Jwara Chikitsa

Rasayana Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 3
Preceding Chapter	Vajikarana
Succeeding Chapter	Raktapitta Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 3, Chapter on the management of Jwara)

Abstract

This chapter on jwara is specially important from the standpoint of its management. It covers various endogenous and exogenous causes of jwara with its management principles. It encompasses a wide set of concepts related to diversified pathogenesis of diseases, including variations in dosha states, their degrees in less or severe form, clinical features and their management. The stages of disease and change in treatments need special attention. The important concept of functional aspects of disease involving psychogenic factors and affliction of unknown factors causing jwara are described in detail with their psycho-spiritual therapies. Do’s and don’ts during jwara and after its remission are applicable in every disease. The etio-pathogenesis and management of recurrence of jwara denotes importance of observing prescribed codes even after being free from disease. Due to the cardinal feature of raised body temperature or a perception of it, jwara is often considered synonymous with fever. However, it is not always necessary to consider jwara disease as fever, because it covers many other principles of management of disease. Modern medicine literature describes two components of fever, one where the cause or etiology is known and the other where it is unknown and is described as FUO (Fever of Unknown Origin). Thus, there is no curative treatment of FUO is available in modern medicine. On the other hand, this chapter describes important Ayurvedic concepts of jwara or fever which are important to understand the etiology of fever and thus the management.

Keywords: Jwara roga, Santapa, pitta fever, ushma, heat regulation.

Introduction

The first two chapters of Chikitsa Sthana describe rasayana and vajikarana to serve the first purpose of preservation, promotion, and rejuvenation of health. The second purpose – the treatment of disease - is dealt in subsequent chapters of this sthana. Jwara Chikitsa has been dealt first because Ayurveda holds that jwara is not merely the increase in body temperature (fever) but also a feeling of malaise, unease and discomfort, and involves the deha, indriya,and mana (physical body, sensory organs, and mind). While the balanced state of vata, pitta, and kapha manifest health by rhythmic circulation of fluids, digestion, metabolism, and nutrition respectively, their imbalance manifest as pain, increase in body heat, and inflammations. Jwara is an imbalanced state of pitta, which damages the physiology of digestion and metabolism. Inappropriately digested food transforms into a substance called amavisha which is a predisposing cause of many diseases. The initial manifestation of stagnated amavisha in rasa dhatu (plasma) is jwara. Thus, jwara is an important indication for the circulating amavisha and requires early treatment before its progression.

This chapter of Jwara Chikitsa establishes many guiding principles for treatment of various diseases described later in this section. These are classification, types, association with body tissues, and identification of progression, precautions and specific order of treatment. Causes and symptoms of recurrence and their remedies are widely described in this chapter.

Sanskrit text, Transliteration and English Translation

अथातो ज्वरचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō jwaracikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto jwaracikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

We shall now explain the chapter on the treatment of jwara (different types of fever).

Thus said lord Atreya.[1-2]

Queries of Agnivesha

विज्वरं ज्वरसन्देहं पर्यपृच्छत् पुनर्वसुम्| विविक्ते शान्तमासीनमग्निवेशः कृताञ्जलिः||३||

देहेन्द्रियमनस्तापी सर्वरोगाग्रजो बली| ज्वरः प्रधानो रोगाणामुक्तो भगवता पुरा||४||

तस्य प्राणिसपत्नस्य ध्रुवस्य प्रलयोदये| प्रकृतिं च प्रवृत्तिं च प्रभावं कारणानि च||५||

पूर्वरूपमधिष्ठानं बलकालात्मलक्षणम्| व्यासतो विधिभेदाच्च पृथग्भिन्नस्य चाकृतिम्||६||

लिङ्गमामस्य जीर्णस्य सौषधं च क्रियाक्रमम्| विमुञ्चतः प्रशान्तस्य चिह्नं यच्च पृथक् पृथक्||७||

ज्वरावसृष्टो रक्ष्यश्च यावत्कालं यतो यतः| प्रशान्तः कारणैर्यैश्च पुनरावर्तते ज्वरः||८||

याश्चापि पुनरावृत्तं क्रियाः प्रशमयन्ति तम्| जगद्धितार्थं तत् सर्वं भगवन्! वक्तुमर्हसि||९||

तदग्निवेशस्य वचो निशम्य गुरुरब्रवीत्| ज्वराधिकारे यद्वाच्यं तत् सौम्य! निखिलं शृणु||१०||

vijwaraṁ jwarasandēhaṁ paryapr̥cchat punarvasum| viviktē śāntamāsīnamagnivēśaḥ kr̥tāñjaliḥ||3||

dēhēndriyamanastāpī sarvarōgāgrajō balī| jwaraḥ pradhānō rōgāṇāmuktō bhagavatā purā||4||

tasya prāṇisapatnasya dhruvasya pralayōdayē| prakr̥tiṁ ca pravr̥ttiṁ ca prabhāvaṁ kāraṇāni ca||5||

pūrvarūpamadhiṣṭhānaṁ balakālātmalakṣaṇam| vyāsatō vidhibhēdācca [2] pr̥thagbhinnasya cākr̥tim||6||

liṅgamāmasya jīrṇasya sauṣadhaṁ ca kriyākramam| vimuñcataḥ praśāntasya cihnaṁ yacca pr̥thak pr̥thak||7||

jvarāvasr̥ṣṭō rakṣyaśca yāvatkālaṁ yatō yataḥ| praśāntaḥ kāraṇairyaiśca punarāvartatē jwaraḥ||8||

yāścāpi punarāvr̥ttaṁ kriyāḥ praśamayanti tam| jagaddhitārthaṁ tat sarvaṁ bhagavan! vaktumarhasi||9||

tadagnivēśasya vacō niśamya gururabravīt| jvarādhikārē yadvācyaṁ tat saumya! nikhilaṁ śr̥ṇu||10||

vijwaraM jwarasandehaM paryapRucchat punarvasum| vivikte shAntamAsInamagniveshaH kRutA~jjaliH||3||

dehendriyamanastApI sarvarogAgrajo balI| jwaraH pradhAno rogANAmukto bhagavatA purA||4||

tasya prANisapatnasya dhruvasya pralayodaye| prakRutiM ca pravRuttiM ca prabhAvaM kAraNAni ca||5||

pUrvarUpamadhiShThAnaM balakAlAtmalakShaNam| vyAsato vidhibhedAcca pRuthagbhinnasya cAkRutim||6||

li~ggamAmasya jIrNasya sauShadhaM ca kriyAkramam| vimu~jcataH prashAntasya cihnaM yacca pRuthak pRuthak||7||

jwaravasRuShTo rakShyashca yAvatkAlaM yato yataH| prashAntaH kAraNairyaishca punarAvartate jwaraH||8||

yAshcApi punarAvRuttaM kriyAH prashamayanti tam| jagaddhitArthaM tat sarvaM bhagavan! vaktumarhasi||9||

tadagniveshasya vaco nishamya gururabravIt| jwaradhikAre yadvAcyaM tat saumya! nikhilaM shRuNu||10||

Punarvasu, who was free from all types of diseases (jwara) and was having complete peace of mind, was sitting in a lonely place; where Agnivesha approached him and asked his queries about jwara with a modest namaskar (greeting, with hands folded).

Oh lord! You have already stated earlier that (in Nidana Sthana) “jwara afflicts the body, senses and the mind, is the first disease to be manifested, and is the principal and the most powerful disease.” This enemy of human beings is invariably associated with the birth and death of creatures. Therefore, kindly elucidate the following points for the benefit of the humanity –

• Prakriti or the nature of the disease
• Pravritti or origin of the disease
• Prabhava, the sequels of the disease
• Karana or the causative factors
• Purvarupa or the premonitory signs and symptoms
• Adhisthana or place of manifestation
• Bala kala or its severity and the time of manifestation
• Atma lakshana or cardinal features which are invariably associated with this disease
• Details of classification (vidhi bheda)
• Signs and symptoms of each type of the disease
• Sign and symptoms of ama jwara i.e. primary stage of the disease
• Sign and symptoms of jirna jwaraa i.e. chronic stage
• Drugs for the treatment of the disease
• Various therapeutic procedures
• Signs and symptoms that are manifested when the fever is getting cured, or when it is alleviated – both separately
• The duration for which the patient who has become free from a disease has to avoid certain regimens and the reasons for that
• The reasons for the reattack of the fever after it has subsided
• The therapies which should be administered in order to alleviate this reattack of this fever;

After hearing this statement of Agnivesha, the preceptor (Atreya) replied: “all these will be explained in this chapter on the description of fever. Oh benevolent one, listen to the details.”[3-10]

Synonyms of jwara

ज्वरो विकारो रोगश्च व्याधिरातङ्क एव च| एकोऽर्थो नामपर्यायैर्विविधैरभिधीयते||११||

jvarō vikārō rōgaśca vyādhirātaṅka ēva ca| ēkō'rthō nāmaparyāyairvividhairabhidhīyatē||11||

jvaro vikAro rogashca vyAdhirAta~gka eva ca| eko~artho nAmaparyAyairvividhairabhidhIyate||11||

Jwara, vikara, roga, vyadhi and atanka – these terms are synonymous and used to indicate this condition. [11]

Prakriti or nature of jwara

तस्य प्रकृतिरुद्दिष्टा दोषाः शारीरमानसाः| देहिनं न हि निर्दोषं ज्वरः समुपसेवते||१२||

क्षयस्तमो ज्वरः पाप्मा मृत्युश्चोक्ता यमात्मकाः| पञ्चत्वप्रत्ययान्नॄणां क्लिश्यतां स्वेन कर्मणा||१३||

इत्यस्य प्रकृतिः प्रोक्ता, ...|१४|

tasya prakr̥tiruddiṣṭā dōṣāḥ śārīramānasāḥ| dēhinaṁ na hi nirdōṣaṁ jwaraḥ samupasēvatē||12||

kṣayastamō jwaraḥ pāpmā mr̥tyuścōktā yamātmakāḥ| pañcatvapratyayānnr̥̄ṇāṁ kliśyatāṁ svēna karmaṇā||13||

ityasya prakr̥tiḥ prōktā, ...|14|

tasya prakRutiruddiShTA doShAH shArIramAnasAH| dehinaM na hi nirdoShaM jwaraH samupasevate||12||

kShayastamo jwaraH pApmA mRutyushcoktA yamAtmakAH| pa~jcatvapratyayAnnRUNAM klishyatAM svena karmaNA||13||

ityasya prakRutiH proktA, ...|14|

The three physical doshas and the two manasika doshas are the natural factors responsible for jwara (prakriti) as jwara cannot originate in a person having the balance of these three dosha (nirdosha – in the state of homeostasis). Therefore, these sharirika and manasika doshas are the prakriti of jwara.

Kshaya (emaciation), tama (feeling of entering into darkness), jwara, papma (manifestations of the sinful acts) and mrityu (death) are all the various presentations of Yamaraja (lord of deaths). These are the causes of death (panchatva) in individuals suffering from various grievances, due to their own deeds and hence have been accepted as equivalent to Yama (lord of death). In this way the prakriti (basic nature) of jwara has been described. [12-13]

Pravritti (origin of the disease)

... प्रवृत्तिस्तु परिग्रहात्| निदाने पूर्वमुद्दिष्टा रुद्रकोपाच्च दारुणात्||१४||

द्वितीये हि युगे शर्वमक्रोधव्रतमास्थितम्| दिव्यं सहस्रं वर्षाणामसुरा अभिदुद्रुवुः||१५||

तपोविघ्नाशनाः कर्तुं तपोविघ्नं महात्मनः| पश्यन् समर्थश्चोपेक्षां चक्रे दक्षः प्रजापतिः||१६||

पुनर्माहेश्वरं भागं ध्रुवं दक्षः प्रजापतिः| यज्ञे न कल्पयामास प्रोच्यमानः सुरैरपि||१७||

ऋचः पशुपतेर्याश्च शैव्य आहतयश्च याः| यज्ञसिद्धिप्रदास्ताभिर्हीनं चैव स इष्टवान्||१८||

अथोत्तीर्णव्रतो देवो बुद्ध्वा दक्षव्यतिक्रमम्| रुद्रो रौद्रं पुरस्कृत्य भावमात्मविदात्मनः||१९||

सृष्ट्वा ललाटे चक्षुर्वै दग्ध्वा तानसुरान् प्रभुः| बालं क्रोधाग्निसन्तप्तमसृजत् सत्रनाशनम्||२०||

ततो यज्ञः स विध्वस्तो व्यथिताश्च दिवौकसः| दाहव्यथापरीताश्च भ्रान्ता भूतगणा दिशः||२१||

अथेश्वरं देवगणः सह सप्तर्षिभिर्विभुम्| तमृग्भिरस्तुवन् यावच्छैवे भावे शिवः स्थितः||२२||

शिवं शिवाय भूतानां स्थितं ज्ञात्वा कृताञ्जलिः| भिया भस्मप्रहरणस्त्रिशिरा नवलोचनः||२३||

ज्वालामालाकुलो रौद्रो ह्रस्वजङ्घोदरः क्रमात्| क्रोधाग्निरुक्तवान् देवमहं किं करवाणि ते||२४||

तमुवाचेश्वरः क्रोधं ज्वरो लोके भविष्यसि| जन्मादौ निधने च त्वमपचारान्तरेषु च||२५||

... pravr̥ttistu parigrahāt| nidānē pūrvamuddiṣṭā rudrakōpācca dāruṇāt||14||

dvitīyē hi yugē śarvamakrōdhavratamāsthitam| divyaṁ sahasraṁ varṣāṇāmasurā abhidudruvuḥ||15||

tapōvighnāśanāḥ kartuṁ tapōvighnaṁ mahātmanaḥ| paśyan samarthaścōpēkṣāṁ cakrē dakṣaḥ prajāpatiḥ||16||

punarmāhēśvaraṁ bhāgaṁ dhruvaṁ dakṣaḥ prajāpatiḥ| yajñē na kalpayāmāsa prōcyamānaḥ surairapi||17||

r̥caḥ paśupatēryāśca śaivya āhatayaśca yāḥ| yajñasiddhipradāstābhirhīnaṁ caiva sa iṣṭavān||18||

athōttīrṇavratō dēvō buddhvā dakṣavyatikramam| rudrō raudraṁ puraskr̥tya bhāvamātmavidātmanaḥ||19||

sr̥ṣṭvā lalāṭē cakṣurvai dagdhvā tānasurān prabhuḥ| bālaṁ krōdhāgnisantaptamasr̥jat satranāśanam||20||

tatō yajñaḥ sa vidhvastō vyathitāśca divaukasaḥ| dāhavyathāparītāśca bhrāntā bhūtagaṇā diśaḥ||21||

athēśvaraṁ dēvagaṇaḥ saha saptarṣibhirvibhum| tamr̥gbhirastuvan yāvacchaivē bhāvē śivaḥ sthitaḥ||22||

śivaṁ śivāya bhūtānāṁ sthitaṁ jñātvā kr̥tāñjaliḥ| bhiyā bhasmapraharaṇastriśirā navalōcanaḥ||23||

jvālāmālākulō raudrō hrasvajaṅghōdaraḥ kramāt| krōdhāgniruktavān dēvamahaṁ kiṁ karavāṇi tē||24||

tamuvācēśvaraḥ krōdhaṁ jvarō lōkē bhaviṣyasi| janmādau nidhanē ca tvamapacārāntarēṣu ca||25||

... pravRuttistu parigrahAt| nidAne pUrvamuddiShTA rudrakopAcca dAruNAt||14||

dvitIye hi yuge sharvamakrodhavratamAsthitam| divyaM sahasraM varShANAmasurA abhidudruvuH||15||

tapovighnAshanAH kartuM tapovighnaM mahAtmanaH| pashyan samarthashcopekShAM cakre dakShaH prajApatiH||16||

punarmAheshvaraM bhAgaM dhruvaM dakShaH prajApatiH| yaj~je na kalpayAmAsa procyamAnaH surairapi||17||

RucaH pashupateryAshca shaivya Ahatayashca yAH| yaj~jasiddhipradAstAbhirhInaM caiva sa iShTavAn||18||

athottIrNavrato devo buddhvA dakShavyatikramam| rudro raudraM puraskRutya bhAvamAtmavidAtmanaH||19||

sRuShTvA lalATe cakShurvai dagdhvA tAnasurAn prabhuH| bAlaM krodhAgnisantaptamasRujat satranAshanam||20||

tato yaj~jaH sa vidhvasto vyathitAshca divaukasaH| dAhavyathAparItAshca bhrAntA bhUtagaNA dishaH||21||

atheshvaraM devagaNaH saha saptarShibhirvibhum| tamRugbhirastuvan yAvacchaive bhAve shivaH sthitaH||22||

shivaM shivAya bhUtAnAM sthitaM j~jAtvA kRutA~jjaliH| bhiyA bhasmapraharaNastrishirA navalocanaH||23||

jvAlAmAlAkulo raudro hrasvaja~gghodaraH kramAt| krodhAgniruktavAn devamahaM kiM karavANi te||24||

tamuvAceshvaraH krodhaM jvaro loke bhaviShyasi| janmAdau nidhane ca tvamapacArAntareShu ca||25||

The origin of jwara is because of the tendency for greed or attachment (parigraha). It has been described earlier in the Nidana Sthana that the origin of jwara resulted from the ferocious wrath of Rudra (Lord Shiva).

During the Treta Yuga (second age) Lord Shiva took a vow of not manifesting anger or wrath for one thousand celestial years. During this time the asuras (the demons) indulged in the creating obstruction, playing mischiefs and destroying the sacrament and the meditation of the rishis (sages). Daksha Prajapati was capable of combating these demons but he ignored his duties of opposing those demons and further organized a yajna (ritual of sacrifice) in which he did not offer any share to Lord Shiva in spite of being told to do so by the other lords. He even did not chant the hymns (richa) described in the veda of lord Shiva which provide fulfilment to the desired objective of yajna and even did not offer ahuti (pouring of ghee in the sacrificial fire) to Lord Shiva. Lord Shiva perceived whole of this situation regarding Daksha Prajapati’s non observance of rules and became angry. He then brought forward his Raudra (wrathful) bhava (nature) and opened his third eye, destroying all those demons by burning them and further gave rise to a child like form named Virabhadra to his wrath, who was stuffed with his anger and was capable of destroying the yajna of Daksha. That child demolished the yajna of Daksha Prajapati as a result of which the gods got afflicted with burning sensation and pain and started running in different directions and became afflicted. Then the gods along with the seven rishis offered those substantial hymns to Lord Shiva till he became pleased and switched over to his Shiva (the compassionate or benevolent and auspicious) form. When it was known that Lord Shiva is returned to his auspicious disposition, then Virabhadra who was produced from the wrathful fire of Lord Shiva, who had three heads and nine eyes, used ash as his weapon, had the flame of his fire as his garland, was wrathful, had frightful and small thighs and stomach approached lord Shiva with folded hands and enquired about his future work. Lord Shiva replied to him that “you will become jwara in this world and afflict people in the beginning of life – at birth and at the time of death and will also afflict those who will resort to erratic regimen.”[14-25]

Prabhava, the sequels of the disease

सन्तापः सारुचिस्तृष्णा साङ्गमर्दो हृदि व्यथा| ज्वरप्रभावो, जन्मादौ निधने च महत्तमः||२६||

प्रकृतिश्च प्रवृत्तिश्च प्रभावश्च प्रदर्शितः|२७|

santāpaḥ sārucistr̥ṣṇā sāṅgamardō hr̥di vyathā| jwaraprabhāvō, janmādau nidhanē ca mahattamaḥ||26||

prakr̥tiśca pravr̥ttiśca prabhāvaśca pradarśitaḥ|27|

santApaH sArucistRuShNA sA~ggamardo hRudi vyathA| jwaraprabhAvo, janmAdau nidhane ca mahattamaH||26||

prakRutishca pravRuttishca prabhAvashca pradarshitaH|27|

Santapa (feeling of heat or raised temperature), aruchi (anorexia), trishna (morbid thirst), angamarda (body ache), hrid vyatha (pain in the cardiac region) – these are the invariable manifestations of jwara. At the time of birth and death, jwara is manifested in the form of tamas (moha- altered state of consciousness). In this way the prakriti (nature), pravritti (origin) and the prabhava (invariable manifestations) of jwara are described. [26-27]

निदाने कारणान्यष्टौ पूर्वोक्तानि विभागशः||२७||

nidānē kāraṇānyaṣṭau pūrvōktāni vibhāgaśaḥ||27||

nidAne kAraNAnyaShTau pUrvoktAni vibhAgashaH||27||

Earlier in the Nidana Sthana the etiological factors for each of the eight varieties of jwara have been described separately. [27]

Premonitory symptoms of jwara

आलस्यं नयने सास्रे जृम्भणं गौरवं क्रमः| ज्वलनातपवाय्वम्बुभक्तिद्वेषावनिश्चितौ||२८||

अविपाकास्यवैरस्ये हानिश्च बलवर्णयोः| शीलवैकृतमल्पं च ज्वरलक्षणमग्रजम्||२९||

ālasyaṁ nayanē sāsrē jr̥mbhaṇaṁ gauravaṁ kramaḥ| jvalanātapavāyvambubhaktidvēṣāvaniścitau||28||

avipākāsyavairasyē hāniśca balavarṇayōḥ| śīlavaikr̥tamalpaṁ ca jwaralakṣaṇamagrajam||29||

AlasyaM nayane sAsre jRumbhaNaM gauravaM kramaH| jvalanAtapavAyvambubhaktidveShAvanishcitau||28||

avipAkAsyavairasye hAnishca balavarNayoH| shIlavaikRutamalpaM ca jwaralakShaNamagrajam||29||

Laziness, lacrimation, yawning, heaviness, mental fatigue, uncertainty and intolerance about the liking and disliking for the heat, sun, wind and water; indigestion, anorexia, depletion in strength, complexion, and slight change in conduct, are the premonitory signs and symptoms of jwara.[28-29]

Sites of jwara

केवलं समनस्कं च ज्वराधिष्ठानमुच्यते| शरीरं, बलकालस्तु निदाने सम्प्रदर्शितः||३०||

kēvalaṁ samanaskaṁ ca jvarādhiṣṭhānamucyatē| śarīraṁ, balakālastu nidānē sampradarśitaḥ||30||

kevalaM samanaskaM ca jwaradhiShThAnamucyate| sharIraM, balakAlastu nidAne sampradarshitaH||30||

The whole body and the mind are the sites of manifestation of jwara. The severity and the time of manifestation of jwara have been described in Nidana Sthana.[30]

Cardinal feature

ज्वरप्रत्यात्मिकं लिङ्गं सन्तापो देहमानसः| ज्वरेणाविशता भूतं न हि किञ्चिन्न तप्यते||३१||

jwarapratyātmikaṁ liṅgaṁ santāpō dēhamānasaḥ| jvarēṇāviśatā bhūtaṁ na hi kiñcinna tapyatē||31||

jwarapratyAtmikaM li~ggaM santApo dehamAnasaH| jvareNAvishatA bhUtaM na hi ki~jcinna tapyate||31||

The clinical features invariably associated with jwara are the feeling of heat or increased body temperature and discomfort in body and mind. Jwara afflicts the whole body including mind and sensory organs in all living beings. [31]

Classification

द्विविधो विधिभेदेन ज्वरः शारीरमानसः| पुनश्च द्विविधो दृष्टः सौम्यश्चाग्नेय एव वा||३२||

अन्तर्वेगो बहिर्वेगो द्विविधः पुनरुच्यते| प्राकृतो वैकृतश्चैव साध्यश्चासाध्य एव च||३३||

पुनः पञ्चविधो दृष्टो दोषकालबलाबलात्| सन्ततः सततोऽन्येद्युस्तृतीयकचतुर्थकौ||३४||

पुनराश्रयभेदेन धातूनां सप्तधा मतः| भिन्नः कारणभेदेन पुनरष्टविधो ज्वरः||३५||

dvividhō vidhibhēdēna jwaraḥ śārīramānasaḥ| punaśca dvividhō dr̥ṣṭaḥ saumyaścāgnēya ēva vā||32||

antarvēgō bahirvēgō dvividhaḥ punarucyatē| prākr̥tō vaikr̥taścaiva sādhyaścāsādhya ēva ca||33||

punaḥ pañcavidhō dr̥ṣṭō dōṣakālabalābalāt| santataḥ satatō'nyēdyustr̥tīyakacaturthakau||34||

punarāśrayabhēdēna dhātūnāṁ saptadhā mataḥ| bhinnaḥ kāraṇabhēdēna punaraṣṭavidhō jwaraḥ||35||

dvividho vidhibhedena jwaraH shArIramAnasaH| punashca dvividho dRuShTaH saumyashcAgneya eva vA||32||

antarvego bahirvego dvividhaH punarucyate| prAkRuto vaikRutashcaiva sAdhyashcAsAdhya eva ca||33||

punaH pa~jcavidho dRuShTo doShakAlabalAbalAt| santataH satato~anyedyustRutIyakacaturthakau||34||

punarAshrayabhedena dhAtUnAM saptadhA mataH| bhinnaH kAraNabhedena punaraShTavidho jwaraH||35||

Jwara is classified into two types each on the basis of the following criteria –

• Sharira (physical) and manasa (mental)
• Saumya (predominated by cold) and agneya (predominated by heat)
• Antarvega (internal) and bahirvega (external)
• prakrita (according to seasons) and vaikrita (unseasonal)
• sadhya (curable) and asadhya (incurable)

Jwara is again classified into five categories depending upon the strength and weakness of dosha and the time. These are intermittent in nature:

1. Santata
2. Satata
3. Anyedushka
4. Tritiyaka
5. Chaturthaka.

Depending upon the ashraya (site of manifestation in the body) among the seven dhatus (body tissues) jwara is again classified into seven categories.

Jwara is classified into eight types on the basis of eight causes of jwara (dosha predominance). [32-35]

Clinical features of somatic and psychic jwara

शारीरो जायते पूर्वं देहे, मनसि मानसः| वैचित्त्यमरतिर्ग्लानिर्मनसस्तापलक्षणम्||३६||

इन्द्रियाणां च वैकृत्यं ज्ञेयं सन्तापलक्षणम्|३७|

śārīrō jāyatē pūrvaṁ dēhē, manasi mānasaḥ| vaicittyamaratirglānirmanasastāpalakṣaṇam||36||

indriyāṇāṁ ca vaikr̥tyaṁ jñēyaṁ santāpalakṣaṇam|37|

shArIro jAyate pUrvaM dehe, manasi mAnasaH| vaicittyamaratirglAnirmanasastApalakShaNam||36||

indriyANAM ca vaikRutyaM j~jeyaM santApalakShaNam|37|

The sharira type of jwara first appears in the body and the manasa type, first appears in the mind. Vaichitya (mental instability), arati (disliking for everything) and glani (feeling of weakness in the body) are the signs and symptoms of the manas tapa (mental affliction of jwara). The loss of ease in sensing the objects is the feature of the santapa of the indriya. [36-37]

Desires of patient to diagnose dosha dominance

वातपित्तात्मकः शीतमुष्णं वातकफात्मकः||३७||

इच्छत्युभयमेतत्तु ज्वरो व्यामिश्रलक्षणः|३८|

vātapittātmakaḥ śītamuṣṇaṁ vātakaphātmakaḥ||37||

icchatyubhayamētattu jvarō vyāmiśralakṣaṇaḥ|38|

vAtapittAtmakaH shItamuShNaM vAtakaphAtmakaH||37||

icchatyubhayametattu jvaro vyAmishralakShaNaH|38|

A patient suffering from vatapittaja variety of jwara desires for cold things, while, a patient suffering from jwara caused by vata and kapha dosha longs for hot things. However, when both of these types of doshas get mixed then such patient manifests both the kinds of symptoms. [37-38]

Attenuating nature of vata dosha

योगवाहः परं वायुः संयोगादुभयार्थकृत्||३८||

दाहकृत्तेजसा युक्तः, शीतकृत् सोमसंश्रयात्|३९|

yōgavāhaḥ paraṁ vāyuḥ saṁyōgādubhayārthakr̥t||38||

dāhakr̥ttējasā yuktaḥ, śītakr̥t sōmasaṁśrayāt|39|

yogavAhaH paraM vAyuH saMyogAdubhayArthakRut||38||

dAhakRuttejasA yuktaH, shItakRut somasaMshrayAt|39|

Vata dosha is exceedingly yogavahi (which accentuates the properties of others) in nature. It produces both type of effects on combination with the two doshas. On combining with tejas it produces burning sensation while in combination with soma it produces cooling effect. [38-39]

Features of internal and external jwara

अन्तर्दाहोऽधिकस्तृष्णा प्रलापः श्वसनं भ्रमः||३९||

सन्ध्यस्थिशूलमस्वेदो दोषवर्चोविनिग्रहः| अन्तर्वेगस्य लिङ्गानि ज्वरस्यैतानि लक्षयेत्||४०||

सन्तापोऽभ्यधिको बाह्यस्तृष्णादीनां च मार्दवम्| बहिर्वेगस्य लिङ्गानि सुखसाध्यत्वमेव च||४१||

antardāhō'dhikastr̥ṣṇā pralāpaḥ śvasanaṁ bhramaḥ||39||

sandhyasthiśūlamasvēdō dōṣavarcōvinigrahaḥ| antarvēgasya liṅgāni jwarasyaitāni lakṣayēt||40||

santāpō'bhyadhikō bāhyastr̥ṣṇādīnāṁ ca mārdavam| bahirvēgasya liṅgāni sukhasādhyatvamēva ca||41||

antardAho~adhikastRuShNA pralApaH shvasanaM bhramaH||39||

sandhyasthishUlamasvedo doShavarcovinigrahaH| antarvegasya li~ggAni jwarasyaitAni lakShayet||40||

santApo~abhyadhiko bAhyastRuShNAdInAM ca mArdavam| bahirvegasya li~ggAni sukhasAdhyatvameva ca||41||

Excessive burning sensation inside the body, morbid thirst, delirium, dyspnea, giddiness, pain in bones and joints, absence of sweating, non-excretion of doshas and the feces – are the clinical features of antarvegi jwara (internal manifestation of jwara).

Excessive rise in the body temperature and above features in mild form are the features of bahirvegi (external type of jwara) and this type of jwara is easily curable. [39-41]

Prakrita jwara(seasonal jwara)

प्राकृतः सुखसाध्यस्तु वसन्तशरदुद्भवः| उष्णमुष्णेन संवृद्धं पित्तं शरदि कुप्यति||४२||

चितः शीते कफश्चैवं वसन्ते समुदीर्यते| वर्षास्वम्लविपाकाभिरद्भिरोषधिभिस्तथा||४३||

सञ्चितं पित्तमुद्रिक्तं शरद्यादित्यतेजसा| ज्वरं सञ्जनयत्याशु तस्य चानुबलः कफः||४४||

प्रकृत्यैव विसर्गस्य तत्र नानशनाद्भयम्| अद्भिरोषधिभिश्चैव मधुराभिश्चितः कफः||४५||

हेमन्ते, सूर्यसन्तप्तः स वसन्ते प्रकुप्यति| वसन्ते श्लेष्मणा तस्माज्ज्वरः समुपजायते||४६||

आदानमध्ये तस्यापि वातपित्तं भवेदनु| आदावन्ते च मध्ये च बुद्ध्वा दोषबलाबलम्||४७||

शरद्वसन्तयोर्विद्वाञ्ज्वरस्य प्रतिकारयेत्| कालप्रकृतिमुद्दिश्य निर्दिष्टः प्राकृतो ज्वरः||४८||

प्रायेणानिलजो दुःखः कालेष्वन्येषु वैकृतः| हेतवो विविधास्तस्य निदाने सम्प्रदर्शिताः||४९||

prākr̥taḥ sukhasādhyastu vasantaśaradudbhavaḥ| uṣṇamuṣṇēna saṁvr̥ddhaṁ pittaṁ śaradi kupyati||42||

citaḥ śītē kaphaścaivaṁ vasantē samudīryatē| varṣāsvamlavipākābhiradbhirōṣadhibhistathā||43||

sañcitaṁ pittamudriktaṁ śaradyādityatējasā| jwaraṁ sañjanayatyāśu tasya cānubalaḥ kaphaḥ||44||

prakr̥tyaiva visargasya tatra nānaśanādbhayam| adbhirōṣadhibhiścaiva madhurābhiścitaḥ kaphaḥ||45||

hēmantē, sūryasantaptaḥ sa vasantē prakupyati| vasantē ślēṣmaṇā tasmājjwaraḥ samupajāyatē||46||

ādānamadhyē tasyāpi vātapittaṁ bhavēdanu| ādāvantē ca madhyē ca buddhvā dōṣabalābalam||47||

śaradvasantayōrvidvāñjwarasya pratikārayēt| kālaprakr̥timuddiśya nirdiṣṭaḥ prākr̥tō jwaraḥ||48||

prāyēṇānilajō duḥkhaḥ kālēṣvanyēṣu vaikr̥taḥ| hētavō vividhāstasya nidānē sampradarśitāḥ||49||

prAkRutaH sukhasAdhyastu vasantasharadudbhavaH| uShNamuShNena saMvRuddhaM pittaM sharadi kupyati||42||

citaH shIte kaphashcaivaM vasante samudIryate| varShAsvamlavipAkAbhiradbhiroShadhibhistathA||43||

sa~jcitaM pittamudriktaM sharadyAdityatejasA| jwaraM sa~jjanayatyAshu tasya cAnubalaH kaphaH||44||

prakRutyaiva visargasya tatra nAnashanAdbhayam| adbhiroShadhibhishcaiva madhurAbhishcitaH kaphaH||45||

hemante, sUryasantaptaH sa vasante prakupyati| vasante shleShmaNA tasmAjjwaraH samupajAyate||46||

AdAnamadhye tasyApi vAtapittaM bhavedanu| AdAvante ca madhye ca buddhvA doShabalAbalam||47||

sharadvasantayorvidvA~jjwarasya pratikArayet| kAlaprakRutimuddishya nirdiShTaH prAkRuto jwaraH||48||

prAyeNAnilajo duHkhaH kAleShvanyeShu vaikRutaH| hetavo vividhAstasya nidAne sampradarshitAH||49||

Jwara manifesting in the vasanta or spring season and sharada or autumn season is called prakrita (seasonal) jwara and is easily curable.

Pitta gets aggravated during autumn season because of its inherent hot properties and hot environment. Kapha gets accumulated in winters and gets aggravated during spring season.

The water and drugs (including the eatables) become sour in vipaka (taste that emerges after digestion) during the rainy season, which results in the accumulation of pitta. This accumulated pitta gets aggravated or excited (by the hot sunrays) during the autumn season. This can immediately produce jwara in which kapha dosha is secondarily associated. As vasanta is the part of visarga kala (the time of year when, body has good strength imparted by nature), no problem is created by fasting.

During hemanta (early winter) the water and drugs (including eatables) become sweet in taste, which helps in accumulation of kapha. This kapha gets aggravated during the subsequent spring season due to the strong sunrays (which melt this kapha). Therefore, jwara caused by kapha is manifested during the spring season. The spring is the part of the adana kala (the time when the strength of the creatures is the least as the nature withdraws the strength) and in the jwara caused in this period vata and pitta dosha constitute the secondary associates.

A patient of jwara should be treated keeping in view the strength of the doshas in the beginning, middle and the end of the spring and autumn seasons. This way, depending upon the nature of the seasons, the seasonal types of jwara are described.

Vaikrita jwara

Generally, the jwara caused by vata dosha is difficult to treat in every season. The other types of jwara, get their initial strength from the predominant season, those are (Vaikrita jwara) difficult to treat are –

• vatika jwara irrespective of its season of occurrence
• paitika jwara occurring in seasons other than autumn and
• kaphaja jwara occurring in seasons other than spring.

The causative factors of the different types of jwara have been described in Nidana Sthana (in jwara). [42-49]

Prognosis of jwara

बलवत्स्वल्पदोषेषु ज्वरः साध्योऽनुपद्रवः| हेतुभिर्बहुभिर्जातो बलिभिर्बहुलक्षणः||५०||

ज्वरः प्राणान्तकृद्यश्च शीघ्रमिन्द्रियनाशनः| सप्ताहाद्वा दशाहाद्वा द्वादशाहात्तथैव च||५१||

सप्रलापभ्रमश्वासस्तीक्ष्णो हन्याज्ज्वरो नरम्| ज्वरः क्षीणस्य शूनस्य गम्भीरो दैर्घरात्रिकः||५२||

असाध्यो बलवान् यश्च केशसीमन्तकृज्ज्वरः|५३|

balavatsvalpadōṣēṣu jwaraḥ sādhyō'nupadravaḥ| hētubhirbahubhirjātō balibhirbahulakṣaṇaḥ||50||

jwaraḥ prāṇāntakr̥dyaśca śīghramindriyanāśanaḥ| saptāhādvā daśāhādvā dvādaśāhāttathaiva ca||51||

sapralāpabhramaśvāsastīkṣṇō hanyājjvarō naram| jwaraḥ kṣīṇasya śūnasya gambhīrō dairgharātrikaḥ||52||

asādhyō balavān yaśca kēśasīmantakr̥jjwaraḥ|53|

balavatsvalpadoSheShu jwaraH sAdhyo~anupadravaH| hetubhirbahubhirjAto balibhirbahulakShaNaH||50||

jwaraH prANAntakRudyashca shIghramindriyanAshanaH| saptAhAdvA dashAhAdvA dvAdashAhAttathaiva ca||51||

sapralApabhramashvAsastIkShNo hanyAjjvaro naram| jwaraH kShINasya shUnasya gambhIro dairgharAtrikaH||52||

asAdhyo balavAn yashca keshasImantakRujjwaraH|53|

Sadhya (curable) jwara

Jwara is easily curable if it occurs in a person with strong physique, or if it is caused by the vitiation of lesser amount of dosha and if there are no complications.

Asadhya (incurable) jwara

Jwara having the following characteristics are incurable and lead to death –

• Which is caused by either greater amount of / strong etiological factors
• Which manifests with many clinical features
• Which destroys the sense organs immediately.

Bad prognosis:

Tikshna jwara (severe, associated with delirium, giddiness and breathlessness causes death of the patient either on the seventh, tenth or twelfth day.

Jwara occurring in a weak and emaciated person (kshina), associated with edema (shunasya), seated in deeper body tissues (gambhira), severe (balvan) and that occurring for very long durations (dirgha ratrika) are incurable ones. The jwara in which, the mid hair part of scalp becomes visible, is also considered incurable (kesha simanta krita).[49-53]

Five types of jwara as per frequency

Santata jwara

स्रोतोभिर्विसृता दोषा गुरवो रसवाहिभिः||५३||

सर्वदेहानुगाः स्तब्धा ज्वरं कुर्वन्ति सन्ततम्| दशाहं द्वादशाहं वा सप्ताहं वा सुदुःसहः||५४||

स शीघ्रं शीघ्रकारित्वात् प्रशमं याति हन्ति वा| कालदूष्यप्रकृतिभिर्दोषस्तुल्यो हि सन्ततम्||५५||

निष्प्रत्यनीकः कुरुते तस्माज्ज्ञेयः सुदुःसहः| यथा धातूंस्तथा मूत्रं पुरीषं चानिलादयः||५६||

युगपच्चानुपद्यन्ते नियमात् सन्तते ज्वरे| स शुद्ध्या वाऽप्यशुद्ध्या वा रसादीनामशेषतः||५७||

सप्ताहादिषु कालेषु प्रशमं याति हन्ति वा| यदा तु नातिशुध्यन्ति न वा शुध्यन्ति सर्वशः||५८||

द्वादशैते समुद्दिष्टाः सन्ततस्याश्रयास्तदा| विसर्गं द्वादशे कृत्वा दिवसेऽव्यक्तलक्षणम्||५९||

दुर्लभोपशमः कालं दीर्घमप्यनुवर्तते| इति बुद्ध्वा ज्वरं वैद्य उपक्रामेत्तु सन्ततम् ||६०||

क्रियाक्रमविधौ युक्तः प्रायः प्रागपतर्पणैः|६१|

srōtōbhirvisr̥tā dōṣā guravō rasavāhibhiḥ||53||

sarvadēhānugāḥ stabdhā jwaraṁ kurvanti santatam| daśāhaṁ dvādaśāhaṁ vā saptāhaṁ vā suduḥsahaḥ||54||

sa śīghraṁ śīghrakāritvāt praśamaṁ yāti hanti vā| kāladūṣyaprakr̥tibhirdōṣastulyō hi santatam||55||

niṣpratyanīkaḥ kurutē tasmājjñēyaḥ suduḥsahaḥ| yathā dhātūṁstathā mūtraṁ purīṣaṁ cānilādayaḥ||56||

yugapaccānupadyantē niyamāt santatē jvarē| sa śuddhyā vā'pyaśuddhyā vā rasādīnāmaśēṣataḥ||57||

saptāhādiṣu kālēṣu praśamaṁ yāti hanti vā| yadā tu nātiśudhyanti na vā śudhyanti sarvaśaḥ||58||

dvādaśaitē samuddiṣṭāḥ santatasyāśrayāstadā| visargaṁ dvādaśē kr̥tvā divasē'vyaktalakṣaṇam||59||

durlabhōpaśamaḥ kālaṁ dīrghamapyanuvartatē| iti buddhvā jwaraṁ vaidya upakrāmēttu santatam ||60||

kriyākramavidhau yuktaḥ prāyaḥ prāgapatarpaṇaiḥ|61|

srotobhirvisRutA doShA guravo rasavAhibhiH||53||

sarvadehAnugAH stabdhA jwaraM kurvanti santatam| dashAhaM dvAdashAhaM vA saptAhaM vA suduHsahaH||54||

sa shIghraM shIghrakAritvAt prashamaM yAti hanti vA| kAladUShyaprakRutibhirdoShastulyo hi santatam||55||

niShpratyanIkaH kurute tasmAjj~jeyaH suduHsahaH| yathA dhAtUMstathA mUtraM purIShaM cAnilAdayaH||56||

yugapaccAnupadyante niyamAt santate jvare| sa shuddhyA vA~apyashuddhyA vA rasAdInAmasheShataH||57||

saptAhAdiShu kAleShu prashamaM yAti hanti vA| yadA tu nAtishudhyanti na vA shudhyanti sarvashaH||58||

dvAdashaite samuddiShTAH santatasyAshrayAstadA| visargaM dvAdashe kRutvA divase~avyaktalakShaNam||59||

durlabhopashamaH kAlaM dIrghamapyanuvartate| iti buddhvA jwaraM vaidya upakrAmettu santatam ||60||

kriyAkramavidhau yuktaH prAyaH prAgapatarpaNaiH|61|

The aggravated dosha circulate through the channels carrying rasa (the first nutritional dhatu equivalent to plasma) and spread all over the body and gets stagnated, causes santata jwara. This santata jwara is extremely difficult to treat and manifests its symptoms very quickly. In this type the patient either gets cured (on the pacification of dosha) or killed (on the further aggravation of dosha) on the 10th, 12th or 7th day.

The dosha involved in the manifestation of santata jwara is in accordance with season (kala), vitiated factors (dushya), and the physical constitution of the patient (prakriti) due to which it is nispratyanika (having no opponent / which cannot be inhibited). Thus, it is known to be unbearable.

Additionally, the other dhatu, urine, stool and vata etc. dosha, also get affected simultaneously in this fever. If the involved factors like rasa are purified optimally the fever gets subsided in either 7 or 10 or 12 days, otherwise, the fever kills the patient within that period.

If, some of the 12 constituents of this fever get purified, while some others remain unpurified, then the fever goes in latent stage on the 12th day and reappears on the 13th day and may persist for longer duration. In this way, a physician should understand the causes and features of this type of fever and should initiate the treatment only after a proper understanding of these factors, mostly by the methods beginning with apatarpana. [53-61]

Satata jwara

रक्तधात्वाश्रयः प्रायो दोषः सततकं ज्वरम्||६१||

सप्रत्यनीकः कुरुते कालवृद्धिक्षयात्मकम्| अहोरात्रे सततको द्वौ कालावनुवर्तते||६२||

raktadhātvāśrayaḥ prāyō dōṣaḥ satatakaṁ jwaram||61||

sapratyanīkaḥ kurutē kālavr̥ddhikṣayātmakam| ahōrātrē satatakō dvau kālāvanuvartatē||62||

raktadhAtvAshrayaH prAyo doShaH satatakaM jwaram||61||

sapratyanIkaH kurute kAlavRuddhikShayAtmakam| ahorAtre satatako dvau kAlAvanuvartate||62||

The aggravated dosha when generally lodges in the rakta dhatu, then they manifest with fever twice in 24 hours (Nycthemeron) depending on the time of dosha aggravation or subsidence. The dosha in this type of jwara can be counteracted. [61-62]

Anyedyushka jwara

कालप्रकृतिदूष्याणां प्राप्यैवान्यतमाद्बलम्| अन्येद्युष्कं ज्वरं दोषो रुद्ध्वा मेदोवहाः सिराः||६३||

सप्रत्यनीको जनयत्येककालमहर्निशि|

kālaprakr̥tidūṣyāṇāṁ prāpyaivānyatamādbalam| anyēdyuṣkaṁ jwaraṁ dōṣō ruddhvā mēdōvahāḥ sirāḥ||63||

sapratyanīkō janayatyēkakālamaharniśi|

kAlaprakRutidUShyANAM prApyaivAnyatamAdbalam| anyedyuShkaM jwaraM doSho ruddhvA medovahAH sirAH||63||

sapratyanIko janayatyekakAlamaharnishi|

Vitiated dosha produce anyedushka type of jwara with the support of any one factor amongst the kala (time), prakriti (physical constitution) and dushya (vitiated factors) leading to obstruction in medo vaha sira (the channel of circulation of medasa (fat)). It can be counteracted. This jwara occurs only once during day and night. [63-64]

Tritiyaka and chaturthaka jwara

दोषोऽस्थिमज्जगः कुर्यात्तृतीयकचतुर्थकौ||६४||

गतिर्द्व्येकान्तराऽन्येद्युर्दोषस्योक्ताऽन्यथा परैः| अन्येद्युष्कं ज्वरं कुर्यादपि संश्रित्य शोणितम्||६५||

मांसस्रोतांस्यनुगतो जनयेत्तु तृतीयकम्| संश्रितो मेदसो मार्गं दोषश्चापि चतुर्थकम् ||६६||

अन्येद्युष्कः प्रतिदिनं दिनं हित्वा तृतीयकः| दिनद्वयं यो विश्रम्य प्रत्येति स चतुर्थकः||६७||

dōṣō'sthimajjagaḥ kuryāttr̥tīyakacaturthakau||64||

gatirdvyēkāntarā'nyēdyurdōṣasyōktā'nyathā paraiḥ| anyēdyuṣkaṁ jwaraṁ kuryādapi saṁśritya śōṇitam||65||

māṁsasrōtāṁsyanugatō janayēttu tr̥tīyakam| saṁśritō mēdasō mārgaṁ dōṣaścāpi caturthakam ||66||

anyēdyuṣkaḥ pratidinaṁ dinaṁ hitvā tr̥tīyakaḥ| dinadvayaṁ yō viśramya pratyēti sa caturthakaḥ||67||

doSho~asthimajjagaH kuryAttRutIyakacaturthakau||64||

gatirdvyekAntarA~anyedyurdoShasyoktA~anyathA paraiH| anyedyuShkaM jwaraM kuryAdapi saMshritya shoNitam||65||

mAMsasrotAMsyanugato janayettu tRutIyakam| saMshrito medaso mArgaM doShashcApi caturthakam ||66||

anyedyuShkaH pratidinaM dinaM hitvA tRutIyakaH| dinadvayaM yo vishramya pratyeti sa caturthakaH||67||

When the dosha afflict the asthi dhatu (bone tissue) and majja dhatu (bone marrow), they cause the tritiyaka and chaturthaka jwara respectively.

Some scholars opine that the different types of jwara viz the anyedushaka, tritiyaka and chaturthaka jwara manifest because of the affliction of the some alternate dhatu by the dosha. Anyedushyaka jwara is caused by the affliction of rakta dhatu (blood) also. Tritiyaka jwara manifests when the dosha afflict the mansa dhatu (muscular tissues). Dosha lodging in the channels of circulation of medo dhatu cause chaturthaka jwara.

Anyedushka jwara occurs every day, while tritiyaka jwara occurs after a gap of one day and chaurthaka occurs after two days gap. [64-67]

Cause of alterations in jwara episodes

अधिशेते यथा भूमिं बीजं काले च रोहति| अधिशेते तथा धातुं दोषः काले च कुप्यति||६८||

स वृद्धिं बलकालं च प्राप्य दोषस्तृतीयकम्| चतुर्थकं च कुरुते प्रत्यनीकबलक्षयात्||६९||

कृत्वा वेगं गतबलाः स्वे स्वे स्थाने व्यवस्थिताः| पुनर्विवृद्धाः स्वे काले ज्वरयन्ति नरं मलाः||७०||

कफपित्तात्त्रिकग्राही पृष्ठाद्वातकफात्मकः| वातपित्ताच्छिरोग्राही त्रिविधः स्यात्तृतीयकः||७१||

चतुर्थको दर्शयति प्रभावं द्विविधं ज्वरः| जङ्घाभ्यां श्लैष्मिकः पूर्वं शिरस्तोऽनिलसम्भवः||७२||

adhiśētē yathā bhūmiṁ bījaṁ kālē ca rōhati| adhiśētē tathā dhātuṁ dōṣaḥ kālē ca kupyati||68||

sa vr̥ddhiṁ balakālaṁ ca prāpya dōṣastr̥tīyakam| caturthakaṁ ca kurutē pratyanīkabalakṣayāt||69||

kr̥tvā vēgaṁ gatabalāḥ svē svē sthānē vyavasthitāḥ| punarvivr̥ddhāḥ svē kālē jwarayanti naraṁ malāḥ||70||

kaphapittāttrikagrāhī pr̥ṣṭhādvātakaphātmakaḥ| vātapittācchirōgrāhī trividhaḥ syāttr̥tīyakaḥ||71||

caturthakō darśayati prabhāvaṁ dvividhaṁ jwaraḥ| jaṅghābhyāṁ ślaiṣmikaḥ pūrvaṁ śirastō'nilasambhavaḥ||72||

adhishete yathA bhUmiM bIjaM kAle ca rohati| adhishete tathA dhAtuM doShaH kAle ca kupyati||68||

sa vRuddhiM balakAlaM ca prApya doShastRutIyakam| caturthakaM ca kurute pratyanIkabalakShayAt||69||

kRutvA vegaM gatabalAH sve sve sthAne vyavasthitAH| punarvivRuddhAH sve kAle jwarayanti naraM malAH||70||

kaphapittAttrikagrAhI pRuShThAdvAtakaphAtmakaH| vAtapittAcchirogrAhI trividhaH syAttRutIyakaH||71||

caturthako darshayati prabhAvaM dvividhaM jwaraH| ja~gghAbhyAM shlaiShmikaH pUrvaM shirasto~anilasambhavaH||72||

As a seed remains dormant in the soil and germinates at a favorable time, similarly the doshas remain in dormant condition in the dhatu and get aggravated at a favorable time. These dosha gain strength at an appropriate time and when the power of the inhibiting (disease preventing) factors has subsided, then the tritiyaka and chaturthaka jwara manifest.

The dosha lose their strength after manifesting their signs and symptoms of aggravation and get lodged in their respective places. They again get aggravated and afflict the person with jwara.

The tritiyaka jwara manifests in three types –

• When the kapha and pitta dosha are aggravated then it afflicts the trika pradesh (sacral region)
• When the vata and kapha dosha are aggravated then the back (prishtha) region are affected
• The head region is affected in the case of aggravation of vata and pitta dosha.

Similarly chaturthaka jwara is also of two types –

• Calf region is afflicted in the in the beginning by the vitiation of kapha
• Head region is afflicted in the beginning by the vitiation of vata. [70-72]

विषमज्वर एवान्यश्चतुर्थकविपर्ययः| त्रिविधो धातुरेकैको द्विधातुस्थः करोति यम्||७३||

viṣamajwara ēvānyaścaturthakaviparyayaḥ| trividhō dhāturēkaikō dvidhātusthaḥ karōti yam||73||

viShamajwara evAnyashcaturthakaviparyayaH| trividho dhAturekaiko dvidhAtusthaH karoti yam||73||

Chaturthaka viparyaya jwara is another variety of vishama jwara. Each of the three dosha i.e. vata, pitta and kapha cause this disease by afflicting the two dhatu viz asthi (bone) and majja (bone marrow).[73]

प्रायशः सन्निपातेन दृष्टः पञ्चविधो ज्वरः| सन्निपाते तु यो भूयान् स दोषः परिकीर्तितः||७४||

prāyaśaḥ sannipātēna dr̥ṣṭaḥ pañcavidhō jwaraḥ| sannipātē tu yō bhūyān sa dōṣaḥ parikīrtitaḥ||74||

prAyashaH sannipAtena dRuShTaH pa~jcavidho jwaraH| sannipAte tu yo bhUyAn sa doShaH parikIrtitaH||74||

These five types of jwara are mostly caused by sannipata (simultaneous vitiation of the three dosha), however, the dosha, which is predominant among the three doshas is generally attributed as the causative factors. [74]

Dhatugata jwara

ऋत्वहोरात्रदोषाणां मनसश्च बलाबलात्| कालमर्थवशाच्चैव ज्वरस्तं तं प्रपद्यते||७५||

गुरुत्वं दैन्यमुद्वेगः सदनं छर्द्यरोचकौ| रसस्थिते बहिस्तापः साङ्गमर्दो विजृम्भणम्||७६||

रक्तोष्णाः पिडकास्तृष्णा सरक्तं ष्ठीवनं मुहुः| दाहरागभ्रममदप्रलापा रक्तसंस्थिते||७७||

अन्तर्दाहः सतृण्मोहः सग्लानिः सृष्टविट्कता| दौर्गन्ध्यं गात्रविक्षेपो ज्वरे मांसस्थिते भवेत्||७८||

स्वेदस्तीव्रा पिपासा च प्रलापो वम्यभीक्ष्णशः| स्वगन्धस्यासहत्वं च मेदःस्थे ग्लान्यरोचकौ||७९||

विरेकवमने चोभे सास्थिभेदं प्रकूजनम्| विक्षेपणं च गात्राणां श्वासश्चास्थिगते ज्वरे||८०||

हिक्का श्वासस्तथा कासस्तमसश्चातिदर्शनम्| मर्मच्छेदो बहिः शैत्यं दाहोऽन्तश्चैव मज्जगे||८१||

शुक्रस्थानगतः शुक्रमोक्षं कृत्वा विनाश्य च| प्राणं वाय्वग्निसोमैश्च सार्धं गच्छत्यसौ विभुः||८२||

रसरक्ताश्रितः साध्यो मेदोमांसगतश्च यः| अस्थिमज्जगतः कृच्छ्रः शुक्रस्थो नैव सिद्ध्यति||८३||

r̥tvahōrātradōṣāṇāṁ manasaśca balābalāt| kālamarthavaśāccaiva jwarastaṁ taṁ prapadyatē||75||

gurutvaṁ dainyamudvēgaḥ sadanaṁ chardyarōcakau| rasasthitē bahistāpaḥ sāṅgamardō vijr̥mbhaṇam||76||

raktōṣṇāḥ piḍakāstr̥ṣṇā saraktaṁ ṣṭhīvanaṁ muhuḥ| dāharāgabhramamadapralāpā raktasaṁsthitē||77||

antardāhaḥ satr̥ṇmōhaḥ saglāniḥ sr̥ṣṭaviṭkatā| daurgandhyaṁ gātravikṣēpō jvarē māṁsasthitē bhavēt||78||

svēdastīvrā pipāsā ca pralāpō vamyabhīkṣṇaśaḥ| svagandhasyāsahatvaṁ ca mēdaḥsthē glānyarōcakau||79||

virēkavamanē cōbhē sāsthibhēdaṁ prakūjanam| vikṣēpaṇaṁ ca gātrāṇāṁ śvāsaścāsthigatē jvarē||80||

hikkā śvāsastathā kāsastamasaścātidarśanam| marmacchēdō bahiḥ śaityaṁ dāhō'ntaścaiva majjagē||81||

śukrasthānagataḥ śukramōkṣaṁ kr̥tvā vināśya ca| prāṇaṁ vāyvagnisōmaiśca sārdhaṁ gacchatyasau vibhuḥ||82||

rasaraktāśritaḥ sādhyō mēdōmāṁsagataśca yaḥ| asthimajjagataḥ kr̥cchraḥ śukrasthō naiva siddhyati||83||

RutvahorAtradoShANAM manasashca balAbalAt| kAlamarthavashAccaiva jwarastaM taM prapadyate||75||

gurutvaM dainyamudvegaH sadanaM chardyarocakau| rasasthite bahistApaH sA~ggamardo vijRumbhaNam||76||

raktoShNAH piDakAstRuShNA saraktaM ShThIvanaM muhuH| dAharAgabhramamadapralApA raktasaMsthite||77||

antardAhaH satRuNmohaH saglAniH sRuShTaviTkatA| daurgandhyaM gAtravikShepo jvare mAMsasthite bhavet||78||

svedastIvrA pipAsA ca pralApo vamyabhIkShNashaH| svagandhasyAsahatvaM ca medaHsthe glAnyarocakau||79||

virekavamane cobhe sAsthibhedaM prakUjanam| vikShepaNaM ca gAtrANAM shvAsashcAsthigate jvare||80||

hikkA shvAsastathA kAsastamasashcAtidarshanam| marmacchedo bahiH shaityaM dAho~antashcaiva majjage||81||

shukrasthAnagataH shukramokShaM kRutvA vinAshya ca| prANaM vAyvagnisomaishca sArdhaM gacchatyasau vibhuH||82||

rasaraktAshritaH sAdhyo medomAMsagatashca yaH| asthimajjagataH kRucchraH shukrastho naiva siddhyati||83||

Manifestation of jwara at a particular time or a change in the time of manifestation takes place due to following factors – Jwara occurs according to the strength or weakness of factors like dosha, seasons, day, night, mental status and artha (deeds of previous life).

Manifestation of jwara in the different dhatu (body tissues) –

1. When the vitiated dosha are located in the rasa dhatu, the clinical features manifesting are – heaviness, miserable feeling, anxiety, exhaustion, vomiting, anorexia, increase in external temperature, body ache and yawning.
2. The vitiated doshas causing jwara are located in the rakta dhatu, the clinical features are – Increase in body temperature, eruptions, thirst, frequent spitting mixed with blood burning sensation, discoloration, giddiness, intoxication and incoherent speech.
3. Burning sensation inside the body, thirst, unconsciousness, weakness, diarrhea, foul smell from the body and throwing movement of the limbs are the features manifesting when the doshas causing jwara are lodged in the mamsa dhatu.
4. Vitiated dosha located in the medo dhatu present with the following clinical features – excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate the smell of one’s own body, wet feeling in the body and anorexia.
5. Vitiated dosha located in the asthi dhatu cause the following clinical features – diarrhea, emesis, pain in the bones, production of kujana (a sort of cooing sound) throwing movement of the body and limbs.
6. When the vitiated dosha are located in the majja dhatu then the following signs and symptoms appear – hiccup, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation.
7. Vitiated dosha causing jwara located in the sukra dhatu cause ejaculation and destruction of shukra resulting in the extinction of life along with vayu, agni and soma of the subtle body (sukshma sharira).

The jwara in which doshas are located in the rasa, rakta, mamsa and medas dhatu are curable, while those in which the location is in the asthi and majja dhatu are difficult to treat. The jwara in which the vitiated dosha are located in shukra dhatu is incurable. [75-83]

Clinical features of jwara due to combination of two dosha

हेतुभिर्लक्षणैश्चोक्तः पूर्वमष्टविधो ज्वरः| समासेनोपदिष्टस्य व्यासतः शृणु लक्षणम्||८४||

शिरोरुक् पर्वणां भेदो दाहो रोम्णां प्रहर्षणम्| कण्ठास्यशोषो वमथुस्तृष्णा मूर्च्छा भ्रमोऽरुचिः||८५||

स्वप्ननाशोऽतिवाग्जृम्भा वातपित्तज्वराकृतिः| शीतको गौरवं तन्द्रा स्तैमित्यं पर्वणां च रुक्||८६||

शिरोग्रहः प्रतिश्यायः कासः स्वेदाप्रवर्तनम्| सन्तापो मध्यवेगश्च वातश्लेष्मज्वराकृतिः||८७||

मुहुर्दाहो मुहुः शीतं स्वेदस्तम्भो मुहुर्मुहुः| मोहः कासोऽरुचिस्तृष्णा श्लेष्मपित्तप्रवर्तनम्||८८||

लिप्ततिक्तास्यता तन्द्रा श्लेष्मपित्तज्वराकृतिः| इत्येते द्वन्द्वजाः प्रोक्ताः ...|८९|

hētubhirlakṣaṇaiścōktaḥ pūrvamaṣṭavidhō jwaraḥ| samāsēnōpadiṣṭasya vyāsataḥ śr̥ṇu lakṣaṇam||84||

śirōruk [1] parvaṇāṁ bhēdō dāhō rōmṇāṁ praharṣaṇam| kaṇṭhāsyaśōṣō vamathustr̥ṣṇā mūrcchā bhramō'ruciḥ||85||

svapnanāśō'tivāgjr̥mbhā vātapittajvarākr̥tiḥ| śītakō gauravaṁ tandrā staimityaṁ parvaṇāṁ ca ruk||86||

śirōgrahaḥ pratiśyāyaḥ kāsaḥ svēdāpravartanam| santāpō madhyavēgaśca vātaślēṣmajvarākr̥tiḥ||87||

muhurdāhō muhuḥ śītaṁ svēdastambhō [2] muhurmuhuḥ| mōhaḥ kāsō'rucistr̥ṣṇā ślēṣmapittapravartanam||88||

liptatiktāsyatā tandrā ślēṣmapittajvarākr̥tiḥ| ityētē dvandvajāḥ prōktāḥ ...|89|

hetubhirlakShaNaishcoktaH pUrvamaShTavidho jwaraH| samAsenopadiShTasya vyAsataH shRuNu lakShaNam||84||

shiroruk parvaNAM bhedo dAho romNAM praharShaNam| kaNThAsyashoSho vamathustRuShNA mUrcchA bhramo~aruciH||85||

svapnanAsho~ativAgjRumbhA vAtapittajwarakRutiH| shItako gauravaM tandrA staimityaM parvaNAM ca ruk||86||

shirograhaH pratishyAyaH kAsaH svedApravartanam| santApo madhyavegashca vAtashleShmajwarakRutiH||87||

muhurdAho muhuH shItaM svedastambho muhurmuhuH| mohaH kAso~arucistRuShNA shleShmapittapravartanam||88||

liptatiktAsyatA tandrA shleShmapittajwarakRutiH| ityete dvandvajAH proktAH ...|89|

Signs and symptoms of jwara by combination of vata and pitta:

In Nidana Sthana the eight varieties of jwara along with their causative factors, signs and symptoms have been described in brief. Now their signs and symptoms will be described in detail:

Headache, breaking pain in joints, burning sensation, horripilation, dryness of throat and mouth, nausea, thirst, fainting, giddiness, anorexia, sleeplessness, talkativeness and yawning – all these are the signs and symptoms of jwara by combination of vata and pitta.

Signs and symptoms of jwara by combination of vata and kapha:

Feeling cold, heaviness, drowsiness, timidity, pain in joints, feeling of stiffness of head (sirograha), coryza, cough, impaired sweating and moderate rise in temperature are the signs and symptoms of jwara caused by vata and kapha.

Signs and symptoms of jwara by combination of kapha and pitta:

Frequently changing sensation of hot and cold, frequent increased or decreased sweating, delusions, cough, anorexia, thirst, elimination of phlegm and bile, coating and bitterness in the mouth and drowsiness – all are the clinical features of jwara caused by kapha and pitta.

Thus, here the features of different types of jwara caused by the simultaneous vitiation of two dosha have been described. [84-89]

Sannipataja jwara

... सन्निपातज उच्यते||८९||

सन्निपातज्वरस्योर्ध्वं त्रयोदशविधस्य हि| प्राक्सूत्रितस्य वक्ष्यामि लक्षणं वै पृथक् पृथक्||९०||

भ्रमः पिपासा दाहश्च गौरवं शिरसोऽतिरुक्| वातपित्तोल्बणे विद्याल्लिङ्गं मन्दकफे ज्वरे||९१||

शैत्यं कासोऽरुचिस्तन्द्रापिपासादाहरुग्व्यथाः| वातश्लेष्मोल्बणे व्याधौ लिङ्गं पित्तावरे विदुः||९२||

छर्दिः शैत्यं मुहुर्दाहस्तृष्णा मोहोऽस्थिवेदना| मन्दवाते व्यवस्यन्ति लिङ्गं पित्तकफोल्बणे||९३||

सन्ध्यस्थिशिरसः शूलं प्रलापो गौरवं भ्रमः| वातोल्बणे स्याद् द्व्यनुगे तृष्णा कण्ठास्यशुष्कता||९४||

रक्तविण्मूत्रता दाहः स्वेदस्तृड् बलसङ्क्षयः| मूर्च्छा चेति त्रिदोषे स्याल्लिङ्गं पित्ते गरीयसि||९५||

आलस्यारुचिहृल्लासदाहवम्यरतिभ्रमैः| कफोल्बणं सन्निपातं तन्द्राकासेन चादिशेत्||९६||

प्रतिश्या छर्दिरालस्यं तन्द्राऽरुच्यग्निमार्दवम्| हीनवाते पित्तमध्ये लिङ्गं श्लेष्माधिके मतम्||९७||

हारिद्रमूत्रनेत्रत्वं दाहस्तृष्णा भ्रमोऽरुचिः| हीनवाते मध्यकफे लिङ्गं पित्ताधिके मतम्||९८||

शिरोरुग्वेपथुः श्वासः प्रलापश्छर्द्यरोचकौ| हीनपित्ते मध्यकफे लिङ्गं स्यान्मारुताधिके||९९||

शीतको गौरवं तन्द्रा प्रलापोऽस्थिशिरोऽतिरुक्| हीनपित्ते वातमध्ये लिङ्गं श्लेष्माधिके विदुः||१००||

श्वासः कासः प्रतिश्यायो मुखशोषोऽतिपार्श्वरुक्| कफहीने पित्तमध्ये लिङ्गं वाताधिके मतम्||१०१||

वर्चोभेदोऽग्निदौर्बल्यं [३] तृष्णा दाहोऽरुचिर्भ्रमः| कफहीने वातमध्ये लिङ्गं पित्ताधिके विदुः||१०२||

सन्निपातज्वरस्योर्ध्वमतो वक्ष्यामि लक्षणम्| क्षणे दाहः क्षणे शीतमस्थिसन्धिशिरोरुजा||१०३||

सास्रावे कलुषे रक्ते निर्भुग्ने चापि दर्शने [४] | सस्वनौ सरुजौ कर्णौ कण्ठः शूकैरिवावृतः||१०४||

तन्द्रा मोहः प्रलापश्च कासः श्वासोऽरुचिर्भ्रमः| परिदग्धा खरस्पर्शा जिह्वा स्रस्ताङ्गता परम्||१०५||

ष्ठीवनं रक्तपित्तस्य कफेनोन्मिश्रितस्य च| शिरसो लोठनं तृष्णा निद्रानाशो हृदि व्यथा||१०६||

स्वेदमूत्रपुरीषाणां चिराद्दर्शनमल्पशः| कृशत्वं नातिगात्राणां प्रततं कण्ठकूजनम्||१०७||

कोठानां श्यावरक्तानां मण्डलानां च दर्शनम्| मूकत्वं स्रोतसां पाको गुरुत्वमुदरस्य च||१०८||

चिरात् पाकश्च दोषाणां सन्निपातज्वराकृतिः|१०९|

... sannipātaja ucyatē||89||

sannipātajwarasyōrdhvaṁ trayōdaśavidhasya hi| prāksūtritasya vakṣyāmi lakṣaṇaṁ vai pr̥thak pr̥thak||90||

bhramaḥ pipāsā dāhaśca gauravaṁ śirasō'tiruk| vātapittōlbaṇē vidyālliṅgaṁ mandakaphē jvarē||91||

śaityaṁ kāsō'rucistandrāpipāsādāharugvyathāḥ| vātaślēṣmōlbaṇē vyādhau liṅgaṁ pittāvarē viduḥ||92||

chardiḥ śaityaṁ muhurdāhastr̥ṣṇā mōhō'sthivēdanā| mandavātē vyavasyanti liṅgaṁ pittakaphōlbaṇē||93||

sandhyasthiśirasaḥ śūlaṁ pralāpō gauravaṁ bhramaḥ| vātōlbaṇē syād dvyanugē tr̥ṣṇā kaṇṭhāsyaśuṣkatā||94||

raktaviṇmūtratā dāhaḥ svēdastr̥ḍ balasaṅkṣayaḥ| mūrcchā cēti tridōṣē syālliṅgaṁ pittē garīyasi||95||

ālasyārucihr̥llāsadāhavamyaratibhramaiḥ| kaphōlbaṇaṁ sannipātaṁ tandrākāsēna cādiśēt||96||

pratiśyā chardirālasyaṁ tandrā'rucyagnimārdavam| hīnavātē pittamadhyē liṅgaṁ ślēṣmādhikē matam||97||

hāridramūtranētratvaṁ dāhastr̥ṣṇā bhramō'ruciḥ| hīnavātē madhyakaphē liṅgaṁ pittādhikē matam||98||

śirōrugvēpathuḥ śvāsaḥ pralāpaśchardyarōcakau| hīnapittē madhyakaphē liṅgaṁ syānmārutādhikē||99||

śītakō gauravaṁ tandrā pralāpō'sthiśirō'tiruk| hīnapittē vātamadhyē liṅgaṁ ślēṣmādhikē viduḥ||100||

śvāsaḥ kāsaḥ pratiśyāyō mukhaśōṣō'tipārśvaruk| kaphahīnē pittamadhyē liṅgaṁ vātādhikē matam||101||

varcōbhēdō'gnidaurbalyaṁ tr̥ṣṇā dāhō'rucirbhramaḥ| kaphahīnē vātamadhyē liṅgaṁ pittādhikē viduḥ||102||

sannipātajwarasyōrdhvamatō vakṣyāmi lakṣaṇam| kṣaṇē dāhaḥ kṣaṇē śītamasthisandhiśirōrujā||103||

sāsrāvē kaluṣē raktē nirbhugnē cāpi darśanē | sasvanau sarujau karṇau kaṇṭhaḥ śūkairivāvr̥taḥ||104||

tandrā mōhaḥ pralāpaśca kāsaḥ śvāsō'rucirbhramaḥ| paridagdhā kharasparśā jihvā srastāṅgatā param||105||

ṣṭhīvanaṁ raktapittasya kaphēnōnmiśritasya ca| śirasō lōṭhanaṁ tr̥ṣṇā nidrānāśō hr̥di vyathā||106||

svēdamūtrapurīṣāṇāṁ cirāddarśanamalpaśaḥ| kr̥śatvaṁ nātigātrāṇāṁ pratataṁ kaṇṭhakūjanam||107||

kōṭhānāṁ śyāvaraktānāṁ maṇḍalānāṁ ca darśanam| mūkatvaṁ srōtasāṁ pākō gurutvamudarasya ca||108||

cirāt pākaśca dōṣāṇāṁ sannipātajvarākr̥tiḥ|109|

... sannipAtaja ucyate||89||

sannipAtajwarasyordhvaM trayodashavidhasya hi| prAksUtritasya vakShyAmi lakShaNaM vai pRuthak pRuthak||90||

bhramaH pipAsA dAhashca gauravaM shiraso~atiruk| vAtapittolbaNe vidyAlli~ggaM mandakaphe jvare||91||

shaityaM kAso~arucistandrApipAsAdAharugvyathAH| vAtashleShmolbaNe vyAdhau li~ggaM pittAvare viduH||92||

chardiH shaityaM muhurdAhastRuShNA moho~asthivedanA| mandavAte vyavasyanti li~ggaM pittakapholbaNe||93||

sandhyasthishirasaH shUlaM pralApo gauravaM bhramaH| vAtolbaNe syAd dvyanuge tRuShNA kaNThAsyashuShkatA||94||

raktaviNmUtratA dAhaH svedastRuD balasa~gkShayaH| mUrcchA ceti tridoShe syAlli~ggaM pitte garIyasi||95||

AlasyArucihRullAsadAhavamyaratibhramaiH| kapholbaNaM sannipAtaM tandrAkAsena cAdishet||96||

pratishyA chardirAlasyaM tandrA~arucyagnimArdavam| hInavAte pittamadhye li~ggaM shleShmAdhike matam||97||

hAridramUtranetratvaM dAhastRuShNA bhramo~aruciH| hInavAte madhyakaphe li~ggaM pittAdhike matam||98||

shirorugvepathuH shvAsaH pralApashchardyarocakau| hInapitte madhyakaphe li~ggaM syAnmArutAdhike||99||

shItako gauravaM tandrA pralApo~asthishiro~atiruk| hInapitte vAtamadhye li~ggaM shleShmAdhike viduH||100||

shvAsaH kAsaH pratishyAyo mukhashoSho~atipArshvaruk| kaphahIne pittamadhye li~ggaM vAtAdhike matam||101||

varcobhedo~agnidaurbalyaM tRuShNA dAho~arucirbhramaH| kaphahIne vAtamadhye li~ggaM pittAdhike viduH||102||

sannipAtajwarasyordhvamato vakShyAmi lakShaNam| kShaNe dAhaH kShaNe shItamasthisandhishirorujA||103||

sAsrAve kaluShe rakte nirbhugne cApi darshane | sasvanau sarujau karNau kaNThaH shUkairivAvRutaH||104||

tandrA mohaH pralApashca kAsaH shvAso~arucirbhramaH| paridagdhA kharasparshA jihvA srastA~ggatA param||105||

ShThIvanaM raktapittasya kaphenonmishritasya ca| shiraso loThanaM tRuShNA nidrAnAsho hRudi vyathA||106||

svedamUtrapurIShANAM cirAddarshanamalpashaH| kRushatvaM nAtigAtrANAM pratataM kaNThakUjanam||107||

koThAnAM shyAvaraktAnAM maNDalAnAM ca darshanam| mUkatvaM srotasAM pAko gurutvamudarasya ca||108||

cirAt pAkashca doShANAM sannipAtajwarakRutiH|109|

Description of sannipataja jwara (caused by combined tridosha):

The sannipataja variety of jwara, has thirteen sub types have been described in Nidana Sthana. Now the clinical features of each type will be described separately:

• Sannipataja jwara in which vata and pitta are codominant while kapha is recessive has the following clinical features – giddiness, thirst, burning sensation, heaviness and excessive headache. [91]
• Sannipataja jwara in which vata and kapha are codominant while pitta is recessive has the following clinical features – Coldness, cough, anorexia, drowsiness, thirst, burning sensation and pain. [92]
• Sannipataja jwara in which pitta and kapha are codominant while vata is recessive has the following clinical features – Emesis, coldness, frequent burning sensation, thirst, unconsciousness and pain in the bones. [93]
• Sannipataja jwara in which vitiated vata predominates over the other two doshas presents with the following signs and symptoms **pain in the joints, bones and head; delirium, heaviness, giddiness, thirst and dryness of the throat as well as the mouth [94]
• Sannipataja jwara in which vitiated pitta predominates over the other two doshas presents with the following signs and symptoms – blood in stool and urine, burning sensation, vomiting, arati (disliking for doing any work), giddiness, drowsiness and cough. [95]
• Sannipataja jwara in which vitiated kapha predominates over the other two doshas presents with the following signs and symptoms – laziness, anorexia, nausea, burning sensation, vomiting, arati (restlessness), giddiness, drowsiness and cough. [96]
• Sannipataja jwara in which vitiated kapha is excessively vitiated, pitta moderately vitiated and vata is less vitiated presents with the following clinical features – coryza, vomiting, laziness, drowsiness, anorexia and weak digestion. [97]
• Sannipataja jwara in which vitiated pitta is excessively vitiated, kapha moderately vitiated and vata is less vitiated presents with the following clinical features – yellowish discoloration of urine and eyes, burning sensation, thirst, giddiness and anorexia. [98]
• Sannipataja jwara in which vitiated vata is excessively vitiated, kapha moderately vitiated and pitta is less vitiated presents with the following clinical features – headache, trembling, breathlessness, delirium, vomiting and anorexia. [99]
• Sannipataja jwara in which vitiated kapha is excessively vitiated, vata moderately vitiated and pitta is less vitiated presents with the following clinical features – coldness, heaviness, drowsiness, delirium and excessive pain in bones as well as head. [100]
• Sannipataja jwara in which vitiated vata is excessively vitiated, pitta moderately vitiated and kapha is less vitiated presents with the following clinical features – dyspnoea, cough, coryza, dryness of the mouth and excessive pain in the flanks. [101]
• Sannipataja jwara in which vitiated pitta is excessively vitiated, vata moderately vitiated and kapha is less vitiated presents with the following clinical features – diarrhea, weak digestion, thirst, burning sensation, anorexia and giddiness. [102]
• In sannipataja jwara with all the three doshas vitiated to the same extent, following signs and symptoms are observed:
  • Patient has feeling of burning sensation sometimes and sometimes feeling of cold
  • Pain in the bones, joints and head
  • Eyes are with excessive lacrimation, dull, reddish with eyeballs protruded out.
  • Ringing sound and pain in the ears
  • Pricking pain in throat like thorn of grain
  • Drowsiness, delusion, delirium, cough, breathlessness, anorexia and giddiness
  • Burning sensation of tongue, and turns rough to touch
  • Excessive fatigue
  • Spitting of blood and bile mixed with phlegm (sputum)
  • Swaying movements of head, thirst, sleeplessness and pain in the cardiac region
  • Sweat, urine and stool reduced in amount with delayed evacuation.
  • Body is not excessively emaciated (due to accumulated dosha)
  • Constant kujana (cooing sound)
  • Urticaria and bluish – black or reddish circular patches appear on the skin
  • Patient speaks less or unable to speak
  • Inflammation of srotasa
  • Heaviness in the abdomen
  • The doshas undergo paka after a very long time (conversion into the healthy state of the doshas do not occur early). [103-109]

Prognosis of sannipata jwara

दोषे विबद्धे नष्टेऽग्नौ सर्वसम्पूर्णलक्षणः||१०९||

सन्निपातज्वरोऽसाध्यः कृच्छ्रसाध्यस्त्वतोऽन्यथा| निदाने त्रिविधा प्रोक्ता या पृथग्जज्वराकृतिः||११०||

संसर्गसन्निपातानां तया चोक्तं स्वलक्षणम्|१११|

dōṣē vibaddhē naṣṭē'gnau sarvasampūrṇalakṣaṇaḥ||109||

sannipātajvarō'sādhyaḥ kr̥cchrasādhyastvatō'nyathā| nidānē trividhā prōktā yā pr̥thagjajvarākr̥tiḥ||110||

saṁsargasannipātānāṁ tayā cōktaṁ svalakṣaṇam|111|

doShe vibaddhe naShTe~agnau sarvasampUrNalakShaNaH||109||

sannipAtajvaro~asAdhyaH kRucchrasAdhyastvato~anyathA| nidAne trividhA proktA yA pRuthagjajvarAkRutiH||110||

saMsargasannipAtAnAM tayA coktaM svalakShaNam|111|

If there is obstruction (or non – elimination) of the dosha, the agnis are completely destroyed and if all the signs and symptoms are fully manifested, then sannipata jwara is incurable; otherwise it is treatable with difficulty.

The clinical features of jwaras caused by the individual doshas vata, pitta and kapha have been described separately in the Nidana Sthana. From these sign and symptoms, the features of dwandaja types and the sannipataja types can be known and decided. [109-110]

Classification of agantuja jwara

आगन्तुरष्टमो यस्तु स निर्दिष्टश्चतुर्विधः||१११||

अभिघाताभिषङ्गाभ्यामभिचाराभिशापतः|

āganturaṣṭamō yastu sa nirdiṣṭaścaturvidhaḥ||111||

abhighātābhiṣaṅgābhyāmabhicārābhiśāpataḥ|

AganturaShTamo yastu sa nirdiShTashcaturvidhaH||111||

abhighAtAbhiSha~ggAbhyAmabhicArAbhishApataH|

The eighth type of jwara i.e. agantuja type (that caused due to external/exogenous factors) is of four types, viz: abhihataja, abhishangaja, abhicharaja and abhishapaja.[111]

Abhighataja jwara (due to injury or trauma)

शस्त्रलोष्टकशाकाष्ठमुष्ट्यरत्नितलद्विजैः||११२||

तद्विधैश्च हते गात्रे ज्वरः स्यादभिघातजः| तत्राभिघातजे वायुः प्रायो रक्तं प्रदूषयन्||११३||

सव्यथाशोफवैवर्ण्यं करोति सरुजं ज्वरम्|११४|

śastralōṣṭakaśākāṣṭhamuṣṭyaratnitaladvijaiḥ||112||

tadvidhaiśca hatē gātrē jvaraḥ syādabhighātajaḥ| tatrābhighātajē vāyuḥ prāyō raktaṁ pradūṣayan||113||

savyathāśōphavaivarṇyaṁ karōti sarujaṁ jvaram|114|

shastraloShTakashAkAShThamuShTyaratnitaladvijaiH||112||

tadvidhaishca hate gAtre jvaraH syAdabhighAtajaH| tatrAbhighAtaje vAyuH prAyo raktaM pradUShayan||113||

savyathAshophavaivarNyaM karoti sarujaM jvaram|114|

The jwara caused by the injury from weapons, stones, hunters, wood, fist, palm of the sole, teeth and such other things is called abhighataja. In this type, vitiated vata affects predominantly rakta (blood) to resulting in jwara with discomfort, swelling, discoloration and pain.[112-114]

Abhishangaja, abhishapaja and abhicharaja jwara

कामशोकभयक्रोधैरभिषक्तस्य यो ज्वरः||११४||

सोऽभिषङ्गाज्वरो ज्ञेयो यश्च भूताभिषङ्गजः| कामशोकभयाद्वायुः, क्रोधात् पित्तं, त्रयो मलाः||११५||

भूताभिषङ्गात् कुप्यन्ति भूतसामान्यलक्षणाः| भूताधिकारे व्याख्यातं तदष्टविधलक्षणम्||११६||

विषवृक्षानिलस्पर्शात्तथाऽन्यैर्विषसम्भवैः| अभिषक्तस्य चाप्याहुर्ज्वरमेकेऽभिषङ्गजम्||११७||

चिकित्सया विषघ्न्यैव स शमं लभते नरः| अभिचाराभिशापाभ्यां सिद्धानां यः प्रवर्तते||११८||

सन्निपातज्वरो घोरः स विज्ञेयः सुदुःसहः| सन्निपातज्वरस्योक्तं लिङ्गं यत्तस्य तत् स्मृतम्||११९||

चित्तोन्द्रियशरीराणामर्तयोऽन्याश्च नैकशः| प्रयोगं त्वभिचारस्य दृष्ट्वा शापस्य चैव हि||१२०||

स्वयं श्रुत्वाऽनुमानेन लक्ष्यते प्रशमेन वा| वैविध्यादभिचारस्य शापस्य च तदात्मके||१२१||

यथाकर्मप्रयोगेण लक्षणं स्यात् पृथग्विधम्| ध्याननिःश्वासबहुलं लिङ्गं कामज्वरे स्मृतम्||१२२||

शोकजे बाष्पबहुलं त्रासप्रायं भयज्वरे| क्रोधजे बहुसंरम्भं भूतावेशे त्वमानुषम्||१२३||

मूर्च्छामोहमदग्लानिभूयिष्ठं विषसम्भवे| केषाञ्चिदेषां लिङ्गानां सन्तापो जायते पुरः||१२४||

पश्चात्तुल्यं तु केषाञ्चिदेषु कामज्वरादिषु| कामादिजानामुद्दिष्टं ज्वराणां यद्विशेषणम्||१२५||

कामादिजानां रोगाणामन्येषामपि तत् स्मृतम्| मनस्यभिहते पूर्वं कामाद्यैर्न तथा बलम्||१२६||

ज्वरः प्राप्नोति वाताद्यैर्देहो यावन्न दूष्यति| देहे चाभिह(द्रु)ते पूर्वं वाताद्यैर्न तथा बलम्||१२७||

ज्वरः प्राप्नोति कामाद्यैर्मनो यावन्न दूष्यति| ते पूर्वं केवलाः पश्चान्निजैर्व्यामिश्रलक्षणाः||१२८||

हेत्वौषधविशिष्टाश्च भवन्त्यागन्तवो ज्वराः|१२९|

kāmaśōkabhayakrōdhairabhiṣaktasya yō jvaraḥ||114||

sō'bhiṣaṅgājvarō jñēyō yaśca bhūtābhiṣaṅgajaḥ| kāmaśōkabhayādvāyuḥ, krōdhāt pittaṁ, trayō malāḥ||115||

bhūtābhiṣaṅgāt kupyanti bhūtasāmānyalakṣaṇāḥ| bhūtādhikārē vyākhyātaṁ tadaṣṭavidhalakṣaṇam||116||

viṣavr̥kṣānilasparśāttathā'nyairviṣasambhavaiḥ| abhiṣaktasya cāpyāhurjvaramēkē'bhiṣaṅgajam||117||

cikitsayā viṣaghnyaiva sa śamaṁ labhatē naraḥ| abhicārābhiśāpābhyāṁ siddhānāṁ yaḥ pravartatē||118||

sannipātajvarō ghōraḥ sa vijñēyaḥ suduḥsahaḥ| sannipātajvarasyōktaṁ liṅgaṁ yattasya tat smr̥tam||119||

cittōndriyaśarīrāṇāmartayō'nyāśca naikaśaḥ| prayōgaṁ tvabhicārasya dr̥ṣṭvā śāpasya caiva hi||120||

svayaṁ śrutvā'numānēna lakṣyatē praśamēna vā| vaividhyādabhicārasya śāpasya ca tadātmakē||121||

yathākarmaprayōgēṇa lakṣaṇaṁ syāt pr̥thagvidham| dhyānaniḥśvāsabahulaṁ liṅgaṁ kāmajvarē smr̥tam||122||

śōkajē bāṣpabahulaṁ trāsaprāyaṁ bhayajvarē| krōdhajē bahusaṁrambhaṁ bhūtāvēśē tvamānuṣam||123||

mūrcchāmōhamadaglānibhūyiṣṭhaṁ viṣasambhavē| kēṣāñcidēṣāṁ liṅgānāṁ santāpō jāyatē puraḥ||124||

paścāttulyaṁ tu kēṣāñcidēṣu kāmajvarādiṣu| kāmādijānāmuddiṣṭaṁ jvarāṇāṁ yadviśēṣaṇam||125||

kāmādijānāṁ rōgāṇāmanyēṣāmapi tat smr̥tam| manasyabhihatē pūrvaṁ kāmādyairna tathā balam||126||

jvaraḥ prāpnōti vātādyairdēhō yāvanna dūṣyati| dēhē cābhiha(dru)tē pūrvaṁ vātādyairna tathā balam||127||

jvaraḥ prāpnōti kāmādyairmanō yāvanna dūṣyati|128|

kAmashokabhayakrodhairabhiShaktasya yo jvaraH||114||

so~abhiSha~ggAjvaro j~jeyo yashca bhUtAbhiSha~ggajaH| kAmashokabhayAdvAyuH, krodhAt pittaM, trayo malAH||115||

bhUtAbhiSha~ggAt kupyanti bhUtasAmAnyalakShaNAH| bhUtAdhikAre vyAkhyAtaM tadaShTavidhalakShaNam||116||

viShavRukShAnilasparshAttathA~anyairviShasambhavaiH| abhiShaktasya cApyAhurjvarameke~abhiSha~ggajam||117||

cikitsayA viShaghnyaiva sa shamaM labhate naraH| abhicArAbhishApAbhyAM siddhAnAM yaH pravartate||118||

sannipAtajvaro ghoraH sa vij~jeyaH suduHsahaH| sannipAtajvarasyoktaM li~ggaM yattasya tat smRutam||119||

cittondriyasharIrANAmartayo~anyAshca naikashaH| prayogaM tvabhicArasya dRuShTvA shApasya caiva hi||120||

svayaM shrutvA~anumAnena lakShyate prashamena vA| vaividhyAdabhicArasya shApasya ca tadAtmake||121||

yathAkarmaprayogeNa lakShaNaM syAt pRuthagvidham| dhyAnaniHshvAsabahulaM li~ggaM kAmajvare smRutam||122||

shokaje bAShpabahulaM trAsaprAyaM bhayajvare| krodhaje bahusaMrambhaM bhUtAveshe tvamAnuSham||123||

mUrcchAmohamadaglAnibhUyiShThaM viShasambhave| keShA~jcideShAM li~ggAnAM santApo jAyate puraH||124||

pashcAttulyaM tu keShA~jcideShu kAmajvarAdiShu| kAmAdijAnAmuddiShTaM jvarANAM yadvisheShaNam||125||

kAmAdijAnAM rogANAmanyeShAmapi tat smRutam| manasyabhihate pUrvaM kAmAdyairna tathA balam||126||

jvaraH prApnoti vAtAdyairdeho yAvanna dUShyati| dehe cAbhiha(dru)te pUrvaM vAtAdyairna tathA balam||127||

jvaraH prApnoti kAmAdyairmano yAvanna dUShyati| tē pūrvaṁ kēvalāḥ paścānnijairvyāmiśralakṣaṇāḥ||128||

hētvauṣadhaviśiṣṭāśca bhavantyāgantavō jvarāḥ|129|

Abhishangaja jwara: Jwara caused by the affliction of passion, grief, fear, anger and evil spirits including germs is called abhishangaja jwara. Vata gets aggravated by passion, grief and fear, while pitta is aggravated by anger and all the three doshas are afflicted by bhootas (evil spirits or germs). Simultaneously, the signs and symptoms of the respective type of bhoota are described here. In the bhutadhikara section, the characteristic features of eight types of bhoota are described. Some acharyas opine that the jwara caused by the contact of the poisonous air of the toxic plants and other such toxins is called abhishangaja jwara. This type of jwara gets cured by the administration of antidotes of this poison.

Abhicharaja jwara: The activities such as abhichara (evil tantrik rituals) and abhishapa of siddhas (curse by saints who have attained spiritual perfection) results in the manifestation of sannipataja jwara, which are respectively called abhicharaja and abhishapaja jwara respectively. These types of jwara are intolerable and the clinical features of sannipata jwara manifest in them accompanied by other clinical features of the mind, sense organs and body due to the cause afflicting.

Abhishapaja jwara, abhicharaja and abhishapdaja jwara can be ascertained from the following clinical features –

• Either by the direct observation of the performance of the tantric rituals and shapa (curse)
• By hearing from others about it
• By inference (anumana) about it from some feature and
• By the alleviation of jwara after counteracting their effects.

Depending upon the varieties of abhichara and abhishapa, tantric and disease occurred by curse are there, clinical features also vary. A through understanding is essential for the diagnosis of such varieties of diseases.

Jwara of psychological origin are further described as:-

• Kamaja jwara - Dhyana (constantly thinking of same object), frequent sighs of lament are the clinical features of jwara caused by kama (passion)
• Shokaja jwara - Excessive crying is the clinical presentation of jwara caused by grief.
• Bhayaja jwara - Patient generally feels himself threatened in the jwara caused by fear.
• Krodhaj jwara - Patient is agitated excessively in the jwara caused by anger.

Para psychic manifestations are also presented in the jwara due to affliction by the bhootas (evil spirits).

Jwara caused by visha (intoxications) is associated with the features of fainting, unconsciousness, intoxication and fatigue.

In some jwara, fever appears first and then the signs and symptoms of kama etc. as described above are manifested, and it may happen the other way also.

The specific features of kama etc. as described in the context of jwara are also applicable to other diseases caused by these factors (as unmada etc.).

In kama jwara etc. the mind is first afflicted by passion etc. but the jwara does not manifest until the doshas as vata, pitta, kapha of the body are not vitiated. Similarly, the vitiation of the doshas in the body also does not gain enough strength to produce jwara unless the mind is afflicted by these factors (kama, chinta etc.)

The jwara caused by external causes are at first independent but later they get mixed up with the signs and symptoms of nija jwara (endogenous fevers). However, these agantuja jwaras have their own etiological factors and treatments. [114-129]

General patho-physiology of jwara

संसृष्टाः सन्निपतिताः पृथग्वा कुपिता मलाः||१२९||

रसाख्यं धातुमन्वेत्य पक्तिं स्थानान्निरस्य च| स्वेन तेनोष्मण चैव कृत्वा देहोष्मणो बलम्||१३०||

स्रोतांसि रुद्ध्वा सम्प्राप्ताः केवलं देहमुल्बणाः| सन्तापमधिकं देहे जनयन्ति नरस्तदा||१३१||

भवत्यत्युष्णसर्वाङ्गो ज्वरितस्तेन चोच्यते|१३२|

saṁsr̥ṣṭāḥ sannipatitāḥ pr̥thagvā kupitā malāḥ||129||

rasākhyaṁ dhātumanvētya paktiṁ sthānānnirasya ca| svēna tēnōṣmaṇa caiva kr̥tvā dēhōṣmaṇō balam||130||

srōtāṁsi ruddhvā samprāptāḥ kēvalaṁ dēhamulbaṇāḥ| santāpamadhikaṁ dēhē janayanti narastadā||131||

bhavatyatyuṣṇasarvāṅgō jvaritastēna cōcyatē|132|

te pUrvaM kevalAH pashcAnnijairvyAmishralakShaNAH||128||

hetvauShadhavishiShTAshca bhavantyAgantavo jvarAH| saMsRuShTAH sannipatitAH pRuthagvA kupitA malAH||129||

rasAkhyaM dhAtumanvetya paktiM sthAnAnnirasya ca| svena tenoShmaNa caiva kRutvA dehoShmaNo balam||130||

srotAMsi ruddhvA samprAptAH kevalaM dehamulbaNAH| santApamadhikaM dehe janayanti narastadA||131||

bhavatyatyuShNasarvA~ggo jvaritastena cocyate|132|

These aggravated dosha either alone or in the combination of two or three, spread along with the rasa dhatu (the first dhatu responsible for nourishment of the body) and displace the jatharagni from its own place. Supplemented by the dosha’s own heat and the heat of the jatharagni, the heat of the body gets accentuated and they are further aggravated by the blockage of the circulatory channels. It then pervades the entire body to produce excessive heat. Therefore, the temperature increases all over the body and this condition is called jwara.[129-132]

Cause of lack of sweating

स्रोतसां सन्निरुद्धत्वात् स्वेदं ना नाधिगच्छति||१३२||

स्वस्थानात् प्रच्युते चाग्नौ प्रायशस्तरुणेज्वरे|१३३|

srōtasāṁ sanniruddhatvāt svēdaṁ nā nādhigacchati||132||

svasthānāt pracyutē cāgnau prāyaśastaruṇējvarē|133|

srotasAM sanniruddhatvAt svedaM nA nAdhigacchati||132||

svasthAnAt pracyute cAgnau prAyashastaruNejvare|133|

A person suffering from taruna jwara (the initial stage of jwara) does not sweat because of the obstruction of the channels of circulation and the displacement of agni. [132-133]

Clinical features of Ama Jwara (first stage of jwara)

अरुचिश्चाविपाकश्च गुरुत्वमुदरस्य च||१३३||

हृदयस्याविशुद्धिश्च तन्द्रा चालस्यमेव च| ज्वरोऽविसर्गी बलवान् दोषाणामप्रवर्तनम्||१३४||

लालाप्रसेको हृल्लासः क्षुन्नाशो विरसं मुखम्| स्तब्धसुप्तगुरुवं च गात्राणां बहुमूत्रता||१३५||

न विड् जीर्णा न च ग्लानिर्ज्वरस्यामस्य लक्षणम्| aruciścāvipākaśca gurutvamudarasya ca||133||

hr̥dayasyāviśuddhiśca tandrā cālasyamēva ca| jvarō'visargī balavān dōṣāṇāmapravartanam||134||

lālāprasēkō hr̥llāsaḥ kṣunnāśō virasaṁ mukham| stabdhasuptaguruvaṁ ca gātrāṇāṁ bahumūtratā||135||

na viḍ jīrṇā na ca glānirjvarasyāmasya lakṣaṇam|

arucishcAvipAkashca gurutvamudarasya ca||133||

hRudayasyAvishuddhishca tandrA cAlasyameva ca| jvaro~avisargI balavAn doShANAmapravartanam||134||

lAlApraseko hRullAsaH kShunnAsho virasaM mukham| stabdhasuptaguruvaM ca gAtrANAM bahumUtratA||135||

na viD jIrNA na ca glAnirjvarasyAmasya lakShaNam|

The ama jwara (first stage of jwara) presents with the following clinical features –

• Anorexia, indigestion, heaviness in the stomach
• Feeling of heaviness and accumulation of impurities in cardiac region, drowsiness and laziness
• Continuous, fever with acute onset.
• Non-elimination of the dosha along with mala or waste products
• Excess salivation, nausea, loss of appetite, and tastelessness in the mouth
• Rigidity, numbness and heaviness of the body
• Excessive urination
• Improper formation of stool
• Absence of muscle emaciation [133-136]

Clinical features of pachyamana jwara (second stage of jwara)

ज्वरवेगोऽधिकस्तृष्णा प्रलापः श्वसनं भ्रमः||१३६||

मलप्रवृत्तिरुत्क्लेशः पच्यमानस्य लक्षणम्|१३७|

jvaravēgō'dhikastr̥ṣṇā pralāpaḥ śvasanaṁ bhramaḥ||136||

malapravr̥ttirutklēśaḥ pacyamānasya lakṣaṇam|137|

jvaravego~adhikastRuShNA pralApaH shvasanaM bhramaH||136||

malapravRuttirutkleshaH pacyamAnasya lakShaNam|137|

The features of pachyamana jwara (second stage of fever) are as follows – high grade fever and excess thirst, delirium, dyspnea, giddiness and excess evacuation of wastes [136]

Clinical features of nirama jwara (third stage of jwara)

क्षुत् क्षामता लघुत्वं च गात्राणां ज्वरमार्दवम्||१३७||

दोषप्रवृत्तिरष्टाहो निरामज्वरलक्षणम्|१३८|

kṣut kṣāmatā laghutvaṁ ca gātrāṇāṁ jvaramārdavam||137||

dōṣapravr̥ttiraṣṭāhō nirāmajvaralakṣaṇam|138|

kShut kShAmatA laghutvaM ca gAtrANAM jvaramArdavam||137||

doShapravRuttiraShTAho nirAmajvaralakShaNam|138|

Restoration of hunger, debility, lightness in the body, reduced fever, elimination of the dosha along with the waste products from the body – are all the clinical features of nirama jwara (condition when the patient’s body becomes free from the ama). These features generally appear on the 8th day. [137-138]

Precaution at first stage of fever

नवज्वरे दिवास्वप्नस्नानाभ्यङ्गान्नमैथुनम्||१३८||

क्रोधप्रवातव्यायामान् कषायांश्च विवर्जयेत्|१३९|

navajvarē divāsvapnasnānābhyaṅgānnamaithunam||138||

krōdhapravātavyāyāmān kaṣāyāṁśca vivarjayēt|139|

navajvare divAsvapnasnAnAbhya~ggAnnamaithunam||138||

krodhapravAtavyAyAmAn kaShAyAMshca vivarjayet|139|

The patient, in the state of nava jwara (first stage fever) should avoid certain things as – daytime sleep, bath, massage, heavy to digest food, sexual intercourse, anger, direct exposure to wind, exercise, and kashaya (astringent foods). [138-139]

Contra-indications of langhana (fasting)

ज्वरे लङ्घनमेवादावुपदिष्टमृते ज्वरात्||१३९||

क्षयानिलभयक्रोधकामशोकश्रमोद्भवात् |१४०|

jvarē laṅghanamēvādāvupadiṣṭamr̥tē jvarāt||139||

kṣayānilabhayakrōdhakāmaśōkaśramōdbhavāt |140|

jvare la~gghanamevAdAvupadiShTamRute jvarAt||139||

kShayAnilabhayakrodhakAmashokashramodbhavAt |140|

Langhana or fasting is prescribed in the initial stage of jwara except those caused by kshaya (consumption), vata dominant jwara, fear, anger, passion, grief and physical exertion.[139-140]

Benefits of langhana (fasting) in jwara

लङ्घनेन क्षयं नीते दोषे सन्धुक्षितेऽनले||१४०||

विज्वरत्वं लघुत्वं च क्षुच्चैवास्योपजायते | प्राणाविरोधिना चैनं लङ्घनेनोपपादयेत्||१४१||

बलाधिष्ठानमारोग्यं यदर्थोऽयं क्रियाक्रमः|१४२|

laṅghanēna kṣayaṁ nītē dōṣē sandhukṣitē'nalē||140||

vijvaratvaṁ laghutvaṁ ca kṣuccaivāsyōpajāyatē | prāṇāvirōdhinā cainaṁ laṅghanēnōpapādayēt||141||

balādhiṣṭhānamārōgyaṁ yadarthō'yaṁ kriyākramaḥ|142|

la~gghanena kShayaM nIte doShe sandhukShite~anale||140||

vijvaratvaM laghutvaM ca kShuccaivAsyopajAyate | prANAvirodhinA cainaM la~gghanenopapAdayet||141||

balAdjhiShThAnamArogyaM yadartho~ayaM kriyAkramaH|142|

Langhana reduces the aggravated dosha and stimulates the agni, as a result of which jwara subsides and the body becomes light and the person’s appetite is restored.

Langhana should be performed to the extent that it does not hamper the vitality or strength of the individual. The aim of all these measures is to regain the health which also depends on the physical, mental and spiritual strength. [140-142]

Management principle of jwara

लङ्घनं स्वेदनं कालो यवाग्वस्तिक्तको रसः||१४२||

पाचनान्यविपक्वानां दोषाणां तरुणे ज्वरे|१४३|

laṅghanaṁ svēdanaṁ kālō yavāgvastiktakō rasaḥ||142||

pācanānyavipakvānāṁ dōṣāṇāṁ taruṇē jvarē|143|

la~gghanaM svedanaM kAlo yavAgvastiktako rasaH||142||

pAcanAnyavipakvAnAM doShANAM taruNe jvare|143|

Langhana (fasting), swedana (fomentation), kala (waiting period of eight days), yavagu (medicated gruels) and tikta rasa drugs (drugs having bitter taste) and all digestive enhancers of avipakva dosha (untransformed) are prescribed in the taruna jwara (the initial stage of jwara).[142]

Various drinks for management of thirst

तृष्यते सलिलं चोष्णं दद्याद्वातकफज्वरे ||१४३||

मद्योत्थे पैत्तिके चाथ शीतलं तिक्तकैः शृतम्| दीपनं पाचनं चैव ज्वरघ्नमुभयं हि तत्||१४४||

स्रोतसां शोधनं बल्यं रुचिस्वेदकरं शिवम्|१४५|

tr̥ṣyatē salilaṁ cōṣṇaṁ dadyādvātakaphajvarē ||143||

madyōtthē paittikē cātha śītalaṁ tiktakaiḥ śr̥tam| dīpanaṁ pācanaṁ caiva jvaraghnamubhayaṁ hi tat||144||

srōtasāṁ śōdhanaṁ balyaṁ rucisvēdakaraṁ śivam|145|

tRuShyate salilaM coShNaM dadyAdvAtakaphajvare ||143||

madyotthe paittike cAtha shItalaM tiktakaiH shRutam| dIpanaM pAcanaM caiva jvaraghnamubhayaM hi tat||144||

srotasAM shodhanaM balyaM rucisvedakaraM shivam|145|

If the patient of jwara feels thirsty, he should be given :

Hot water to drink if the jwara caused by aggravation of vata and kapha;

If the jwara is pitta dominant or if it occurs as a result of intake of alcohol, water boiled with bitter drugs and then cooled, is given.

Both of these are dipana, (digestive stimulant), pachana (enhancing digestion), and jwaraghna (alleviators of jwara). They help in cleansing the channels of circulation and promote strength, appetite, sweating and auspiciousness. [143-145]

Shadanga paniya

मुस्तपर्पटकोशीरचन्दनोदीच्यनागरैः||१४५||

शृतशीतं जलं दद्यात् पिपासाज्वरशान्तये|१४६|

mustaparpaṭakōśīracandanōdīcyanāgaraiḥ||145||

śr̥taśītaṁ jalaṁ dadyāt pipāsājvaraśāntayē|146|

mustaparpaTakoshIracandanodIcyanAgaraiH||145||

shRutashItaM jalaM dadyAt pipAsAjvarashAntaye|146|

Patient should be given water cooled after boiling it with musta, parpataka, ushira, chandana, udichya and nagara for the alleviation of thirst and jwara. [145]

Indication of vamana (therapeutic emesis)

कफप्रधानानुत्क्लिष्टान् दोषानामाशयस्थितान्||१४६||

बुद्ध्वा ज्वरकरान् काले वम्यानां वमनैर्हरेत्|१४७|

kaphapradhānānutkliṣṭān dōṣānāmāśayasthitān||146||

buddhvā jvarakarān kālē vamyānāṁ vamanairharēt|147|

kaphapradhAnAnutkliShTAn doShAnAmAshayasthitAn||146||

buddhvA jvarakarAn kAle vamyAnAM vamanairharet|147|

If the jwara is predominantly caused by vitiated kapha dosha, located in the amashaya (stomach) and is in a stage of utklesha (in a stage of being on the verge of coming out of its place), then it should be eliminated by the administration of emetics.

Note: The status of kapha should be ascertained clearly before the administration of drug and emetics should be given only to those patients who are found suitable for emesis.[147]

Hazards of improper vamana (therapeutic emesis)

अनुपस्थितदोषाणां वमनं तरुणेज्वरे||१४७||

हृद्रोगं श्वासमानाहं मोहं च जनयेद्भृशम्| सर्वदेहानुगाः सामा धातुस्था असुनिर्हराः ||१४८||

दोषाः फलानामामानां स्वरसा इव सात्ययाः|१४९|

anupasthitadōṣāṇāṁ vamanaṁ taruṇējvarē||147||

hr̥drōgaṁ śvāsamānāhaṁ mōhaṁ ca janayēdbhr̥śam| sarvadēhānugāḥ sāmā dhātusthā asunirharāḥ ||148||

dōṣāḥ phalānāmāmānāṁ svarasā iva sātyayāḥ|149|

anupasthitadoShANAM vamanaM taruNejvare||147||

hRudrogaM shvAsamAnAhaM mohaM ca janayedbhRusham| sarvadehAnugAH sAmA dhAtusthA asunirharAH ||148||

doShAH phalAnAmAmAnAM svarasA iva sAtyayAH|149|

If vamana (emesis) is administered to a jwara patient in whom the dosha have not attained the stage of utklesha (verge of coming out), then they may cause acute form of heart disease, dyspnea, anaha (obstruction to the movement of flatus and feces) and illusion. Attempting to take out the anupasthita dosha (unprepared to be eliminated) from the body of a person bring complications for the person and is just like attempting to take out juice from a raw fruit which creates complications (destroys the fruit). [147-149]

Post vamana protocol

वमितं लङ्घितं काले यवागूभिरुपाचरेत्||१४९||

यथास्वौषधसिद्धाभिर्मण्डपूर्वाभिरादितः| यावज्ज्वरमृदूभावात् षडहं वा विचक्षणः||१५०||

तस्याग्निर्दीप्यते ताभिः समिद्भिरिव पावकः| ताश्च भेषजसंयोगाल्लघुत्वाच्चाग्निदीपनाः||१५१||

वातमूत्रपुरीषाणां दोषाणां चानुलोमनाः| स्वेदनाय द्रवोष्णत्वाद्द्रवत्वात्तृट्प्रशान्तये||१५२||

आहारभावात् प्राणाय सरत्वाल्लाघवाय च| ज्वरघ्न्यो ज्वरसात्म्यत्वात्तस्मात् पेयाभिरादितः||१५३||

vamitaṁ laṅghitaṁ kālē yavāgūbhirupācarēt||149||

yathāsvauṣadhasiddhābhirmaṇḍapūrvābhirāditaḥ| yāvajjvaramr̥dūbhāvāt ṣaḍahaṁ vā vicakṣaṇaḥ||150||

tasyāgnirdīpyatē tābhiḥ samidbhiriva pāvakaḥ| tāśca bhēṣajasaṁyōgāllaghutvāccāgnidīpanāḥ||151||

vātamūtrapurīṣāṇāṁ dōṣāṇāṁ cānulōmanāḥ| svēdanāya dravōṣṇatvāddravatvāttr̥ṭpraśāntayē||152||

āhārabhāvāt prāṇāya saratvāllāghavāya ca| jvaraghnyō jvarasātmyatvāttasmāt pēyābhirāditaḥ||153||

vamitaM la~gghitaM kAle yavAgUbhirupAcaret||149||

yathAsvauShadhasiddhAbhirmaNDapUrvAbhirAditaH| yAvajjvaramRudUbhAvAt ShaDahaM vA vicakShaNaH||150||

tasyAgnirdIpyate tAbhiH samidbhiriva pAvakaH| tAshca bheShajasaMyogAllaghutvAccAgnidIpanAH||151||

vAtamUtrapurIShANAM doShANAM cAnulomanAH| svedanAya dravoShNatvAddravatvAttRuTprashAntaye||152||

AhArabhAvAt prANAya saratvAllAghavAya ca| jvaraghnyo jvarasAtmyatvAttasmAt peyAbhirAditaH||153||

The patient after being given emesis and kept on fasting should be administered yavagu (a gruel preparation) prepared by boiling with the drugs mentioned further, in appropriate time. Before administering yavagu, the patient should be given manda (extremely thin gruel). This should be continued by the wise for either six days or till the jwara becomes mild.

As the addition of samidha (fuel) accelerates the fire, similarly the digestive fire also becomes stimulated by the consumption of gruels. These gruels are inherently light for digestion and they further stimulate the agni due to the addition of drugs to it.

These help in anulomana (elimination through the downward movement) of flatus, urine, feces and doshas. Being liquid and hot they also cause sweating. Being watery in nature they also alleviate thirst. Due to their nourishing property as a diet, they sustain the prana (vitality) and cause lightness of the body because of their laxative property. They bring down the jwara and are also wholesome for the jwara patients.

In view of above, a jwara patient should in the beginning be administered with different types of peya (thin gruels). [149-153]

Contra-indications of yavagu

ज्वरानुपचरेद्धीमानृते मद्यसमुत्थितात्| मदात्यये मद्यनित्ये ग्रीष्मे पित्तकफाधिके||१५४||

ऊर्ध्वगे रक्तपित्ते च यवागूर्न हिता ज्वरे|१५५|

jvarānupacarēddhīmānr̥tē madyasamutthitāt| madātyayē madyanityē grīṣmē pittakaphādhikē||154||

ūrdhvagē raktapittē ca yavāgūrna hitā jvarē|155|

jvarAnupacareddhImAnRute madyasamutthitAt| madAtyaye madyanitye grIShme pittakaphAdhike||154||

Urdhvage raktapitte ca yavAgUrna hitA jvare|155|

However, these gruels are contraindicated in the fevers caused by intake of alcohol, in alcoholism, for persons addicted to alcohol, in summer seasons, when there is predominance of pitta and kapha and in urdhwaga rakta–pitta (a disease characterized by bleeding from the different upper channels of the body).[154]

तत्र तर्पणमेवाग्रे प्रयोज्यं लाजसक्तुभिः||१५५||

ज्वरापहैः फलरसैर्युक्तं समधुशर्करम्|१५६|

tatra tarpaṇamēvāgrē prayōjyaṁ lājasaktubhiḥ||155||

jvarāpahaiḥ phalarasairyuktaṁ samadhuśarkaram|156|

tatra tarpaNamevAgre prayojyaM lAjasaktubhiH||155||

jvarApahaiH phalarasairyuktaM samadhusharkaram|156|

In cases where yavagu administration is prohibited, the physician should administer in the beginning tarpana (nutritional diet) prepared from laja saktu (powder of roasted grains) mixed with honey, sugar and fruit juices, which have jwara alleviating properties.[155]

Guidelines for diet, mouth cleansing and tooth brush

ततः सात्म्यबलापेक्षी भोजयेज्जीर्णतर्पणम्||१५६||

तनुना मुद्गयूषेण जाङ्गलानां रसेन वा| अन्नकालेषु चाप्यस्मै विधेयं दन्तधावनम्||१५७||

योऽस्य वक्त्ररसस्तस्माद्विपरीतं प्रियं च यत्| तदस्य मुखवैशद्यं प्रकाङ्क्षां चान्नपानयोः||१५८||

धत्ते रसविशेषाणामभिज्ञत्वं करोति यत्| विशोध्य द्रुमशाखाग्रैरास्यं प्रक्षाल्य चासकृत्||१५९||

मस्त्विक्षुरसमद्याद्यैर्यथाहारमवाप्नुयात्|१६०|

tataḥ sātmyabalāpēkṣī bhōjayējjīrṇatarpaṇam||156||

tanunā mudgayūṣēṇa jāṅgalānāṁ rasēna vā| annakālēṣu cāpyasmai vidhēyaṁ dantadhāvanam||157||

yō'sya vaktrarasastasmādviparītaṁ priyaṁ ca yat| tadasya mukhavaiśadyaṁ prakāṅkṣāṁ cānnapānayōḥ||158||

dhattē rasaviśēṣāṇāmabhijñatvaṁ karōti yat| viśōdhya drumaśākhāgrairāsyaṁ prakṣālya cāsakr̥t||159||

mastvikṣurasamadyādyairyathāhāramavāpnuyāt|160|

tataH sAtmyabalApekShI bhojayejjIrNatarpaNam||156||

tanunA mudgayUSheNa jA~ggalAnAM rasena vA| annakAleShu cApyasmai vidheyaM dantadhAvanam||157||

yo~asya vaktrarasastasmAdviparItaM priyaM ca yat| tadasya mukhavaishadyaM prakA~gkShAM cAnnapAnayoH||158||

dhatte rasavisheShANAmabhij~jatvaM karoti yat| vishodhya drumashAkhAgrairAsyaM prakShAlya cAsakRut||159||

mastvikShurasamadyAdyairyathAhAramavApnuyAt|160|

Depending upon the habituation (satmya) and the strength of the patient, after digestion of the tarpana, patient is administered thin soup of mudga (green gram) or meat of wild animals. During food time, the patient’s teeth should be cleaned with the twig of plants, which should be such that their taste can counteract the taste of the patient’s mouth and is relishing to the patient. Such kind of cleaning of teeth makes the patient feel freshness in his mouth, develops appetite for food and drinks and becomes capable of appreciating the taste of food to be taken. The mouth should be cleaned several times with water after cleaning with twigs. Thereafter the patient should be given mastu (thin butter milk), sugarcane juice, alcoholic drinks etc. with suitable and appropriate diet.[156-159]

पाचनं शमनीयं वा कषायं पाययेद्भिषक्||१६०||

ज्वरितं षडहेऽतीते लघ्वन्नप्रतिभोजितम्|१६१|

pācanaṁ śamanīyaṁ vā kaṣāyaṁ pāyayēdbhiṣak||160||

jvaritaṁ ṣaḍahē'tītē laghvannapratibhōjitam|161|

pAcanaM shamanIyaM vA kaShAyaM pAyayedbhiShak||160||

jvaritaM ShaDahe~atIte laghvannapratibhojitam|161|

The jwara patient, after six days and having been given light diet to eat, should be administered decoctions, which are either pachana (stimulant of digestion) or shamana (alleviator of doshas). [160-161]

Contra-indications of kashaya (astringents)

स्तभ्यन्ते न विपच्यन्ते कुर्वन्ति विषमज्वरम्||१६१||

दोषा बद्धाः कषायेण स्तम्भित्वात्तरुणे ज्वरे| न तु कल्पनमुद्दिश्य कषायः प्रतिषिध्यते||१६२||

यः कषायकषायः स्यात् स वर्ज्यस्तरुणज्वरे|१६३|

stabhyantē na vipacyantē kurvanti viṣamajvaram||161||

dōṣā baddhāḥ kaṣāyēṇa stambhitvāttaruṇē jvarē| na tu kalpanamuddiśya kaṣāyaḥ pratiṣidhyatē||162||

yaḥ kaṣāyakaṣāyaḥ syāt sa varjyastaruṇajvarē|163|

stabhyante na vipacyante kurvanti viShamajvaram||161||

doShA baddhAH kaShAyeNa stambhitvAttaruNe jvare| na tu kalpanamuddishya kaShAyaH pratiShidhyate||162||

yaH kaShAyakaShAyaH syAt sa varjyastaruNajvare|163|

If, decoctions of astringent drugs are administered to the patient in taruna jwara (first stage of jwara) stage, then the doshas do not undergo paka (digested) and get adhered due to stickiness. This leads to the onset of vishama jwara (irregular fevers). The term kashaya has two meanings i.e. the decoction prepared by boiling the drugs and astringent taste. In the first stage of jwara (taruna jwara), the astringent tasted drugs are prohibited. [161-163]

Yusha (soup) indications

यूषैरम्लैरनम्लैर्वा जाङ्गलैर्वा रसैर्हितैः||१६३||

दशाहं यावदश्नीयाल्लघ्वन्नं ज्वरशान्तये|१६४|

yūṣairamlairanamlairvā jāṅgalairvā rasairhitaiḥ||163||

daśāhaṁ yāvadaśnīyāllaghvannaṁ jvaraśāntayē|164|

yUShairamlairanamlairvA jA~ggalairvA rasairhitaiH||163||

dashAhaM yAvadashnIyAllaghvannaM jvarashAntaye|164|

The patient should be given light diet along with yusha (soup) prepared from vegetables and pulses and rasa (soup) of the meat of animals inhabiting arid regions, for the alleviation of jwara, up to the tenth day. Amla (sour) things may or may not be added to these yusha. [163-164]

Indications and contra-indications of ghrita

अत ऊर्ध्वं कफे मन्दे वातपित्तोत्तरे ज्वरे||१६४||

परिपक्वेषु दोषेषु सर्पिष्पानं यथाऽमृतम्| निर्दशाहमपि ज्ञात्वा कफोत्तरमलङ्घितम्||१६५||

न सर्पिः पाययेद्वैद्यः कषायैस्तमुपाचरेत् | यावल्लघुत्वादशनं दद्यान्मांसरसेन च||१६६||

बलं ह्यलं निग्रहाय दोषाणां, बलकृच्च तत् |१६७|

ata ūrdhvaṁ kaphē mandē vātapittōttarē jvarē||164||

paripakvēṣu dōṣēṣu sarpiṣpānaṁ yathā'mr̥tam| nirdaśāhamapi jñātvā kaphōttaramalaṅghitam||165||

na sarpiḥ pāyayēdvaidyaḥ kaṣāyaistamupācarēt | yāvallaghutvādaśanaṁ dadyānmāṁsarasēna ca||166||

balaṁ hyalaṁ nigrahāya dōṣāṇāṁ, balakr̥cca tat |167|

ata UrdhvaM kaphe mande vAtapittottare jvare||164||

paripakveShu doSheShu sarpiShpAnaM yathA~amRutam| nirdashAhamapi j~jAtvA kaphottaramala~gghitam||165||

na sarpiH pAyayedvaidyaH kaShAyaistamupAcaret | yAvallaghutvAdashanaM dadyAnmAMsarasena ca||166||

balaM hyalaM nigrahAya doShANAM, balakRucca tat |167|

Thereafter, in case of less aggravation of kapha dosha and excess aggravation of vata and pitta dosha, and in whom the dosha have reached the pakva stage (having no ama ansha), ghee should be given to the patients. It is like amrita (nectar) for them.

Ghee should not be given to jwara patient even after the tenth day, if the kapha dosha still predominates and if the signs and symptoms of well accomplished langhana have not appeared. In such case kashaya should be administered to the patient till the body becomes light.

Till the features of langhana appear in the body, the patient should be given light to digest food along with the meat soup of wild animals and birds. This destroys the strength of the doshas and promotes the strength of the body. [164-167]

Indication of milk

दाहतृष्णापरीतस्य वातपित्तोत्तरं ज्वरम्||१६७||

बद्धप्रच्युतदोषं वा निरामं पयसा जयेत्|१६८|

dāhatr̥ṣṇāparītasya vātapittōttaraṁ jvaram||167||

baddhapracyutadōṣaṁ vā nirāmaṁ payasā jayēt|168|

dAhatRuShNAparItasya vAtapittottaraM jvaram||167||

baddhapracyutadoShaM vA nirAmaM payasA jayet|168|

A patient with the following conditions should be given milk in nirama stage in the body –

• When the patient has excessive burning sensation and thirst
• If vata and pitta dosha predominate the patient is suffering from jwara
• If the dosha are either baddha (static), or prachyuta (slightly dislodged). [167]

Indication of virechana

क्रियाभिराभिः प्रशमं न प्रयाति यदा ज्वरः||१६८||

अक्षीणबलमांसाग्नेः शमयेत्तं विरेचनैः|१६९|

kriyābhirābhiḥ praśamaṁ na prayāti yadā jvaraḥ||168||

akṣīṇabalamāṁsāgnēḥ śamayēttaṁ virēcanaiḥ|169|

kriyAbhirAbhiH prashamaM na prayAti yadA jvaraH||168||

akShINabalamAMsAgneH shamayettaM virecanaiH|169|

If the jwara does not subside by the therapies described before, then virechana (purgation) should be given for its alleviation provided, the patient is neither emaciated, weak, depleted of muscle tissue nor has reduced digestive power. [168-169]

Indications of niruha (enema with decoction)

ज्वरक्षीणस्य न हितं वमनं न विरेचनम्||१६९||

कामं तु पयसा तस्य निरूहैर्वा हरेन्मलान्| निरूहो बलमग्निं च विज्वरत्वं मुदं रुचिम्||१७०||

परिपक्वेषु दोषेषु प्रयुक्तः शीघ्रमावहेत्| पित्तं वा कफपित्तं वा पित्ताशयगतं हरेत्||१७१||

स्रंसनं त्रीन्मलान् बस्तिर्हरेत् पक्वाशयस्थितान्|१७२|

jvarakṣīṇasya na hitaṁ vamanaṁ na virēcanam||169||

kāmaṁ tu payasā tasya nirūhairvā harēnmalān| nirūhō balamagniṁ ca vijvaratvaṁ mudaṁ rucim||170||

paripakvēṣu dōṣēṣu prayuktaḥ śīghramāvahēt| pittaṁ vā kaphapittaṁ vā pittāśayagataṁ harēt||171||

sraṁsanaṁ trīnmalān bastirharēt pakvāśayasthitān|172|

jvarakShINasya na hitaM vamanaM na virecanam||169||

kAmaM tu payasA tasya nirUhairvA harenmalAn| nirUho balamagniM ca vijvaratvaM mudaM rucim||170||

paripakveShu doSheShu prayuktaH shIghramAvahet| pittaM vA kaphapittaM vA pittAshayagataM haret||171||

sraMsanaM trInmalAn bastirharet pakvAshayasthitAn|172|

Neither vamana (emesis) nor virechana (purgation) is useful for patients emaciated by fever. It is thus desirable to remove their malas by the administration of milk or niruha (ununctuous type of medicated enema prepared by decoctions etc.)

Niruha basti administered when the dosha are in paripakva stage immediately promotes the strength and the power of digestion, alleviates fever and causes happiness and brings relish for food.

Purgation (stransana) eliminates kapha or kapha pitta dosha from the pittashaya (lower portion of the stomach and small intestine). Basti eliminates all the three dosha lodged in the pakwashaya.[169-170]

Indication of anuvasana (unctuous enema)

ज्वरे पुराणे सङ्क्षीणे कफपित्ते दृढाग्नये||१७२||

रूक्षबद्धपुरीषाय प्रदद्यादनुवासनम्|१७३|

jvarē purāṇē saṅkṣīṇē kaphapittē dr̥ḍhāgnayē||172||

rūkṣabaddhapurīṣāya pradadyādanuvāsanam|173|

jvare purANe sa~gkShINe kaphapitte dRuDhAgnaye||172||

rUkShabaddhapurIShAya pradadyAdanuvAsanam|173|

In chronic types of fever (jirna jwara) anuvasana type of basti (medicated enema with oils) should be given in the following conditions –

• When kapha and pitta are alleviated
• When there is strong power of digestion
• When there is ununctuousness (rukshata) and bandhatwa (obstruction, compactness) in the feces. [172-173]

Indications of murdha-virechana (nasal errhines)

गौरवे शिरसः शूले विबद्धेष्विन्द्रियेषु च||१७३||

जीर्णज्वरे रुचिकरं कुर्यान्मूर्धविरेचनम्|१७४|

gauravē śirasaḥ śūlē vibaddhēṣvindriyēṣu ca||173||

jīrṇajvarē rucikaraṁ kuryānmūrdhavirēcanam|174|

gaurave shirasaH shUle vibaddheShvindriyeShu ca||173||

jIrNajvare rucikaraM kuryAnmUrdhavirecanam|174|

Murdha virechana should be done in patients suffering from chronic type of fevers who have heaviness and pain in head, impaired sensoria. This develops relish for food and also the objects. [173-174]

Various external procedures

अभ्यङ्गांश्च प्रदेहांश्च परिषेकावगाहने||१७४||

विभज्य शीतोष्णकृतं कुर्याज्जीर्णे ज्वरे भिषक्| तैराशु प्रशमं याति बहिर्मार्गगतो ज्वरः||१७५||

लभन्ते सुखमङ्गानि बलं वर्णश्च वर्धते|१७६|

धूपनाञ्जनयोगैश्च यान्ति जीर्णज्वराः शमम्||१७६||

त्वङ्मात्रशेषा येषां च भवत्यागन्तुरन्वयः|१७७|

abhyaṅgāṁśca pradēhāṁśca pariṣēkāvagāhanē||174||

vibhajya śītōṣṇakr̥taṁ kuryājjīrṇē jvarē bhiṣak| tairāśu praśamaṁ yāti bahirmārgagatō jvaraḥ||175||

labhantē sukhamaṅgāni balaṁ varṇaśca vardhatē| dhūpanāñjanayōgaiśca yānti jīrṇajvarāḥ śamam||176||

tvaṅmātraśēṣā yēṣāṁ ca bhavatyāganturanvayaḥ|177|

abhya~ggAMshca pradehAMshca pariShekAvagAhane||174||

vibhajya shItoShNakRutaM kuryAjjIrNe jvare bhiShak| tairAshu prashamaM yAti bahirmArgagato jvaraH||175||

labhante sukhama~ggAni balaM varNashca vardhate| dhUpanA~jjanayogaishca yAnti jIrNajvarAH shamam||176||

tva~gmAtrasheShA yeShAM ca bhavatyAganturanvayaH|177|

Abhyanga (massage), pradeha (unguentum), parisheka (sprinkling of water), and avagahana (bathing) should be done in patients of jirna jwara (chronic fevers) considering the types of jwara with their hot and cold types. By these measures the bahirmargagata (located in the external tissues) jwara gets alleviated instantaneously. There is a feeling of ease in the body along with the promotion of strength and complexion.

Jirna jwara (chronic stage) also gets alleviated by the administration of dhupana (fumigation) and anjana (collyrium).

Jwara located in skin and of exogenous nature or types can be treated with same. [174-177]

Various dietary articles used in treatment

इति क्रियाक्रमः सिद्धो ज्वरघ्नः सम्प्रकाशितः||१७७||

येषां त्वेष क्रमस्तानि द्रव्याण्यूर्ध्वमतः शृणु| रक्तशाल्यादयः शस्ताः पुराणाः षष्टिकैः सह||१७८||

यवाग्वोदनलाजार्थे ज्वरितानां ज्वरापहाः|१७९|

iti kriyākramaḥ siddhō jvaraghnaḥ samprakāśitaḥ||177||

yēṣāṁ tvēṣa kramastāni dravyāṇyūrdhvamataḥ śr̥ṇu| raktaśālyādayaḥ śastāḥ purāṇāḥ ṣaṣṭikaiḥ saha||178||

yavāgvōdanalājārthē jvaritānāṁ jvarāpahāḥ|179|

iti kriyAkramaH siddho jvaraghnaH samprakAshitaH||177||

yeShAM tveSha kramastAni dravyANyUrdhvamataH shRuNu| raktashAlyAdayaH shastAH purANAH ShaShTikaiH saha||178||

yavAgvodanalAjArthe jvaritAnAM jvarApahAH|179|

Proper line of treatment for the alleviation of jwara has been described above, the ingredients used for therapies in accordance to the above stated line of treatment has been described further.

For this purpose, rakta shali, shashtika type of purana (preserved for over an year) rice are the best and should be given in the form of yavagu (gruel), odana (boiled rice), laja (fried paddy) as these mitigate jwara of the patient. [177-179]

Ten types of yavagu (gruel) in jwara

लाजपेयां सुखजरां पिप्पलीनागरैः शृताम्||१७९||

पिबेज्ज्वरी ज्वरहरां क्षुद्वानल्पाग्निरादितः| अम्लाभिलाषी तामेव दाडिमाम्लां सनागराम्||१८०||

सृष्टविट् पैत्तिको वाऽथ शीतां मधुयुतां पिबेत्| पेयां वा रक्तशालीनां पार्श्वबस्तिशिरोरुजि||१८१||

श्वदंष्ट्राकण्टकारिभ्यां सिद्धां ज्वरहरां पिबेत्| ज्वरातिसारी पेयां वा पिबेत् साम्लां शृतां नरः||१८२||

पृश्निपर्णीबलाबिल्वनागरोत्पलधान्यकैः| शृतां विदारीगन्धाद्यैर्दीपनीं स्वेदनीं नरः||१८३||

कासी श्वासी च हिक्की च यवागूं ज्वरितः पिबेत्| विबद्धवर्चाः सयवां पिप्पल्यामलकैः शृताम्||१८४||

सर्पिष्मतीं पिबेत् पेयां ज्वरी दोषानुलोमनीम्| कोष्ठे विबद्धे सरुजि पिबेत् पेयां शृतां ज्वरी||१८५||

मृद्वीकापिप्पलीमूलचव्यामलकनागरैः| पिबेत् सबिल्वां पेयां वा ज्वरे सपरिकर्तिके||१८६||

बलावृक्षाम्लकोलाम्लकलशीधावनीशृताम्| अस्वेदनिद्रस्तृष्णार्तः पिबेत् पेयां सशर्कराम्||१८७||

नागरामलकैः सिद्धां घृतभृष्टां ज्वरापहाम्|१८८|

lājapēyāṁ sukhajarāṁ pippalīnāgaraiḥ śr̥tām||179||

pibējjvarī jvaraharāṁ kṣudvānalpāgnirāditaḥ| amlābhilāṣī tāmēva dāḍimāmlāṁ sanāgarām||180||

sr̥ṣṭaviṭ paittikō vā'tha śītāṁ madhuyutāṁ pibēt| pēyāṁ vā raktaśālīnāṁ pārśvabastiśirōruji||181||

śvadaṁṣṭrākaṇṭakāribhyāṁ siddhāṁ jvaraharāṁ pibēt| jvarātisārī pēyāṁ vā pibēt sāmlāṁ śr̥tāṁ naraḥ||182||

pr̥śniparṇībalābilvanāgarōtpaladhānyakaiḥ| śr̥tāṁ vidārīgandhādyairdīpanīṁ svēdanīṁ naraḥ||183||

kāsī śvāsī ca hikkī ca yavāgūṁ jvaritaḥ pibēt| vibaddhavarcāḥ sayavāṁ pippalyāmalakaiḥ śr̥tām||184||

sarpiṣmatīṁ pibēt pēyāṁ jvarī dōṣānulōmanīm| kōṣṭhē vibaddhē saruji pibēt pēyāṁ śr̥tāṁ jvarī||185||

mr̥dvīkāpippalīmūlacavyāmalakanāgaraiḥ| pibēt sabilvāṁ pēyāṁ vā jvarē saparikartikē||186||

balāvr̥kṣāmlakōlāmlakalaśīdhāvanīśr̥tām| asvēdanidrastr̥ṣṇārtaḥ pibēt pēyāṁ saśarkarām||187||

nāgarāmalakaiḥ siddhāṁ ghr̥tabhr̥ṣṭāṁ jvarāpahām|188|

lAjapeyAM sukhajarAM pippalInAgaraiH shRutAm||179||

pibejjvarI jvaraharAM kShudvAnalpAgnirAditaH| amlAbhilAShI tAmeva dADimAmlAM sanAgarAm||180||

sRuShTaviT paittiko vA~atha shItAM madhuyutAM pibet| peyAM vA raktashAlInAM pArshvabastishiroruji||181||

shvadaMShTrAkaNTakAribhyAM siddhAM jvaraharAM pibet| jvarAtisArI peyAM vA pibet sAmlAM shRutAM naraH||182||

pRushniparNIbalAbilvanAgarotpaladhAnyakaiH| shRutAM vidArIgandhAdyairdIpanIM svedanIM naraH||183||

kAsI shvAsI ca hikkI ca yavAgUM jvaritaH pibet| vibaddhavarcAH sayavAM pippalyAmalakaiH shRutAm||184||

sarpiShmatIM pibet peyAM jvarI doShAnulomanIm| koShThe vibaddhe saruji pibet peyAM shRutAM jvarI||185||

mRudvIkApippalImUlacavyAmalakanAgaraiH| pibet sabilvAM peyAM vA jvare saparikartike||186||

balAvRukShAmlakolAmlakalashIdhAvanIshRutAm| asvedanidrastRuShNArtaH pibet peyAM sasharkarAm||187||

nAgarAmalakaiH siddhAM ghRutabhRuShTAM jvarApahAm|188|

• The peya prepared with laja (fried paddy) and boiled with pippali and nagara is light to digest and should be given to the patient in the beginning of the jwara when the digestive power is reduced. However, it should be ascertained before administration that the patient is desirous for food before administration.
• If there is movement of bowel and the patient is desirous of sour things, then the peya described above should be made sour by adding daḍima and should be given along with nagara.
• The above mentioned peya should be cooled and added with honey before administration in paittika type of patient.
• A patient suffering from shula (pain) in the parshva (flanks), basti (urinary bladder) and shira (head) regions should be given peya prepared from red variety of shali rice and boiled with shvadashtra and kantakari as this alleviates jwara.
• A person suffering from jwaratisara (fever associated with diarrhoea) should be given peya which is sour and is boiled with prishniparni, bala, bilva, nagara, utpala and dhanyaka.
• Patients suffering from jwara associated with kasa (bronchitis), shwasa (difficulty in breathing) and hikka (hiccups) should be given yavagu prepared by boiling with the group of drugs belonging to vidarigandhadi gana, which acts as a stimulant of digestion and promotes sweating.
• Peya prepared of yava (barley) boiled with pippali and amalaki should be given to a patient suffering from jwara associated with koshthabaddhata(constipation). It causes anulomana (downward movement) of dosa. This peya mixed with ghee should be taken by the patient suffering from jwara associated with constipation.
• The peya prepared by boiling with mridvika, pippali mula, chavya, amalaka and nagara should be taken by the patient suffering from jwara associated with constipation and pain.
• Peya boiled with bala, vrikshamla, kolamla, kalashi (simha pucchi), dhavani (kantakari) and bilva should be given to a patient suffering from jwara associated with sawing pain. (cutting pain).
• Peya prepared by boiling with nagara and amalaka fried with ghee and mixed with sugar is jwaraghna (alleviates jwara). It should be given to a patient suffering from asweda (absence of sweating), anidra (sleeplessness) and trishna (morbid thirst). (179-188)

Indications of soup

मुद्गान्मसूरांश्चणकान् कुलत्थान् समकुष्टकान्||१८८|| यूषार्थे यूषसात्म्यानां ज्वरितानां प्रदापयेत्|१८९| mudgānmasūrāṁścaṇakān kulatthān samakuṣṭakān||188|| yūṣārthē yūṣasātmyānāṁ jvaritānāṁ pradāpayēt|189|

mudgAnmasUrAMshcaNakAn kulatthAn samakuShTakAn||188|| yUShArthe yUShasAtmyAnAM jvaritAnAM pradApayet|189|

Yusha is wholesome for some patients of jwara. This yusha may be prepared from mudga, masura, chanaka, kulattha and makushtha.(188-189)

Indications of vegetables

पटोलपत्रं सफलं कुलकं पापचेलिकम्||१८९|| कर्कोटकं कठिल्लं च विद्याच्छाकं ज्वरे हितम्|१९०| paṭōlapatraṁ saphalaṁ kulakaṁ pāpacēlikam||189|| karkōṭakaṁ kaṭhillaṁ ca vidyācchākaṁ jvarē hitam|190| paTolapatraM saphalaM kulakaM pApacelikam||189|| karkoTakaM kaThillaM ca vidyAcchAkaM jvare hitam|190| The leaves and fruits of patola, kulaka (karvellaka), papachelika (patha), karkotaka, kathilla (red variety of punarnava) shakas are useful in the patients of jwara. (189-190)

Indication of animal meat soups

लावान् कपिञ्जलानेणांश्चकोरानुपचक्रकान्||१९०|| कुरङ्गान् कालपुच्छांश्च हरिणान् पृषताञ्छशान्| प्रदद्यान्मांससात्म्याय ज्वरिताय ज्वरापहान्||१९१|| ईषदम्लाननम्लान् वा रसान् काले विचक्षणः| कुक्कुटांश्च मयूरांश्च तित्तिरिक्रौञ्चवर्तकान्||१९२|| गुरूष्णत्वान्न शंसन्ति ज्वरे केचिच्चिकित्सकाः| लङ्घनेनानिलबलं ज्वरे यद्यधिकं भवेत्||१९३|| भिषङ्मात्राविकल्पज्ञो दद्यात्तानपि कालवित्|१९४|

lāvān kapiñjalānēṇāṁścakōrānupacakrakān||190|| kuraṅgān kālapucchāṁśca hariṇān pr̥ṣatāñchaśān| pradadyānmāṁsasātmyāya jvaritāya jvarāpahān||191|| īṣadamlānanamlān vā rasān kālē vicakṣaṇaḥ| kukkuṭāṁśca mayūrāṁśca tittirikrauñcavartakān||192|| gurūṣṇatvānna śaṁsanti jvarē kēciccikitsakāḥ| laṅghanēnānilabalaṁ jvarē yadyadhikaṁ bhavēt||193|| bhiṣaṅmātrāvikalpajñō dadyāttānapi kālavit|194|

lAvAn kapi~jjalAneNAMshcakorAnupacakrakAn||190|| kura~ggAn kAlapucchAMshca hariNAn pRuShatA~jchashAn| pradadyAnmAMsasAtmyAya jvaritAya jvarApahAn||191|| IShadamlAnanamlAn vA rasAn kAle vicakShaNaH| kukkuTAMshca mayUrAMshca tittirikrau~jcavartakAn||192|| gurUShNatvAnna shaMsanti jvare keciccikitsakAH| la~gghanenAnilabalaM jvare yadyadhikaM bhavet||193|| bhiSha~gmAtrAvikalpaj~jo [1] dadyAttAnapi kAlavit|194|

The soup prepared from lava, kapinjala (white variety of tittiri), ena (krushna sara), chakora, upachakraka (a variety of chakora), kuranga, kala puccha (a type of harina), harina (coppery coloured dear), priashata (spotted dear) and shasha (rabbit) are alleviators of jwara and hence should be given to the patients of jwara for whom meat is wholesome. These meat soups may be made slightly sour or taken as such. The wise physician should administer these soups at apropriate time. Some physicians do not advise the meat soups of animals such as kukkuta, mayura, tittiri, krauncha and vartaka as they are heavy to digest and hot potency. In jwara if vayu gets aggravated because of langhana, then the physician acquainted with the signs of the doshas should give the meat soup of these animals also at apropriate time. (190-194)

Anupana(beverages)

घर्माम्बु चानुपानार्थं तृषिताय प्रदापयेत्||१९४|| मद्यं वा मद्यसात्म्याय यथादोषं यथाबलम्|१९५| gharmāmbu cānupānārthaṁ tr̥ṣitāya pradāpayēt||194|| madyaṁ vā madyasātmyāya yathādōṣaṁ yathābalam|195|

gharmAmbu cAnupAnArthaM tRuShitAya pradApayet||194|| madyaM vA madyasAtmyAya yathAdoShaM yathAbalam|195|

Hot water should be given to drink to a thirsty person. Depending upon the doshas involved and the strength of the patient madya (wines) may be given to those patients for whom it is wholesome. (194-195)

Contra-indications in jwara

गुरूष्णस्निग्धमधुरान् कषायांश्च नवज्वरे||१९५|| आहारान् दोषपक्त्यर्थं प्रायशः परिवर्जयेत्| अन्नपानक्रमः सिद्धो ज्वरघ्नः सम्प्रकाशितः||१९६||

gurūṣṇasnigdhamadhurān kaṣāyāṁśca navajvarē||195|| āhārān dōṣapaktyarthaṁ prāyaśaḥ parivarjayēt| annapānakramaḥ siddhō jvaraghnaḥ samprakāśitaḥ||196||

gurUShNasnigdhamadhurAn kaShAyAMshca navajvare||195|| AhArAn doShapaktyarthaM prAyashaH parivarjayet| annapAnakramaH siddho jvaraghnaH samprakAshitaH||196||

Food ingredients, which are heavy to digest, hot in potency, with unctuous property, sweet and astringent taste should preferably be avoided in a patient suffering from nava jwara (the patient of first stage of jwara) in order to fascilitate the paka of the doshas. So, the diet and drinks, which are wholesome to the patient of jwara have been described here. (195-196)

Decoctions indicated in jwara

अत ऊर्ध्वं प्रवक्ष्यन्ते कषाया ज्वरनाशनाः| पाक्यं शीतकषायं वा मुस्तपर्पटकं पिबेत्||१९७|| सनागरं पर्पटकं पिबेद्वा सदुरालभम्| किराततिक्तकं मुस्तं गुडूचीं विश्वभेषजम्||१९८|| पाठामुशीरं सोदीच्यं पिबेद्वा ज्वरशान्तये| ज्वरघ्ना दीपनाश्चैते कषाया दोषपाचनाः||१९९|| तृष्णारुचिप्रशमना मुखवैरस्यनाशनाः|२००| ata ūrdhvaṁ pravakṣyantē kaṣāyā jvaranāśanāḥ| pākyaṁ śītakaṣāyaṁ vā mustaparpaṭakaṁ pibēt||197|| sanāgaraṁ parpaṭakaṁ pibēdvā sadurālabham| kirātatiktakaṁ mustaṁ guḍūcīṁ viśvabhēṣajam||198|| pāṭhāmuśīraṁ sōdīcyaṁ pibēdvā jvaraśāntayē| jvaraghnā dīpanāścaitē kaṣāyā dōṣapācanāḥ||199|| tr̥ṣṇārucipraśamanā mukhavairasyanāśanāḥ|200|

ata UrdhvaM pravakShyante kaShAyA jvaranAshanAH| pAkyaM shItakaShAyaM vA mustaparpaTakaM pibet||197|| sanAgaraM parpaTakaM pibedvA sadurAlabham| kirAtatiktakaM mustaM guDUcIM vishvabheShajam||198|| pAThAmushIraM sodIcyaM pibedvA jvarashAntaye| jvaraghnA dIpanAshcaite kaShAyA doShapAcanAH||199|| tRuShNAruciprashamanA mukhavairasyanAshanAH|200|

Now, we will describe the kashayas (decoctions), which alleviate jwara. These are as follows – 1-2. Musta and parpaṭaka can be taken either in the form of decoction (pakya) or shita kashaya (soaking the drugs for overnight period in water and then filtering the content and using the filtrate). 3. Parpataka decoction may be given to the patient along with nagara and duralabha. 4. The decoction made from kirata tikta, musta, guduchi and vishva bheshaja. 5. The decoction of patha and ushira alongwith udichya. The above mentioned, decoctions which are used for the alleviation of jwara are jwaraghna. They stimulate the power of digestion, help in the pachana (metabolic transformation) of the doshas; alleviate thirst, anorexia and cure mukha vairasya (bad taste of the mouth). (197-199)

Kashaya in vishama jwara

कलिङ्गकाः पटोलस्य पत्रं कटुकरोहिणी||२००||

पटोलः सारिवा मुस्तं पाठा कटुकरोहिणी| निम्बः पटोलस्त्रिफला मृद्वीका मुस्तवत्सकौ|| २०१||

किराततिक्तममृता चन्दनं विश्वभेषजम्| गुडूच्यामलकं मुस्तमर्धश्लोकसमापनाः||c०२||

कषायाः शमयन्त्याशु पञ्च पञ्चविधाञ्ज्वरान्| सन्ततं सततान्येद्युस्तृतीयकचतुर्थकान्||२०३||

kaliṅgakāḥ paṭōlasya patraṁ kaṭukarōhiṇī||200||

paṭōlaḥ sārivā mustaṁ pāṭhā kaṭukarōhiṇī| nimbaḥ paṭōlastriphalā mr̥dvīkā mustavatsakau||101||

kirātatiktamamr̥tā candanaṁ viśvabhēṣajam| guḍūcyāmalakaṁ mustamardhaślōkasamāpanāḥ||202||

kaṣāyāḥ śamayantyāśu pañca pañcavidhāñjvarān| santataṁ satatānyēdyustr̥tīyakacaturthakān||203||

kali~ggakAH paTolasya patraM kaTukarohiNI||200||

paTolaH sArivA mustaM pAThA kaTukarohiNI| nimbaH paTolastriphalA mRudvIkA mustavatsakau||201||

kirAtatiktamamRutA candanaM vishvabheShajam| guDUcyAmalakaM mustamardhashlokasamApanAH||202||

kaShAyAH shamayantyAshu pa~jca pa~jcavidhA~jjvarAn| santataM satatAnyedyustRutIyakacaturthakAn||203||

The five types of jwara named the santata, satata, anyedyushka, tritiyaka and chaturthaka are quickly cured by the five types of decoctions made from drugs described below:

1. Kalingaka, patola leaves and katuka rohini
2. Patola, sariva, musta, patha and katuka rohini
3. Nimbi, patola, triphala, mrudvika, musta and vatsaka
4. Kiratatikta, amrta, chandana, vishva bheshaja; and
5. Guduchi, amalaka and musta. (200-203)

वत्सकारग्वधौ पाठां षड्ग्रन्थां कटुरोहिणीम्| मूर्वां सातिविषां निम्बं पटोलं धन्वयासकम्||२०४||

वचां मुस्तमुशीरं च मधुकं त्रिफलां बलाम्| पाक्यं शीतकषायं वा पिबेज्ज्वरहरं नरः||२०५||

मधूकमुस्तमृद्वीकाकाश्मर्याणि परूषकम्| त्रायमाणामुशीरं च त्रिफलां कटुरोहिणीम्||२०६||

पीत्वा निशिस्थितं जन्तुर्ज्वराच्छीघ्रं विमुच्यते|२०७|

vatsakāragvadhau pāṭhāṁ ṣaḍgranthāṁ kaṭurōhiṇīm| mūrvāṁ sātiviṣāṁ nimbaṁ paṭōlaṁ dhanvayāsakam||204||

vacāṁ mustamuśīraṁ ca madhukaṁ triphalāṁ balām| pākyaṁ śītakaṣāyaṁ vā pibējjvaraharaṁ naraḥ||205||

madhūkamustamr̥dvīkākāśmaryāṇi parūṣakam| trāyamāṇāmuśīraṁ ca triphalāṁ kaṭurōhiṇīm||206||

pītvā niśisthitaṁ janturjvarācchīghraṁ vimucyatē|207|

vatsakAragvadhau pAThAM ShaDgranthAM kaTurohiNIm| mUrvAM sAtiviShAM nimbaM paTolaM dhanvayAsakam||204||

vacAM mustamushIraM ca madhukaM triphalAM balAm| pAkyaM shItakaShAyaM vA pibejjvaraharaM naraH||205||

madhUkamustamRudvIkAkAshmaryANi parUShakam| trAyamANAmushIraM ca triphalAM kaTurohiNIm||206||

pItvA nishisthitaM janturjvarAcchIghraM vimucyate|207|

The decoction or shita kashaya of the following drugs should be taken by a person for curing jwara:

1. vatsaka, aragavadha, patha, shad grantha and katurohini
2. murva along with ativisha, nimbi, patola and dhanavayasaka
3. vacha, musta, ushira, madhuka, triphala and bala

the shita kashaya of madhuka, musta, mrudvika, kashmarya, parushaka, trayamana, ushira, triphala, and katu rohini, prepared by keeping overnight, immediately cures the jwara of living beings. (204-207)

जात्यामलकमुस्तानि तद्वद्धन्वयवासकम्||२०७||

विबद्धदोषो ज्वरितः कषायं सगुडं पिबेत्| त्रिफलां त्रायमाणां च मृद्वीकां कटुरोहिणीम्||२०८||

पित्तश्लेष्महरस्त्वेष कषायो ह्यानुलोमिकः| त्रिवृताशर्करायुक्तः पित्तश्लेष्मज्वरापहः||२०९||

jātyāmalakamustāni tadvaddhanvayavāsakam||207||

vibaddhadōṣō jvaritaḥ kaṣāyaṁ saguḍaṁ pibēt| triphalāṁ trāyamāṇāṁ ca mr̥dvīkāṁ kaṭurōhiṇīm||208||

pittaślēṣmaharastvēṣa kaṣāyō hyānulōmikaḥ| trivr̥tāśarkarāyuktaḥ pittaślēṣmajvarāpahaḥ||209||

jAtyAmalakamustAni tadvaddhanvayavAsakam||207||

vibaddhadoSho jvaritaH kaShAyaM saguDaM pibet| triphalAM trAyamANAM ca mRudvIkAM kaTurohiNIm||208||

pittashleShmaharastveSha kaShAyo hyAnulomikaH| trivRutAsharkarAyuktaH pittashleShmajvarApahaH||209||

The decoction of either jati, amalaka and musta or that of dhanavayavasakam along with guda (jaggery) should be given to the patient suffering from jwara where the doshas are in vibaddha state (adhered to dhatus).

The decoction of triphala, trayamana, mrudvika and katu rohini alleviates pitta and shleshma and causes the anulomana of doshas. This decoction when taken along with trivruta and sharkara cures jwara caused by the aggravation of pitta and shleshma. (207-209)

Formulations used in sannipata jwara

बृहत्यौ वत्सकं मुस्तं देवदारु महौषधम्| कोलवल्ली च योगोऽयं सन्निपातज्वरापहः||२१०|| शटी पुष्करमूलं च व्याघ्री शृङ्गी दुरालभा| गुडूची नागरं पाठा किरातं कटुरोहिणी||२११|| एष शट्यादिको वर्गः सन्निपातज्वरापहः| कासहृद्ग्रहपार्श्वार्तिश्वासतन्द्रासु शस्यते||२१२|| बृहत्यौ पौष्करं भार्गी शटी शृङ्गी दुरालभा| वत्सकस्य च बीजानि पटोलं कटुरोहिणी||२१३|| बृहत्यादिर्गणः प्रोक्तः सन्निपातज्वरापहः| कासादिषु च सर्वेषु दद्यात् सोपद्रवेषु च||२१४|| br̥hatyau vatsakaṁ mustaṁ dēvadāru mahauṣadham| kōlavallī ca yōgō'yaṁ sannipātajvarāpahaḥ||210|| śaṭī puṣkaramūlaṁ ca vyāghrī śr̥ṅgī durālabhā| guḍūcī nāgaraṁ pāṭhā kirātaṁ kaṭurōhiṇī||211|| ēṣa śaṭyādikō vargaḥ sannipātajvarāpahaḥ| kāsahr̥dgrahapārśvārtiśvāsatandrāsu śasyatē||212|| br̥hatyau pauṣkaraṁ bhārgī śaṭī śr̥ṅgī durālabhā| vatsakasya ca bījāni paṭōlaṁ kaṭurōhiṇī||213|| br̥hatyādirgaṇaḥ prōktaḥ sannipātajvarāpahaḥ| kāsādiṣu ca sarvēṣu dadyāt sōpadravēṣu ca||214||

bRuhatyau vatsakaM mustaM devadAru mahauShadham| kolavallI ca yogo~ayaM sannipAtajvarApahaH||210|| shaTI puShkaramUlaM ca vyAghrI shRu~ggI durAlabhA| guDUcI nAgaraM pAThA kirAtaM kaTurohiNI||211|| eSha shaTyAdiko vargaH sannipAtajvarApahaH| kAsahRudgrahapArshvArtishvAsatandrAsu shasyate||212|| bRuhatyau pauShkaraM bhArgI shaTI shRu~ggI durAlabhA| vatsakasya ca bIjAni paTolaM kaTurohiNI||213|| bRuhatyAdirgaNaH proktaH sannipAtajvarApahaH| kAsAdiShu ca sarveShu dadyAt sopadraveShu ca||214||

A decoction prepared from both the varities of bruhati, vatsaka, musta, devadaru, mahaushadha, and kolavalli cures sannipata jwara. Shati, pushkaramula, vyaghri, shringi, duralabha, guduchi, nagara, patha, kirata, katurohini, - all together are called by the name of shaṭyādi varga. The decoction made from these drugs helps in curing sannipāta jwara along with kāsa (coughs), hṛd graham (a kind of heart disease), pārshva artī (pain in the flanks), shvāsa (breathlessness) and tandrā (drowsiness). Both the varieties of bṛhatī, pauṡhkar, bhārgī, shaṭī, ṡṛngī, durālabhā, seeds of vatsaka, patola and katu rohiṇī – are together called the bṛhatyādi gaṇa and the decoction made from it cures the sannipāta jwara. And is also useful in complications like kasa. (210-214)

कषायाश्च यवाग्वश्च पिपासाज्वरनाशनाः| निर्दिष्टा भेषजाध्याये भिषक्तानपि योजयेत्||२१५||

kaṣāyāśca yavāgvaśca pipāsājvaranāśanāḥ| nirdiṣṭā bhēṣajādhyāyē bhiṣaktānapi yōjayēt||215||

kaShAyAshca yavAgvashca pipAsAjvaranAshanAH| nirdiShTA bheShajAdhyAye bhiShaktAnapi yojayet||215|| Different types of decoctions and gruels are also described in the first four chapters of Sutra sthana which also cure pipāsā (thirst) and jwara. They may also be used by the physician for the treatment of jwara. (215)

Advantage of ghee

ज्वराः कषायैर्वमनैर्लङ्घनैर्लघुभोजनैः| रूक्षस्य ये न शाम्यन्ति सर्पिस्तेषां भिषग्जितम्||२१६|| रूक्षं तेजो ज्वरकरं तेजसा रूक्षितस्य च| यः स्यादनुबलो धातुः स्नेहवध्यः स चानिलः||२१७||

jvarāḥ kaṣāyairvamanairlaṅghanairlaghubhōjanaiḥ| rūkṣasya yē na śāmyanti sarpistēṣāṁ bhiṣagjitam||216|| rūkṣaṁ tējō jvarakaraṁ tējasā rūkṣitasya ca| yaḥ syādanubalō dhātuḥ snēhavadhyaḥ [1] sa cānilaḥ||217||

jvarAH kaShAyairvamanairla~gghanairlaghubhojanaiH| rUkShasya ye na shAmyanti sarpisteShAM bhiShagjitam||216|| rUkShaM tejo jvarakaraM tejasA rUkShitasya ca| yaH syAdanubalo dhAtuH snehavadhyaH [1] sa cAnilaH||217||

If in a person of ununctuous disposition, jwara doesn’t get cured by the use of decoctions, emesis, fasting and by light diet, then jwara in such a person should be cured by the use of medicated ghṛt. Jwara is manifested by ununctuous state of tejasa in such a person and a patient suffering from jwara further develops ununctuousness due to the action of this tejas (pitta). The vata gets aggravated due to the action of this tejasa and it can be corrected by the use of some unctuous material like ghṛit. (216-217)

कषायाः सर्व एवैते सर्पिषा सह योजिताः| प्रयोज्या ज्वरशान्त्यर्थमग्निसन्धुक्षणाः शिवाः||२१८|| kaṣāyāḥ sarva ēvaitē sarpiṣā saha yōjitāḥ| prayōjyā jvaraśāntyarthamagnisandhukṣaṇāḥ śivāḥ||218|| kaShAyAH sarva evaite sarpiShA saha yojitAH| prayojyA jvarashAntyarthamagnisandhukShaNAH shivAH||218|| Ghṛit should be added to all those decoctions described above for the alleviation of jwara. They stimulate the power of digestion and endow auspiciousness. (218)

Various medicated ghee formulations

पिप्पल्यश्चन्दनं मुस्तमुशीरं कटुरोहिणी| कलिङ्गकास्तामलकी सारिवाऽतिविषा स्थिरा||२१९|| द्राक्षामलकबिल्वानि त्रायमाणा निदिग्धिका| सिद्धमितैर्घृतं सद्यो जीर्णज्वरमपोहति||२२०|| क्षयं कासं शिरःशूलं पार्श्वशूलं हलीमकम्| अंसाभितापमाग्निं च विषमं सन्नियच्छति||२२१||

pippalyaścandanaṁ mustamuśīraṁ kaṭurōhiṇī| kaliṅgakāstāmalakī sārivā'tiviṣā sthirā||219|| drākṣāmalakabilvāni trāyamāṇā nidigdhikā| siddhamitairghr̥taṁ sadyō jīrṇajvaramapōhati||220|| kṣayaṁ kāsaṁ śiraḥśūlaṁ pārśvaśūlaṁ halīmakam| aṁsābhitāpamāgniṁ ca viṣamaṁ sanniyacchati||221||

pippalyashcandanaM mustamushIraM kaTurohiNI| kali~ggakAstAmalakI sArivA~ativiShA sthirA||219|| drAkShAmalakabilvAni trAyamANA nidigdhikA| siddhamitairghRutaM sadyo jIrNajvaramapohati||220|| kShayaM kAsaM shiraHshUlaM pArshvashUlaM halImakam| aMsAbhitApamAgniM ca viShamaM sanniyacchati||221||

Medicated ghṛit prepared by boiling with pipalī, candana, mustā, katurohiṇī, kalingaka, tāmalakī (bhūmyāmalakī), sārivā, ativishā, sthirā, drākṡā, āmalaka, bilva, trāyamāṇa and nidigdhikā cure chronic types of jwara instantaneously. It also cures kṡaya (consumption), kāsa (coughs), shiraḥshula (headache), pārshvasūla (pain in the sides of chest), halīmaka (a type of jaundice), ansābhitāpa (burning sensation in the scapular region) and viṡama agnī (irregularity in the power of digestion). (219-221)

वासां गुडूचीं त्रिफलां त्रायमाणां यवासकम्| पक्त्वा तेन कषायेण पयसा द्विगुणेन च||२२२||

पिप्पलीमुस्तमृद्वीकाचन्दनोत्पलनागरैः| कल्कीकृतैश्च विपचेद्धृतं जीर्णज्वरापहम्||२२३||

vāsāṁ guḍūcīṁ triphalāṁ trāyamāṇāṁ yavāsakam| paktvā tēna kaṣāyēṇa payasā dviguṇēna ca||222||

pippalīmustamr̥dvīkācandanōtpalanāgaraiḥ| kalkīkr̥taiśca vipacēddhr̥taṁ jīrṇajvarāpaham||223||

vAsAM guDUcIM triphalAM trAyamANAM yavAsakam| paktvA tena kaShAyeNa payasA dviguNena ca||222||

pippalImustamRudvIkAcandanotpalanAgaraiH| kalkIkRutaishca vipaceddhRutaM jIrNajvarApaham||223||

Ghṛit prepared from the decoction made by boiling vāsa, guḍucī, triphalā, trāyamāṇa and yavāsaka, milk in double the quantity, paste of pippalī, mustā, mṛdvīkā, candana, utpala and nagara cures chronic fevers.(222-223)

बलां श्वदंष्ट्रां बृहतीं कलसीं धावनीं स्थिराम्| निम्बं पर्पटकं मुस्तं त्रायमाणां दुरालभाम्||२२४||

कृत्वा कषायं पेष्यार्थे दद्यात्तामलकीं शटीम्| द्राक्षां पुष्करमूलं च मेदामामलकानि च||२२५||

घृतं पयश्च तत् सिद्धं सर्पिर्ज्वरहरं परम्| क्षयकासशिरःशूलपार्श्वशूलांसतापनुत् ||२२६||

balāṁ śvadaṁṣṭrāṁ br̥hatīṁ kalasīṁ dhāvanīṁ sthirām| nimbaṁ parpaṭakaṁ mustaṁ trāyamāṇāṁ durālabhām||224||

kr̥tvā kaṣāyaṁ pēṣyārthē dadyāttāmalakīṁ śaṭīm| drākṣāṁ puṣkaramūlaṁ ca mēdāmāmalakāni ca||225||

ghr̥taṁ payaśca tat siddhaṁ sarpirjvaraharaṁ param| kṣayakāsaśiraḥśūlapārśvaśūlāṁsatāpanut ||226||

balAM shvadaMShTrAM bRuhatIM kalasIM dhAvanIM sthirAm| nimbaM parpaTakaM mustaM trAyamANAM durAlabhAm||224||

kRutvA kaShAyaM peShyArthe dadyAttAmalakIM shaTIm| drAkShAM puShkaramUlaM ca medAmAmalakAni ca||225||

ghRutaM payashca tat siddhaM sarpirjvaraharaM param| kShayakAsashiraHshUlapArshvashUlAMsatApanut ||226||

Ghṛit prepared from boiling the decoction of balā, shvadamṡtrā, bṛhatī, kalasī, dhāvānī, sthirā, nimba, parpaṭaka, musta, trāyamāṇā and durālabhā; paste of tāmalakī, shatī, drāksā, puṡkarmūla, medā and āmalakī, ghee and milk; is an excellent medicine for the treatment of jwara. It also cures kṡaya (consumption), kāsa (coughs), shiraḥshula (headache), pārshvasūla (pain in the sides of chest), halīmaka (a type of jaundice), ansābhitāpa (burning sensation in the scapular region. (224-226)

Formulations used in purification therapies

ज्वरिभ्यो बहुदोषेभ्य ऊर्ध्वं चाधश्च बुद्धिमान्| दद्यात् संशोधनं काले कल्पे यदुपदेक्ष्यते||२२७|| मदनं पिप्पलीभिर्वा कलिङ्गैर्मधुकेन वा| युक्तमुष्णाम्बुना पेयं वमनं ज्वरशान्तये||२२८|| क्षौद्राम्बुना रसेनेक्षोरथवा लवणाम्बुना| ज्वरे प्रच्छर्दनं शस्तं मद्यैर्वा तर्पणेन वा||२२९|| मृद्वीकामलकानां वा रसं प्रस्कन्दनं पिबेत्| रसमामलकानां वा घृतभृष्टं ज्वरापहम्||२३०|| लिह्याद्वा त्रैवृतं चूर्णं संयुक्तं मधुसर्पिषा| पिबेद्वा क्षौद्रमावाप्य सघृतं त्रिफलारसम्||२३१|| आरग्वधं वा पयसा मृद्वीकानां रसेन वा| त्रिवृतां त्रायमाणां वा पयसा ज्वरितः पिबेत्||२३२|| ज्वराद्विमुच्यते पीत्वा मृद्वीकाभिः सहाभयाम्| पयोऽनुपानमुष्णं वा पीत्वा द्राक्षारसं नरः||२३३||

jvaribhyō bahudōṣēbhya ūrdhvaṁ cādhaśca buddhimān| dadyāt saṁśōdhanaṁ kālē kalpē yadupadēkṣyatē||227|| madanaṁ pippalībhirvā kaliṅgairmadhukēna vā| yuktamuṣṇāmbunā pēyaṁ vamanaṁ jvaraśāntayē||228|| kṣaudrāmbunā rasēnēkṣōrathavā lavaṇāmbunā| jvarē pracchardanaṁ śastaṁ madyairvā tarpaṇēna vā||229|| mr̥dvīkāmalakānāṁ vā rasaṁ praskandanaṁ pibēt| rasamāmalakānāṁ vā ghr̥tabhr̥ṣṭaṁ jvarāpaham||230|| lihyādvā traivr̥taṁ cūrṇaṁ saṁyuktaṁ madhusarpiṣā| pibēdvā kṣaudramāvāpya saghr̥taṁ triphalārasam||231|| āragvadhaṁ vā payasā mr̥dvīkānāṁ rasēna vā| trivr̥tāṁ trāyamāṇāṁ vā payasā jvaritaḥ pibēt||232|| jvarādvimucyatē pītvā mr̥dvīkābhiḥ sahābhayām| payō'nupānamuṣṇaṁ vā pītvā drākṣārasaṁ naraḥ||233||

jvaribhyo bahudoShebhya UrdhvaM cAdhashca buddhimAn| dadyAt saMshodhanaM kAle kalpe yadupadekShyate||227|| madanaM pippalIbhirvA kali~ggairmadhukena vA| yuktamuShNAmbunA peyaM vamanaM jvarashAntaye||228|| kShaudrAmbunA rasenekShorathavA lavaNAmbunA| jvare pracchardanaM shastaM madyairvA tarpaNena vA||229|| mRudvIkAmalakAnAM vA rasaM praskandanaM pibet| rasamAmalakAnAM vA ghRutabhRuShTaM jvarApaham||230|| lihyAdvA traivRutaM cUrNaM saMyuktaM madhusarpiShA| pibedvA kShaudramAvApya saghRutaM triphalArasam||231|| AragvadhaM vA payasA mRudvIkAnAM rasena vA| trivRutAM trAyamANAM vA payasA jvaritaH pibet||232|| jvarAdvimucyate pItvA mRudvIkAbhiH sahAbhayAm| payo~anupAnamuShNaM vA pItvA drAkShArasaM naraH||233||

Elimination therapies (of doshas), both in upward and downward routes should be administered at apropriate time, to a patient suffering from jwara, having more aggravated doshas. Details of these methods and the formulations used for them will be discussed in the kalpa sthana. Vamana performed by hot water and madana mixed with either pippalī, kalinga or madhūka alleviates jwara. Emetic therapy given by administering water mixed with honey, sugar cane juice, water mixed with rock salt, alcoholic drinks and tarpaṇa (roasted corn flour eaten mixed with water) is also useful in jwara. A patient suffering from jwara can also be given the juice of mṛdvīkā and āmalaka for purgation. The juice of āmalaka fried with ghṛit also cures jwara. Following recipes are also useful for purgation in a patient suffering from jwara – ¨ powder of trivṛt mixed with honey and ghṛit prepared in the form of linctus. ¨ Juice of triphalā mixed with honey and ghṛit ¨ Āragvadha along with milk or the juice of mṛdvikā ¨ tṛvrita and trāyamāṇa along with milk ¨ mṛdvikā and abhayā along with warm milk or the juice of drākṡā as anupāna. (227-233)

Formulations with medicated milk

कासाच्छ्वासाच्छिरःशूलात्पार्श्वशूलाच्चिरज्वरात्| मुच्यते ज्वरितः पीत्वा पञ्चमूलीशृतं पयः||२३४|| एरण्डमूलोत्क्वथितं ज्वरात् सपरिकर्तिकात्| पयो विमुच्यते पीत्वा तद्वद्बिल्वशलाटुभिः||२३५|| त्रिकण्टकबलाव्याघ्रीगुडनागरसाधितम्| वर्चोमूत्रविबन्धघ्नं शोफज्वरहरं पयः||२३६|| सनागरं समृद्वीकं सघृतक्षौद्रशर्करम्| शृतं पयः सखर्जूरं पिपासाज्वरनाशनम्||२३७|| चतुर्गुणेनाम्भसा वा शृतं ज्वरहरं पयः| धारोष्णं वा पयः सद्यो वातपित्तज्वरं जयेत्||२३८|| जीर्णज्वराणां सर्वेषां पयः प्रशमनं परम्| पेयं तदुष्णं शीतं वा यथास्वं भेषजैः शृतम्||२३९|| kāsācchvāsācchiraḥśūlātpārśvaśūlāccirajvarāt| mucyatē jvaritaḥ pītvā pañcamūlīśr̥taṁ payaḥ||234|| ēraṇḍamūlōtkvathitaṁ jvarāt saparikartikāt| payō vimucyatē pītvā tadvadbilvaśalāṭubhiḥ||235|| trikaṇṭakabalāvyāghrīguḍanāgarasādhitam| varcōmūtravibandhaghnaṁ śōphajvaraharaṁ payaḥ||236|| sanāgaraṁ samr̥dvīkaṁ saghr̥takṣaudraśarkaram| śr̥taṁ payaḥ sakharjūraṁ pipāsājvaranāśanam||237|| caturguṇēnāmbhasā vā śr̥taṁ jvaraharaṁ payaḥ| dhārōṣṇaṁ vā payaḥ sadyō vātapittajvaraṁ jayēt||238|| jīrṇajvarāṇāṁ sarvēṣāṁ payaḥ praśamanaṁ param| pēyaṁ taduṣṇaṁ śītaṁ vā yathāsvaṁ bhēṣajaiḥ śr̥tam||239||

kAsAcchvAsAcchiraHshUlAtpArshvashUlAccirajvarAt| mucyate jvaritaH pItvA pa~jcamUlIshRutaM payaH||234|| eraNDamUlotkvathitaM jvarAt saparikartikAt| payo vimucyate pItvA tadvadbilvashalATubhiH||235|| trikaNTakabalAvyAghrIguDanAgarasAdhitam| varcomUtravibandhaghnaM shophajvaraharaM payaH||236|| sanAgaraM samRudvIkaM saghRutakShaudrasharkaram| shRutaM payaH sakharjUraM pipAsAjvaranAshanam||237|| caturguNenAmbhasA vA shRutaM jvaraharaM payaH| dhAroShNaM vA payaH sadyo vAtapittajvaraM jayet||238|| jIrNajvarANAM sarveShAM payaH prashamanaM param| peyaM taduShNaM shItaM vA yathAsvaM bheShajaiH shRutam||239||

A patient suffering from chira jwara (chronic type of fevers), kāsa, shvāsa, shirah shūla and pārshva shūla gets cured by taking milk boiled with panchamūla (bilva and shyonāka, gambhāri, pātalā and gaṇikārikā). Milk boiled either with the root of eranda or the shalātū (unripe fruit cut into pieces) of bilva when taken cures fever along with parikartikā in the abdomen (sawing pain). Milk boiled with trikanṭaka, balā, vyāghrī, guḍa and nāgara, cures jwara along with shopha (oedema) and obstruction of the urine and faeces. The medicine prepared by boiling milk with nāgara, mṛdvīkā, khajūra and added with ghṛit, honey and sugar cures jwara associated with thirst. Milk boiled by adding water four times cures jwara. Dhāroshṇa mlk (freshly milked from the cow, when its still hot) immediately cures jwara caused by the aggravation of vāta and pitta. All types of chronic fevers are alleviated by milk. It can be taken either hot, cold or after boiling with drugs apropriate to the kind of fever. (234-239)

Medicated enemas

प्रयोजयेज्ज्वरहरान्निरूहान् सानुवासनान्| पक्वाशयगते दोषे वक्ष्यन्ते ये च सिद्धिषु||२४०|| पटोलारिष्टपत्राणि सोशीरश्चतुरङ्गुलः| ह्रीबेरं रोहिणी तिक्ता श्वदंष्ट्रा मदनानि च||२४१|| स्थिरा बला च तत् सर्वं पयस्यर्धोदके शृतम्| क्षीरावशेषं निर्यूहं संयुक्तं मधुसर्पिषा||२४२|| कल्कैर्मदनमुस्तानां पिप्पल्या मधुकस्य च| वत्सकस्य च संयुक्तं बस्तिं दद्याज्ज्वरापहम्||२४३|| शुद्धे मार्गे हृते दोषे विप्रसन्नेषु धातुषु| गताङ्गशूलो लघ्वङ्गः सद्यो भवति विज्वरः||२४४|| आरग्वधमुशीरं च मदनस्य फलं तथा| चतस्रः पर्णिनीश्चैव [१] निर्यूहमुपकल्पयेत्||२४५|| प्रियङ्गुर्मदनं मुस्तं शताह्वा मधुयष्टिका| कल्कः सर्पिर्गुडः क्षौद्रं ज्वरघ्नो बस्तिरुत्तमः||२४६|| गुडूचीं त्रायमाणां च चन्दनं मधुकं वृषम्| स्थिरां बलां पृश्निपर्णीं मदनं चेति साधयेत्||२४७|| रसं जाङ्गलमांसस्य रसेन सहितं भिषक्| पिप्पलीफलमुस्तानां कल्केन मधुकस्य च||२४८|| ईषत्सलवणं युक्त्या निरूहं मधुसर्पिषा| ज्वरप्रशमनं दद्याद्बलस्वेदरुचिप्रदम्||२४९|| जीवन्तीं मधुकं मेदां पिप्पलीं मदनं वचाम्| ऋद्धिं रास्नां बलां विश्वं [२] शतपुष्पां शतावरीम्||२५०|| पिष्ट्वा क्षीरं जलं सर्पिस्तैलं च विपचेद्भिषक्| आनुवासनिकं स्नेहमेतं विद्याज्ज्वरापहम्||२५१|| पटोलपिचुमर्दाभ्यां गुडूच्या मधुकेन च| मदनैश्च शृतः स्नेहो ज्वरघ्नमनुवासनम्||२५२|| चन्दनागुरुकाश्मर्यपटोलमधुकोत्पलैः| सिद्धः स्नेहो ज्वरहरः स्नेहबस्तिः प्रशस्यते||२५३|| prayōjayējjvaraharānnirūhān sānuvāsanān| pakvāśayagatē dōṣē vakṣyantē yē ca siddhiṣu||240|| paṭōlāriṣṭapatrāṇi sōśīraścaturaṅgulaḥ| hrībēraṁ rōhiṇī tiktā śvadaṁṣṭrā madanāni ca||241|| sthirā balā ca tat sarvaṁ payasyardhōdakē śr̥tam| kṣīrāvaśēṣaṁ niryūhaṁ saṁyuktaṁ madhusarpiṣā||242|| kalkairmadanamustānāṁ pippalyā madhukasya ca| vatsakasya ca saṁyuktaṁ bastiṁ dadyājjvarāpaham||243|| śuddhē mārgē hr̥tē dōṣē viprasannēṣu dhātuṣu| gatāṅgaśūlō laghvaṅgaḥ sadyō bhavati vijvaraḥ||244|| āragvadhamuśīraṁ ca madanasya phalaṁ tathā| catasraḥ parṇinīścaiva [1] niryūhamupakalpayēt||245|| priyaṅgurmadanaṁ mustaṁ śatāhvā madhuyaṣṭikā| kalkaḥ sarpirguḍaḥ kṣaudraṁ jvaraghnō bastiruttamaḥ||246|| guḍūcīṁ trāyamāṇāṁ ca candanaṁ madhukaṁ vr̥ṣam| sthirāṁ balāṁ pr̥śniparṇīṁ madanaṁ cēti sādhayēt||247|| rasaṁ jāṅgalamāṁsasya rasēna sahitaṁ bhiṣak| pippalīphalamustānāṁ kalkēna madhukasya ca||248|| īṣatsalavaṇaṁ yuktyā nirūhaṁ madhusarpiṣā| jvarapraśamanaṁ dadyādbalasvēdarucipradam||249|| jīvantīṁ madhukaṁ mēdāṁ pippalīṁ madanaṁ vacām| r̥ddhiṁ rāsnāṁ balāṁ viśvaṁ [2] śatapuṣpāṁ śatāvarīm||250|| piṣṭvā kṣīraṁ jalaṁ sarpistailaṁ ca vipacēdbhiṣak| ānuvāsanikaṁ snēhamētaṁ vidyājjvarāpaham||251|| paṭōlapicumardābhyāṁ guḍūcyā madhukēna ca| madanaiśca śr̥taḥ snēhō jvaraghnamanuvāsanam||252|| candanāgurukāśmaryapaṭōlamadhukōtpalaiḥ| siddhaḥ snēhō jvaraharaḥ snēhabastiḥ praśasyatē||253||

prayojayejjvaraharAnnirUhAn sAnuvAsanAn| pakvAshayagate doShe vakShyante ye ca siddhiShu||240|| paTolAriShTapatrANi soshIrashcatura~ggulaH| hrIberaM rohiNI tiktA shvadaMShTrA madanAni ca||241|| sthirA balA ca tat sarvaM payasyardhodake shRutam| kShIrAvasheShaM niryUhaM saMyuktaM madhusarpiShA||242|| kalkairmadanamustAnAM pippalyA madhukasya ca| vatsakasya ca saMyuktaM bastiM dadyAjjvarApaham||243|| shuddhe mArge hRute doShe viprasanneShu dhAtuShu| gatA~ggashUlo laghva~ggaH sadyo bhavati vijvaraH||244|| AragvadhamushIraM ca madanasya phalaM tathA| catasraH parNinIshcaiva [1] niryUhamupakalpayet||245|| priya~ggurmadanaM mustaM shatAhvA madhuyaShTikA| kalkaH sarpirguDaH kShaudraM jvaraghno bastiruttamaH||246|| guDUcIM trAyamANAM ca candanaM madhukaM vRuSham| sthirAM balAM pRushniparNIM madanaM ceti sAdhayet||247|| rasaM jA~ggalamAMsasya rasena sahitaM bhiShak| pippalIphalamustAnAM kalkena madhukasya ca||248|| IShatsalavaNaM yuktyA nirUhaM madhusarpiShA| jvaraprashamanaM dadyAdbalasvedarucipradam||249|| jIvantIM madhukaM medAM pippalIM madanaM vacAm| RuddhiM rAsnAM balAM vishvaM [2] shatapuShpAM shatAvarIm||250|| piShTvA kShIraM jalaM sarpistailaM ca vipacedbhiShak| AnuvAsanikaM snehametaM vidyAjjvarApaham||251|| paTolapicumardAbhyAM guDUcyA madhukena ca| madanaishca shRutaH sneho jvaraghnamanuvAsanam||252|| candanAgurukAshmaryapaTolamadhukotpalaiH| siddhaH sneho jvaraharaH snehabastiH prashasyate||253||

Niruha and anuvāsana types of bastīs (medicated enemas) which will be described in the siddhī sthāna should be administered when the doshhās are lodged in the pakwāshaya, for the treatment of jwara. Paṭola, arishṭa leaves, ushīra, chaturangula, hṛībera, rohiṇī, tiktā, shvadanṡṭrā, madana, sthirā and balā – these drugs should be boiled in milk by adding water which should be taken in equal the quantity of milk. This should be boiled till the amount equal to that of milk is left. To this mixture honey and ghṛit should be added along with the kalka of madana, mustā, pippalī, madhūka and vatsaka. This portion should be administered in the form of enema for the cure jwara. When the margās (channels) are clean, the doshās are eliminated and the dhātūs are refreshed. Then the pain in the body disappears and the body becomes light and instantaneously free from fever. A decoction prepared from āragvadha, ushīra, fruits of madana, shālaparṇī, pṛshnīparṇī, māshaparṇī and mudgaparṇī, mixed with the paste of priyangū, madana, mustā, shatāvhā and madhuyashṭī should be used as an enema, for the cure of jwara. A decoction prepared from guḍūcī, trāyamāṇa, candana, madhūka, vṛṡa, sthirā, balā, pṛshnīparṇī and madana, to which meat soup of jāngala type of animals (those inhabiting in arid lands) and the paste of pippalī, phala, mustā and madhūka has been added. A small quantity of rock salt should also be added to this decoction along with honey and ghṛit and used as nirūha type of medicated enema for the alleviation of jwara as it promotes strength, sweating and taste appreciation. A medicated ghṛit prepared from the paste of jīvantī, madhūka, medā, pippalī, madana, vachā, ṛddhī, rāsnā, balā, vishva, shatapushpā and shatāvarī, boiled with milk, water, ghṛita and oil, should be used as anuvāsana vastī for the treatment of jwara. The sneha (ghṛit and oil) boiled with paṭola, picumarda, guḍucī, madhūka and madana should also be used as anuvāsana vastī for the treatment of jwara. The sneha boiled with candana, agurū, kāshmarya, paṭola, madhūka and utpala is exceedingly useful for the administration as anuvāsana vastī to cure jwara. (241-253)

Indications of shiro-virechana (nasal errhines)

यदुक्तं भेषजाध्याये विमाने रोगभेषजे| शिरोविरेचनं कुर्याद्युक्तिज्ञस्तज्ज्वरापहम्||२५४|| यच्च नावनिकं तैलं याश्च तैलं याश्च प्राग्धूमवर्तयः| मात्राशितीये निर्दिष्टाः प्रयोज्यास्ता ज्वरेष्वपि||२५५|| yaduktaṁ bhēṣajādhyāyē vimānē rōgabhēṣajē| śirōvirēcanaṁ kuryādyuktijñastajjvarāpaham||254|| yacca nāvanikaṁ tailaṁ yāśca tailaṁ yāśca prāgdhūmavartayaḥ| mātrāśitīyē nirdiṣṭāḥ prayōjyāstā jvarēṣvapi||255|| yaduktaM bheShajAdhyAye vimAne rogabheShaje| shirovirecanaM kuryAdyuktij~jastajjvarApaham||254|| yacca nAvanikaM tailaM yAshca tailaM yAshca prAgdhUmavartayaH| mAtrAshitIye nirdiShTAH prayojyAstA jvareShvapi||255|| Drugs for shirovirechana therapy (module of taking out the doshās from the uttamānga - shira) are already described in the Bheṡajādhyāya of Sūtra sthāna and Rog bhiṡagjitīya chapter of vimāna sthāna. A physician well versed in these treatment modules should apply them for the treatment of jwara. The medicated oil and the dhuma vartī described for application as nasal drop and dhuma varti respectively in the mātrāshitīya chapter, should also be used for the treatment of jwara.(254-255)

External aplications

अभ्यङ्गांश्च प्रदेहांश्च परिषेकांश्च कारयेत्| यथाभिलाषं शीतोष्णं विभज्य द्विविधं ज्वरम्||२५६|| सहस्रधौतं सर्पिर्वा तैलं वा चन्दनादिकम्| दाहज्वरप्रशमनं दद्यादभ्यञ्जनं भिषक्||२५७|| abhyaṅgāṁśca pradēhāṁśca pariṣēkāṁśca kārayēt| yathābhilāṣaṁ śītōṣṇaṁ vibhajya dvividhaṁ jvaram||256|| sahasradhautaṁ sarpirvā tailaṁ vā candanādikam| dāhajvarapraśamanaṁ dadyādabhyañjanaṁ bhiṣak||257||

abhya~ggAMshca pradehAMshca pariShekAMshca kArayet| yathAbhilAShaM shItoShNaM vibhajya dvividhaM jvaram||256|| sahasradhautaM sarpirvA tailaM vA candanAdikam| dAhajvaraprashamanaM dadyAdabhya~jjanaM bhiShak||257||

Abhyanga (massage), pradeha (unction) and pariṡeka (medicated bath) should be given to the patient, either hot or cold, according to the appropriateness of the two types of jwara of the patient. Medicated ghṛit called as Sahasra dhauta ghṛta and medicated oil called chandanadya taila should be given for massage to the patient, as these alleviate jwara associated with burning. (256-257)

Chandanadya taila

अथ चन्दनाद्यं तैलमुपदेक्ष्यामः-चन्दनभद्रश्रीकालानुसार्यकालीयकपद्मापद्मकोशीरसारिवामधुकप्रपौण्डरीकनागपुष्पोदीच्यवन्यपद्मोत्पलनलिनकुमुद-सौगन्धिकपुण्डरीकशतपत्रबिसमृणालशालूकशैवालकशेरुकानन्ताकुशकाशेक्षुदर्भशरनलशालिमूलजम्बुवेतसवानीरगुन्द्रा-ककुभासनाश्वकर्णस्यन्दनवातपोथशालतालधवतिनिशखदिरकदरकदम्बकाश्मर्यफलसर्जप्लक्षवटकपीतनोदुम्बराश्वत्थ-न्यग्रोधधातकीदूर्वेत्कटशृङ्गाटकमञ्जिष्ठाज्योतिष्मतीपुष्करबीजक्रौञ्चादनबदरीकोविदारकदली-संवर्तकारिष्टशतपर्वाशीतकुम्भिकाशतावरीश्रीपर्णीश्रावणीमहाश्रावणीरोहिणीशीतपाक्योदनपाकीकालबलापयस्याविदारी-जीवकर्षभकमेदामहामेदामधुरसर्ष्यप्रोक्तातृणशून्यमोचरसाटरूषकबकुलकुटजपटोलनिम्बशाल्मलीनारिकेल-खर्जूरमृद्वीकाप्रियालप्रियङ्गुधन्वनात्मागुप्तामधूकानामन्येषां च शीतवीर्याणां यथालाभमौषधानां कषायं कारयेत्| तेन कषायेण द्विगुणितपयसा तेषामेव च कल्केन कषायार्धमात्रं मृद्वग्निना साधयेत्तैलम्| एतत्तैलमभ्यङ्गात् सद्यो दाहज्वरमपनयति| एतैरेव चौषधैरश्लक्ष्णपिष्टैः सुशीतैः प्रदेहं कारयेत्| एतैरेव च शृतशीतं सलिलमवगाहपरिषेकार्थं प्रयुञ्जीत||२५८|| इति चन्दनाद्यं तैलम्| मध्वारनालक्षीरदधिघृतसलिलसेकावगाहाश्च सद्यो दाहज्वरमपनयन्ति शीतस्पर्शत्वात्||२५९|| atha candanādyaṁ tailamupadēkṣyāmaḥ-candanabhadraśrīkālānusāryakālīyakapadmāpadmakōśīrasārivāmadhukaprapauṇḍarīkanāgapuṣpōdīcyavanyapadmōtpalanalinakumuda-saugandhikapuṇḍarīkaśatapatrabisamr̥ṇālaśālūkaśaivālakaśērukānantākuśakāśēkṣudarbhaśaranalaśālimūlajambuvētasavānīragundrā-kakubhāsanāśvakarṇasyandanavātapōthaśālatāladhavatiniśakhadirakadarakadambakāśmaryaphalasarjaplakṣavaṭakapītanōdumbarāśvattha-nyagrōdhadhātakīdūrvētkaṭaśr̥ṅgāṭakamañjiṣṭhājyōtiṣmatīpuṣkarabījakrauñcādanabadarīkōvidārakadalī-saṁvartakāriṣṭaśataparvāśītakumbhikāśatāvarīśrīparṇīśrāvaṇīmahāśrāvaṇīrōhiṇīśītapākyōdanapākīkālabalāpayasyāvidārī-jīvakarṣabhakamēdāmahāmēdāmadhurasarṣyaprōktātr̥ṇaśūnyamōcarasāṭarūṣakabakulakuṭajapaṭōlanimbaśālmalīnārikēla-kharjūramr̥dvīkāpriyālapriyaṅgudhanvanātmāguptāmadhūkānāmanyēṣāṁ [1] ca śītavīryāṇāṁ yathālābhamauṣadhānāṁ kaṣāyaṁ kārayēt| tēna kaṣāyēṇa dviguṇitapayasā tēṣāmēva ca kalkēna kaṣāyārdhamātraṁ mr̥dvagninā sādhayēttailam| ētattailamabhyaṅgāt sadyō dāhajvaramapanayati| ētairēva cauṣadhairaślakṣṇapiṣṭaiḥ suśītaiḥ pradēhaṁ kārayēt| ētairēva ca śr̥taśītaṁ salilamavagāhapariṣēkārthaṁ prayuñjīta||258|| iti candanādyaṁ tailam| madhvāranālakṣīradadhighr̥tasalilasēkāvagāhāśca sadyō dāhajvaramapanayanti śītasparśatvāt||259||

atha candanAdyaM tailamupadekShyAmaH-candanabhadrashrIkAlAnusAryakAlIyakapadmApadmakoshIrasArivAmadhukaprapauNDarIkanAgapuShpodIcyavanyapadmotpalanalinakumuda-saugandhikapuNDarIkashatapatrabisamRuNAlashAlUkashaivAlakasherukAnantAkushakAshekShudarbhasharanalashAlimUlajambuvetasavAnIragundrA-kakubhAsanAshvakarNasyandanavAtapothashAlatAladhavatinishakhadirakadarakadambakAshmaryaphalasarjaplakShavaTakapItanodumbarAshvattha-nyagrodhadhAtakIdUrvetkaTashRu~ggATakama~jjiShThAjyotiShmatIpuShkarabIjakrau~jcAdanabadarIkovidArakadalI-saMvartakAriShTashataparvAshItakumbhikAshatAvarIshrIparNIshrAvaNImahAshrAvaNIrohiNIshItapAkyodanapAkIkAlabalApayasyAvidArI-jIvakarShabhakamedAmahAmedAmadhurasarShyaproktAtRuNashUnyamocarasATarUShakabakulakuTajapaTolanimbashAlmalInArikela-kharjUramRudvIkApriyAlapriya~ggudhanvanAtmAguptAmadhUkAnAmanyeShAM [1] ca shItavIryANAM yathAlAbhamauShadhAnAM kaShAyaM kArayet| tena kaShAyeNa dviguNitapayasA teShAmeva ca kalkena kaShAyArdhamAtraM mRudvagninA sAdhayettailam| etattailamabhya~ggAt sadyo dAhajvaramapanayati| etaireva cauShadhairashlakShNapiShTaiH sushItaiH pradehaM kArayet| etaireva ca shRutashItaM salilamavagAhapariShekArthaM prayu~jjIta||258|| iti candanAdyaM tailam| madhvAranAlakShIradadhighRutasalilasekAvagAhAshca sadyo dAhajvaramapanayanti shItasparshatvAt||259||

Now, Chandanadya taila preparation will be described – chandana (red variety of chandana), bhadrashrī (white variety of candana), kālānusārya, kāiyaka, padma, padmaka, ushira, sārivā, madhuka, nāgapushpa, udīcya, vanya, padma, utpala, nalina (a white variety of padma), kumuda; saugandhika, punḍarīka, shata patra, bis, mṛnāla, shālūka, shaivāla, kasheruka, anantā, kusha, kāsa, ikṡu, darbha, shara, nala – root of shāli, jambu, vetasa, vānīra (a variety of vetasa which do not have fragrant root), gundrā, kakubha, asana, ashvakarṇa (a variety of shāla), syandana (nemi vṛkṡa), vātapothā (palāsha), shala, tāla, dava, tinisha (vanjula), khadira, kadara (viṭkhadira), kadamba, fruit of kāshmarya, sarja, plakṡa, vaṭa (the variety without any adventitious root), kapītana (popularly known as gandhamuṅḍa), udumbara, ashvattha, nyagodhra, dhātakī, dūrvā, itkaṭa, shṛṅgāṭaka, mañjishthā, jyotiṡmatī (kangaṇikā), seeds of puṡkara, karuñacandana, badarī, kovidāra, kadalī, samvartaka, ariṡṭa (a variety of neem growing in the hills), shataparvā (bibhītaka), shita kumbhikā (kāṡṭha pāṭalā), shatāvarī, shriparṇī, shrāvaṇī, mahā shrāvaṇī (alambusha – having big fruits), rohiṇī, sīta pākī (gaṅḍa dūrvā), odana pākī (nīla bheṅḍī), kālā (kākolī), balā, payasyā, vidārī, jīvaka, ṛṡabhaka, medā, mahamedā, madurasa, ṛṡyaproktā (ṛddhī), tṛṇa shūnya (ketakī), mocarasa, ātaruṡaka, bakula, kuṭaja, paṭola, shālmalī, nārīkela, kharjūra, mṛdvīkā, priyāla, priyangū, dhanvana, ātma guptā, madhūka, and such other drugs which are cold in potency. Also, the drugs which have the same cooling effect can also be added to prepare this decoction, using double the quantity of water. The kalka (paste) of all the above mentioned drugs must also be taken. Oil mixed with the above stated decoction and paste should be boiled on mild fire till half the quantity is left. Massage of this medicated oil instantaneously cures dāha jwara. The above mentioned drugs should be made in the form of a fine paste and then used as a pradeha when it has cooled. The water boiled with these drugs should be used when cooled for avagāha and pariṡeka (bathing and sprinkling over the body respectively). The seka and avagāha (sprinkling of water and bathing) with madhu, āranāla (sour gruel), milk, curd, ghṛita and water cure dāha jwara instantaneously, because of their cold touch.(258-259)

Guidelines for a patient with burning sensation

भवन्ति चात्र- पौष्करेषु सुशीतेषु पद्मोत्पलदलेषु च| कदलीनां च पत्रेषु क्षौमेषु विमलेषु च||२६०|| चन्दनोदकशीतेषु शीते धारागृहेऽपि वा| हिमाम्बुसिक्ते सदने दाहार्तः संविशेत् सुखम्||२६१|| हेमशङ्खप्रवालानां मणीनां मौक्तिकस्य च| चन्दनोदकशीतानां संस्पर्शानुरसान् स्पृशेत्||२६२|| स्रग्भिर्नीलोत्पलैः पद्मैर्व्यजनैर्विविधैरपि| शीतवातावहैर्व्यज्ज्येच्चन्दनोदकवर्षिभिः ||२६३|| नद्यस्तडागाः पद्मिन्यो ह्रदाश्च विमलोदकाः| अवगाहे हिता दाहतृष्णाग्लानिज्वरापहाः||२६४|| प्रियाः प्रदक्षिणाचाराः प्रमदाश्चन्दनोक्षिताः| सान्त्वयेयुः परैः कामैर्मणिमौक्तिकभूषणाः||२६५|| शीतानि चान्नपानानि शीतान्युपवनानि च| वायवश्चन्द्रपादाश्च शीता दाहज्वरापहाः||२६६|| bhavanti cātra- pauṣkarēṣu suśītēṣu padmōtpaladalēṣu ca| kadalīnāṁ ca patrēṣu kṣaumēṣu vimalēṣu ca||260|| candanōdakaśītēṣu śītē dhārāgr̥hē'pi vā| himāmbusiktē sadanē dāhārtaḥ saṁviśēt sukham||261|| hēmaśaṅkhapravālānāṁ maṇīnāṁ mauktikasya ca| candanōdakaśītānāṁ saṁsparśānurasān spr̥śēt||262|| sragbhirnīlōtpalaiḥ padmairvyajanairvividhairapi| śītavātāvahairvyajjyēccandanōdakavarṣibhiḥ ||263|| nadyastaḍāgāḥ padminyō hradāśca vimalōdakāḥ| avagāhē hitā dāhatr̥ṣṇāglānijvarāpahāḥ||264|| priyāḥ pradakṣiṇācārāḥ pramadāścandanōkṣitāḥ| sāntvayēyuḥ paraiḥ kāmairmaṇimauktikabhūṣaṇāḥ||265|| śītāni cānnapānāni śītānyupavanāni ca| vāyavaścandrapādāśca śītā dāhajvarāpahāḥ||266||

bhavanti cAtra- pauShkareShu sushIteShu padmotpaladaleShu ca| kadalInAM ca patreShu kShaumeShu vimaleShu ca||260|| candanodakashIteShu shIte dhArAgRuhe~api vA| himAmbusikte sadane dAhArtaH saMvishet sukham||261|| hemasha~gkhapravAlAnAM maNInAM mauktikasya ca| candanodakashItAnAM saMsparshAnurasAn spRushet||262|| sragbhirnIlotpalaiH padmairvyajanairvividhairapi| shItavAtAvahairvyajjyeccandanodakavarShibhiH ||263|| nadyastaDAgAH padminyo hradAshca vimalodakAH| avagAhe hitA dAhatRuShNAglAnijvarApahAH||264|| priyAH pradakShiNAcArAH pramadAshcandanokShitAH| sAntvayeyuH paraiH kAmairmaNimauktikabhUShaNAH||265|| shItAni cAnnapAnAni shItAnyupavanAni ca| vAyavashcandrapAdAshca shItA dAhajvarApahAH||266||

A patient of jwara suffering from burning sensation should reside in a house cooled by the leaves of puṡkara, padma, utpala, kadalī or kṡauma. The house can also be cooled by cold water of sandalwood or the patient can also reside in a dhāra gṛha (a house coled by running water either flowing from above or falling from the roof) or a house cooled by ice cool water. This gives comfort to the patient. His body should be touched with the pleasant touch of gold or conch shell or coral or jewels and pearls which are cooled by the sandalwood water. He should be made to wear the garlands made of nīlotpala or padma and fanned with the cold air from different types of fans which are cooled with sandalwood water. He should take bath in rivers, ponds, ponds having lotus plant and lakes having clean water. This bath alleviates burning sensation, morbid thirst, glāni and jwara. Such patient should also be comforted with the touch of ladies smeared with sandalwood paste, wearing desirable jewels and pearls; which are affectionate and skilled with polite manners. Diet and drinks which are cold, cooling gardens, cold wind and cold rays of the moon; alleviate jwara with burning sensation. (260-266)

Agurvadya tailam

अथोष्णाभिप्रायिणां ज्वरितानामभ्यङ्गादीनुपक्रमानुपदेक्ष्यामः-अगुरुकुष्ठतगरपत्रनलदशैलेयध्यामकहरेणुकास्थौणेयकक्षेमकैलावराङ्गदलपुरतमालपत्रभूतीकरोहिषसरलशल्लकी-देवदार्वग्निमन्थबिल्वस्योनाककाश्मर्यपाटलापुनर्नवावृश्चीरकण्टकारीबृहतीशालपर्णीपृश्निपर्णीमाषपर्णीमुद्गपर्णीगोक्षुरकैरण्ड-शोभाञ्जनकवरुणार्कचिरबिल्वतिल्वकशटीपुष्करमूलगण्डीरोरुबूकपत्तूराक्षीवाश्मान्तकशिग्रुमातुलुङ्गपीलुकमूलकपर्णी-तिलपर्णीपीलुपर्णीमेषशृङ्गीहिंस्रादन्तशठैरावतकभल्लातकास्फोतकाण्डीरात्मजैकेषीकाकरञ्जधान्यकाजमोद-पृथ्वीकासुमुखसुरसकुठेरककालमालकपर्णासक्षवकफणिज्झकभूस्तृणशृङ्गवेरपिप्पलीसर्षपाश्वगन्धारास्नारुहारोहावचाबलातिबला-गुडूचीशतपुष्पाशीतवल्लीनाकुलीगन्धनाकुलीश्वेताज्योतिष्मतीचित्रकाध्यण्डाम्लचाङ्गेरी-तिलबदरकुलत्थमाषाणामेवंविधानामन्येषां चोष्णवीर्याणां यथालाभमौषधानां कषायं कारयेत्, तेन कषायेण तेषामेव चकल्केन सुरासौवीरकतुषोदकमैरेयमेदकदधिमण्डारनालकट्वरप्रतिविनीतेन तैलपात्रं विपाचयेत्| तेन सुखोष्णेन तैलेनोष्णाभिप्रायिणं ज्वरितमभ्यञ्ज्यात्, तथा शीतज्वरः प्रशाम्यति; एतैरेव चौषधैः श्लक्ष्णपिष्टैः सुखोष्णैः प्रदेहंकारयेत्, एतैरेव च शृतं सुखोष्णं सलिलमवगाहनार्थं परिषेकार्थं च प्रयुञ्जीत शीतज्वरप्रशमार्थम्||२६७|| इत्यगुर्वाद्यं तैलम् athōṣṇābhiprāyiṇāṁ jvaritānāmabhyaṅgādīnupakramānupadēkṣyāmaḥ-agurukuṣṭhatagarapatranaladaśailēyadhyāmakaharēṇukāsthauṇēyakakṣēmakailāvarāṅgadalapuratamālapatrabhūtīkarōhiṣasaralaśallakī-dēvadārvagnimanthabilvasyōnākakāśmaryapāṭalāpunarnavāvr̥ścīrakaṇṭakārībr̥hatīśālaparṇīpr̥śniparṇīmāṣaparṇīmudgaparṇīgōkṣurakairaṇḍa-śōbhāñjanakavaruṇārkacirabilvatilvakaśaṭīpuṣkaramūlagaṇḍīrōrubūkapattūrākṣīvāśmāntakaśigrumātuluṅgapīlukamūlakaparṇī-tilaparṇīpīluparṇīmēṣaśr̥ṅgīhiṁsrādantaśaṭhairāvatakabhallātakāsphōtakāṇḍīrātmajaikēṣīkākarañjadhānyakājamōda-pr̥thvīkāsumukhasurasakuṭhērakakālamālakaparṇāsakṣavakaphaṇijjhakabhūstr̥ṇaśr̥ṅgavērapippalīsarṣapāśvagandhārāsnāruhārōhāvacābalātibalā-guḍūcīśatapuṣpāśītavallīnākulīgandhanākulīśvētājyōtiṣmatīcitrakādhyaṇḍāmlacāṅgērī- tilabadarakulatthamāṣāṇāmēvaṁvidhānāmanyēṣāṁ cōṣṇavīryāṇāṁ yathālābhamauṣadhānāṁ kaṣāyaṁ kārayēt, tēna kaṣāyēṇa tēṣāmēva ca kalkēnasurāsauvīrakatuṣōdakamairēyamēdakadadhimaṇḍāranālakaṭvaraprativinītēna tailapātraṁ vipācayēt| tēna sukhōṣṇēna tailēnōṣṇābhiprāyiṇaṁ jvaritamabhyañjyāt, tathā śītajvaraḥ praśāmyati; ētairēva cauṣadhaiḥ ślakṣṇapiṣṭaiḥ sukhōṣṇaiḥ pradēhaṁkārayēt, ētairēva ca śr̥taṁ sukhōṣṇaṁ salilamavagāhanārthaṁ pariṣēkārthaṁ ca prayuñjīta śītajvarapraśamārtham||267|| ityagurvādyaṁ tailam

athoShNAbhiprAyiNAM jvaritAnAmabhya~ggAdInupakramAnupadekShyAmaH-agurukuShThatagarapatranaladashaileyadhyAmakahareNukAsthauNeyakakShemakailAvarA~ggadalapuratamAlapatrabhUtIkarohiShasaralashallakI-devadArvagnimanthabilvasyonAkakAshmaryapATalApunarnavAvRushcIrakaNTakArIbRuhatIshAlaparNIpRushniparNImAShaparNImudgaparNIgokShurakairaNDa-shobhA~jjanakavaruNArkacirabilvatilvakashaTIpuShkaramUlagaNDIrorubUkapattUrAkShIvAshmAntakashigrumAtulu~ggapIlukamUlakaparNI-tilaparNIpIluparNImeShashRu~ggIhiMsrAdantashaThairAvatakabhallAtakAsphotakANDIrAtmajaikeShIkAkara~jjadhAnyakAjamoda-pRuthvIkAsumukhasurasakuTherakakAlamAlakaparNAsakShavakaphaNijjhakabhUstRuNashRu~ggaverapippalIsarShapAshvagandhArAsnAruhArohAvacAbalAtibalA-guDUcIshatapuShpAshItavallInAkulIgandhanAkulIshvetAjyotiShmatIcitrakAdhyaNDAmlacA~ggerI- tilabadarakulatthamAShANAmevaMvidhAnAmanyeShAM coShNavIryANAM yathAlAbhamauShadhAnAM kaShAyaM kArayet, tena kaShAyeNa teShAmeva ca kalkenasurAsauvIrakatuShodakamaireyamedakadadhimaNDAranAlakaTvaraprativinItena tailapAtraM vipAcayet| tena sukhoShNena tailenoShNAbhiprAyiNaM jvaritamabhya~jjyAt, tathA shItajvaraH prashAmyati; etaireva cauShadhaiH shlakShNapiShTaiH sukhoShNaiHpradehaM kArayet, etaireva ca shRutaM sukhoShNaM salilamavagAhanArthaM pariShekArthaM ca prayu~jjIta shItajvaraprashamArtham||267|| ityagurvAdyaM tailam

Now, we will explain the therapies for patients of jwara for whom hot treatment is desirable – A decoction prepared from aguru, kuṡṭha, tagara, patra, nalada, shaileya, dhyāmaka, hareṇuka, sthauṇeyaka, kṡemaka, elā, varāñga, dala, pura, tamāla patra, bhūtika, rohiṡa, sarala, shallakī, devadārū, agnimantha, bilva, shyonāka, kāshmarya, pāṭalā, punarnavā, vṛṡcīra, kanṭakārī, bṛhatī, shālaparṇī, pṛshniparṇī, māṡaparṇī, mudgaparṇī, gokṡur, eranda, shobhānjana, varuṇa, arka, cirabilva, tilvaka, shaṭī, puṡkaramūla, ganḍīra, urūbaka, pattūra, akṡīva, aṡmantaka, shigru, mātulunga, pīlūka, mūlaka prṇī, tila parṇī, pīlu parṇī, meṡa shṛngī, hiṁsrā, danta shaṭha, airāvata, bhallātaka, āsphoṭaka, āndḍīra, ātmajā, ekaiṡikā (ambaṡṭhā) karanja, dhānyaka, ajamodā, pṛthvīkā, sumukhā, surasā, kuṭheraka, kāla mālaka, parṇāsa, kṡavaka, phaṇijjhaka, bhūstṛṇa, shṛngabera, pippalī, sarṡapa, ashvagandhā, rāsnā, ruhā (vṛkṡa rūhā), rohā (añjalīkārikā), vacā, balā, atibalā, guḍucī, shatapuṡpā, shita vallī, nākulī, gandha nākulī, shvetā, jyotiṡmatī, citraka, adhyaṇdā, amla cāngerī, tila, badara, kulattha, māṡa, and such other drugs which are hot in potency. A decoction and paste should be prepared from all the drugs described or those amongst them which are available. These decoction and paste should be added with surā (alcoholic drinks), sauvīraka (vinegar), tuṡodaka (a type of vinegar), maireya (an alcoholic drink), dadhi manḍa (scum of curd), ārnāla (sour gruel recipe), kaṭvara (watery curd along with the fat content) should be boiled in one pātra of oil (3.072 l). When this oil is still luke warm, it should be massaged to the patient suffering from jwara for whom hot therapy is indicated. This will cure shīta jwara . The above mentioned drugs should be made in the form of a fine paste and then used as a pradeha when it is cooled. The water boiled with these drugs should be used when cooled for avagāha and pariṡeka (bathing and sprinkling over the body respectively). (267)

Indications of fomentation for alleviating cold

भवन्ति चात्र- त्रयोदशविधः स्वेदः स्वेदाध्याये निदर्शितः| मात्राकालविदा युक्तः स च शीतज्वरापहः||२६८|| सा कुटी तच्च शयनं तच्चावच्छादनं ज्वरम्| शीतं प्रशमयन्त्याशु धूपाश्चागुरुजा घनाः||२६९|| चारूपचितगात्र्यश्च तरुण्यो यौवनोष्मणा| आश्लेषाच्छमयन्त्याशु प्रमदाः शिशिरज्वरम्||२७०|| स्वेदनान्यन्नपानानि वातश्लेष्महराणि च| शीतज्वरं जयन्त्याशु संसर्गबलयोजनात्||२७१||

bhavanti cātra- trayōdaśavidhaḥ svēdaḥ svēdādhyāyē nidarśitaḥ| mātrākālavidā yuktaḥ sa ca śītajvarāpahaḥ||268|| sā kuṭī tacca śayanaṁ taccāvacchādanaṁ jvaram| śītaṁ praśamayantyāśu dhūpāścāgurujā ghanāḥ||269|| cārūpacitagātryaśca taruṇyō yauvanōṣmaṇā| āślēṣācchamayantyāśu pramadāḥ śiśirajvaram||270|| svēdanānyannapānāni vātaślēṣmaharāṇi ca| śītajvaraṁ jayantyāśu saṁsargabalayōjanāt||271||

bhavanti cAtra- trayodashavidhaH svedaH svedAdhyAye nidarshitaH| mAtrAkAlavidA yuktaH sa ca shItajvarApahaH||268|| sA kuTI tacca shayanaM taccAvacchAdanaM jvaram| shItaM prashamayantyAshu dhUpAshcAgurujA ghanAH||269|| cArUpacitagAtryashca taruNyo yauvanoShmaNA| AshleShAcchamayantyAshu pramadAH shishirajvaram||270|| svedanAnyannapAnAni vAtashleShmaharANi ca| shItajvaraM jayantyAshu saMsargabalayojanAt||271|| Thirteen varities of sweda procedures have been described in the swedā adhyāya of sūtra sthāna. A physician who is well versed with the proper duration of sweda as suitable to the season and person should administer them for the treatment of shīta jwara. Sleeping on a bed and covering oneself with clothes in the kuṭi sweda (fomentation technique by keeping the patient in a cottage) immediately alleviates shīta. Similarly, the strong fumigation by agurū also alleviates shīta. Shīta jwara is also cured by the embrace of passionate ladies who are beautiful, have plump body and are young, due to their youthful heat. Different types of diet and drinks which cause fomentation and alleviate vāta and kapha, instantaneously alleviate shīta jwara. These should be administered keeping in view of the saṁsarga (combination of two doshhās) and the bala of each doshha. (268-271)

Contra-indications of langhana

वातजे श्रमजे चैव पुराणे क्षतजे ज्वरे| लङ्घनं न हितं विद्याच्छमनैस्तानुपाचरेत्||२७२||

vātajē śramajē caiva purāṇē kṣatajē jvarē| laṅghanaṁ na hitaṁ vidyācchamanaistānupācarēt||272|| vAtaje shramaje caiva purANe kShataje jvare| la~gghanaM na hitaM vidyAcchamanaistAnupAcaret||272|| Langhana (fasting) is not useful for patients suffering from jwara caused by aggravated vata, by exhaustion, in chronic fevers, in fevers caused by kshata (external and internal injuries). Such patients should be treated by shamana therapy (alleviation therapy). (272)

Guidelines for improving agni (digestive strength)

विक्षिप्यामाशयोष्माणं यस्माद्गत्वा रसं नृणाम्| ज्वरं कुर्वन्ति दोषास्तु हीयतेऽग्निबलं ततः||२७३|| यथा प्रज्वलितो वह्निः स्थाल्यामिन्धनवानपि| न पचत्योदनं सम्यगनिलप्रेरितो बहिः||२७४|| पक्तिस्थानात्तथा दोषैरूष्मा क्षिप्तो बहिर्नृणाम्| न पचत्यभ्यवहृतं कृच्छ्रात् पचति वा लघु||२७५|| अतोऽग्निबलरक्षार्थं लङ्घनादिक्रमो हितः| सप्ताहेन हि पच्यन्ते सप्तधातुगता मलाः||२७६|| निरामश्चाप्यतः प्रोक्तो ज्वरः प्रायोऽष्टमेऽहनि| उदीर्णदोषस्त्वल्पाग्निरश्नन् गुरु विशेषतः||२७७|| मुच्यते सहसा प्राणैश्चिरं क्लिश्यति वा नरः| एतस्मात्कारणाद्विद्वान् वातिकेऽप्यादितो ज्वरे||२७८|| नाति गुर्वति वा स्निग्धं भोजयेत् सहसा नरम्| ज्वरे मारुतजे त्वादावनपेक्ष्यापि हि क्रमम्||२७९|| कुर्यान्निरनुबन्धानामभ्यङ्गादीनुपक्रमान्| पाययित्वा कषायं च भोजयेद्रसभोजनम्||२८०|| जीर्णज्वरहरं कुर्यात् सर्वशश्चाप्युपक्रमम्| श्लेष्मलानामवातानां ज्वरोऽनुष्णः कफाधिकः||२८१|| परिपाकं न सप्ताहेनापि याति मृदूष्मणाम्| तं क्रमेण यथोक्तेन लङ्घनाल्पाशनादिना||२८२|| आदशाहमुपक्रम्य कषायाद्यैरुपाचरेत्|२८३|

vikṣipyāmāśayōṣmāṇaṁ yasmādgatvā rasaṁ nr̥ṇām| jvaraṁ kurvanti dōṣāstu hīyatē'gnibalaṁ tataḥ||273|| yathā prajvalitō vahniḥ sthālyāmindhanavānapi| na pacatyōdanaṁ samyaganilaprēritō bahiḥ||274|| paktisthānāttathā dōṣairūṣmā kṣiptō bahirnr̥ṇām| na pacatyabhyavahr̥taṁ kr̥cchrāt pacati vā laghu||275|| atō'gnibalarakṣārthaṁ laṅghanādikramō hitaḥ| saptāhēna hi pacyantē saptadhātugatā malāḥ||276|| nirāmaścāpyataḥ prōktō jvaraḥ prāyō'ṣṭamē'hani| udīrṇadōṣastvalpāgniraśnan guru viśēṣataḥ||277|| mucyatē sahasā prāṇaiściraṁ kliśyati vā naraḥ| ētasmātkāraṇādvidvān vātikē'pyāditō jvarē||278|| nāti gurvati vā snigdhaṁ bhōjayēt sahasā naram| jvarē mārutajē tvādāvanapēkṣyāpi hi kramam||279|| kuryānniranubandhānāmabhyaṅgādīnupakramān| pāyayitvā kaṣāyaṁ ca bhōjayēdrasabhōjanam||280|| jīrṇajvaraharaṁ kuryāt sarvaśaścāpyupakramam| ślēṣmalānāmavātānāṁ jvarō'nuṣṇaḥ [1] kaphādhikaḥ||281|| paripākaṁ na saptāhēnāpi yāti mr̥dūṣmaṇām| taṁ kramēṇa yathōktēna laṅghanālpāśanādinā||282|| ādaśāhamupakramya kaṣāyādyairupācarēt|283|

vikShipyAmAshayoShmANaM yasmAdgatvA rasaM nRuNAm| jvaraM kurvanti doShAstu hIyate~agnibalaM tataH||273|| yathA prajvalito vahniH sthAlyAmindhanavAnapi| na pacatyodanaM samyaganilaprerito bahiH||274|| paktisthAnAttathA doShairUShmA kShipto bahirnRuNAm| na pacatyabhyavahRutaM kRucchrAt pacati vA laghu||275|| ato~agnibalarakShArthaM la~gghanAdikramo hitaH| saptAhena hi pacyante saptadhAtugatA malAH||276|| nirAmashcApyataH prokto jvaraH prAyo~aShTame~ahani| udIrNadoShastvalpAgnirashnan guru visheShataH||277|| mucyate sahasA prANaishciraM klishyati vA naraH| etasmAtkAraNAdvidvAn vAtike~apyAdito jvare||278|| nAti gurvati vA snigdhaM bhojayet sahasA naram| jvare mArutaje tvAdAvanapekShyApi hi kramam||279|| kuryAnniranubandhAnAmabhya~ggAdInupakramAn| pAyayitvA kaShAyaM ca bhojayedrasabhojanam||280|| jIrNajvaraharaM kuryAt sarvashashcApyupakramam| shleShmalAnAmavAtAnAM jvaro~anuShNaH kaphAdhikaH||281|| paripAkaM na saptAhenApi yAti mRudUShmaNAm| taM krameNa yathoktena la~gghanAlpAshanAdinA||282|| AdashAhamupakramya kaShAyAdyairupAcaret|283|

The aggravated doshas afflict the rasa dhatu and displace the agnī from the āmāshaya, for causing jwara. Thus, such patients have less of agni (digestive strength). Even if a rice pot is kept on burning fire with enough fuel, the rice will not get cooked if the fire is blown out by a strong wind. Similarly, in a patient of jwara, the ūṡmā (digestive fire) is blown out of the paktī sthāna (place of digestion) and in this condition the consumed food is not digested properly. If the food is light, then also it gets digested with difficulty. Therefore, the line of treatment in jwara of langhana is useful for the preservation of the power of digestion. The malās of the seven dhātus get metabolized in seven days. Therefore, generally on the eighth day the jwara becomes nirāma (free from the accumulated metabolic waste product). If a person takes heavy food in the stage when the doshās are aggravated and the power of digestion is suppressed, he succumbs to death immediately, or becomes miserable for a long time. Therefore, a wise physician should not immediately give either heavy or unctuous food in the beginning stage of jwara, even if it is caused by the aggravation of vāta. If the jwara is caused by vāta and is not associated with the other two doshas then, in exception to the above rule the patient should be given massage and such other therapies. He should be given decoctions and meat or vegetable soups to drink. All the therapies described for chronic fever are useful for the management of this kind of fever. (273-283)

Guidelines for management in sannipata conditions

सामा ये ये च कफजाः कफपित्तज्वराश्च ये||२८३|| लङ्घनं लङ्घनीयोक्तं तेषु कार्यं प्रति प्रति|२८४| वमनैश्च विरेकैश्च बस्तिभिश्च यथाक्रमम्||२८४|| ज्वरानुपचरेद्धीमान् कफपित्तानिलोद्भवान्|२८५| संसृष्टान् सन्निपतितान् बुद्ध्वा तरतमैः समैः||२८५|| ज्वरान् दोषक्रमापेक्षी यथोक्तैरौषधैर्जयेत्| वर्धनेनैकदोषस्य क्षपणेनोच्छ्रितस्य वा||२८६|| कफस्थानानुपूर्व्या वा सन्निपातज्वरं जयेत्|२८७| sāmā yē yē ca kaphajāḥ kaphapittajvarāśca yē||283|| laṅghanaṁ laṅghanīyōktaṁ tēṣu kāryaṁ prati prati|284| vamanaiśca virēkaiśca bastibhiśca yathākramam||284|| jvarānupacarēddhīmān kaphapittānilōdbhavān|285| saṁsr̥ṣṭān sannipatitān buddhvā taratamaiḥ samaiḥ||285|| jvarān dōṣakramāpēkṣī yathōktairauṣadhairjayēt| vardhanēnaikadōṣasya kṣapaṇēnōcchritasya vā||286|| kaphasthānānupūrvyā vā sannipātajvaraṁ jayēt|287|

sAmA ye ye ca kaphajAH kaphapittajvarAshca ye||283|| la~gghanaM la~gghanIyoktaM teShu kAryaM prati prati|284| vamanaishca virekaishca bastibhishca yathAkramam||284|| jvarAnupacareddhImAn kaphapittAnilodbhavAn|285| saMsRuShTAn sannipatitAn buddhvA taratamaiH samaiH||285|| jvarAn doShakramApekShI yathoktairauShadhairjayet| vardhanenaikadoShasya kShapaNenocchritasya vA||286|| kaphasthAnAnupUrvyA vA sannipAtajvaraM jayet|287|

Langhana and similar other therapies described in the twenty second chapter of sutra sthana should be invariably administered in the following conditions – ¨ When the jwara is in the sama stage ¨ When jwara is produced by the aggravated kapha dosha ¨ When both the kapha and the pitta dosha are aggravated together Vaman, virechana and bastī therapies should be administered to cure the jwara caused by the aggravated vāta, pitta and kapha dosha respectively. In the case of saṁsṛṡṭra and sannīpātaja (in case of combination of two or all the three doshas) type of jwara, the tara, tama and sama (lesser, greater or equal) status of the vitiated doshās should be ascertained and the treatment planned according to the line of treatment and drugs prescribed for that dosha. Sannipātaja jwara should be treated by increasing one dosha, reducing the excessively aggravated one or by correcting the sites of the doshās in order, beginning with the site of kapha.(283-287)

Management of karnamulika shotha (inflammatoion near the root of the ears)

सन्निपातज्वरस्यान्ते कर्णमूले सुदारूणः||२८७|| शोथः सञ्जायते तेन कश्चिदेव प्रमुच्यते| रक्तावसेचनैः शीघ्रं सर्पिष्पानैश्च तं जयेत्||२८८|| प्रदेहैः कफपित्तघ्नैर्नावनैः कवलग्रहैः|२८९| sannipātajvarasyāntē karṇamūlē sudārūṇaḥ||287|| śōthaḥ sañjāyatē tēna kaścidēva pramucyatē| raktāvasēcanaiḥ śīghraṁ sarpiṣpānaiśca taṁ jayēt||288|| pradēhaiḥ kaphapittaghnairnāvanaiḥ kavalagrahaiḥ|289

sannipAtajvarasyAnte karNamUle sudArUNaH||287|| shothaH sa~jjAyate tena kashcideva pramucyate| raktAvasecanaiH shIghraM sarpiShpAnaishca taM jayet||288|| pradehaiH kaphapittaghnairnAvanaiH kavalagrahaiH|289|

A seious sequale of sannipataja jwara is inflammation near the root of the ears which is a very serious condition and very few of such paients survive. Thus, efforts must be made immediately to cure it through therapeutic measures which alleviate kapha and pitta like blood letting, intake of ghee, pradeha (application of unction), nāvana (nasal instillation) and kavala graham (mouthful of liquid medication).(287-289)

Indications of blood letting

शीतोष्णस्निग्धरूक्षाद्यैर्ज्वरो यस्य न शाम्यति||२८९|| शाखानुसारी रक्तस्य सोऽवसेकात् प्रशाम्यति|२९०| śītōṣṇasnigdharūkṣādyairjvarō yasya na śāmyati||289|| śākhānusārī raktasya sō'vasēkāt praśāmyati|290| shItoShNasnigdharUkShAdyairjvaro yasya na shAmyati||289|| shAkhAnusArI raktasya so~avasekAt prashAmyati|290| When the jwara doesn’t get cured by either hot or cold or unctuous or ununctuous therapies etc., then it should be understood as śākhānusāri (that which is located in the peripheral tissues). Such type of fever gets cured by the administration of blood letting therapy. (289-290)

Indication of consumption of ghee

विसर्पेणाभिघातेन यश्च विस्फोटकैर्ज्वरः||२९०|| तत्रादौ सर्पिषः पानं कफपित्तोत्तरो न चेत्|२९१| visarpēṇābhighātēna yaśca visphōṭakairjvaraḥ||290|| tatrādau sarpiṣaḥ pānaṁ kaphapittōttarō na cēt|291| visarpeNAbhighAtena yashca visphoTakairjvaraH||290|| tatrAdau sarpiShaH pAnaM kaphapittottaro na cet|291|

If jwara arises in a patient as a complication of visarpa (erysipelas like disease), abhighāta (injury) and visphoṭaka (eruptions in the body), the patient in such case should be given ghee to drink provided kapha and pitta dośha are not aggravated. (290-291)

Management of jeerna jwara (chronic stage)

दौर्बल्याद्देहधातूनां ज्वरो जीर्णोऽनुवर्तते||२९१|| बल्येः सम्बृंहणैस्तस्मादाहारैस्तमुपाचरेत्|२९२| daurbalyāddēhadhātūnāṁ jvarō jīrṇō'nuvartatē||291|| balyēḥ sambr̥ṁhaṇaistasmādāhāraistamupācarēt|292| daurbalyAddehadhAtUnAM jvaro jIrNo~anuvartate||291|| balyeH sambRuMhaNaistasmAdAhAraistamupAcaret|292| The fever turns chronic if there is weakness in the tissues of the body. Hence such patients should be given foods which promote the strength and are nourishing. (291-292)

Management of dosha dominance in vishamajwara

कर्म साधारणं जह्यात्तृतीयकचतुर्थकौ ||२९२|| आगन्तुरनुबन्धो हि प्रायशो विषमज्वरे| वातप्रधानं सर्पिर्भिर्बस्तिभिः सानुवासनैः||२९३|| स्निग्धोष्णैरन्नपानैश्च शमयेद्विषमज्वरम्| विरेचनेन पयसा सर्पिषा संस्कृतेन च||२९४|| विषमं तिक्तशीतैश्च ज्वरं पित्तोत्तरं जयेत्| वमनं पाचनं रूक्षमन्नपानं विलङ्घनम्||२९५|| कषायोष्णं च विषमे ज्वरे शस्तं कफोत्तरे|२९६| karma sādhāraṇaṁ jahyāttr̥tīyakacaturthakau ||292|| āganturanubandhō hi prāyaśō viṣamajvarē| vātapradhānaṁ sarpirbhirbastibhiḥ sānuvāsanaiḥ||293|| snigdhōṣṇairannapānaiśca śamayēdviṣamajvaram| virēcanēna payasā sarpiṣā saṁskr̥tēna ca||294|| viṣamaṁ tiktaśītaiśca jvaraṁ pittōttaraṁ jayēt| vamanaṁ pācanaṁ rūkṣamannapānaṁ vilaṅghanam||295|| kaṣāyōṣṇaṁ ca viṣamē jvarē śastaṁ kaphōttarē|296| karma sAdhAraNaM jahyAttRutIyakacaturthakau ||292|| Aganturanubandho hi prAyasho viShamajvare| vAtapradhAnaM sarpirbhirbastibhiH sAnuvAsanaiH||293|| snigdhoShNairannapAnaishca shamayedviShamajvaram| virecanena payasA sarpiShA saMskRutena ca||294|| viShamaM tiktashItaishca jvaraM pittottaraM jayet| vamanaM pAcanaM rUkShamannapAnaM vila~gghanam||295|| kaShAyoShNaM ca viShame jvare shastaM kaphottare|296|

The general line of treatment of jwaras should not be followed for the management of tṛtīyaka and chaturthaka jwara as these two types of fever are mostly associated with āgantu or extraneous factors as būtās or evil spirits including germs. When vāyu is predominantly aggravated in these two types of jwara, then they should be cured by the administration of ghee, niruha and anuvāsana vastīs (medicated enemas), unctuous and hot diet and drinks. When the pitta doshha is dominant the patient should be given purgation therapy, medicated milk, ghee and articles which are bitter and cold. In state of kapha predominance, then the patient should be administered emetic therapy, pācana (therapy which promotes the digestion and metabolism), ununctuos diet and drinks, fasting and hot decoctions are useful. (292-296)

Guidelines and various formulations in vishama jwara

योगाः पराः प्रवक्ष्यन्ते विषमज्वरनाशनाः||२९६|| प्रयोक्तव्या मतिमता दोषादीन् प्रविभज्य ते| सुरा समण्डा पानार्थे भक्ष्यार्थे चरणायुधः||२९७|| तित्तिरिश्च मयूरश्च प्रयोज्या विषमज्वरे| पिबेद्वा षट्पलं सर्पिरभयां वा प्रयोजयेत्||२९८|| त्रिफलायाः कषायं वा गुडूच्या रसमेव वा| नीलिनीमजगन्धां च त्रिवृतां कटुरोहिणीम्||२९९|| पिबेज्ज्वरागमे युक्त्या स्नेहस्वेदोपपादितः| सर्पिषो महतीं मात्रां पीत्वा वा छर्दयेत् पुनः||३००|| उपयुज्यान्नपानं वा प्रभूतं पुनरुल्लिखेत्| सान्नं मद्यं प्रभूतं वा पीत्वा स्वप्याज्ज्वरागमे||३०१|| आस्थापनं यापनं वा कारयेद्विषमज्वरे| पयसा वृषदंशस्य शकृद्वा तदहः पिबेत्||३०२|| वृषस्य दधिमण्डेन सुरया वा ससैन्धवम्| पिप्पल्यास्त्रिफलायाश्च दध्नस्तक्रस्य सर्पिषः||३०३|| पञ्चगव्यस्य पयसः प्रयोगो विषमज्वरे| रसोनस्य सतैलस्य प्राग्भक्तमुपसेवनम्||३०४|| मेद्यानामुष्णवीर्याणामामिषाणां च भक्षणम्| हिङ्गुतुल्या तु वैयाघ्री वसा नस्यं ससैन्धवा||३०५|| पुराणसर्पिः सिंहस्य वसा तद्वत् ससैन्धवा| सैन्धवं पिप्पलीनां च तण्डुलाः समनःशिलाः||३०६|| नेत्राञ्जनं तैलपिष्टं शस्यते विषमज्वरे| पलङ्कषा निम्बपत्रं वचा कुष्ठं हरीतकी||३०७|| सर्षपाः सयवाः सर्पिर्धूपनं ज्वरनाशनम्| ये धूमा धूपनं यच्च नावनं चाञ्जनं च यत्||३०८|| मनोविकारे निर्दिष्टं कार्यं तद्विषमज्वरे| मणीनामोषधीनां च मङ्गल्यानां विषस्य च||३०९|| धारणादगदानां च सेवनान्न भवेज्ज्वरः|३१०| yōgāḥ parāḥ pravakṣyantē viṣamajvaranāśanāḥ||296|| prayōktavyā matimatā dōṣādīn pravibhajya tē| surā samaṇḍā pānārthē bhakṣyārthē caraṇāyudhaḥ||297|| tittiriśca mayūraśca prayōjyā viṣamajvarē| pibēdvā ṣaṭpalaṁ sarpirabhayāṁ vā prayōjayēt||298|| triphalāyāḥ kaṣāyaṁ vā guḍūcyā rasamēva vā| nīlinīmajagandhāṁ ca trivr̥tāṁ kaṭurōhiṇīm||299|| pibējjvarāgamē yuktyā snēhasvēdōpapāditaḥ| sarpiṣō mahatīṁ mātrāṁ pītvā vā chardayēt punaḥ||300|| upayujyānnapānaṁ vā prabhūtaṁ punarullikhēt| sānnaṁ madyaṁ prabhūtaṁ vā pītvā svapyājjvarāgamē||301|| āsthāpanaṁ yāpanaṁ vā kārayēdviṣamajvarē| payasā vr̥ṣadaṁśasya śakr̥dvā tadahaḥ pibēt||302|| vr̥ṣasya dadhimaṇḍēna surayā vā sasaindhavam| pippalyāstriphalāyāśca dadhnastakrasya sarpiṣaḥ||303|| pañcagavyasya payasaḥ prayōgō viṣamajvarē| rasōnasya satailasya prāgbhaktamupasēvanam||304|| mēdyānāmuṣṇavīryāṇāmāmiṣāṇāṁ ca bhakṣaṇam| hiṅgutulyā tu vaiyāghrī vasā nasyaṁ sasaindhavā||305|| purāṇasarpiḥ siṁhasya vasā tadvat sasaindhavā| saindhavaṁ pippalīnāṁ ca taṇḍulāḥ samanaḥśilāḥ||306|| nētrāñjanaṁ tailapiṣṭaṁ śasyatē viṣamajvarē| palaṅkaṣā nimbapatraṁ vacā kuṣṭhaṁ harītakī||307|| sarṣapāḥ sayavāḥ sarpirdhūpanaṁ jvaranāśanam| yē dhūmā dhūpanaṁ yacca nāvanaṁ cāñjanaṁ ca yat||308|| manōvikārē nirdiṣṭaṁ kāryaṁ tadviṣamajvarē| maṇīnāmōṣadhīnāṁ ca maṅgalyānāṁ viṣasya ca||309|| dhāraṇādagadānāṁ ca sēvanānna bhavējjvaraḥ|310|

yogAH parAH pravakShyante viShamajvaranAshanAH||296|| prayoktavyA matimatA doShAdIn pravibhajya te| surA samaNDA pAnArthe bhakShyArthe caraNAyudhaH||297|| tittirishca mayUrashca prayojyA viShamajvare| pibedvA ShaTpalaM sarpirabhayAM vA prayojayet||298|| triphalAyAH kaShAyaM vA guDUcyA rasameva vA| nIlinImajagandhAM ca trivRutAM kaTurohiNIm||299|| pibejjvarAgame yuktyA snehasvedopapAditaH| sarpiSho mahatIM mAtrAM pItvA vA chardayet punaH||300|| upayujyAnnapAnaM vA prabhUtaM punarullikhet| sAnnaM madyaM prabhUtaM vA pItvA svapyAjjvarAgame||301|| AsthApanaM yApanaM vA kArayedviShamajvare| payasA vRuShadaMshasya shakRudvA tadahaH pibet||302|| vRuShasya dadhimaNDena surayA vA sasaindhavam| pippalyAstriphalAyAshca dadhnastakrasya sarpiShaH||303|| pa~jcagavyasya payasaH prayogo viShamajvare| rasonasya satailasya prAgbhaktamupasevanam||304|| medyAnAmuShNavIryANAmAmiShANAM ca bhakShaNam| hi~ggutulyA tu vaiyAghrI vasA nasyaM sasaindhavA||305|| purANasarpiH siMhasya vasA tadvat sasaindhavA| saindhavaM pippalInAM ca taNDulAH samanaHshilAH||306|| netrA~jjanaM tailapiShTaM shasyate viShamajvare| pala~gkaShA nimbapatraM vacA kuShThaM harItakI||307|| sarShapAH sayavAH sarpirdhUpanaM jvaranAshanam| ye dhUmA dhUpanaM yacca nAvanaM cA~jjanaM ca yat||308|| manovikAre nirdiShTaM kAryaM tadviShamajvare| maNInAmoShadhInAM ca ma~ggalyAnAM viShasya ca||309|| dhAraNAdagadAnAM ca sevanAnna bhavejjvaraH|310| Formulations which are effective in curing jwara are being described. A wise physician should administer them, keeping in view their suitability for the type of dosha involved. These recipes are as follows – ¨ Sura along with its manda (alcohol along with its supernatant part) as drink ¨ The meat of cock, patridge and peacock are used as food ¨ Intake of medicated ghee called as shatapala; abhaya; triphala decoction; guḍuci juice; preparation of nīlinī, ajagandhā, trivruta and kaṭurohiṇī during the onset of fever. These things should be administered to the patient appropriately, after the patient is given snehana and swedana therapies (oleation and sudation). ¨ Emesis after the administration of ghee in large quantity ¨ Emesis after taking large quantity of food and drinks ¨ Sleeping after taking large quantity of alcohol along with food when the attack of fever is due ¨ Administration of āsthāpana and yāpanā bastīs ¨ Intake of cat’s stool mixed with milk on the same day ¨ Intake of cat’s stool mixed with either dadhi manḍa (scum of curd) or alcohol or rock salt or pippalī or triphalā or curd or butter or milk or ghee or panchagavya (mixture of five products obtained from cow); ¨ Intake of rasona along with oil immediately before food ¨ Intake of meat of animals which are fatty and hot in potency ¨ Inhalation of hingu and vasā of vyāghra (tiger) taken in equal quantity and mixed with rock salt. ¨ Inhalation of old ghee and vasā of siṁha (lion) taken in equal quantity and mixed with rock salt. ¨ Application of anjana prepared of rock salt, seeds of pippalī and manaḥshilā mixed with oil ¨ Fumigation by palaṅkaṡā, leaves of nimba, vacā, kuṡṭha, harītakī, sarṡapa, yava and ghee ¨ Administration of formulations of dhūma (medicated smoking), dhūpana (fumigation), nāvana (nasal instillation of medicine), and anjana (collyrium) which are prescribed in the treatment of manovikāra or psychic ailments like unmāda and apasamāra. ¨ Wearing of maṇis (precious stones and jewels), auṡadha (drugs), mangalya (auspicious talisman) and viṡa (poisonous substances) ¨ Intake of agada (antidote like drugs).(296-309)

Spiritual therapy

सोमं सानुचरं देवं समातृगणमीश्वरम्||३१०|| पूजयन् प्रयतः शीघ्रं मुच्यते विषमज्वरात्| विष्णुं सहस्रमूर्धानं चराचरपतिं विभुम्||३११|| स्तुवन्नामसहस्रेण ज्वरान् सर्वानपोहति| ब्रह्माणमश्विनाविन्द्रं हुतभक्षं हिमाचलम्||३१२|| गङ्गां मरुद्गणांश्चेष्ट्या पूजयञ्जयति ज्वरान्| भक्त्या मातुः पितुश्चैव गुरूणां पूजनेन च||३१३|| ब्रह्मचर्येण तपसा सत्येन नियमेन च| जपहोमप्रदानेन वेदानां श्रवणेन च||३१४|| ज्वराद्विमुच्यते शीघ्रं साधूनां दर्शनेन च| sōmaṁ sānucaraṁ dēvaṁ samātr̥gaṇamīśvaram||310|| pūjayan prayataḥ śīghraṁ mucyatē viṣamajvarāt| viṣṇuṁ sahasramūrdhānaṁ carācarapatiṁ vibhum||311|| stuvannāmasahasrēṇa jvarān sarvānapōhati| brahmāṇamaśvināvindraṁ hutabhakṣaṁ himācalam||312|| gaṅgāṁ marudgaṇāṁścēṣṭyā [5] pūjayañjayati jvarān| bhaktyā mātuḥ pituścaiva gurūṇāṁ pūjanēna ca||313|| brahmacaryēṇa tapasā satyēna niyamēna ca| japahōmapradānēna vēdānāṁ śravaṇēna ca||314|| somaM sAnucaraM devaM samAtRugaNamIshvaram||310|| pUjayan prayataH shIghraM mucyate viShamajvarAt| viShNuM sahasramUrdhAnaM carAcarapatiM vibhum||311|| stuvannAmasahasreNa jvarAn sarvAnapohati| brahmANamashvinAvindraM hutabhakShaM himAcalam||312|| ga~ggAM marudgaNAMshceShTyA [5] pUjaya~jjayati jvarAn| bhaktyA mAtuH pitushcaiva gurUNAM pUjanena ca||313|| brahmacaryeNa tapasA satyena niyamena ca| japahomapradAnena vedAnAM shravaNena ca||314|| jvarAdvimucyate shIghraM sAdhUnAM darshanena ca| Prayers should be offered to lord ishvara along with umā, their attendents and matṛs. This immediately cures viṡama jwara. Recitation of the sahasra nāma (one thousand names) of Lord Viṡnū, who has one thousand heads, who is the chief of the carācara (moving and non-moving things of the universe) and who is omnipresent cures all type of jwara. Offering prayers through iṡṭī or yajña (fire ritual) to Brahmā, the Ashvinīs, īndra, āgni, the Himalayās, the Ganges and the followers of Māruts cures the jwara. Devotion to father and mother, prayer to gurūs, observance of celibacy, practice of tapa (penance), truthfulness and niyama (religious rites), japa (incantations), homa (like yajña – offering oblation to fire), hearing the recitation of the vedās and the darshana (visiting) of saints immediately cures jwara. (310-314)

Management of jwara located in various dhatu

ज्वरे रसस्थे वमनमुपवासं च कारयेत्||३१५|| सेकप्रदेहौ रक्तस्थे तथा संशमनानि च| विरेचनं सोपवासं मांसमेदःस्थिते हितम्||३१६|| अस्थिमज्जगते देया निरूहाः सानुवासनाः|३१७|

jvarādvimucyatē śīghraṁ sādhūnāṁ darśanēna ca| jvarē rasasthē vamanamupavāsaṁ ca kārayēt||315|| sēkapradēhau raktasthē tathā saṁśamanāni ca| virēcanaṁ sōpavāsaṁ māṁsamēdaḥsthitē hitam||316|| asthimajjagatē dēyā nirūhāḥ sānuvāsanāḥ|317|

jvare rasasthe vamanamupavAsaM ca kArayet||315|| sekapradehau raktasthe tathA saMshamanAni ca| virecanaM sopavAsaM mAMsamedaHsthite hitam||316|| asthimajjagate deyA nirUhAH sAnuvAsanAH|317|

When the doshās causing jwara are located in – ¨ the rasa dhātu, then vamana and upavāsa (emesis and fasting) should be done. ¨ the rakta dhātu, then seka and pradeha (pouring of hot medicated liquids and ointment application) should be done. ¨ in the mānsa and the medas virecana and upavāsa should be done. ¨ in the asthī and majjā dhātūs, nirūha and anuvāsana bastīs should be given. (315-317)

Management of abhicharaja and abhishangaja jwara

शापाभिचाराद्भूतानामभिषङ्गाच्च यो ज्वरः||३१७|| दैवव्यपाश्रयं तत्र सर्वमौषधमिष्यते| śāpābhicārādbhūtānāmabhiṣaṅgācca yō jvaraḥ||317|| daivavyapāśrayaṁ tatra sarvamauṣadhamiṣyatē| shApAbhicArAdbhUtAnAmabhiSha~ggAcca yo jvaraH||317|| daivavyapAshrayaM tatra sarvamauShadhamiShyate| The jwara caused by shapa (curse), abhichara (tantric rituals with evil purpose), bhutabhishanga (afflication by micro organisms or evil spirits), daiva vyapashraya chikitsa (performance of spiritual therapies) is the most desired therapy. (317)

Management of abhighataja jwara

अभिघातज्वरो नश्येत् पानाभ्यङ्गेन सर्पिषः||३१८|| रक्तावसेकैर्मद्यैश्च सात्म्यैर्मांसरसौदनैः| सानाहो मद्यसात्म्यानां मदिरारसभोजनैः||३१९|| क्षतानां व्रणितानां च क्षतव्रणचिकित्सया| abhighātajvarō naśyēt pānābhyaṅgēna sarpiṣaḥ||318|| raktāvasēkairmadyaiśca sātmyairmāṁsarasaudanaiḥ| sānāhō madyasātmyānāṁ madirārasabhōjanaiḥ||319|| kṣatānāṁ vraṇitānāṁ ca kṣatavraṇacikitsayā| abhighAtajvaro nashyet pAnAbhya~ggena sarpiShaH||318|| raktAvasekairmadyaishca sAtmyairmAMsarasaudanaiH| sAnAho madyasAtmyAnAM madirArasabhojanaiH||319|| kShatAnAM vraNitAnAM ca kShatavraNacikitsayA| Jwara caused by abhighāta (external injury) gets cured by the intake and massage of ghee, blood letting, in take of rice with wholesome meat soup. If such patients of abhighata jwara, are suffering from anaha (gaseous distention of abdomen) and are accustomed to alcohol, then they should be given food with alcohol and meat soup. For the treatment of jwara caused by kshata (injury like cuts, stabs etc.) and vraṇa (ulcers) line of treatment suggested for kshata and vrana should be adopted. (318-320)

Management of agantuja jwara due to mental factors

आश्वासेनेष्टलाभेन वायोः प्रशमनेन च||३२०|| हर्षणैश्च शमं यान्ति कामशोकभयज्वराः| काम्यैरर्थैर्मनोज्ञैश्च पित्तघ्नैश्चाप्युपक्रमैः||३२१|| सद्वाक्यैश्च शमं याति ज्वरः क्रोधसमुत्थितः| कामात् क्रोधज्वरो नाशं क्रोधात् कामसमुद्भवः||३२२|| याति ताभ्यामुभाभ्यां च भयशोकसमुत्थितः|३२३| ज्वरस्य वेगं कालं च चिन्तयञ्ज्वर्यते तु यः||३२३|| तस्येष्टैस्तु विचित्रैश्च विषयैर्नाशयेत् स्मृतिम्|३२४| āśvāsēnēṣṭalābhēna vāyōḥ praśamanēna ca||320|| harṣaṇaiśca śamaṁ yānti kāmaśōkabhayajvarāḥ| kāmyairarthairmanōjñaiśca pittaghnaiścāpyupakramaiḥ||321|| sadvākyaiśca śamaṁ yāti jvaraḥ krōdhasamutthitaḥ| kāmāt krōdhajvarō nāśaṁ krōdhāt kāmasamudbhavaḥ||322|| yāti tābhyāmubhābhyāṁ ca bhayaśōkasamutthitaḥ|323| jvarasya vēgaṁ kālaṁ ca cintayañjvaryatē tu yaḥ||323|| tasyēṣṭaistu vicitraiśca viṣayairnāśayēt smr̥tim|324| AshvAseneShTalAbhena vAyoH prashamanena ca||320|| harShaNaishca shamaM yAnti kAmashokabhayajvarAH| kAmyairarthairmanoj~jaishca pittaghnaishcApyupakramaiH||321|| sadvAkyaishca shamaM yAti jvaraH krodhasamutthitaH| kAmAt krodhajvaro nAshaM krodhAt kAmasamudbhavaH||322|| yAti tAbhyAmubhAbhyAM ca bhayashokasamutthitaH|323| jvarasya vegaM kAlaM ca cintaya~jjvaryate tu yaH||323|| tasyeShTaistu vicitraishca viShayairnAshayet smRutim|324| The jwara caused by kāma (passion), shoka (grief) and bhaya (fear) gets cured by the āshvāshana (assurance), ishṭa labha (providing the desired object), alleviation of vāyu and harshana (bringing excietment). The jwara caused by krodha gets subsided by providing the kamya artha (desired object), manojna artha (pleasing object), therapies for the alleviation of pitta and sadvakya (correct advice). The jwara caused by krodha gets subsided by kama and that caused by kama gets cured by krodha. Jwara caused by bhaya (fear) and shoka (grief or sorrow) gets subsided by both kama and krodha. If a patient gets jwara just by thinking about its episode, then his mind should be diverted to desirable, different and surprising incidents (vishaya).(320-323)

Signs of remission of jwara

ज्वरप्रमोक्षे पुरुषः कूजन् वमति चेष्टते| श्वसन्विवर्णः स्विन्नाङ्गो वेपते लीयते मुहुः||३२४|| प्रलपत्युष्णसर्वाङ्गः शीताङ्गश्च भवत्यपि| विसञ्ज्ञो ज्वरवेगार्तः सक्रोध इव वीक्ष्यते ||३२५|| सदोषशब्दं च शकृद्द्रवं स्रवति वेगवत्| लिङ्गान्येतानि जानीयाज्ज्वरमोक्षे विचक्षणः||३२६|| बहुदोषस्य बलवान् प्रायेणाभिनवो ज्वरः| सत्क्रियादोषपक्त्या चेद्विमुञ्चति सुदारुणम्||३२७|| कृत्वा दोषवशाद्वेगं क्रमादुपरमन्ति ये| तेषामदारुणो मोक्षो ज्वराणां चिरकारिणाम्||३२८|| jvarapramōkṣē puruṣaḥ kūjan vamati cēṣṭatē| śvasanvivarṇaḥ svinnāṅgō vēpatē līyatē muhuḥ||324|| pralapatyuṣṇasarvāṅgaḥ śītāṅgaśca bhavatyapi| visañjñō jvaravēgārtaḥ sakrōdha iva vīkṣyatē ||325|| sadōṣaśabdaṁ ca śakr̥ddravaṁ sravati vēgavat| liṅgānyētāni jānīyājjvaramōkṣē vicakṣaṇaḥ||326|| bahudōṣasya balavān prāyēṇābhinavō jvaraḥ| satkriyādōṣapaktyā cēdvimuñcati sudāruṇam||327|| kr̥tvā dōṣavaśādvēgaṁ kramāduparamanti yē| tēṣāmadāruṇō mōkṣō jvarāṇāṁ cirakāriṇām||328|| jvarapramokShe puruShaH kUjan vamati ceShTate| shvasanvivarNaH svinnA~ggo vepate lIyate muhuH||324|| pralapatyuShNasarvA~ggaH shItA~ggashca bhavatyapi| visa~jj~jo jvaravegArtaH sakrodha iva vIkShyate ||325|| sadoShashabdaM ca shakRuddravaM sravati vegavat| li~ggAnyetAni jAnIyAjjvaramokShe vicakShaNaH||326|| bahudoShasya balavAn prAyeNAbhinavo jvaraH| satkriyAdoShapaktyA cedvimu~jcati sudAruNam||327|| kRutvA doShavashAdvegaM kramAduparamanti ye| teShAmadAruNo mokSho jvarANAM cirakAriNAm||328|| The clinical features manifested at the time of remission of (sannipata jwara) are – the patient produces kujana (rumbling) sound, vomiting, abnormal movements of the limbs (cheshta), heavy breathing or difficulty in breathing, discoloration, svinna anga (sweating), trembling (vepate), frequent fainting (lihyate muhuḥ), delirium, the body becoming very hot and cold at times, unconsciousness, more rise of temperature, angry appearance and forceful passage of liquid stools mixed with doshas with sound. If a severe condition of jwara with excessively aggravated doshas and recent onset, is treated with appropriate therapy, then dosha paka occurs. Because of this, the sudden remmision of jwara occurs with difficulty. (daruna moksha). In chronic stage of jwara, the episodes are remitted depending upon strength of dosha. The remission occurs slowly without difficulty. (324-328)

Signs of completely cured jwara patient

विगतक्लमसन्तापमव्यथं विमलेन्द्रियम्| युक्तं प्रकृतिसत्त्वेन विद्यात् पुरुषमज्वरम्||३२९|| vigataklamasantāpamavyathaṁ vimalēndriyam| yuktaṁ prakr̥tisattvēna vidyāt puruṣamajvaram||329||

vigataklamasantApamavyathaM vimalendriyam| yuktaM prakRutisattvena vidyAt puruShamajvaram||329||

Disappearance of klama (mental fatigue) and santapa (temperature), absence of pain, clarity of senses, gaining natural mental faculties – are all the signs and symptoms of a person who has become free from jwara.(329)

Precautions after being cured from jwara

सज्वरो ज्वरमुक्तश्च विदाहीनि गुरूणि च| असात्म्यान्यन्नपानानि विरुद्धानि च वर्जयेत्||३३०|| व्यवायमतिचेष्टाश्च स्नानमत्यशनानि च| तथा ज्वरः शमं याति प्रशान्तो जायते न च||३३१|| व्यायामं च व्यवायं च स्नानं चङ्क्रमणानि च| ज्वरमुक्तो न सेवेत यावन्न बलवान् भवेत्||३३२|| sajvarō jvaramuktaśca vidāhīni gurūṇi ca| asātmyānyannapānāni viruddhāni ca varjayēt||330|| vyavāyamaticēṣṭāśca snānamatyaśanāni ca| tathā jvaraḥ śamaṁ yāti praśāntō jāyatē na ca||331|| vyāyāmaṁ ca vyavāyaṁ ca snānaṁ caṅkramaṇāni ca| jvaramuktō na sēvēta yāvanna balavān bhavēt||332||

sajvaro jvaramuktashca vidAhIni gurUNi ca| asAtmyAnyannapAnAni viruddhAni ca varjayet||330|| vyavAyamaticeShTAshca snAnamatyashanAni ca| tathA jvaraH shamaM yAti prashAnto jAyate na ca||331|| vyAyAmaM ca vyavAyaM ca snAnaM ca~gkramaNAni ca| jvaramukto na seveta yAvanna balavAn bhavet||332|| A person suffering from jwara and the one who has become free from it should not indulge in and avoid the following - the intake of food and drinks which are vidahi (causing burning sensation), guru (heavy), asatmya (unwholesome) and viruddha (mutually contradictory); sexual intercourse, excessive exhaustion, bath and excessive walking. By observing these rules the fever gets alleviated and does not occur again. Exercise, sexual intercourse, bath, chankramana (brisk walk) – these should be avoided by the person who has become free from jwara till he regains strength. (330-332)

Punaravarti jwara (recurrent jwara)

असञ्जातबलो यस्तु ज्वरमुक्तो निषेवते| वर्ज्यमेतन्नरस्तस्य पुनरावर्तते ज्वरः||३३३|| दुर्हृतेषु च दोषेषु यस्य वा विनिवर्तते| स्वल्पेनप्यपचारेण तस्य व्यावर्तते पुनः||३३४|| चिरकालपरिक्लिष्टं दुर्बलं हीनतेजसम् [१] | अचिरेणैव कालेन स हन्ति पुनरागतः||३३५|| अथवाऽपि परीपाकं धातुष्वेव क्रमान्मलाः| यान्ति ज्वरमकुर्वन्तस्ते तथाऽप्यपकुर्वते||३३६|| दीनतां श्वयथुं ग्लानिं पाण्डुतां नान्नकामताम्| कण्डूरुत्कोठपिडकाः कुर्वन्त्यग्निं च ते मृदुम्||३३७|| एवमन्येऽपि च गदा व्यावर्तन्ते पुनर्गताः| अनिर्घातेन दोषाणामल्पैरप्यहितैर्नृणाम्||३३८|| निर्वृत्तेऽपि ज्वरे तस्माद्यथावस्थं यथाबलम्| यथाप्राणं हरेद्दोषं प्रयोगैर्वा शमं नयेत्||३३९|| मृदुभिः शोधनैः शुद्धिर्यापना बस्तयो हिताः| हिताश्च लघवो यूषा जाङ्गलामिषजा रसाः||३४०|| अभ्यङ्गोद्वर्तनस्नानधूपनान्यञ्जनानि च| हितानि पुनरावृत्ते ज्वरे तिक्तघृतानि च||३४१|| गुर्व्यभिष्यन्द्यसात्म्यानां भोजनात् पुनरागते| लङ्घनोष्णोपचारादिः क्रमः कार्यश्च पूर्ववत्||३४२|| किराततिक्तकं तिक्ता मुस्तं पर्पटकोऽमृता| घ्नन्ति पीतानि चाभ्यासात् पुनरावर्तकं ज्वरम्||३४३|| asañjātabalō yastu jvaramuktō niṣēvatē| varjyamētannarastasya punarāvartatē jvaraḥ||333|| durhr̥tēṣu ca dōṣēṣu yasya vā vinivartatē| svalpēnapyapacārēṇa tasya vyāvartatē punaḥ||334|| cirakālaparikliṣṭaṁ durbalaṁ hīnatējasam | acirēṇaiva kālēna sa hanti punarāgataḥ||335|| athavā'pi parīpākaṁ dhātuṣvēva kramānmalāḥ| yānti jvaramakurvantastē tathā'pyapakurvatē||336|| dīnatāṁ śvayathuṁ glāniṁ pāṇḍutāṁ nānnakāmatām| kaṇḍūrutkōṭhapiḍakāḥ kurvantyagniṁ ca tē mr̥dum||337|| ēvamanyē'pi ca gadā vyāvartantē punargatāḥ| anirghātēna dōṣāṇāmalpairapyahitairnr̥ṇām||338|| nirvr̥ttē'pi jvarē tasmādyathāvasthaṁ yathābalam| yathāprāṇaṁ harēddōṣaṁ prayōgairvā śamaṁ nayēt||339|| mr̥dubhiḥ śōdhanaiḥ śuddhiryāpanā bastayō hitāḥ| hitāśca laghavō yūṣā jāṅgalāmiṣajā rasāḥ||340|| abhyaṅgōdvartanasnānadhūpanānyañjanāni ca| hitāni punarāvr̥ttē jvarē tiktaghr̥tāni ca||341|| gurvyabhiṣyandyasātmyānāṁ bhōjanāt punarāgatē| laṅghanōṣṇōpacārādiḥ kramaḥ kāryaśca pūrvavat||342|| kirātatiktakaṁ tiktā mustaṁ parpaṭakō'mr̥tā| ghnanti pītāni cābhyāsāt punarāvartakaṁ jvaram||343||

asa~jjAtabalo yastu jvaramukto niShevate| varjyametannarastasya punarAvartate jvaraH||333|| durhRuteShu ca doSheShu yasya vA vinivartate| svalpenapyapacAreNa tasya vyAvartate punaH||334|| cirakAlaparikliShTaM durbalaM hInatejasam [1] | acireNaiva kAlena sa hanti punarAgataH||335|| athavA~api [2] parIpAkaM dhAtuShveva kramAnmalAH| yAnti jvaramakurvantaste tathA~apyapakurvate||336|| dInatAM shvayathuM glAniM pANDutAM nAnnakAmatAm| kaNDUrutkoThapiDakAH kurvantyagniM ca te mRudum||337|| evamanye~api ca gadA vyAvartante punargatAH| anirghAtena doShANAmalpairapyahitairnRuNAm||338|| nirvRutte~api jvare tasmAdyathAvasthaM yathAbalam| yathAprANaM hareddoShaM prayogairvA shamaM nayet||339|| mRudubhiH shodhanaiH shuddhiryApanA bastayo hitAH| hitAshca laghavo yUShA jA~ggalAmiShajA rasAH||340|| abhya~ggodvartanasnAnadhUpanAnya~jjanAni ca| hitAni punarAvRutte jvare tiktaghRutAni ca||341|| gurvyabhiShyandyasAtmyAnAM bhojanAt punarAgate| la~gghanoShNopacArAdiH kramaH kAryashca pUrvavat||342|| kirAtatiktakaM tiktA mustaM parpaTako~amRutA| ghnanti pItAni cAbhyAsAt punarAvartakaM jvaram||343|| If a person, who has become free from jwara, resorts to prohibited factors (as described before) before gaining strength, then the jwara reappears. If a person becomes free from jwara when the dośhās have not been eliminated properly, then, even with mild irregularity in regimens (apachara), it reappears. As such patients have already suffered for a long time; hence there is weakness and loss of vitality in the tissues. If the fever reappears in them and then this certainly leads to their death. Sometimes, dośhās undergo paripāka (metabolic transformation) in the dhātūs and gradually the fever subsides. But, their harmful effects continue as a result of which the patient suffers from dīnata (uneasiness), shvayathu (oedema), glani (lassitude), panduta (pallor or anemia), loss of appetite, itching, urticaria, pimples and suppression of the power of digestion. Similarly, other diseases which are already cured reappear in the individual due to the non – elimination of the dośhās completely, even by resorting to little unwholesome regime after the cure of the disease. Therefore, the dośhās should be eliminated from the body either by elimination or alleviation therapies depending upon the stage and strength of the dośhās, even after the fever subsides in a patient of jwara. For this purpose mild elimination therapies and yāpanā bastīs should be administered. Yūśa (vegetable soups) and rasa (meat soups) of animal’s meat, which are light, are useful in this condition. Abhyanga, udvartana, snāna, dhūpana, anjana and ghee prepared boiling with bitter drugs are useful in the treatment of jwara, which has reappeared in a patient. If the fever reappears because of the intake of food which is guru (heavy), abhiṡyandī (which cause obstruction in the channels of the body) and unwholesome; then langhana (fasting) and hot therapies should be administered for its treatment as described before. Habitual intake of the decoction of kirāta tiktaka, tiktā, mustā; parpaṭaka and amṛtā cures repeated fever. (333-343)

Guidelines for management

तस्यां तस्यामवस्थायां ज्वरितानां विचक्षणः| ज्वराक्रियाक्रमापेक्षी कुर्यात्तत्तच्चिकित्सितम्||३४४|| tasyāṁ tasyāmavasthāyāṁ jvaritānāṁ vicakṣaṇaḥ| jvarākriyākramāpēkṣī kuryāttattaccikitsitam||344||

tasyAM tasyAmavasthAyAM jvaritAnAM vicakShaNaH| jvarAkriyAkramApekShI kuryAttattaccikitsitam||344|| The wise physician should treat the patient in different stages of jwara, according to the line of treatment of jwara. (344)

रोगराट् सर्वभूतानामन्तकृद्दारुणो ज्वरः| तस्माद्विशेषतस्तस्य यतेत प्रशमे भिषक्||३४५|| rōgarāṭ sarvabhūtānāmantakr̥ddāruṇō jvaraḥ| tasmādviśēṣatastasya yatēta praśamē bhiṣak||345|| rogarAT sarvabhUtAnAmantakRuddAruNo jvaraH| tasmAdvisheShatastasya yateta prashame bhiShak||345|| Jwara is the king of diseases and it causes the death of all creatures and is of serious nature. Therefore, the physician should make special efforts for its treatment. (345)

Summary

तत्र श्लोकः- यथाक्रमं यथाप्रश्नमुक्तं ज्वरचिकित्सितम्| आत्रेयेणाग्निवेशाय भूतानां हितकाम्यया||३४६|| tatra ślōkaḥ- yathākramaṁ yathāpraśnamuktaṁ jvaracikitsitam| ātrēyēṇāgnivēśāya bhūtānāṁ hitakāmyayā||346||

tatra shlokaH- yathAkramaM yathAprashnamuktaM jvaracikitsitam| AtreyeNAgniveshAya bhUtAnAM hitakAmyayA||346||

With a desire for the welfare of the living creatures, Atreya has furnished the replies to the queries of Agniveśa regarding the treatment of jwara. (347)

Tattva vimarsha

· All diseases including jwara occur due to disequilibrium of dosha. If the dosha are in equilibrium state, health is maintained and disease cannot occur. · The origin of all diseases is because of the tendency for greed or attachment (parigraha). ¨ In order to know a disease, the diagnosis of sharira (physical) and manasa (mental); saumya (predominated by cold) and agneya (predominated by heat); antarvega (internal) and bahirvega (external); prakrita (according to seasons) and vaikrita (unseasonal); sadhya (curable) and asadhya (incurable) should be made and treated accordingly. ¨ The psychic involvement in a disease shall be assessed on the basis of vaichitya (mental instability), arati (disliking for everything) and glani (feeling of weakness in the body). ¨ Dosha dominance can be assessed by the desire to take cold or hot things. In vata-pitta dominant diseases, there is desire for cold things and in vata-kapha dominant diseases, there is desire for hot things. ¨ Seasonal variations in temperature, environment can adversely affect the dosha balance leading to diseases originated from naturally vitiated dosha. ¨ As a seed remains dormant in the soil and germinates at a favourable time, similarly the doshas remain in dormant condition in the dhatu and get aggravated at a favourable time. These dosha gain strength at an apropriate time and when the power of the inhibiting (disease preventing) factors subsides, then disease occurs. ¨ In the abhighataja jwara, caused by any injury, vitiated vata affects predominantly rakta (blood) to resulting in jwara with discomfort, swelling, discoloration and pain. This resembles with inflammation. ¨ The exogenous jwara caused by external causes are at first independent, but later they get mixed up with the signs and symptoms of nija jwara (endogenous fevers). ¨ The processes of vitiated dosha spread all over body after combining with the rasa ( first dhatu of nutrition), its effect of displacement of agni (hampering metabolism), obstruction of transport channels specifically sweat pores leading to increase in internal heat are important milestones in pathogenesis of jwara. ¨ Langhana (fasting) reduces the aggravated dosha, stimulates the agni, and leads to lightness and restoration of appetite with alleviation of jwara . ¨ Langhana should be performed to the extent that it does not hamper the vitality or strength of the individual. The aim of all these measures is to regain the health which also depends on the physical, mental and spiritual strength. ¨ Any treatment shall always be performed after proper assessment of nature and state of dosha. Otherwise it leads to complications and adverse effects. ¨ The purification treatments are done only in a state of utklishta dosha (on the verge of being expelled out). If the dosha are excessively vitiated, but not in utklishta, then pre-purification treatments like deepana, pachana, snehana are performed to bring the dosha to utlishta state. ¨ Langhana (fasting), swedana (fomentation to remove obstruction in sweat pores), kala (waiting period of eight days), yavagu (medicated gruels) and tikta rasa drugs (drugs having bitter taste) and all digestive enhancers of avipakwa dosha (untransformed) are prescribed in the initial stage of jwara. ¨ When vayu is predominantly aggravated in jwara, then patient should be treated by the administration of ghee, niruha and anuvasana bastis (medicated enemas), unctuous and hot diet and drinks. ¨ When the pitta dosha is dominant the patient should be given purgation therapy, medicated milk, ghee and articles which are bitter and cold. ¨ In state of kapha predominance, the patient should be administered emetic therapy, pachana (therapy which promotes the digestion and metabolism), non-unctuous diet and drinks, fasting and hot decoctions are useful. ¨ When the doshas causing jwara are located in the rasa dhatu, then vamana and upavasa (emesis and fasting) should be done; in case of location in the rakta dhatu, seka and pradeha (pouring of hot medicated liquids and ointment application) should be done; in case of mamsa and the medas virechana and upavasa should be done; in the asthi and majja dhatus, niruha and anuvasana bastis should be given. ¨ The jwara caused by shapa (curse), abhichara (tantric rituals with evil purpose), bhutabhishanga (affliction by micro organisms or evil spirits), daiva vyapashraya chikitsa (performance of spiritual therapies) is the most desired therapy. ¨ Jwara caused by abhighata (external injury) gets cured by the intake and massage of ghee, blood-letting, intake of rice with wholesome meat soup. ¨ Mental factors like kama (passion), shoka (grief) and bhaya (fear) gets cured by the ashvasana (assurance), ishṭa labha (providing the desired object), alleviation of vayu and harshana (bringing excitement or pleasure). ¨ Krodha (anger) subsides by providing kamya artha (desired object), manojna artha (pleasing object), therapies for the alleviation of pitta and sadvakya (correct advice). ¨ The jwara caused by krodha subsides by kama and that caused by kama gets cured by krodha. Jwara caused by bhaya (fear) and shoka (grief or sorrow) subsides by both kama and krodha. ¨ If a patient gets jwara just by thinking about it, then his mind should be diverted to desirable, different and surprising incidents (vishaya). ¨ For prevention of re-occurrence of jwara and during its treatment, one should avoid the following: intake of food and drinks which are vidahi (causing burning sensation), guru (heavy), asatmya (unwholesome) and viruddha (mutually contradictory); sexual intercourse, excessive exhaustion, bath, excessive walking exercise, should be avoided by the person who has become free from jwara till he regains strength. ¨ The remission of jwara depends upon strength of dosha. In acute stage, the remission occurs with difficulty because of severity of dosha. In chronic stage, the remission occurs without difficulty due to mild strength of dosha. ¨ The signs of regaining health after remission of a disease are disappearance of klama (mental fatigue) and santapa (raised temperature/feeling of heat), absence of pain, clarity of senses and gaining natural mental faculties. ¨ If a person, who has become free from jwara, resorts to prohibited factors (as described before) before gaining strength, then the jwara reappears.

Vidhi vimarsha

Jwara in Ayurveda is not merely rise in body temperature, but a complex syndrome associated with some other features of the body, mind and the sense organs. Elevated body temperature or feeling of heat is part of the manifestation of jwara. Because of this feature of elevated body temperature, jwara is closely related to FUO of modern medicine. Fever is defined as a state of increase in core body temperature, often as defense response of host to invasion of micro-organism or inanimate matter known as pathogen. This involves many reactions such as cytokine mediation, numerous physiologic, endocrine, immunological and autonomic responses. However, in the clinical setting and the public perception fever is typically defined as a pyrogen mediated rise in body temperature above the normal range. This definition ignores the fact that the rise in body temperature is but one component of this multifaceted response. Further, the body temperature is an agglomeration of the many different temperatures the body has, each representative of a particular body part. The anatomic variability of the body temperature - The core and the shell The concept of core and shell is a bit similar to our concept of koshtha and shakha. Shakha is rasa or raktadi dhatu and twacha. Koshtha includes the panchadasha koshthanga. Koshtha is the place where the main agni (jatharagni) resides. This agni digests and metabolizes the food consumed (the animal and vegetable derived panchabhautika food) to a form suitable for use by our body (panchabhautika form suitable for our body). This it does with the help of other agnis i.e. bhutagni and dhatvagnis, which are also nourished by it (jatharagni). As per the functions described of the five types of pitta in the body the function of ushma has not been specifically attributed to anyone. Why could it have been so? This could have been so because as described in the words of Acharya Sushruta, ‘agni is nowhere in the body besides pitta, but both of them can’t be attributed as same’ and Acharya Charaka stated, ‘Agni resides in body in the form of pitta; it is responsible for all auspicious and inauspicious works, digestion and indigestion, vision and lack of vision, normalcy or abnormalcy of body heat regulation, normal or abnormal complexion, valour and fear, anger and pleasure, confusion and blissful state and other similar functions. (Cha. Su. 12/11)’. In the explanation of this verse, Chakrapani has described that the production of ushma is the function of bhrajaka pitta. However, the authors suggest that the production of heat or ushma occurs due to all the five types of pitta. All reactions and transformations occurring in nature are of two types - either they consume heat (are endothermic) or they give out heat energy (are exothermic). Similarly, all the catabolic and anabolic (metabolic) processes occurring in our body cannot be outside the boundary of the same. However, we can’t detail about at which stage of food digestion and metabolism energy is consumed and at which stage heat or energy is released. The description of diurnal and age-specific variation of body temperature has been described in Ayurveda also, regarding doshika variation seen as per time of day and age. The physiology of thermoregulation: In a person, in resting phase (as during sleep when no external work is being done) more than half of the body’s heat is generated because of the inefficiency of the biochemical processes which convert the food energy into the free energy pool as ATP; heat is derived as a result of both internal work (as peristalsis, pericardial contractions, blood circulations, etc.) and biochemical processes and reactions involved in maintaining the structural and functional integrity of the various organ systems (the utilization and the synthesis of ATP). Heat is derived from the biochemical reactions occurring in all living cells. The energy is derived from the catabolism of metabolites such as glucose, and this is used for the purpose of oxidative phosphorylation to convert ADP into ATP. (taken from the Thermoregulation section of http://m-learning.zju.edu.cn/G2S/Template/View.aspx?courseId=27252&topMenuId=118135&action=view&type=&name=&menuType=1&curfolid=118582). This description of heat production as a result of the various biochemical processes is just like the description of Ayurveda which states that pitta is the one which is responsible for dahana, pachana, and the production of ushma in the body. In the case when some external work is also being performed, additional heat is generated as a byproduct of skeletal muscle contractions. Heat generated in the vital organs lying deep within the body core is distributed throughout the body with the help of circulatory system. This description of the distribution of heat with the help of circulatory system supports the notion that the ashraya of pitta is rakta (ashraya – ashrayi bhava). The importance of ashraya – ashrayi bhava is that the increase/ decrease/ alteration in the amount or qualities of one affect the other (in the case of kapha and pitta) and that we are visualizing here. According to the response derived from the nervous system, the circulatory system, determines and regulates the temperature of the various body parts and the rate of heat loss from the body surface to the environment. This whole description is about the regulation of ushma of the body by the pitta under the control and the regulation of vata dosha. If the external temperature is raised in atmosphere (as in summer or near fire or wearing too much clothigs), the body temperature is also raised. This rise is conveyed to the hypothalamus by skin warmth receptors. This inhibits adrenergic activity of sympathetic nervous system, controlling the vasoconstriction and metabolic rate and resulting in vasodilatation. The cutaneous blood flow increases to transport more heat from core to dissipate it at skin surface through heat loss mechanisms by conduction, convection and radiation. This leads to increase in heat loss and decrease in core body temperature. If the heat is sufficiently intense, then the cholinergic sympathetic fibers innervating the sweat glands stimulate sweating which causes heat loss. Behavioral responses to heat also occur which help with heat loss as wearing loose light clothes, fanning, drinking cold drinks, etc. The description made in this paragraph supports another fact stated in Ayurveda that the second ashraya of pitta is sweda. In response to the cold environment, the cold skin receptors are stimulated and the blood is diverted into the skin which also gets cooled. These signals are received by the hypothalamic thermostat and the higher cortical centres, which then initiate responses promoting heat gain and inhibit centers promoting heat loss. The sympathetic centers are activated resulting in several body responses – • Constriction of blood vessels of skin by norepinephrine • Increased thermogenesis by the increased oxidation of brown fat (found in infants and some other animals) • Piloerection occurs, trapping air close to skin (romaharsha – has been described as a premonitory sign of jwara in Ayurveda. as this shows that there is going to be consequent rise in body temperature) • Thermogenesis is increased by epinephrine secretion from adrenal medulla In the excess cold, the shivering center in the hypothalamus is also activated which causes shivering by causing the involuntary contraction of the skeletal muscles (which generates heat). Some compensatory behavioral mechanisms are also activated which help to increase the body temperature as - huddling, voluntary physical activity (hand rubbing, pacing, etc.), sheltering next to a heat source, wearing warm and more clothes, etc. In cases when the environmental temperature increases or decreases gradually (as for summer to fall or in winter to spring) the temperature regulation depends on the regulation of metabolic rate by thyroid hormones under the control of hypothalamus (thyrotropin). Pathogenesis of fever: Modern science has defined fever as – “fever is a normal adaptation in response to a pyrogenic stimulus resulting in the generation of cytokines and prostaglandins.” These pyrogens can be either exogenous (originating outside the body like microbes and their products) or endogens (those which are derived from the host cells). Exogenous pyrogens usually cause fever by inducing the release of endogenous pyrogens [e.g., IL -1, tumor necrosis factor (TNF) – α, interferon (IFN) – γ, IFN – β, IL -6, Ciliary Neurotropic Factor (CNTF), etc.] which raise the hypothalamic set point. Sources of these cytokines range from neutrophils and monocytes to hepatic kupfer cells, splenic sinusoidal cells, alveolar macrophages or peritoneal lining cells. Aside from viral, bacterial or other pathogenic infections, endogenous pyrogen release is also present in other diseases, inflammatory processes, trauma, tissue necrosis, cancer or antigen-antibody complexes. Elevation of the hypothalamic set point: The pyrogenic cytokines exert their effect on the hypothalamus (CVOS – circumventricular organ system – which is a small cluster of neuronal tissue lying outside the blood-brain barrier, surrounding and possessing intrinsic neuronal connections with the hypothalamic regulatory centers). This CVOS has numerous receptors for the endogenous cytokines as well as the microbes or their products (exogenous cytokines); which in turn induce prostaglandin synthesis (amongst which the main prostaglandin produced is PGE2) which consequentially causes a rise in the neurotransmitter cyclic adenosine 5’ – monophosphate (cyclic AMP or cAMP). This cAMP eventually activates the neuronal endings of the thermoregulatory unit in the hypothalamus. Then this neuronal output from the hypothalamus leads to a raised core body temperature as per the new set point. This resetting of the thermostat activates a diverse set of endocrine, autonomic, and behavioral processes to elevate the body temperature. Some viral diseases can act directly on the hypothalamus by bypassing the CVOS by initiating the synthesis of cytokines as IL – 1 and TNF within the central nervous system. Such CNS cytokines explain the increased body temperatures as seen in CNS hemorrhage, trauma and infection. Achieving the Raised set point: The neurons in the vasomotor center get activated to commence peripheral vasoconstriction also resulting in the chill. With the shunting of blood to internal organs (to decrease heat loss through the skin to the environment), adrenaline is released which results in increased metabolic rate and muscle tone. If all these heat-conserving and production mechanisms do not suffice to raise the core body temperature adequately, then shivering (a means of heat production by the muscles) as well as non – shivering thermogenesis by the liver may also commence. Behavioral activities such as putting on more clothing, bedding or drinking hot beverages may also help raise body temperature by decreasing heat loss.

Diagrams representing the mechanisms for heat conservation and production mechanisms of fever. All these processes of vasoconstriction and heat production continue until the hypothalamus detects that the new set point has been achieved (by the temperature of blood bathing its neurons). This whole description of the pathogenesis of fever resembles, to some extent, to the samprapti of jwara and the advised treatment schedule of jwara. The description of regulation of temperature by the hypothalamus is not present in our texts of Ayurveda, but it has been described before that whatever activities are taking place in our body are due to vata dosha because it is the sole initiator, controller, and regulator. It is the one who can move the agni from the amashaya to the whole body via the circulation (rasa). The circulation of rasa has been described due to vyana vata and in the pathogenesis of jwara no specific mention of vata dosha has been made. So, should we regard its role as absent? We don’t think so. Under the control of vata dosha, the pitta/agni/ushma is moved increasingly from the koshtha to the shakha to produce the desired increased body temperature. The description of swedavarodha is also present in Ayurveda, which scientifically speaking is the effect of peripheral vasoconstriction occurring to conserve the heat for the production of raised body temperature; this points to their observance of this phenomenon. Jwara has been defined as one in which there are features of santapa (raised body temperature/uneasiness or displeasure of the senses and the mind/displeasure or discomfort in the mana), swedavarodha (absence of sweating) and the feature of sarvang grahana (uneasiness/feeling of heaviness/pain in the whole body).The feature of sarvang grahana is like the non – specific arthralgias and myalgias occurring during fevers. Here we would once again like to highlight the concept of fevers as considered in modern science which makes them very close to that stated in Ayurveda – “The febrile response is a complex physiologic reaction to a disease (of which temperature rise is a component) involving many mechanisms as cytokine-mediated rise in core temperature, generation of acute phase reactants and the activation of numerous physiologic, endocrinologic, autonomic and immunologic systems or processes. However, in the clinical setting and the public perception fever is typically defined as a pyrogen mediated rise in body temperature above the normal range. This definition ignores the fact that the rise in body temperature is but one component of this multifaceted response.” Then, the hypothalamus maintains the temperature at the febrile level by the normal thermoregulatory mechanisms and after some time a reduction in the pyrogens (or the administration of the antipyretic medication) resets the hypothalamic set point back towards normal. In this case, the hormones as arginine, vasopressin, alpha-melanocyte stimulating hormone and corticotropin releasing factor are given out, acting as endogenous antipyretics, which result in heat loss process, vasodilation and sweating which continue, until the lower set point of the hypothalamus is achieved. This process may also be aided by behavioral processes such as removal of clothing etc. which aid in heat dissipation. The other features associated with increased core temperature as non – specific myalgias and arthralgias are associated with the peripheral production of PGE2 by the influence of circulating cytokines.

Effects of Fever

Studies have demonstrated that fever is caused by the chemicals produced by our body cells, it’s a body’s complex physiological response/reaction to some insult. In this context, it is supposed to be beneficial to the multicellular organism in which it is being produced. A growing body of research in immunology and neurophysiology has led to the recent understanding that fever is generally an adaptive physiological response to some threat. (Kluger 1979, 1986, Saper and Breder 1994, Cooper 1995, Kozak et al..1995, Dinarello 1996, Klufgr et al. 1996, Mackocwiak et al. 1997, Rowsay 1997, Kluger et al. 1998, Wang et al. 1998). With the advent of advanced molecular techniques and increasing interest of the scientists in the febrile response as an adaptive host response, much knowledge about the benefits of fever has been gained. Acute phase responses including fever results in increased and improved immune system. Such adaptations include increased neutrophil migration, increased secretion of inter – leukin 1, proliferation of T lymphocyte, increased production of interferon, hypoferremia and increased secretion of chemicals that are antibacterial, antitumour and/or antiviral in nature (Duff and Durum 1982, Cunha et al. 1984, Fletcher 1987, Styrt and Sugarman 1990, Holtzclaw 1992 etc.). Further evidence about the beneficial effects of fever comes from several studies conducted on patients diagnosed as having sepsis. The study revealed that patients with bacteremia or fungemia who were able to mount a febrile response had a higher survival rate as compared to those who were not (Byranit et al. 1971, Weenstein et al., 1983). The ability of patients with sepsis to react with a febrile response has been associated with a survival rate nearly double to that of hypothermic patients (Arons et al. 1999). A study done by Graham et al. (1990) demonstrated that patients treated with antipyretic therapy as aspirin, acetaminophen, and ibuprofen during infection with rhinovirus had an extended period of viral shedding. Dorn et al. (1989) also showed that children with chicken pox who were given acetaminophen took a significantly longer time for the total crusting of lesions as compared to those treated with a placebo. These two studies though do not demonstrate a firm causal link between non – treatment of fever and improved clinical outcome, but they do provide additional support for the theory that fever is beneficial to patients. Even animal models have demonstrated repeatedly that fever is an important feature of the acute phase response and is associated with shortened duration of illness and improved survival (Jiang eta l. 2000). In another study, Jiang et al. 2000 induced bacterial peritonitis in mice and found decreased bacterial load and improved survival in animals with febrile core temperatures as compared to normothermic controls.

Antipyretic therapy

Antipyretic therapy might be justified at least in theory, if the metabolic cost of fever exceeds its physiologic benefit, if the treatment provided gives symptomatic relief without adversely affecting the course of the febrile illness or if the toxicological costs of the antipyretic regimen (side effects) were lower than its beneficial effects. Antipyretic therapy is commonly administered to enhance patient comfort. If the temperature is greater than the 41 0 C other physical cooling measures as evaporative cooling with tepid water mist, cooling blankets, sponging with various solutions, exposure to circulating fans, etc. should be started. These physical methods of antipyresis promote heat loss by conduction, convection, and evaporation. Traditionally evaporation has been considered as the most superior method of physical antipyresis because such methods are deemed to be least likely to induce shivering. However, with external cooling methods, it has to be kept in mind that these methods lower the temperature of the febrile patients by overwhelming effector mechanisms which have been evoked by an elevated thermoregulatory set point. Therefore, unless concomitant antipyretic regimens have been started or used or shivering is inhibited by other pharmacological means, external cooling may be vigorously opposed in the febrile patients by thermoregulatory mechanisms endeavoring to maintain elevated body temperatures.

An analysis of the line of treatment described in Ayurveda for jwara

When we observe the line of treatment of jwara, we find that the principles stated here are meant to let the body reach the raised set point of body temperature and also aid the body in achieving it. This is the reason why Ayurveda has described langhana (fasting/light diet), swedana (fomentation), kala (passage of time), yavāgū (medicated gruels) and tikta rasa drugs (drugs having bitter taste) – all of these help in the pācana of avipakwa doshās in the initial stage of jwara management. The scientific explanation is available for the first three of these. Scientifically some data is available which reports that fasting or calorie restriction helps in the reduction of the inflammatory mediators. Many studies suggest that long-term CR improves several components of immune function including responses of T cells to mitogens, natural kill-cell (NK) activity, cytotoxic T lymphocyte (CTL) activity and the ability of mononuclear cells to produce pro-inflammatory cytokines. CR attenuated the age-associated increase in the ratio of memory to naïve T cells in monkeys, and this was associated with a reduction in the pro-inflammatory cytokines, TNF-α, etc. (). Though the authors want to specify that no study quoted has been done on the Ayurvedic parameters of langhana, but some clue to the possible benefits of this process of langhana is obtained by the above studies. As per Ayurveda, the indication of langhana is not intended for some patients of jwara and all patients of jwara don’t have to perform langhana for the same amount. Individualized basis has to be followed for it also.

Further, the process of swedana (fomentation) refers to methods which aid in the production of sweating such as covering oneself with warm beddings, putting on more clothing, etc., and not hot sudation as is commonly understood. All these measures might be intending to help the body reach the desired set point in jwara and let the raised body temperature perform their functions.

Kala refers to waiting for a certain period, and we are sure this was meant to allow the body to have its own time to resolve its intended purpose. Numerous studies have reported that the raised body temperature has several beneficial effects on the body and it seems that the purpose of kala was also the same ref. Further, the authors would like to highlight that this waiting for a certain period was also done with the proper supervision of the physician and as per the requirement of the patient. In a patient with a very high grade of temperature, the line of treatment was not all which is stated above. There the line of treatment described is that of external cooling measures as per the facilities available at that time (in the verse of treatment of paittika jwara). So, here we can see that the principles for the management of jwara in Ayurveda allowed the body to have its due reaction at the same time keeping an eye on the patient’s condition. Unless this was the reason why did they pick the story of Lord Shiva transforming to his Rudra form (agitated form)? The mythological story described for the beginning of jwara shows that the system (the body) which was in Shiva (balance/beautiful/harmonious/homeostatic) form, due to some insult or challenge (could be internal or external) has converted into an agitated form (Rudra) to counteract it. Again this Rudra has to revert to Shiva for the person to be healthy in the true sense.

Current practices in treatments of jwara (referred from Chikitsa Pradeep)

Principles of treatment: 1. Langhana (fasting) 2. Swedanam (fomentation) 3. Kala ( waiting period of six days) 4. Yavagu (thick gruel) 5. Tikta rasa (bitter taste drugs) Principal drugs: 1. Vatsanabha 2. Maricha 3. Malla 4. Bitter drugs like Guduchi

Type Name of preparation Dose Time of administration Anupana (vehicle) Vataja, kaphaja, Vata-kaphaja Chaturbhuja kalpa 250-500 mg Empty stomach Three times in a day Honey + lukewarm beverages Naga guti mishrana 250-375 mg Empty stomach Three times in a day Honey + sugar Tribhuvanakirti rasa 125 mg – 250 mg After lunch and dinner Ginger juice 5 ml and honey Pittaja and vata-pittaja Sutashekhar kalpa 125-250 mg Empty stomach Three times in a day Dadimavaleha Samshamani vati 250 – 500 mg Empty stomach Three times in a day Lukewarm water Maha sudarshana ghana vati 250 – 500 mg Empty stomach Three times in a day Lukewarm water Jirna jwara (chronic) Swarna –vasanta 250-500 mg After lunch and dinner Two times in a day Chyavanprasha Aarogyavardhini 250-500 mg After lunch and dinner Two times in a day Milk mixed with sugar Virechana kalpa Eranda sneha (medicated castor oil) 40-80 ml Early morning One time empty stomach Decoction of ginger or lukewarm water

There are many other formulations used in clinical practices. The list of formulations can be referred from the list of formularies given below:

1. Bhaishajya ratnavali – Authored by Govindadasa and commented by Ambikadatta Shastri
2. Sidhdha Yoga samgraha – Authored by Yadavji Trikamji Acharya
3. Chikitsa pradeep – Authored by B.V.Gokhale
4. Ayurvedic formulary of India
5. Ayurvedic Pharmacopoea of India

Glossary

Prakriti (prakRuti; प्रकृति) - the nature of the disease Pravritti (pravRutti; प्रवृत्ति ) – the origin of the disease Prabhava (prabhAva; प्रभाव) – the manifestation of the disease Adhishthana (Adhiśthāna; अधिष्ठानं) - place of manifestation of the disease, or the place of residing or the location Atma Lakshana (Ātma lakṡaṇa; आत्मलक्षण) - clinical features which are invariably associated with this disease Vimunchatah (vimu~jcataH ; विमुञ्चतः) - getting cured, Prashant (prashAnta ; प्रशान्त ) - being alleviated Aahuti (āhūtī ; आहूती) - pouring of ghee and other substances considered sacred in the sacrificial fire Yagya (Yajña; यज्ञ ) - Ritual of sacrifice in which sacrifices are made in a small holy fire along with hymn chanting Parigraha (parigraha; परिग्रह) - Feeling of attachment and greed Sheela (shIla; शील) – the general behavior and conduct of the person Saumya (saumya; सौम्य) – one in a modest form, not very fierce, in context of jwara it is the kind of jwara which is predominated by kapha dosha or is cold in nature Agneya (āgneya; आग्नेय) – predominated by heat or pitta dosha Antarvegi (antarvegi; अन्तर्वेगी)- that which is presenting with more features of doshas circulating within the body tissues, more related to koshtha; is diffic ult to treat. Bahirvegi (Bahirvegi; बहिर्वेगो) – the form in which the doshas are circulating in the shakha and hence the features are more evident Prakrita (prAkRut; प्राकृत) – the one which is natural; here it means dosha aggravation occuring naturally according to the seasons Vaikrita (vaikRuta; वैकृत)- unseasonal, the aggravation of dosha in a time which is not its natural aggravating time. Nishpratyaneeka (niShpratyanIka; निष्प्रत्यनीक) - having no opponent or which can’t be inhibited. The doshās involved in the the manifestation of santata type of jwara are very similar in property to the season (kāla), dhātūs (dushya), and the physical constitution of the patient (prakṛtī) due to which it is having no opponent Suduhsah (suduHsahaH; सुदुःसहः )- that which is unbearable. Sapratyaneeka (sapratyanIka; सप्रत्यनीक) – that which can be counteracted. Gatabalaah (gatabalAH; गतबलाः) - losing one’s strength; here the doshas after aggravation present with the clinical features and in that case the doshās get consumed and lose their strength Shookai (shUkai; शूकै ) - sharp edged thorns or bristles like the covering of the cereals Paridagdha (paridagdhA; परिदग्धा) - the tongue of the patient appears burn’t (blackish) at the margins Kharasparsha - (kharasparshA; खरस्पर्शा ) is rough in touch Srastaangata (srastA~ggatA; स्रस्ताङ्गता) - excessive prostration Bhuta (bhUta; भूत) - evil spirits or germs Abhichaara (abhicAra; अभिचार) - evil tāntric rituals (AbhishAp; अभिशापा) – curse or bad spell Tandra (tandrA; तन्द्रा) - drowsiness Moha (moha; मोह ) – increased attachment such as lust, unconsciousness, Pralaapa (pralApa; प्रलाप) - delirium Vibaddha (Vibaddha; विबद्ध) - obstruction or non – elimination Vyaamishra (vyAmishra; व्यामिश्र) – that which is of mixed type yogavāhī (yogavAhi; योगवाहि) – one which accentuates the properties of others jwarasyAmasya ( jwarasyAmasya; र्ज्वरस्यामस्य) - The āma jwara or the first stage of jwara in which the body is predominated by dosha having ama. Pachyamaanasya (pacyamAnasya; पच्यमानस्य) the stage of fevers in which the ama is being digested, resultantly the obstruction of the srotasas gets relieved and the features start presenting in a more bahirvegi manner Niraama jwara (nirAmajwara; निरामज्वर) – the condition when the patient’s body becomes free from the āma Ashtaaho (aShTAho; अष्टाहो ) - the 8th day of the fever when usually the body becomes free from the effect of ama Kashaaya (kaShAya; कषाय) - medicines having astringent taste Vijwara (Vijwara; विज्वर) - jwara subsides Anupasthita doshanam (anupasthitadoShANAM; अनुपस्थितदोषाणां) - the doshās have not reached the stage of utklesha (verge of coming out) and thus are not presenting themselves for being removed out of the body.

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