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===Sanskrit Text, Transliteration and English Translation===

==Sanskrit Text, Transliteration and English Translation==

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Thus said Lord Atreya. [1-2]

Thus said Lord Atreya. [1-2]

==== Synonyms of Nidana (causative factors) and its types  ====

==== Synonyms of Nidana (causative factors) and its types  ====

Diseases could be diagnosed by studying their ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (sign and symptoms), ''upashaya'' (exploratory therapy) and ''samprapti'' (pathogenesis).[6]

Diseases could be diagnosed by studying their ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (sign and symptoms), ''upashaya'' (exploratory therapy) and ''samprapti'' (pathogenesis).[6]

==== Definition of ''Nidana'' ====

==== Definition of Nidana ====

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''Nidana'' is the etiological factor as described earlier. [7]

Nidana is the cause or etiological factor as described earlier. [7]

==== Definition of ''Poorvarupa'' (premonitory signs) ====

==== Definition of [[Poorvarupa]] (premonitory signs) ====

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Symptoms that manifest themselves before the appearance of the disease are known as ''poorvarupa''. [8]

Symptoms that manifest themselves before the appearance of the disease are known as ''poorvarupa''. [8]

==== Definition of ''Linga'' (sign) and its synonyms ====

==== Definition of [[Linga]] (sign) and its synonyms ====

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Sign and symptoms when fully manifested are called as ''linga''. ''Linga, akruti, lakshana, chihna, samsthana, vyanjana'' and ''rupa'' are synonyms of ''linga''. [9]

Sign and symptoms when fully manifested are called as ''linga''. ''Linga, akruti, lakshana, chihna, samsthana, vyanjana'' and ''rupa'' are synonyms of ''linga''. [9]

==== Definition of ''Upashaya'' (pacifying factors) ====

==== Definition of [[Upashaya]] (pacifying factors) ====

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Medicines, diets and regimens that bring about relief either by acting directly on the cause of a disease or the disease itself or by producing such effects indirectly are termed ''upashaya'' (pacifying agents or factors).[10]

Medicines, diets and regimens that bring about relief either by acting directly on the cause of a disease or the disease itself or by producing such effects indirectly are termed ''upashaya'' (pacifying agents or factors).[10]

==== Definition of ''Samprapti'' (pathogenesis) ====

====[[Samprapti]] (pathogenesis)====

 

===== Definition =====

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Like ''nidana'' and ''rupa, samprapti'' has been described here with its synonyms which are indicative of its definition.  [11]

Like ''nidana'' and ''rupa, samprapti'' has been described here with its synonyms which are indicative of its definition.  [11]

==== Types of ''samprapti'' (pathogenesis) ====

===== Types of ''samprapti'' (pathogenesis) =====

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''Samprapti'' can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerological classification), ''pradhanya'' (dominance of ''dosha''), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]

''Samprapti'' can be further classified, depending upon certain specific characteristics, by ''sankhya'' (numerical classification), ''pradhanya'' (dominance of ''dosha''), ''vidhi'' (types of diseases), ''vikalpa'' (dominance of one or the other attributes of ''doshas''), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]

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''Sankhya'' type of classification of ''samprapti'' numerically groups diseases by their pathogenesis, such as, eight types of ''jwara''(fever), five types of ''gulma'' (abdominal lump), seven types of ''kushtha'' (skin diseases), etc. [12.1].

''Sankhya'' type of classification of ''samprapti'' numerically groups diseases by their pathogenesis, such as, eight types of ''jwara''(fever), five types of ''gulma'' (abdominal lump), seven types of ''kushtha'' (skin diseases), etc. [12.1].

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''Pradhanya'' (classification of ''samprapti'', or pathogenesis) indicates the dominance or primacy of one particular ''dosha'' above other ''doshas''. If two ''doshas'' get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three ''doshas'' get vitiated then the superlative term ''ttama'' is used to indicate the most predominant one. [12.2]

''Pradhanya'' (dominance) indicates the dominance or primacy of one particular ''dosha'' above other ''doshas''. If two ''doshas'' get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three ''doshas'' get vitiated then the superlative term ''ttama'' is used to indicate the most predominant one. [12.2]

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Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''doshas'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]

Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''doshas'', diseases could be of three types; they could also be of four varieties, viz. ''sadhya'' (curable), ''asadhya'' (incurable), ''mrudu'' (mild), and ''daruna'' (severe). [12.3]

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Predominance of one or the other attribute of the three ''doshas'' (in the manifestation of the disease) is known as ''vikalpa'' here. [12.4]

Predominance of one or the other attribute of the three ''doshas'' (in the manifestation of the disease) is known as ''vikalpa'' here. [12.4]

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In brief, the above topics are the objectives of this section ‘Diagnosis of diseases’ ([[Nidana Sthana]]). They will again be discussed in detail later in this chapter. [14]

In brief, the above topics are the objectives of this section ‘Diagnosis of diseases’ ([[Nidana Sthana]]). They will again be discussed in detail later in this chapter. [14]

==== Origin of ''jwara'' ====

 

==== Origin ====

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''Jwara'' (fever) is described first among disorders because temperature (or body heat) is a life-sustaining force, and is the first condition (afflicting patients of somatic conditions).  [16]

''Jwara'' (fever) is described first among disorders because temperature (or body heat) is a life-sustaining force, and is the first condition (afflicting patients of somatic conditions).  [16]

==== Types of ''jwara'' ====

==== Types ====

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Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (suitable uses) of ''jwara''. [18]

Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (suitable uses) of ''jwara''. [18]

==== Etio-pathogenesis of ''vata''-dominant ''jwara'' ====

==== [[vata]]-dominant jwara ====

===== Causes =====

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Excess use of rough, light to digest, and cold (food), over administration of therapeutic emesis and therapeutic purgation, ''asthapana'' (non-unctuous enema), ''shirovirechana'' (head evacuation), overexertion, suppression of urges, ''anashana'' (fasting), injury, copulation, agitation, lamentation, excessive blood-letting, night vigils and improper/odd posture of body – cause vitiation of ''vayu'' [19]

Excess use of rough, light to digest, and cold (food), over administration of therapeutic emesis and therapeutic purgation, ''asthapana'' (non-unctuous enema), ''shirovirechana'' (head evacuation), overexertion, suppression of urges, ''anashana'' (fasting), injury, copulation, agitation, lamentation, excessive blood-letting, night vigils and improper/odd posture of body – cause vitiation of ''vayu'' [19]

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==== Clinical features ====

===== Clinical features =====

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The patient would experience abrupt  onset and remission (of fever), with variations in temperature and severity. ''Jwara'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs,  excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]

The patient would experience abrupt  onset and remission (of fever), with variations in temperature and severity. ''Jwara'' would be particularly severe at the end of digestion and there would be temporal variations as well (i.e., day, night and in summer). The patient’s skin would appear rough, and there would be reddish discoloration of nails, eyes, face, urine, stool and skin. The patient would experience excessively reduced tendency to pass urine, feces, excessive tearing of nails, etc. Debilitating pain radiating from the toe up, with various sensations felt at various parts as the pain travels – numbness in feet, cramps in the calves, looseness in knee joints (and also in all other joints), weakness in thighs,  excruciating pain in the waist region, aching in the sides, pressure sensation in back, churning in shoulder, cutting in arms, extracting in scapular region and constricting feeling in chest, inability to move the jaws, tinnitus, and piercing pain (pricking pain) in the temple region. (Other symptoms include) astringent taste or lack of taste in the mouth (distaste), dryness of mouth, palate and throat, thirst, catching pain (grabbing pain) in the heart, dry vomiting, dry cough, loss of sneezing and eructation, aversion to the taste, salivation, anorexia, diminished digestive power, malaise, increased yawning, bending, shivering, exhaustion, giddiness, delirium, insomnia, horripilation, sensitivity in teeth, and the desire for hot. Factors mentioned in the etiology are alleviating and contrary to them are aggravating. [21]

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===== ''Pitta'' dominant ''jwara'' =====

==== ''Pitta'' dominant ''jwara'' ====

 

===== Causes =====

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उष्णाम्ललवणक्षारकटुकाजीर्णभोजनेभ्योऽतिसेवितेभ्यस्तथा तीक्ष्णातपाग्निसन्तापश्रमक्रोधविषमाहारेभ्यश्च पित्तं प्रकोपमापद्यते||२२||

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनेभ्योऽतिसेवितेभ्यस्तथा तीक्ष्णातपाग्निसन्तापश्रमक्रोधविषमाहारेभ्यश्च पित्तं प्रकोपमापद्यते||२२||

तद्यदा प्रकुपितमामाशयादूष्माणमुपसृज्याद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधाय द्रवत्वादग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयत् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२३||

तद्यदा प्रकुपितमामाशयादूष्माणमुपसृज्याद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधाय द्रवत्वादग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयत् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२३||

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तस्य विदाहकाले मध्यन्दिनेऽर्धरात्रे शरदि वा विशेषेण,कटुकास्यता,घ्राणमुखकण्ठौष्ठतालुपाकः, तृष्णा, मदो, भ्रमो, मूर्च्छा, पित्तच्छर्दनम्, अतीसारः, अन्नद्वेषः, सदनं, खेदः, प्रलापः, रक्तकोठाभिनिर्वृत्तिः शरीरे, हरितहारिद्रत्वं नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थमूष्मणस्तीव्रभावः, अतिमात्रं दाहः, शीताभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्चेति पित्तज्वरलिङ्गानि भवन्ति||२४||

tadyadā prakupitamāmāśayādūṣmāṇamupasr̥jyādyamāhāra-pariṇāmadhātuṁ rasanāmānamanvavetya rasasvedavahāni srotāṁsi pidhāya dravatvādagnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayat kevalaï śarīramanu-prapadyate, tadā jwaramabhinirvartayati||23||

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tadyadA prakupitamAmAshayAdUShmANamupasRujyAdyamAhArapariNAmadhAtuM [1] rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyadravatvAdagnimupahatya paktisthAnAdUShmANaM bahirnirasya [2] prapIDayat kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||23||  

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tadyadā prakupitamāmāśayādūṣmāṇamupasr̥jyādyamāhāra-pariṇāmadhātuṁ rasanāmānamanvavetya rasasvedavahāni srotāṁsi pidhāya dravatvādagnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayat kevalaï śarīramanu-prapadyate, tadā jwaramabhinirvartayati||23||

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tasyemāni liṅgāni bhavanti; tadyathā- yugapadeva kevale śarīre jwarasyabhyagamanamabhivéddhirvā bhuktasya vidāhakāle madhyandinerdharātre śaradi vā viśeṣeṇa, kaṭukāsyatā, ghrāṇamukhakaṇṭhauṣṭhatālupākaḥ, tr̥ṣṇā, mado, bhramo, mūrcchā, pittacchardanaï, atīsāraḥ, annadvēṣaḥ, sadanaṁ, khedaḥ, pralāpaḥ, raktakoṭhābhinirvr̥ttiḥ śarīre, haritahāridrat-vaṁ nakhanayanavadanamūtrapurīṣatvacāï, atyarthamūṣmaṇ-astīvrabhāvaḥ, atimātraṁ dāhaḥ, śītābhiprāyatā, nidānoktānupaśayo viparītopaśayaśceti pittajwaraliṅgāni bhavanti||24||

तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तस्य विदाहकाले मध्यन्दिनेऽर्धरात्रे शरदि वा विशेषेण,कटुकास्यता,घ्राणमुखकण्ठौष्ठतालुपाकः, तृष्णा, मदो, भ्रमो, मूर्च्छा, पित्तच्छर्दनम्, अतीसारः, अन्नद्वेषः, सदनं, खेदः, प्रलापः, रक्तकोठाभिनिर्वृत्तिः शरीरे, हरितहारिद्रत्वं नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थमूष्मणस्तीव्रभावः, अतिमात्रं दाहः, शीताभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्चेति पित्तज्वरलिङ्गानि भवन्ति||२४||

tadyadA prakupitamAmAshayAdUShmANamupasRujyAdyamAhArapariNAmadhAtuM [1] rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyadravatvAdagnimupahatya paktisthAnAdUShmANaM bahirnirasya [2] prapIDayat kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||23||  

tasyemāni liṅgāni bhavanti; tadyathā- yugapadeva kevale śarīre jwarasyabhyagamanamabhivéddhirvā bhuktasya vidāhakāle madhyandinerdharātre śaradi vā viśeṣeṇa, kaṭukāsyatā, ghrāṇamukhakaṇṭhauṣṭhatālupākaḥ, tr̥ṣṇā, mado, bhramo, mūrcchā, pittacchardanaï, atīsāraḥ, annadvēṣaḥ, sadanaṁ, khedaḥ, pralāpaḥ, raktakoṭhābhinirvr̥ttiḥ śarīre, haritahāridrat-vaṁ nakhanayanavadanamūtrapurīṣatvacāï, atyarthamūṣmaṇ-astīvrabhāvaḥ, atimātraṁ dāhaḥ, śītābhiprāyatā, nidānoktānupaśayo viparītopaśayaśceti pittajwaraliṅgāni bhavanti||24||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktasya vidAhakAle madhyandine~ardharAtre sharadivA visheSheNa, kaTukAsyatA, ghrANamukhakaNThauShThatAlupAkaH, tRuShNA, mado, bhramo, mUrcchA, pittacchardanam, atIsAraH, annadveShaH, sadanaM,khedaH, pralApaH, raktakoThAbhinirvRuttiH sharIre, haritahAridratvaM nakhanayanavadanamUtrapurIShatvacAm, atyarthamUShmaNastIvrabhAvaH, atimAtraMdAhaH, shItAbhiprAyatA, nidAnoktAnupashayo viparItopashayashceti pittajvarali~ggAni [3] bhavanti||24||

tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktasya vidAhakAle madhyandine~ardharAtre sharadivA visheSheNa, kaTukAsyatA, ghrANamukhakaNThauShThatAlupAkaH, tRuShNA, mado, bhramo, mUrcchA, pittacchardanam, atIsAraH, annadveShaH, sadanaM,khedaH, pralApaH, raktakoThAbhinirvRuttiH sharIre, haritahAridratvaM nakhanayanavadanamUtrapurIShatvacAm, atyarthamUShmaNastIvrabhAvaH, atimAtraMdAhaH, shItAbhiprAyatA, nidAnoktAnupashayo viparItopashayashceti pittajvarali~ggAni [3] bhavanti||24||

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The symptoms of this type of ''jwara'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''pitta'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''pitta'' (or ''paittika'') ''jwara''. [22-24]

The symptoms of this type of ''jwara'' include simultaneous high fever in the whole body, specially at the time during digestion of meals, midday, middle of the night or in the Autumn season. This type of fever leaves a pungent taste in the mouth, ''paka'' (ulceration or inflammation) of the nose, mouth, throat, lips and palate, unquenchable thirst, narcosis, giddiness, fainting, vomiting of ''pitta'' (bile), ''atisara'' (diarrhea), aversion to food, malaise, dejection, delirium, appearance of reddish patches in the body, green or yellow coloration in nails, eyes, mouth, urine, feces and skin, excessive migraine and burning sensation, desire for cold things, unsuitability of included factors in etiology and suitability of opposite ones – these symptoms are of ''pitta'' (or ''paittika'') ''jwara''. [22-24]

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===== ''Kapha''-dominant ''jwara'' =====

==== ''Kapha''-dominant ''jwara'' ====

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The symptoms of ''shleshmaja'' (''kaphaja'') ''jwara'' include the simultaneous onset of mild fever in the whole body, specially just after meals, forenoon, early night or spring season. This type of fever causes heaviness in the body, less desire to eat, excess secretion of ''shleshma'' (phlegm), sweet taste in the mouth, nausea, coating in the heart (causing wheezing), vomiting, mild appetite, excessive sleep or narcolepsy, stiffness, drowsiness, cough, dyspnea, coryza, coldness, whiteness in nails, eyes, face, urine and skin, urticarial patches in the body, desire to be subjected to heat, unsuitability of the described etiological factors and suitability of opposite to them. [27]

The symptoms of ''shleshmaja'' (''kaphaja'') ''jwara'' include the simultaneous onset of mild fever in the whole body, specially just after meals, forenoon, early night or spring season. This type of fever causes heaviness in the body, less desire to eat, excess secretion of ''shleshma'' (phlegm), sweet taste in the mouth, nausea, coating in the heart (causing wheezing), vomiting, mild appetite, excessive sleep or narcolepsy, stiffness, drowsiness, cough, dyspnea, coryza, coldness, whiteness in nails, eyes, face, urine and skin, urticarial patches in the body, desire to be subjected to heat, unsuitability of the described etiological factors and suitability of opposite to them. [27]

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