The Compendium of Caraka 1.10: daśamo 'adhyāyaḥ /

Now we shall explain the major chapter on the four pillars.

Thus spoke the venerable Ātreya.

'Medicine consists of four pillars and sixteen constituents,' so physicians declare, referring to what was described in the preceding chapter as having sixteen qualities; 'that medicine, properly administered, is sufficient for health,' said the venerable Punarvasu Ātreya.

'Not so,' said Maitreya. 'For what reason? For some patients are seen who possess equipment, are attended by excellent attendants, have self-control, and are treated by skilled physicians, yet they die; and others similarly situated survive. Therefore, medicine is ineffective, just as a little water poured into a pit or a lake, or a handful of dust scattered into a flowing river or a dust-heap. Likewise, others are seen who lack equipment, lack attendants, lack self-control, and are treated by unskilled physicians, yet they recover; and others similarly situated die.

And since one treated succeeds, and one treated dies; one untreated succeeds, and one untreated dies; therefore it is considered that medicine is no different from non-medicine.'

"Maitreya! You think erroneously," said Ātreya. "For what reason? What you said—that patients provided with this medicine endowed with the sixteen qualities die—is unsound. For medicine is never non-causal in diseases that are curable by medicine. Moreover, as for those patients who recover purely without medicine, it is not the case that there would be no specific difference in their recovery were they provided with complete medicine. For just as a man who helps a fallen man to stand up—a man who is capable of rising—would impart strength to him, so that he rises more quickly and without distress, in the same way patients [recover] from obtaining complete medicine. And as for those patients who die even with medicine alone, not all who are provided with medicine would recover. For not all diseases are curable by therapeutic means, nor is there success for diseases curable by therapeutic means without therapeutic means; nor is this collection of medicine meant for incurable diseases. For a wise physician is not able to raise up a patient who is about to die. Skilled ones act after careful examination. For just as an archer who knows the technique, devoted to continuous practice, having taken his bow and discharging an arrow, does not miss when aiming at a large body that is not excessively distant, and accomplishes his intended objective; so a physician endowed with his proper qualities, equipped with requisites, undertaking action after careful observation, without error, certainly provides health to a curable patient. Therefore, medicine is not undifferentiated from non-medicine.

And this is directly perceptible to us: that we treat the sick person with health-promoting medicine; we nourish the emaciated and weak with non-emaciating measures; we deplete the obese and fatty; we treat one overcome by heat with cold, and one overcome by cold with heat; we replenish deficient tissues; we reduce excessive ones; treating diseases by counteracting their cause, we properly establish them in their natural state. When we act in this way, this collection of medicine becomes exceedingly pleasing to them.

And on this point there are [verses]:
The physician who knows the distinction between curable and incurable, acts with prior knowledge,
and initiates treatment at the proper time, certainly accomplishes that which he undertakes.

Loss of wealth, knowledge, and fame, along with censure and non-acceptance,
would certainly fall upon the physician who attempts to treat an incurable disease.

Curable is considered to be easily curable, and also curable with difficulty;
and incurable is of two kinds: palliable and that which is beyond all intervention.

For curable diseases there is a threefold classification according to mild, moderate, and severe degrees;
but there is no such classification for incurable diseases, which are fixed.

A disease whose causes, prodromes, and symptoms are mild,
whose affected tissue is not similar in qualities [to the doṣa], and whose doṣa does not match the constitution,

and whose time does not share identical qualities, whose region is not difficult to treat,
which has a single pathway, is recent, and has no complications,

where a single doṣa is involved in its onset, the body is capable of tolerating all medicines,
and the four pillars are fully available—this is the characteristic of an easily curable disease.

When causes, prodromes, and symptoms are of moderate strength;
when there is similarity with any one among time, constitution, and affected tissue;

occurring in pregnant women, the aged, or children, not heavily afflicted with complications;
requiring surgery, alkali, or cautery; not chronic, born in a difficult terrain;

one should know a disease with a single pathway, where the four pillars are not fully complete,
or one with two pathways, not exceedingly long-standing, or born of two doṣas, as curable with difficulty.

Owing to remaining lifespan, a disease is palliable, though incurable, where through wholesome regimen
slight comfort is obtained, yet it flares up quickly with a minor cause;

deep-seated, located in multiple tissues, residing in vital points and joints,
constantly recurring, persisting for a long time,

and born of two doṣas—such a disease one should know [as palliable]. Likewise, one born of three doṣas should be rejected;
surpassing the scope of treatment, traversing all pathways,

producing anxiety, restlessness, and stupor, destroying the sense organs,
greatly aggravated in a weak person, and accompanied by fatal signs.

Having thus first examined the specific characteristics of diseases,
the wise physician should then initiate treatment on curable ones.

He who knows the distinction between curable and incurable and possesses right understanding
will not entertain erroneous views like those of Maitreya.

Here are two verses:
Here, medicine, the qualities of the pillars, the efficacy having medicine as its foundation,
the opinions of Ātreya and Maitreya, the resolution of the dual views,

and the fourfold classification of diseases with their respective characteristics,
upon which therapeutics depends, have been declared in the Great Chapter on the Four Pillars.

Thus ends the tenth chapter, named "The Great Chapter on the Four Pillars", in the Ślokasthāna of the treatise composed by Agniveśa and redacted by Caraka.