Writing prescriptions is an important aspect of medical practice. A written medical prescription is a health-care program implemented by a physician or other medical doctors in the form of instructions that govern the plan of care for an individual patient. The prescription is a document which brings coordination between the Bhishak (physician), Upasthata (attendant), and Rogi (patient), all the important participants in the disease management. General prescription should ideally comprise elements like date, patient name, sex, age and address, diagnosis, name of the drug, strength of the drug (if applicable), quantity of the drug, directions for use, and brief details of the practitioner. These include the legal obligations as well as convenience of patient and the practitioner.
It has been observed that present day Ayurveda physicians are writing lengthy prescriptions having multiple ingredient combinations in one prescription, which leads to overdosing of medicines. Some of these combinations may contain drugs from Schedule E-1 of Drugs and Cosmetics Act – 1940, which may lead to certain unwanted effects or Adverse Drug Reactions (ADRs) in patients. Even the National Pharmacovigilance Centre for Ayurveda, Siddha, and Unani Drugs at Jamnagar reports that many reported ADRs are due to the irrational combinations of drugs. Hence, there is a need to codify some guidelines for ethical prescription writing in Ayurveda.
Though a prescription is an instruction to a pharmacist and guidelines to the patient; it can also be used as a source of mini case-sheet of the patient, which enables to have a better understanding of the condition of the patient in order to have a comparative health status of the patient and to have a quick thought process on the effect of the drug on reversing pathology in the patient.
Ayurveda has its own unique comprehensive way of diagnosis and treatment which warrants an altered way of prescription writing in many aspects in comparison with conventional prescriptions. Ayurvedic way of examination considers many factors like Desha, Dhushya, Bala, Kala, Prakruti, Vaya, Ahara, Vihara, etc., and each factor has potential role in the determination of certain medicaments for the patient. Out of these, understanding Prakriti (the basic constitution) of the patient itself needs a thorough examination, which is an essential aspect to be written in the prescription. Enumeration of signs and symptoms in Ayurvedic terminologies, which is more convenient for an Ayurvedic clinician to arrive at an Ayurvedic diagnosis, could also be a general method to be followed, more for the understanding of Doshik state and affected Dhatus.
Ayurveda also gives utmost importance to the etiology, which is the first line of disease treatment. A thorough tracking of the possible causative factors in terms of diet, certain habits, lifestyle, and mentioning the most important causative factors is very useful to keep in the prescription being written.
Selection of a drug and its dose should always be judicious and should follow specified guidelines in order to attain success in the treatment. Charaka emphasizes that ideal drug or treatment is the one which does not lead to any kind of other side effects, while pacifying a disease. Seer also emphasized that administration of a drug in higher or lesser doses will not be useful in therapeutics. Great caution is warranted by Seer while prescribing medicines in children and prefers prescribing disease-specific drugs in lesser doses. It is also said that excessive usage of certain drugs will pose adversely and settle in certain reactions, and if aversion is developed toward certain types of medicaments, palatable medicaments are to be prepared and administered appropriately. All such references make it clear that ancient Indian physicians have better understanding of drug prescribing methods. Considering these; it can be said that a drug should be disease specific, palatable, minimal in dose and number.
If any Teekshna Dravya (potent or toxic substance) is the component of the prescription, as far as possible, a suitable antagonistic drug is to be added, which will check the unwanted effects. Patient is to be counseled properly to follow the complete course of the treatment, as remnants of disease will settle down into full-blown stages.
Anupana and Sahapana (adjuvant) also have a great impact in therapeutics. Besides increasing palatability, they also help in increasing the bioavailability of the drug and sometimes have antidotal activities, and thus help in counteracting possible adverse drug reactions if any.
In general, an inscription may contain a metallic or herbo-mineral preparation, a pill and certain liquid dosage form, or a confectionary. Symptomatic treatment approaches are to be avoided as the treatment modalities in Ayurveda are entirely different than the conventional methods. Besides all these, instructions on dietary regulations and lifestyle modifications are to be reflected in the prescription, which will check further progress of the disease.