ISSN: 2322 - 0902 (P)

ISSN: 2322 - 0910 (O)

International Journal of Ayurveda
and Pharma Research
Review Article

BASIC DIMENSIONS OF QUALITY HEALTHCARE IN ANCIENT SYSTEM OF INDIAN MEDICINE: A

CUE FOR CURRENT PRACTICE
Samir Bhoyar1, U.R.Sekhar Namburi2*, Nakul Khode3, Shubhangi Jadhav3, M.N. Suryawanshi4
1SRF, *2Research Officer (Sc-II),3JRF, 4Assistant Director, In charge, Regional Ayurveda Research Institute for Mother &
Child health, Nagpur, Maharashtra, India.
ABSTRACT
Health is one of the basic and important requirements of every individual in the world. The health and its
care is a complex phenomenon which can be managed by self or by health care professionals as per the
conditions. Now a day's several healthcare institutions are budding up however it is not ensured that
everybody will get the kind of treatment they require. The main reason for this situation is lack in the
quality and ethics in healthcare management. Healthcare system needs highly qualified doctors,
paramedical staff and medicines which are critical for producing effective management and helps in high-
quality outcomes, otherwise poor-quality care adds significantly to the costs of patients and sometimes
results in delay in recovery from the disease or lead to major loss. Hence it is one of the very strong issues
in health management in the present materialistic world. Ayurveda is a very distinct Indian medical
science and has some unique qualities in catering the health service and management for the needy,
based on the Chatushpada (four pillars of treatment) theory. It consists of Bhishag (physician), Upastha
(medical attendant), Rogi (patient) and Dravya (medicine). These four factors are mutually dependant on
each other and its proper employment gives good outcome of Chikitsa (treatment). Each of the four
factors possesses four qualities essential for a treatment to be successful. In absence of any one of these,
the treatment may not be successful. However among these four pillars, physician has got prime
importance since in any case treatment is not possible in his absence.
KEYWORDS: Chikitsa Chatushpada, Bhishag, Upastha, Rogi, Dravya, Quality Healthcare.
INTRODUCTION
Medicine is a divine field and earlier doctors were disease of patients.[4] It has given ample emphasis on
recognised as a God. The doctor- patient relationship
[1] preventive as well as curative aspect for various kinds of
was very pure and people used to pray doctors for their diseases. In this condition proper Chikitsa (treatment) is
work towards humanity. But later on tremendous very necessary to eradicate the disease as well as to bring
commercialization occurred in medical field where patient the Doshas to homeostasis.[5] Generally Chikitsa is a
have to spend huge amount of money for better health process of management which involves multi factorial
services. However considerable number of medical issues and persons. In Ayurveda, however the success of
negligence cases were recorded and started to come in Chikitsa depends mainly upon four factors which are
limelight. Simultaneously there was increase in awareness known as Chikitsa Chatushpada. These Chatushpada
among the people for better services in respect to their includes Bhishag, Upastha, Rogi and Dravya. [6]
payment. Since medical profession came under consumer In modern era the healthcare management has
protection act which gives patient a right to ask for better evolved materialistically in many folds and has become
services.[2] As a result patients have become customer and complex system. There are two main broad domains of
doctors have become service providers. This ultimately healthcare management viz. Clinical and Nonclinical.
hampered doctor patient holistic relationship. The basic Clinical management includes those domains of hospital
factor which played major role for such situation was lack management which are directly related to health of the
of quality in various aspects of field of medicine. Hence patient like medical and paramedical staff management,
there is an urge to improve the quality in every aspect of hospital infection control, quality of drugs given to patients
healthcare delivery to people. It is also necessary to win and management of diagnostic procedures. It also includes
the confidence of the patient towards healthcare various other categories like pharmacy, inventory
professionals and to regain that lost divine touch by management, biomedical waste management, medical
improving the quality of healthcare system. It would also record management etc. However this advancement is
help to improve doctor patient relationship. However compromising many times in the care of the sufferer as the
these things were very well taken care in the ancient whole management is involved in maintaining the system.
system of Indian medicine. In ancient days of Indian system of medicine the clinical
Ayurveda is one of the most ancient medical management was not so complex but simple and effective
sciences of the world.[3] The main aim of Ayurveda is to as it was having patient at centre of the care which is based
maintain the health of healthy persons and to eradicate the on Chikitsa Chatushpada. In this regard, National

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 Int. J. Ayur. Pharma Research, 2016;4(11):18-21
Accreditation Board for Hospitals and Healthcare ignorant, acts like a sharp weapon, fire or poison, hence
providers (NABH) is established under quality council of such physicians should be kept apart.[15]
India to assess and certify the quality of services provided Shuchi (Purity of Body and Mind)
by the hospitals and healthcare providers. This board has The physician should be impressive which can be
given standard framework viz. Patient centred standards expressed by Purity various things and sufferer gains the
and organisation centred standards to focus on patient`s confidence to get treatment. Among those maintaining the
safety and quality of care.[7] personal hygiene and dress code are very important
Chikista Chatuspada otherwise physician can be infected or becomes source of
1. Bhishag (Physician) infection. In current practice all over the world lot of
Ancient Indian literature praised a physician emphasis has been given on Hospital Acquired Infections
(Vaidya) like a god.[3] The same literature defined a Control so as to prevent them.
physician as “one who studied medicine with extensive Moreover in ancient classics of Ayurveda
practical experience at the same time able to cure the described that Shuchi is also related to purity of the mind
diseases and save the life of the mankind in all which is a spiritual quality needed to develop holistic
conditions”.[8] Acharya Sushruta has mentioned qualities approach for delivering ethical medical services to the
like a physician should be firm, brave, possessing all society. Further in the classics physicians were recognised
equipments and drugs required, to be intelligent enough to by various names and posts based medico-legal and
manage any situation, ingenious, skilful, well-versed (in professional aspects as mentioned below. These special
precepts and practice), adhering to truth. Acharya Sushruta kinds of physician attribute some unique qualities like
while describing Chatushpada has given great importance specialized Physician in present period.
to the physician. Further he illustrated brilliantly the same A. Qualities of Raja Vaidya: The physician is fit to be
as “if three limbs endowed with good qualities are appointed as a Raja Vaidya (royal physician) who
available then forth limb “the physician” possessing good possesses the six qualities, viz., keen knowledge of the
qualities, will be able to cure even a great disease within science, critical approach, sharp memory, promptness
short time. However without physician the other three and perseverance, he can never miss the target.[16]
limbs, though having all good qualities are futile, just like B. Qualities of Pranabhisara Vaidya: Vaidya who are
Udgatra, Hotra, and Brahma (these are priests of born in noble (respectable) family, well read, having
Samaveda, Rugveda and Atharva veda respectively) sufficient practical experience, skilful, pure, having all
without the Adhvaryu (priest of Yajurveda) has got no equipments and endowed with healthy sense organs,
importance in a sacrifice. Similarly a physician possessing having presence of mind, acquainted with the anatomy
good qualities alone can save the patient always, just as the and physiology of the entire body is known as the
navigator alone can save the boat in water even without Pranabhisara Vaidya.[17]
other assistants with oars”.[9,10] In this regard Acharya
C. Mahanasa Adhikari Vaidya (Physician as a Kitchen
Charak has explained about four ideal qualities which
Superintendent): In earlier days Kings were under
every physician should possess as mentioned below.[11,12]
threat of being killed using poisons by those of wicked
Shastra (knowledge about science) mind who developed hatred towards the king. Hence
A physician should have detailed knowledge of they used to appoint a physician as a Royal Kitchen
theory and practical about various diseases along with superintendent known as Mahanasa Adhikari Vaidya.
their treatment procedures. In this context Acharya [18]
Sushruta explained that one who practices medicine, after 2. Guna of Upastha[19] (Qualities of medical attendant/
learning the science from preceptor and engaged Para medical staff)
constantly in recapitulating it can only be called as best
According to Acharya Charak, the attendant
physician whereas all others are impostors. Further
attending the patient should possess following four
illustrated that donkey carrying a bundle of sandal wood
qualities.
understands only its weight and not the sweet smell of
sandal wood.[13] Buddhiman: Upastha should be intelligent enough to
understand the physician's instructions and act
Drushtakarma (Skills)
accordingly.
It means a physician should have extensive
Daksha: Upastha should be alert and active to inform all
practical experience in respective domain. In this regard
complaints of patient and observations to the physician.
Acharya Sushruta has explained that a physician who
knows either theoretical or practical aspect of science Anurakta: Upastha should have affection or attachment
becomes confused on approaching the patient just like a towards patient with empathetic approach.
coward in a battle field and a bird with only one wing Shuchi : Upastha should also have purity of mind and body
respectively.[14] which is very important while taking care of patients.
Daksha (Alertness) 3. Guna of Rogi [20](Qualities of Patient)
Physician should be alert or should have dexterity. The core of any treatment is patient and a lot of
He must critically analyse the progress of disease and its things depend on the nature of patient as mentioned below
ongoing treatment. In this context Acharya Sushruta has in classics of Ayurveda.
mentioned that Medicine is like nectar, but when used by Jynapaka: Patient should have good memory so that he
would remember all the things related to his illness and
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 Samir Bhoyar et al. Basic Dimensions of Quality Healthcare in Ancient System of Indian Medicine: A Cue for Current Practice
also the instructions given to him by Vaidya. Clinical Chatuspada principles implemented in present health
diagnosis of any disease is based on the Lakshanas services.
(symptoms) of the patients. Whenever a patient fails to CONCLUSION
explain his symptoms and course of illness then it becomes The four limbs of treatment are the base of
a tough job for a physician to make correct diagnosis of the management of hospital service quality having physician
disease. It may results in increase in unnecessary as the chief of the system and patient at the centre of care.
investigations ultimately increasing course of disease and The successful treatment of any disease is the result of
the total cost of treatment. efforts put in by good quality physician, paramedical staff
Bhishagvashya: Obedient to his physician means he with the help of medicine and also the result of genuine
should take medicines as prescribed and should follow the qualities of patients they got. Hence it is important to give
instructions given by the Physician. more stress on these four basic factors (limbs) to improve
Satvavaan: A patient should have good physical and the quality of services in health sector particularly in
mental strength to tolerate disease and treatment. It is developing countries like India where there is scarcity of
good to have a patient with courage and fearlessness. resources. This would ensure the integrity of quality in
Aaddhya: A patient should be capable of paying for the services of health sector and will help to improve and
expenses incurred in his or her treatment. Management of strengthen the relationship between patients and
some diseases require substantial amount of money and healthcare providers.
inability to pay the expenses leads to failure of treatment. REFERENCES
4. Guna of Aushodhi [21](Qualities medicine) 1. Kaviraj Ambikadutta Shastri and Dr Pranajivana
The success of any physician depends on good Mahanekchanda Mehta. Susruta Samhita. Sootra
quality of drugs. A physician without good quality drugs is Sthana.(Yuktaseniya Adhyaya), Varanasi Chowkhambha
as helpless as a brave worrier without weapons. Hence no Sanskrit Sansthan. Chapter34. Verse15-18.
matter how perfect a physician is in diagnosing and 2 K Park. Preventive and Social Medicine.18th ed.2005.
treating any disorder but he is helpless without good 511 p.
quality and effective medicines. 3 K Park. Preventive and Social Medicine. 18th ed.2005. 2
According to Acharya Charak, the Aushodhi to be p.
administered to the patient should possess the following 4 Kaviraj Ambikadutta Shastri and Dr Pranajivana
four ideal qualities. Mahanekchanda Mehta. Susruta samhita: Sootra Sthana.
Bahuta: A medicine should be available in abundant Vedotpatti Adhyaya. Chapter1. Verse 22.Varanasi.
quantity. Chowkhambha Sanskrit Sansthan. 4 p.
Yogyatam: A medicine should be effective and well 5 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
tolerated by patients. Charak Samhita. Sootra Sthana. Kuddakchatuspad
Aanekvidha kalpana: An ideal medicine is one which is adhyaya. Chapter9. Verse4.Varanasi. Chowkhambha
available in various pharmaceutical forms and has multiple Surbharati Prakashan.208 p.
use or indications. 6 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
Sampat: A sampat drug is having richness in efficacy or Charak Samhita. Sootra Sthana. Kuddakchatuspad
potency. adhyaya. Chapter9. Verse3.Varanasi. Chowkhambha
Surbharati Prakashan.207 p.
DISCUSSION
7 National Accreditation Board for Hospitals and
A good management of healthcare plays a crucial
Healthcare Providers [http://nabh.co/introduction.
role in successful treatment of the various diseases. This
aspx] [updated 2016 Jan 17. cited 2016 Jan 18]
mainly involves skilful, semi skilful or unskillful people. In
existing period healthcare management is specified with 8 Kaviraj Ambikadutta Shastri and Dr Pranajivana
various rules and regulations. But these are materialistic Mahanekchanda Mehta. Susrutasamhita. Sootra Sthana;
which measures with infrastructures and professional Yuktaseniya Adhyaya. Chapter34. Verse19-20.Varanasi.
level only. In this regard some organisation like NABH has Chowkhambha Sanskrit Sansthan.
given some principles to assess the quality of services 9 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
provided by the hospitals and healthcare providers. Charak Samhita. SootraSthana. Kuddak chatuspad
However relationship between patient and people adhyaya, Chapter9. Verse10.Varanasi. Chowkhambha
involved in health care services is deteriorating as it has Surbharati Prakashan.211 p.
not been given ample emphasis and consideration as 10 Kaviraj Ambikadutta Shastri and Dr Pranajivana
compare to other parameters like infrastructure and Mahanekchanda Mehta. Susruta samhita. Sootra Sthana.
technological advancements. Further the rights of patients Yuktaseniya Adhyaya. Chapter34. Verse15-18.Varanasi.
are taken into consideration but their qualities are not Chowkhambha Sanskrit Sansthan.
discussed anywhere which may be one of the causes in 11 Dr. Brahmanand Tripathi. Astangahrdayam.
failure of treatment. Therefore old classics mentioned that Sutrasthana. Ayushkamiya Adhyaya. Chapter1. Verse
the holistic approach is needed and physician is a god to 27-29. Varanasi. Chowkhambha Sanskrit Pratishthan.
the patient similarly physician should also sense patient as 20 p.
a God and these things can be practiced if Chikista 12 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
Charak Samhita. Sootra Sthana. Kuddakchatuspad

Available online at: http://ijapr.in 20

 Int. J. Ayur. Pharma Research, 2016;4(11):18-21
adhyaya. Chapter9. Verse6. Varanasi. Chowkhambha 17 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
Surbharati Prakashan. 209 p. Charak Samhita. Sootra Sthana. Kuddakchatuspad
13 Kaviraj Ambikadutta Shastri and Dr Pranajivana adhyaya. Chapter9. Verse18.Varanasi. Chowkhambha
Mahanekchanda Mehta. Susrutasamhita. Sootra Sthana. Surbharati Prakashan.213 p.
Prabhashniya Adhyaya. Chapter4. Verse 3-4. Varanasi. 18 Kaviraj Ambikadutta Shastri and Dr Pranajivana
Chowkhambha Sanskrit Sansthan. 14 p. Mahanekchanda Mehta. Susruta samhita. Kalpa Sthana.
14 Kaviraj Ambikadutta Shastri and Dr Pranajivana Annapanaraksha Kalpa Adhyaya. Chapter 1. Verse 8-
Mahanekchanda Mehta. Susrutasamhita. Sootra Sthana. 11.Varanasi. Chowkhambha Sanskrit Sansthan.
Adhyayana Sampradaniya Adhyaya. Chapter3. Verse 19 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
48-50. Varanasi. Chowkhambha Sanskrit Sansthan.13 p. Charak Samhita. Sootra Sthana. Kuddakchatuspad
15 Kaviraj Ambikadutta Shastri and Dr Pranajivana adhyaya. Chapter9. Verse8.Varanasi. Chowkhambha
Mahanekchanda Mehta. Susruta samhita. Sootra Sthana. Surbharati Prakashan. 210 p.
Adhyayana Sampradaniya Adhyaya. Chapter3. Verse 20 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
51.Varanasi. Chowkhambha Sanskrit Sansthan. 13 p. Charak Samhita. Sootra Sthana. Kuddakchatuspad
16 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey. adhyaya. Chapter9. Verse9.Varanasi. Chowkhambha
Charak Samhita with Charak Chandrika Hindi Surbharati Prakashan 210 p.
commentary. Sootra Sthana. Kuddakchatuspadadhyaya. 21 Dr. Brahmanand Tripathi and Dr. Ganga Sahay Pandey.
Chapter 9. Verse19. Varanasi. Chowkhambha Charak Samhita. Sootra Sthana. Kuddakchatuspad
Surbharati Prakashan.214 p. adhyaya. Chapter 9. Verse 7. Varanasi. Chowkhambha
Surbharati Prakashan. 209 p.

*Address for correspondence

Cite this article as: Dr. U.R.Sekhar Namburi
Samir Bhoyar, U.R.Sekhar Namburi, Nakul Khode, Shubhangi Jadhav, M.N. Research Officer (Sc-II)
Suryawanshi. Basic Dimensions of Quality Healthcare in Ancient System of
Regional Ayurveda Research Institute
Indian Medicine: A Cue for Current Practice. International Journal of
for Mother & Child health, NIT Complex,
Ayurveda and Pharma Research. 2016;4(11):18-21.
Source of support: Nil, Conflict of interest: None Declared Gharkul Parisar, Nandanvan, Nagpur –
440009 (M.S), India,
Mobile No. +91-8055595355
Email: shilpasekhar2k5@yahoo.com

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