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Line 453: + + + + + + + + + + + − + − + − + + + + + + + − + + + + + + + + + + + − + + − Thus ends the first chapter on diagnosis of fever in nidanasthana in the treatise composed by Agnivesha and reducted by Charaka. (1) + − + − • The causative factors, favorable conditions, dominant factors, and origins of jwara are important in the context of nidana. [3]+ − • Somatic diseases could be caused due to soma (kapha), agni (pitta), and vayu (vata) – due to vitiation of single dosha, two doshas, or all three doshas. Psychiatric diseases are attributed to vitiation of rajas and tamas. [4]+ − • A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5] + − • The five key factors of jwara nidana that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]+ − • An ability to understand and observe unmanifested or premonitory signs is important to prevent the progression of a disease. [8]+ − • The signs of a disease could take the form of a cardinal feature, a structural lesion, marks, or a systemic disorder. [9]+ − • Pacification factors include diets, medications, and lifestyle regimen that help provide relief and comfort to the patient and are considered to be among the means to diagnose a disease. [10]+ − • The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season). + − • Jwara is the primary change observed in body that initiates a disease process. [16]+ − • All forms of jwara are caused due to vitiation of doshas, which in turn have various causative factors (for their vitiation). [17]+ − • The important pathological events in process of jwara are as below:+ − 1. Vitiated doshas get accumulated in the amashaya i.e. site of first phase of digestion + − 2. Next, these doshas mix with the undigested food material, in that heated environment, in the amashaya, vitiating the ahar rasa (just digested dood)+ − 3. This vitiated rasa blocks the rasavaha and swedavaha strotas (channels) that regulate body heat. + + + − • Exogenous factors may cause jwara by vitiating rakta (blood), and/or dosha. [30] − • Rise in temperature? is a confirmative sign of jwara. [32] − • The light to digest diet and reduction therapy shall be started as soon as premonitory signs of jwara are observed. [36] − • The best advocated medicine for chronic Jwara is Ghee due to its therapeutic efficacy of pacifying all three dosha. [37] − + − + − + + + + + + + + + − Several types of classifications of Nidana are as under: − A. First Classification − There are four types of Nidana: − 1. Sannikrishta (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of doshaprakopa like chaya etc., are known as sannikrishta. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either. − 2. Viprakrishta (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of doshas to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of kaphadosha during Hemanta ritu (early winter season), causing diseases seen in Vasanta ritu. (spring season). Sannikrishta factors tend to use this foundation prepared by viprakrishta factors. As the diseases are immediately seen after the consumption of Sannikrishta factors, it gives the impression that the disease is caused only due to Sannikrishta factors. Thus, a disease cannot manifest independently by either Viprakrishta or Sannikrishta factors – it would require both. − 3. Vyabhichari (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable. − 4. Pradhanika (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as pradhanika hetu. − + + + + + + + + + + + + − +
→Management of chronic jwara
जीर्णज्वरेषु तु सर्वेष्वेव सर्पिषः पानं प्रशस्यते यथास्वौषधसिद्धस्य; सर्पिर्हि स्नेहाद्वातं शमयति, संस्कारात् कफं, शैत्यात् पित्तमूष्माणं च; तस्माज्जीर्णज्वरेषु सर्वेष्वेव सर्पिर्हितमुदकमिवाग्निप्लुष्टेषु द्रव्येष्विति||३७||
जीर्णज्वरेषु तु सर्वेष्वेव सर्पिषः पानं प्रशस्यते यथास्वौषधसिद्धस्य; सर्पिर्हि स्नेहाद्वातं शमयति, संस्कारात् कफं, शैत्यात् पित्तमूष्माणं च; तस्माज्जीर्णज्वरेषु सर्वेष्वेव सर्पिर्हितमुदकमिवाग्निप्लुष्टेषु द्रव्येष्विति||३७||
भवन्ति चात्र-
भवन्ति चात्र-
यथा प्रज्वलितं वेश्म परिषिञ्चन्ति वारिणा|
यथा प्रज्वलितं वेश्म परिषिञ्चन्ति वारिणा|
नराः शान्तिमभिप्रेत्य तथा जीर्णज्वरे घृतम्||३८||
नराः शान्तिमभिप्रेत्य तथा जीर्णज्वरे घृतम्||३८||
स्नेहाद्वातं शमयति, शैत्यात् पित्तं नियच्छति|
स्नेहाद्वातं शमयति, शैत्यात् पित्तं नियच्छति|
घृतं तुल्यगुणं दोषं संस्कारात्तु जयेत् कफम्||३९||
घृतं तुल्यगुणं दोषं संस्कारात्तु जयेत् कफम्||३९||
नान्यः स्नेहस्तथा कश्चित् संस्कारमनुवर्तते|
नान्यः स्नेहस्तथा कश्चित् संस्कारमनुवर्तते|
यथा सर्पिरतः सर्पिः सर्वस्नेहोत्तमं मतम्||४०||
यथा सर्पिरतः सर्पिः सर्वस्नेहोत्तमं मतम्||४०||
JÍrṇajwareṣu tu sarveṣveva sarpiṣaḥ pānaṁ praśasyate yathāsvauṣadhasiddhasya; sarpirhi snehādvātaṁ śamayati,saṁskārāt kaphaṁ,śaityāt pittamūṣmāṇaṁ ca;tasmājjīrṇajwareṣu sarveṣveva sarpirhitamudakamivāgnipluṣṭeṣu dravyeṣviti||37||
JÍrṇajwareṣu tu sarveṣveva sarpiṣaḥ pānaṁ praśasyate yathāsvauṣadhasiddhasya; sarpirhi snehādvātaṁ śamayati,saṁskārāt kaphaṁ,śaityāt pittamūṣmāṇaṁ ca;tasmājjīrṇajwareṣu sarveṣveva sarpirhitamudakamivāgnipluṣṭeṣu dravyeṣviti||37||
Bhavanti cātra-
Bhavanti cātra-
yathā prajvalitaṁ veśma pariṣiñcanti vāriṇā.
yathā prajvalitaṁ veśma pariṣiñcanti vāriṇā.
narāḥ śāntimabhipretya tathā jīrṇajware ghr̥taï||38||
narāḥ śāntimabhipretya tathā jīrṇajware ghr̥taï||38||
snehādvātaṁ śamayati, śaityāt pittaṁ niyacchati|
snehādvātaṁ śamayati, śaityāt pittaṁ niyacchati|
ghr̥taṁ tulyaguṇaṁ dōṣaṁ saṁskārāttu jayet kaphaï||39||
ghr̥taṁ tulyaguṇaṁ dōṣaṁ saṁskārāttu jayet kaphaï||39||
nānyaḥ snehastathā kaścit- saṁskāramanuvartate|
nānyaḥ snehastathā kaścit- saṁskāramanuvartate|
yathā sarpirataḥ sarpiḥ sarvasnehottamaṁ matam||40||
yathā sarpirataḥ sarpiḥ sarvasnehottamaṁ matam||40||
jIrNajvareShu tu sarveShveva sarpiShaH pAnaM prashasyate yathAsvauShadhasiddhasya; sarpirhi snehAdvAtaM shamayati, saMskArAt kaphaM, shaityAtpittamUShmANaM ca; tasmAjjIrNajvareShu sarveShveva sarpirhitamudakamivAgnipluShTeShu dravyeShviti||37||
jIrNajvareShu tu sarveShveva sarpiShaH pAnaM prashasyate yathAsvauShadhasiddhasya; sarpirhi snehAdvAtaM shamayati, saMskArAt kaphaM, shaityAtpittamUShmANaM ca; tasmAjjIrNajvareShu sarveShveva sarpirhitamudakamivAgnipluShTeShu dravyeShviti||37||
bhavanti cAtra- yathA prajvalitaM veshma pariShi~jcanti vAriNA|
bhavanti cAtra- yathA prajvalitaM veshma pariShi~jcanti vAriNA|
narAH shAntimabhipretya tathA jIrNajvare ghRutam||38||
narAH shAntimabhipretya tathA jIrNajvare ghRutam||38||
snehAdvAtaM shamayati, shaityAt pittaM niyacchati|
snehAdvAtaM shamayati, shaityAt pittaM niyacchati|
ghRutaM tulyaguNaM doShaM saMskArAttu jayet kapham||39||
ghRutaM tulyaguNaM doShaM saMskArAttu jayet kapham||39||
nAnyaH snehastathA kashcit saMskAramanuvartate|
nAnyaH snehastathA kashcit saMskAramanuvartate|
yathA sarpirataH sarpiH sarvasnehottamaM matam||40||
yathA sarpirataH sarpiH sarvasnehottamaM matam||40||
In all types of jirna jwara (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies vata by its unctuousness, kapha by (ghee infused with) kapha pacifying drugs, and pitta by its coldness. Therefore, ghee is useful in all forms of jirna jwara like fire subsides with water. [37]
Here are (the verses) –
In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''vata'' by its unctuousness, ''kapha'' by (ghee infused with) ''kapha'' pacifying drugs, and ''pitta'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other sneha (oil etc.) brings the refinement properties of sanskara (processing with drugs) as ghee and therefore it is said the best one of all the snehas. [38-40]
Here are (the verses) –
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]
गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|
गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|
तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||
तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||
Gadyokto yaḥ punaḥ ślokairarthaḥ samanugīyate.
Gadyokto yaḥ punaḥ ślokairarthaḥ samanugīyate.
tadvyaktivyavasāyārthaṁ dviruktaṁ tanna garhyate||41||
tadvyaktivyavasāyārthaṁ dviruktaṁ tanna garhyate||41||
gadyokto yaH punaH shlokairarthaH samanugIyate|
gadyokto yaH punaH shlokairarthaH samanugIyate|
tadvyaktivyavasAyArthaM dviruktaM tanna garhyate||41||
tadvyaktivyavasAyArthaM dviruktaM tanna garhyate||41||
This subject of jwara has been put here in prose and is again put into the form of verses. The intention is to make the subject clear and understandable. Such repetitions should not be dismissed in disgust. [41]
This subject of ''jwara'' has been put here in prose and is again put into the form of verses. The intention is to make the subject clear and understandable. Such repetitions should not be dismissed in disgust. [41]
तत्र श्लोकाः-
तत्र श्लोकाः-
त्रिविधं नामपर्यायैर्हेतुं पञ्चविधं गदम्|
त्रिविधं नामपर्यायैर्हेतुं पञ्चविधं गदम्|
गदलक्षणपर्यायान् व्याधेः पञ्चविधं ग्रहम्||४२||
गदलक्षणपर्यायान् व्याधेः पञ्चविधं ग्रहम्||४२||
ज्वरमष्टविधं तस्य प्रकृष्टासन्नकारणम्|
ज्वरमष्टविधं तस्य प्रकृष्टासन्नकारणम्|
पूर्वरूपं च रूपं च भेषजं सङ्ग्रहेण च||४३||
पूर्वरूपं च रूपं च भेषजं सङ्ग्रहेण च||४३||
व्याजहार ज्वरस्याग्रे निदाने विगतज्वरः|
व्याजहार ज्वरस्याग्रे निदाने विगतज्वरः|
भगवानग्निवेशाय प्रणताय पुनर्वसुः||४४||
भगवानग्निवेशाय प्रणताय पुनर्वसुः||४४||
Tatra ślōkāḥ-
Tatra ślōkāḥ-
trividhaṁ nāmaparyāyairhetuṁ pañcavidhaṁ gadam.
trividhaṁ nāmaparyāyairhetuṁ pañcavidhaṁ gadam.
gadalakṣaṇaparyāyān vyādheḥ pañcavidhaṁ graham||42||
gadalakṣaṇaparyāyān vyādheḥ pañcavidhaṁ graham||42||
jwaramaṣṭavidhaṁ tasya prakr̥ṣṭāsannakāraṇam.
jwaramaṣṭavidhaṁ tasya prakr̥ṣṭāsannakāraṇam.
pūrvarūpaṁ ca rūpaṁ ca bheṣajaṁ saṅgraheṇa ca||43||
pūrvarūpaṁ ca rūpaṁ ca bheṣajaṁ saṅgraheṇa ca||43||
vyājahāra jwarasyāgre nidāne vigatajwaraḥ.
vyājahāra jwarasyāgre nidāne vigatajwaraḥ.
bhagavānagniveśāya praṇatāya punarvasuḥ||44||
bhagavānagniveśāya praṇatāya punarvasuḥ||44||
tatra shlokAH- trividhaM nAmaparyAyairhetuM pa~jcavidhaM gadam|
tatra shlokAH- trividhaM nAmaparyAyairhetuM pa~jcavidhaM gadam|
gadalakShaNaparyAyAn vyAdheH pa~jcavidhaM graham||42||
gadalakShaNaparyAyAn vyAdheH pa~jcavidhaM graham||42||
jvaramaShTavidhaM tasya prakRuShTAsannakAraNam|
jvaramaShTavidhaM tasya prakRuShTAsannakAraNam|
pUrvarUpaM ca rUpaM ca bheShajaM sa~ggraheNa ca||43||
pUrvarUpaM ca rUpaM ca bheShajaM sa~ggraheNa ca||43||
vyAjahAra jvarasyAgre nidAne vigatajvaraH|
vyAjahAra jvarasyAgre nidAne vigatajvaraH|
bhagavAnagniveshAya praNatAya punarvasuH||44||
bhagavAnagniveshAya praNatAya punarvasuH||44||
To summarize,
To summarize,
Three types of nidana of jwara, along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of jwara. [42-44]
Three types of ''nidana'' of ''jwara'', along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of ''jwara''. [42-44]
Thus ends the first chapter on diagnosis of fever in [[Nidana Sthana]] in the treatise composed by Agnivesha and reducted by Charaka. (1)
Tattva vimarsha:
=== ''Tattva Vimarsha'' ===
*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]
*Somatic diseases could be caused due to ''soma'' (''kapha''), ''agni'' (''pitta''), and ''vayu'' (''vata'') – due to vitiation of single ''dosha'', two ''doshas'', or all three ''doshas''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]
*A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5]
*The five key factors of ''jwara nidana'' that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]
*An ability to understand and observe unmanifested or premonitory signs is important to prevent the progression of a disease. [8]
*The signs of a disease could take the form of a cardinal feature, a structural lesion, marks, or a systemic disorder. [9]
*Pacification factors include diets, medications, and lifestyle regimen that help provide relief and comfort to the patient and are considered to be among the means to diagnose a disease. [10]
*The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season).
*''Jwara'' is the primary change observed in body that initiates a disease process. [16]
*All forms of ''jwara'' are caused due to vitiation of ''doshas'', which in turn have various causative factors (for their vitiation). [17]
*The important pathological events in process of ''jwara'' are as below:
**Vitiated ''doshas'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion
**Next, these ''doshas'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)
**This vitiated ''rasa'' blocks the ''rasavaha'' and ''swedavaha strotas'' (channels) that regulate body heat.
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
Vidhi Vimarsha:
*Exogenous factors may cause ''jwara'' by vitiating ''rakta'' (blood), and/or ''dosha''. [30]
Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in Nidana sthana should be incorporated in the upashaya (pacification factors). Nidana means the causative factor of the diseases. The term Vyadhibodhakam means the diagnosis of diseases with the help of nidana, poorvarupa, rupa, upashaya and samprapti. 1-2 [6]
*Rise in temperature? is a confirmative sign of ''jwara''. [32]
If diseases are not properly known, one cannot start the treatment. Therefore, Nidanapanchaka (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. [7]
*The light to digest diet and reduction therapy shall be started as soon as premonitory signs of ''jwara'' are observed. [36]
*The best advocated medicine for chronic ''jwara'' is Ghee due to its therapeutic efficacy of pacifying all three ''dosha''. [37]
=== ''Vidhi Vimarsha'' ===
Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in [[Nidana Sthana]] should be incorporated in the ''upashaya'' (pacification factors). ''Nidana'' means the causative factor of the diseases. The term ''vyadhibodhakam'' means the diagnosis of diseases with the help of ''nidana, poorvarupa, rupa, upashaya'' and ''samprapti''. 1-2 [6]
If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. [7]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
B. Second classification
Several types of classifications of ''Nidana'' are as under:
==== A.First Classification ====
There are four types of ''Nidana'':
#'''Sannikrishta''' (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of ''doshaprakopa'' like ''chaya'' etc., are known as ''sannikrishta''. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either.
#'''Viprakrishta''' (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of ''doshas'' to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of ''kapha dosha'' during ''Hemanta ritu'' (early winter season), causing diseases seen in ''Vasanta ritu''(spring season). ''Sannikrishta'' factors tend to use this foundation prepared by ''viprakrishta'' factors. As the diseases are immediately seen after the consumption of ''Sannikrishta'' factors, it gives the impression that the disease is caused only due to ''Sannikrishta'' factors. Thus, a disease cannot manifest independently by either ''Viprakrishta'' or ''Sannikrishta'' factors – it would require both.
#'''Vyabhichari''' (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable.
#'''Pradhanika''' (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as ''pradhanika hetu''.
==== B.Second classification ====
Per this classification, nidana could be of three types:
Per this classification, ''nidana'' could be of three types:
1. Asatmyendriyartha samyoga (Abnormal contact of the Indriyas, i.e., sensory & motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as Asatmyendriyarth Samyoga.
1. Asatmyendriyartha samyoga (Abnormal contact of the Indriyas, i.e., sensory & motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as Asatmyendriyarth Samyoga.