years. Dr. Byadgi began his teaching since 2000 and has been writing books and publishing many articles. Dr. Byadgi earned BAMS degree in the year 1995 and completed internship in the year 1997, post graduate degree in the year 2000 and post doctor degree in the year 2003. Reviewer for articles published in European journal of clinical nutrition JAIM, AYU and STM journals. Dr. Byadgi published 50 papers and 13 full papers in seminar proceedings and serving as an editorial board member and Advisory board member of repute journals. He also published 5 books and wrote 4 chapters in a book and contributed significantly for MD scholars research work as a supervisor as well as co-supervisor and guided them to publish their work in reputed journals. Presently working as an Assistant Professor in the Department of Vikriti Vigyan, Faculty of Ayurveda, Instituted of Medical Sciences, Banaras Hindu University, Varanasi since 2005.

Dr. A. K. Pandey is working as a teacher, researcher and practioner in the area of Kayachikitsa (Medicine) since 10 years. Dr. Pandey achieved B.Sc. degree in the year 1991, BAMS degree in the year 2000, MD (Ay) degree in the year 2003, CCYP and Dip. Yoga in the year 2002-2003 and completed post doctor degree in the year 2012. He published more than 54 papers in national and international journals and 10 full papers in seminar proceedings and serving as an editorial board member and Advisory board member of reputed journals. He also published one book and contributed 4 chapters in Geriatric manual (Pub. By Dept of Ayush, Govt of India), 9 chapters in the manual for Ayurvedic therapy (Pub. By NIOS, Ghaziabad functioning under MHRD) and 6 chapters in books related to Ayurveda. Presently working as an Assistant Professor in the Department of Kayachikitsa, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi since 2007.

There has been a long left need to have a textbook on Kayacikitsa (Internal medicine) in English as per CCIM norms, which is relevant to the students, teachers and practitioners of Ayurveda. During my postgraduate graduate days, Prof. R.H. Singh-Distinguished Professor, Banaras Hindu University, former Vice Chanceller, Rajasthan Ayurveda University, Jodhapur, Rajasthan, has given me opportunity to interact with Late Prof. P.V. Sharma, former Director of Post Graduate Institute of Indian Medicine, BHU; on different aspect of health, disease and management pertaining to Ayurveda. He pointed out that dear Dr. Pandey you feel proud that you belong to Kayacikitsa discipline of Ayurveda, which is most fertile and viable branch of Sodasanga Ayurveda. Because Ayurveda means Kayacikitsa and vice-versa, while others are offshoots of the same that is designed for its development. Ayurveda is one of the recognized official systems of medicine in India. In ancient times, Ayurveda is flourished through Guru-Sisya tradition in Gurukula system and it based on self-study (Addhyayana), teaching (Adhyapana) and discussion (Tadvidyasambhasa).

Ayurveda is based on the holistic logic of the creation, life process, health, disease-diathesis as well as management of diseases. Ayurveda disagrees the target or organ oriented approach of biomedical science. It adopts function-oriented approach through its alternative theories of Loka-purusa samya, Pancamahabhuta, Tridosa, Samanya-visesa, Dhatuposana, Agnivyapara, Ama, Ojas, Srotasas etc. Besides this, the concept of Prakrti/Vikrti, clinical sense of Tridosika diagnosis in terms of Rogi-roga pariksa and pulse examination are important tools and techniques for the diagnosis, prognosis and management of ailments. The concept of Ras, Guna, Virya, Vipaka and Prabhava of drugs projects unique holistic pharmacology and pharmacodynamics of the Ayurvrdic drugs. The entire knowledge of Ayurveda seems to have been developed and validated through rigorous fourfold testing methods, viz- 1. Pratyaksa pramana- direct observation, 2. Anumana pramana- inferential evidence, 3. Aptopadesa pramana- scriptural evidence and 4. Yukti pramana-planned rational experimental evidence.

Ayurveda believes in the humoral (Dosika) theory of health and disease. If body humors are in a state of equilibrium body is normal and as soon as they get imbalanced a disease is produced. Medicine is known to be the amalgamation of science and art. First and foremost thing the physician has to do is to win the confidence of his patent otherwise; he failed to threat his patient because so many times patient may not reveal many his ailments and personal problems which may be directly related with the disease process. Caraka has emphasized that if a physician by virtue of his knowledge is not able to enter in the mind of his patients, he cannot threat him successfully.

At the time of management, clinical examination by descent manner, suitable conversation, selection of suitable therapeutic measures including diets and drugs are required to win the confidence and treat him successfully and safely. Now with the change in concepts of health and disease, attention has been drawn to Ayurveda once again. With these background authors of this book, felt that text-books should contains all the necessary information, which should be comprehensive, clear and concise, not have too many details and should be understood easily by the graduate students. Keeping this thought in mind, this book is written jointly with Dr. P.S. Byadgi, Assistant Professor, Department of Roga Vigyana and Vikriti Vigyana, IMS, BHU, Varanasi; primarily at graduate level students as per prescribed syllabi of CCIM. We believe it will also be useful to post-graduate students, residents, Ph.D scholars and practicing physicians of Ayurveda.

The book Kayacikitsa part-I is divided into eight chapters starting from basic tenets of Kayacikitsa of National health programme. Every effort has however been made to avoid needless repetition. The common format of each chapter is brief description of the same followed by details of the chapters. It is my hope and believes that this tiny effort will find favourable response from medical students of Ayurveda, teachers, researchers and offer significant help to the Ayurvedic practitioners.

It has been my endeavour to keep the book error free; however, there may be some typographical errors. If the reader comes across any such error, or wants to send any comment/suggestion, please do write or send an -email at the address given below. It will be dully acknowledged in the subsequent edition.

I offer our sincere thanks and deep sense of gratitude to Prof. R. H. Singh, Distinguished Professor, Banaras Hindu University, Varanasi and Dr. S. K. Joshi, Reader in Shalya Tantra, Govt. Ayurvedic College, Gurukul Kangri, Haridwar, UK for their inspirational thoughts, scientific encouragement and motivations to be I am in the field of Ayurveda specially Kayachikitsa.

I am grateful to our dynamic Director Prof. R. G. Singh, IMS, BHU, Prof. C.B. Jha, Dean, Faculty of Ayurveda, Prof. N.P. Rai, H.O.D. Kayachikitsa, Faculty members such as Prof. M. Diwedi, Prof. V.K. Joshi, Prof. M. Shahu, departmental colleague such as Dr. J.S. Tripathi, Dr. O.P. Singh, Dr. K.N. Murthy, Dr. V.K. Srivastava for their constant encouragement. During compiling this book, I have received generous assistance and good help from my graduate students, PG scholars, researchers, practitioners, many friends, well-wishers and family members including my wife Dr. Madhu Pandey and son Mr. Mridul Pandey. They are too numerous to be mentioned individually, but we offer them all our sincere thanks.

My revered Guru ji Professor R. H. Singh, Distinguished Professor, Banaras Hindu University, the noted scholar Ayurveda specially Kayachikitsa has written the foreword which added attraction to this book for which the author is extremely grateful.

This book is dedicated to the unfading memory of revered and visionary Pt. Madan Mohan Malaviya ji, Founder of Banaras Hindu University.

I am thankful to Jauhari process for their kind co-operation while composing my book. I am extremely thankful to Chaukhambha Sanskrit Sansthan for publishing my book.

It was really a pleasure to go through the prepress format of the textbook of Kayachiktsa authored by Dr. P.S. Byadgi and Dr. A.K. Pandey of the Faculty of Ayurveda Institute of Medical Sciences Banaras Hindu University, Varanasi. The book has been designed according to the existing UG Courses of Ayurveda. It is hoped that the book will be helpful to the students preparing for the final BAMS examinations. Dr. Byadgi who is an Assistant Professor in Roga vijnan-Vikriti vijnan at BHU has already written certain books in the past in the area of his specialization. It is nice that now he is joining hands with Dr. A.K. Pandey who is Assistant Professor in Kayachikitsa. This particular volume seems to present the reading material for paper I of Kayachikitsa, which deals with the basic tenets of the subject. Besides definitions and scope of the subject the prominent topics dealt with in this volume are the concept of Kriyakala, CIkitsa Sutra in general, treatment modalities, Diagnosis and treatment of Fevers and febrile diseases, National Health program and the scope of Ayurveda besides a brief account of different systems of Traditional medicine.

I take this opportunity to remind the prospective readers of this book that they should study the subject with open mind also looking beyond the syllabi and curricula because a syllabus outlines only the minimum requirement of learning. Moreover, the syllabi are merely the rolling document and are liable to frequent changes, sometimes-yearly changes, which seem to be mandatory in the interest of growth of knowledge and updated training of the students. It is also advisable that a graduate student should adopt an innovative mind-set and try to discover newer approaches to the diagnosis and treatment of different diseases including many newer diseases, which might not have been described in Ayurveda. In the age of science of today, technology is occupying the central place. Earlier it was believed that Technology emanates from science but now we see that science emanates from technology. In the absence of appropriate technology, growth of new science is retarded. Our students should be equipped to be able to identify appropriate technologies applicable to the task of "Reverse Innovation" and "Translational Studies" which is the key of success in this sector. Merely repeating the texts without fuller application and contemporary usage of the traditional knowledge, is not enough to make a graduate competent for good practice of Ayurvedic medicine today.

Ayurvedic medicine is quite different from conventional western modern medicine both in terms of its principles as well as in terms of its practices. The Tattva (science) as well as the Vidhi (technology) of Ayurveda are distinctly different from modern biomedical sciences. And hence it is not easy to search parallels between the two. However, the final goal of both the sciences being the same ie life, health, disease and cure, meeting grounds cannot be denied if appropriate technologies are applied with a genuine trans-disciplinary approach. Ayurveda is a complete biomedical science with a long history of thousands of years and it has remained in an unbroken professional practice since antiquity with support of a rich dynamic primary evidence-base in the form of its Sastra and the cumulative experience-base. Ayurveda has its own biology with quantum logic, own pathology, its own diagnostics and own pharmaceutics with richly safe and cost-effective green pharmacy and principles of treatment. With this strength, Ayurveda even today stands as a lively system of positive health care.

The Unique Features of Ayurveda As I have also deliberated in the past in my earlier writings it cannot be overemphasized that inspite of being thousands of years old knowledge system, Ayurveda is being rediscovered today and is liked by millions as the first option of health care. The main attractions seem to be its unique principles, its promise for safety, its green pharmacy and cost-effectiveness. The three important unique features of Ayurveda are: 1. Pronature, 2. Holistic, 3. Individualized care approach.

1. In its entire approach Ayurveda is a pro-Nature system of health care. In Ayurvedic practice, no diagnostic or therapeutic interventions are prescribed which may have anti-Nature impact because Ayurveda believes that our body-mind system is a miniature replica (microcosm) of the Nature (macrocosm) and therefore the health as well as the disease both are the products of the joint action of the two. The moment the microcosm is afflicted with a disease or disorder the Nature starts its protective actions for healing. The Ayurvedic theory of Svabhaoparamvada teaches us that the Nature and our own body are the first rank healers, which are already helping the victim. The doctor-drug duo as external aides should assist the Nature, they should not interfere the ongoing natural healing process. This is why Ayurveda does not prescribe fast acting toxic medications and prefers nutraceuticals and soft medications in the treatment of a patient. In contrast, the entire approach of western modern medicine is anti-Nature as is obvious from its medications like antibiotics, analgesics, anti-inflammatory, antipyretics, beta-blockers, calcium channel blockers and so on. All the medications are designed to counteract the Nature's action with the ambition to overpower the Nature. Now gradually the modern science is also realizing the hollowness of its ambitions. Although antibiotics have helped many victims of fulminating, infections but they have done much more harm. Now it is known that the healthy human body harbors Trillions of nonpathogenic microbes on our body who help us with extremely useful symbiosis in the life process. The estimated number of these microbial cells is ten times more than our body cells. This is called "Microbiome" which in fact is an important invisible organ of our body deserving all efforts of organ protection like any other organ of our body like liver, kidney, heart or brain. Scientists have argued that the concept of human genome should now be revised considering genome, epigenome and microbiome as a combined unit as all the three intimately interact together. The antibiotics and similar other chemical drugs heavily damage the "organ microbiome" and make us weak to take care of our day-to-day physiology and defense from all range of diseases. This is why Ayurveda teaches us to use minimum medication and put more emphasis on lifestyle management and dietary care. In medications too we use soft medicines and nutraceuticals often drawn from the Green resource of the Nature. The Nature also warns us to prevent a disease rather than waiting to treat a disease when it has really emerged which may not be always easy. This is why Ayurveda while deliberating on its objectives emphatically states: "Swasthasya Swasthya Raksanam, Aturasya Vikara Prashamanam " (Caraka).

2. Ayurveda is essentially a Holistic and subjective science in contrast to conventional biomedical sciences which are critically reductionist boasting to be objective and scientific. The classics consider Ayurveda as Holistic because it considers life process in totality encompassing the body, the mind and the Soul all the-three in one sweep. Ayu or life is a three-dimensional entity comprising of body-mind-spirit as a continuum. Further, the so conceived Ayu is in continuum with the universe of the Nature. This is the meaning of the Ayurvedic theory of Loka-Purusaha Samya ie microcosm-macrocosm continuum. On the other hand, the so conceived holism also reflects on the holistic approach to diagnostics and medications practiced in Ayurveda. An Ayurvedic doctor diagnoses and treats his patients in totality encompassing promotion of health, prevention of disease and healing of his ailments not merely by drugs but through comprehensive life style management, dietary care and soft supportive medications wherever needed. Thus the entire intervention is comprehensively holistic in Nature and the entire strategy is "patient centered", not merely "disease centered" as is the case in Allopathy.

It is pertinent to mention here that holistic and subjective approach is the most scientific approach because the Nature itself is a complex and holistic phenomenon. It can be comprehended only through holistic subjective experience, not by mere study of parts and then to try to sum the parts to comprehend the 'whole'. The 'whole" is not merely the sum of the parts. The 'whole' has its own entity. Thus, the modern science too is holistic because science is nothing but a way to understand the Nature, which is a holism. The difficulty comes at the level of technology and artificially designed methods of application of Science to decode its mysteries. Thus science is holistic, though modern technology is reductionist. There is a need to transform modern technology too into a holistic and pronature enterprise, then only one could understand the secrets of Nature in true sense. In the words of Nobel laureate BD Josephson the basic premise of modern bio-science and technology is to reduce the Reality/Nature into a measurable formula to suit the process of measurement. But the Reality/Nature is so complex that it can- not be truly reduced to a measurable formula. Hence, most of the predictions of modern science are merely presumptions still to be proved by better science and subjective experience, which was the approach of ancient Hindu scientists of India.

3. Individualized or personalized health care is another important feature of classical Ayurveda. Ayurveda is practiced on the principle of specificity of Prakrti and Vikrti. Every patient has his own genetically determined Prakrti or Constitution. So also every disease has also its specific Prakrti ie Dosa- Dusya-Adhisthana pattern which is to be addressed during the curati ve treatment. The Deha Prakrti may be modified to a limited extent in its epi-genomic dimensions but cannot be changed fundamentally in one lifetime. In view of such features, each patient is a separate entity and needs to be treated individually. Ayurveda does not prescribe the same treatment to all patients suffering from a particular disease as is often done in Allopathy. The current trends show that conventional modern medicine is also now gradually converging towards this age-old approach of individualized health care advocated by Ayurvedic classics-Purusam Purusam Viksya (Caraka). In the opinion of many activists in the field of genomic medicine Allopathy is not a full science, it is only a half science until it develops its real individualized health care strategy. If so Ayurveda is the only full science at least in its theoretical understanding. There is an urgent need to generate new scientific evidence for it.

I have known both the young authors of this new book for many years in different capacities. Both of them are good teachers, researchers and practitioners of Ayurvedic medicine. Their attempt to compile a textbook is commendable. I wish this new publication all success.

**Contents and Sample Pages**