A physician having thoroughly studied the Science of medicine, and fully pondered on and verified the truths he has assimilated, both by observation and practice, and having attained to that stage of (lucid) knowledge, which would enable him to make a clear exposition of the science (whenever necessary), should open his medical career commence practising) with the permission of the king of his country. He should be cleanly in his habits and well shaved, and should not allow his nails to grow. He should wear white garments, put on a pair of shoes, carry a stick and an umbrella in his hands, and walk about with a mild and benignant look as a friend of all created beings, ready to help all, and frank and friendly in his talk and demeanour, and never allowing the full control of his reason or intellectual powers to be in any way disturbed or interfered with.
A physician, having met with a messenger of happy augury, or having been encouraged on his journey by the notes of auspicious birds or sights, should go to the house of his patient. [Then, having entered the sick room], the physician should view the body of his patient, touch it with his own hands, and enquire (about his complaint . Several authorities hold that these three, (inspection, touch and questioning) largely form the means of our ascertaining the nature of a disease, But that is not correct, inasmuch as the five sense-organs of hearing, sight, etc. and oral enquiry materially contribute to a better diagnosis.
Diseases, which are to be diagnosed with the help of the organ of hearing, will be fully treated, later on, in the Chapter on Vrana-Srava (secretions from an ulcer). The wind (Vayu), making the blood ebullient, forces it up with a distinctly audible report and thus affects the sense of hearing. But this will be dealt with later on in the abovesaid chapter. The heat and coldness of the body, or the gloss, roughness, hardness, or softness of the skin of the affected part as in fever, or in an oedematous swelling of the body, are perceptible by the sense of touch. Fullness or emaciation of the body (cachexia), state and indications of vitality, strength, complexion, etc. are perceived by the sense of sight. Secretions or discharges (from the inflamed mucous membrane of the urethra) in Prameha etc., should be tested with the organ of taste.* The characteristic smell emitted by an ulcer in its critical stage (Arishta) should be determined with the help of the organ of smell.
* The sweet, or any other taste of the discharges should be inferred from the fact of their being or not being swarmed with hosts of ants or flies, etc.
While such facts as the time or season (of the first appearance) of the disease, the caste which the patient belongs to, and things or measures which tend to bring about a manifest amelioration of the disease, or prove comfortable to the patient (Satmyam) as well as the cause of the disease, the aggravation of pain, the strength of the patient, and his state of digestion and appetite, the emission of stool, urine and flatus, or their stoppage, and the maturity of the disease as regards time, should be specifically ascertained by directly interrogating the patient (on those subjects). Though the abovesaid five organs of sense, like the three fundamental vital humours, help us to make the correct diagnosis of a disease, still the objects locally perceived by these senses should not be left out of account in ascertaining its specific nature.
A disease wrongly observed or incorrectly described, or wrongly diagnosed, is sure to mislead a physician.
Having made these observations the physician will try to cure diseases that are curable, adopt palliative measures in cases where palliation is the only remedy that can be offered, and give up a case which is beyond all medical treatment, and mostly those which are of more than a year's standing. Diseases affecting a Brahmana well versed in the Vedas, or a king, or a woman, or an infant, or an old man, or a timid person, or a man in the royal service, or a cunning man, or a man who pretends to possess a knowledge of the science of medicine, or a man who conceals his disease, or a man of an excessively irascible temperament, or a man who has no control over his senses, or a man in extremely indigent circumstances of life or without any one to take care of him, are apt to run into an incurable type though appearing in a common or curable form at the outset. The physician, who practises his art with a regard to these facts, acquires piety, wealth, fame and all wished for objects in life.
A physician should abjure the company of women, nor should he speak in private to them or joke with them. A physician is forbidden to take anything but cooked rice from the hands of a woman.