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Jwara Nidana (view source)

Revision as of 17:50, 5 June 2017

265 bytes added , 17:50, 5 June 2017

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Depending upon the etiological factors, Ayurveda prescribes one of two types of therapies – spiritual and rational. A specific rational treatment of jwara could involve the use of processed ghee (clarified butter) with suitable drugs in a chronic fever is to alleviate all the three doshas.

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=== Text/ Transliteration/Translation ===

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~~Text/ Transliteration/Translation~~

अथातो ज्वरनिदानं व्याख्यास्यामः||१|| इति ह स्माह भगवानात्रेयः||२||

athātō jwaranidānaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2||

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athAto jwaranidAnaM vyAkhyAsyAmaH||1|| iti ha smAha bhagavAnAtreyaH||2||

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Now I shall expound upon the chapter on the “Diagnosis of Jwara (Fever).”

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Now I shall expound upon the chapter on the “Diagnosis of ''Jwara'' (Fever).”

Thus said Lord Atreya. [1-2]

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Nidana (etiology) and its synonyms:

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==== Nidana (etiology) and its synonyms ====

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इह खलु हेतुर्निमित्तमायतनं कर्ता कारणं प्रत्ययः समुत्थानं निदानमित्यनर्थान्तरम् तत्त्रिविधम्- असात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति||३||

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iha khalu hēturnimittamāyatanaṁ kartā kāraṇaṁ pratyayaḥ samutthānaṁ nidānamityanarthāntaram tattrividham-asātmyēndriyārthasaṁyōgaḥ, prajñāparādhaḥ, pariṇāmaścēti||3||

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iha khalu heturnimittamAyatanaM kartA kAraNaM pratyayaH samutthAnaM nidAnamityanarthAntaram| tattrividham- asAtmyendriyArthasaMyogaH, praj~jAparAdhaH,

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iha khalu heturnimittamAyatanaM kartA kAraNaM pratyayaH samutthAnaM nidAnamityanarthAntaram| tattrividham- asAtmyendriyArthasaMyogaH, praj~jAparAdhaH, pariNAmashceti||3||

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pariNAmashceti||3||

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''Hetu'', ''nimitta'', ''ayatana'', ''karta'', ''karana'', ''pratyaya'' and ''samutthana'' are synonyms of ''nidana'' (causative factors). ''Nidana'' could be of three types:

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~~Hetu, nimitta, ayatana, karta, karana, pratyaya and samutthana are synonyms of nidana (causative factors). Nidana could be of three types:~~

a. Asatmyendriyarthasamyoga (unsuitable contact of sense organs with their objects)

b. Pragyaparadha (knowingly engaging in harmful activities), and

c. Kala (seasonal, temporal factors). [3]

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Types of diseases:

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अतस्त्रिविधा व्याधयः प्रादुर्भवन्ति- आग्नेयाः, सौम्याः,वायव्याश्च;-द्विविधाश्चापरे- राजसाः, तामसाश्च||४||

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==== Types of diseases ====

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अतस्त्रिविधा व्याधयः प्रादुर्भवन्ति- आग्नेयाः, सौम्याः,वायव्याश्च;-द्विविधाश्चापरे- राजसाः, तामसाश्च||४||

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atastrividhā vyādhayaḥ prādurbhavanti- āgnēyāḥ, saumyāḥ, vāyavyāśca; dvividhāścāparē- rājasāḥ, tāmasāśca||4||

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(Physical) diseases caused are of three types, viz., agneya (pitta-predominant diseases), saumya (kapha-predominant diseases) and vayavya (vata-predominant diseases). Others (mental) are of two types viz. rajas and tamas. [4]

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Synonyms of disease:

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==== Synonyms of disease ====

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तत्र व्याधिरामयो गद आतङ्को यक्ष्मा ज्वरो विकारो रोग इत्यनर्थान्तरम्||५||

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tatra vyādhirāmayō gada ātaṅkō yakṣmā jvarō vikārō rōga

ityanarthāntaram||5||

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tatra vyAdhirAmayo gada Ata~gko yakShmA jvaro vikAro roga ityanarthAntaram||5||

Vyadhi, amaya, gada, atanka, yakshma, jwara, vikara and roga are synonyms of disease. [5]

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Means for knowledge of disease:

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तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः||6 ||

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==== Means for knowledge of disease ====

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तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः||6 ||

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tasyōpalabdhirnidānapūrvarūpaliṅgōpaśayasamprāptitaḥ ||6 ||

tasyopalabdhirnidAnapUrvarUpali~ggopashayasamprAptitaH||6||

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

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Nidana:

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==== Nidana ====

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तत्र निदानं कारणमित्युक्तमग्रे||७||

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tatra nidānaṁ kāraṇamityuktamagrē ||7||

tatra nidAnaM kAraNamityuktamagre||7||

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

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Poorvarupa [premonitory signs]:

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==== Poorvarupa [premonitory signs] ====

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पूर्वरूपं प्रागुत्पत्ति लक्षणं व्याधेः||८||

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pūrvarūpaṁ prāgutpatti lakṣaṇaṁ vyādhēḥ||8||

pUrvarUpaM prAgutpatti lakShaNaM vyAdheH||8||

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

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

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Linga [sign] and its synonyms:

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==== Linga [sign] and its synonyms ====

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प्रादुर्भूतलक्षणं पुनर्लिङ्गम् तत्र लिङ्गमाकृतिर्लक्षणं चिह्नं संस्थानं व्यञ्जनं रूपमित्यनर्थान्तरम्||९||

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prādurbhūtalakṣaṇaṁ punarliṅgam tatra liṅgamākr̥tirlakṣaṇaṁ cihnaṁ saṁsthānaṁ vyañjanaṁ rūpamityanarthāntaram ||9||

prAdurbhUtalakShaNaM punarli~ggam| tatra li~ggamAkRutirlakShaNaM cihnaM

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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]

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Upashaya [pacifying factors]:

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==== Upashaya [pacifying factors] ====

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उपशयः पुनर्हेतुव्याधिविपरीतानां विपरीतार्थकारिणां चौषधाहारविहाराणामुपयोगः सुखानुबन्धः||१०||

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upaśayaḥ punarhētuvyādhiviparītānāṁ viparītārthakāriṇāṁ

cauṣadhāhāravihārāṇāmupayōgaḥ sukhānubandhaḥ||10||

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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]

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Samprapti [pathogenesis]:

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==== Samprapti [pathogenesis] ====

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सम्प्राप्तिर्जातिरागतिरित्यनर्थान्तरं व्याधेः||११||

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samprāptirjātirāgatirityanarthāntaraṁ vyādhēḥ||11||

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Samprapti, jati and agati are synonyms of pathogenesis of the disease.

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

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Types of samprapti [pathogenesis]:

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==== Types of samprapti [pathogenesis] ====

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सा सङ्ख्याप्राधान्यविधिविकल्पबलकालविशेषैर्भिद्यते|१२|

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sā saṅkhyāprādhānyavidhivikalpabalakālaviśēṣairbhidyatē|12|

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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]

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सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|

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सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|

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saṅkhyā tāvadyathā-aṣṭau jvarāḥ, pañca gulmāḥ, sapta

kuṣṭhānyēvamādiḥ|12|

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sa~gkhyA tAvadyathA-aShTau jwaraH, pa~jca gulmAH, sapta kuShThAnyevamAdiH|12|

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प्राधान्यं पुनर्दोषाणां तरतमाभ्यामुपलभ्यते तत्र द्वयोस्तरः, त्रिषु तम इति|१२|

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prādhānyaṁ punardōṣāṇāṁ taratamābhyāmupalabhyatē| tatra dvayōstaraḥ, triṣu tama iti |12|

prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH,

triShu tama iti|12|

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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 ‘tama’ is used to indicate the most predominant one. [12.2]

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विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|

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vidhirnāma- dvividhā vyādhayō nijāgantubhēdēna, trividhāstridōṣabhēdēna, caturvidhāḥ sādhyāsādhyamr̥dudāruṇabhēdēna|12|

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sAdhyAsAdhyamRududAruNabhedena|12|

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Vidhi or types of diseases can be illustrated as follows:

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==== Vidhi or types of diseases can be illustrated as follows ====

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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]

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समवेतानां पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|

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samavētānāṁ [1] punardōṣāṇāmaṁśāṁśabalavikalpō vikalpō'sminnarthē|12|

samavetAnAM punardoShANAmaMshAMshabalavikalpo vikalpo~asminnarthe|12|

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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]

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बलकालविशेषः पुनर्व्याधीनामृत्वहोरात्राहारकालविधिविनियतो भवति||१२||

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बलकालविशेषः पुनर्व्याधीनामृत्वहोरात्राहारकालविधिविनियतो भवति||१२||

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balakālaviśēṣaḥ punarvyādhīnāmr̥tvahōrātrāhārakālavidhiviniyatō

bhavati||12||

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balakAlavisheShaH punarvyAdhInAmRutvahorAtrAhArakAlavidhiviniyato bhavati||12||

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Specific time of aggravation and manifestation of diseases is determined on the basis of the variations in seasons, time of the day (or night), and intake of food. [12.5]

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तस्माद्व्याधीन् भिषगनुपहतसत्त्वबुद्धिर्हेत्वादिभिर्भावैर्यथावदनुबुद्ध्येत||१३||

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tasmādvyādhīn

bhiṣaganupahatasattvabuddhirhētvādibhirbhāvairyathāvadanubuddhyēta||13||

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tasmAdvyAdhIn bhiShaganupahatasattvabuddhirhetvAdibhirbhAvairyathAvadanubuddhyeta||13||

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On the basis of these factors, physicians should properly diagnose a disease without any affliction in mind and intellect (i.e., without any prejudice or preconceived ideas). [13]

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इत्यर्थसङ्ग्रहो निदानस्थानस्योद्दिष्टो भवति तं विस्तरेणोपदिशन्तो भूयस्तरमतोऽनुव्याख्यास्यामः||१४||

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ityarthasaṅgrahō nidānasthānasyōddiṣṭō bhavati| taṁ vistarēṇōpadiśantō

bhūyastaramatō'nuvyākhyāsyāmaḥ||14||

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ityarthasa~ggraho nidAnasthAnasyoddiShTo bhavati| taM vistareNopadishanto

bhUyastaramato~anuvyAkhyAsyAmaH||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]

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Origin of jwara:

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==== Origin of jwara ====

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तत्र प्रथमत एव तावदाद्याँल्लोभाभिद्रोहकोपप्रभवानष्टौ व्याधीन्निदानपूर्वेण क्रमेण व्याख्यास्यामः, तथा सूत्रसङ्ग्रहमात्रं चिकित्सायाः| चिकित्सितेषु चोत्तरकालं यथोपचितविकाराननुव्याख्यास्यामः ||१५||

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tatra prathamata ēva tāvadādyāmँllōbhābhidrōhakōpaprabhavānaṣṭau vyādhīnnidānapūrvēṇa kramēṇa vyākhyāsyāmaḥ,

tathā sūtrasaṅgrahamātraṁ cikitsāyāḥ| cikitsitēṣu [1] cōttarakālaṁ

yathōpacitavikārānanuvyākhyāsyāmaḥ [2] ||15||

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tatra prathamata eva tAvadAdyAmllobhAbhidrohakopaprabhavAnaShTau

vyAdhInnidAnapUrveNa krameNa vyAkhyAsyAmaH, tathA sUtrasa~ggrahamAtraM

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First described here are the diagnostic features of eight diseases caused due to greed, malice and anger. These would be described along with brief methods of their treatment (a detailed description of their management would be provided in Chikitsa sthana (of this treatise)). [15]

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इह खलु ज्वर एवादौ विकाराणामुपदिश्यते, तत्प्रथमत्वाच्छारीराणाम्||१६||

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iha khalu jwara evādau vikārāṇāmupadiśyate, tatprathamatvācchārīrāṇām||16||

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iha khalu jvara evAdau vikArANAmupadishyate, tatprathamatvAcchArIrANAm||16||

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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]

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Types of jwara:

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==== Types of jwara ====

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अथ खल्वष्टाभ्यः कारणेभ्यो ज्वरः सञ्जायते मनुष्याणां; तद्यथा- वातात्, पित्तात्, कफात्, वातपित्ताभ्यां, वातकफाभ्यां, पित्तकफाभ्यां, वातपित्तकफेभ्यः, आगन्तोरष्टमात् कारणात्||१७||

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atha khalvaṣṭābhyaḥ kāraṇebhyo jwaraḥ sañjāyate manuṣyāṇām; tadyathā- vātāt, pittāt, kaphāt, vātapittābhyāṁ, vātakaphābhyāṁ, pittakaphābhyām, vātapittakaphebhyaḥ, āgantoraṣṭamāt kāraṇāt||17||

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atha khalvaShTAbhyaH kAraNebhyo jvaraH sa~jjAyate manuShyANAM; tadyathA- vAtAt, pittAt, kaphAt, vAtapittAbhyAM, vAtakaphAbhyAM, pittakaphAbhyAM,vAtapittakaphebhyaH, AgantoraShTamAt kAraNAt||17||

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Jwara occurs in humans due to eight causative factors, - vata, pitta, kapha, vata-pitta, vata-kapha, pitta-kapha, vata-pitta-kapha, and agantu (exogenous causes). [17]

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तस्य निदानपूर्वरूपलिङ्गोपशयविशेषाननुव्याख्यास्याम||१८||

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tasya nidānapūrvarūpaliṅgopaśayaviśeṣānanuvyākhyāsyāmaḥ ||18||

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tasya nidAnapUrvarUpali~ggopashayavisheShAnanuvyAkhyAsyAmaH [1] ||18||

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

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Etio-pathogenesis of vata-dominant jwara:

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

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रूक्षलघुशीतवमनविरेचनास्थापनशिरोविरेचनातियोगव्यायामवेगसन्धारणानशनाभिघातव्यवायोद्वेगशोकशोणितातिषेकजागरणविषमशरीरन्यासेभ्योऽतिसेवितेभ्यो वायुः प्रकोपमापद्यते||१९||

rūkṣalaghuśītavamanavirecanāsthāpanaśirovirecanātiyogavyāyāmavegasandhāraṇānaśanābhighātavyavāyodvegaśokaśoṇitātiṣekajāgaraṇaviṣamaśarīranyāsebhyotisevitebhyo vāyuḥ prakopamāpadyate||19||

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sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||

This vitiated vayu, when it gets into the amashaya (stomach), afflicts agni and vitiates the first dhatu (rasa) created through this vitiated digestion process. This (vitiated admixture of vayu and rasa) blocks the channels associated with rasa and sweda (sweat), adversely affecting the digestive processes and moving that heat out of its locus into other parts of the body. This excess heat leads to jwara. [20]

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Clinical features:

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==== Clinical features ====

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तस्येमानि लिङ्गानि भवन्ति; तद्यथा- विषमारम्भविसर्गित्वम्,ऊष्मणो वैषम्यं, तीव्रतनुभावानवस्थानानि ज्वरस्य, जरणान्ते दिवसान्ते निशान्ते घर्मान्ते वा ज्वरस्याभ्यागमनमभिवृद्धिर्वा, विशेषेण परुषारुणवर्णत्वं नखनयनवदनमूत्रपुरीषत्वचामत्यर्थं क्लृप्तीभावश्च; अनेकविधोपमाश्चलाचलाश्च वेदनास्तेषां तेषामङ्गावयवानां; तद्यथा- पादयोः सुप्तता, पिण्डिकयोरुद्वेष्टनं, जानुनोः केवलानां च सन्धीनां विश्लेषणम्, ऊर्वोः सादः, कटीपार्श्वपृष्ठस्कन्धबाह्वंसोरसां च भग्नरुग्णमृदितमथितचटितावपाटितावनुन्न-त्वमिव हन्वोश्चाप्रसिद्धिः, स्वनश्च कर्णयोः, शङ्खयोर्निस्तोदः, कषायास्यता आस्यवैरस्यं वा, मुखतालुकण्ठशोषः, पिपासा, हृदयग्रहः, शुष्कच्छर्दिः,शुष्ककासः, क्षवथूद्गारविनिग्रहः, अन्नरसखेदः, प्रसेकारोचकाविपाकाः, विषादजृम्भाविना-मवेपथुश्रमभ्रमप्रलापप्रजागररोमहर्षदन्तहर्षाः, उष्णाभिप्रायता, निदानोक्तानाम-नुपशयो विपरीतोपशयश्चेति वातज्वरस्य लिङ्गानि भवन्ति||२१||

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tasyemāni liṅgāni bhavanti; tadyathā-viṣamārambhavisargitvaï, ūṣmaṇo vaiṣamyaṁ, tīvratanubhāvānavasthānāni jwarasya, jaraṇānte divasānte niśānte gharmānte vā jwarasyābhyāgamanamabhivr̥ddhirvā, viśeṣeṇa paruṣāruṇavarṇatvaṁ nakhanayanavadanamūtra-purīṣatvacāmatyarthaï klr̥ptībhāvaśca; anekavidhopamāśc-alācalāśca vēdanāsteṣāï teṣāmaṅgāvayavānāṁ; tadyathā- pādayoḥ suptatā, piṇḍikayorudvēṣṭanaï, jānunoḥ kevalānāï ca sandhīnāï viśleṣaṇaï, ūrvoḥ sādaḥ, kaṭīpārśvapr̥ṣṭhaskandhabāhvaṁsorasāï ca bhagnarugṇamr̥ditamathitacaṭitāvapāṭitāvanunnatvamivahanvoścāprasiddhiḥ, svanaśca karṇayoḥ, śaṅkhayornistodaḥ, kaṣāyāsyatā āsyavairasyaï vā, mukhatālukaṇṭhaśoṣaḥ, pipāsā, hr̥dayagrahaḥ, śuṣkacchardiḥ, śuṣkakāsaḥ, kṣavathūdgāravinigrahaḥ, annarasakhedaḥ, prasekārocakā-vipākāḥ, viṣādajr̥mbhāvināmavepathuśramabhramapralāpapra-jāgararomaharṣadantaharṣāḥ, uṣṇābhiprāyatā, nidānoktānām-anupaśayo viparītopaśayaśceti vātajwarasya liṅgāni bhavanti ||21||

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tasyemAni li~ggAni bhavanti; tadyathA- viShamArambhavisargitvam, UShmaNo vaiShamyaM, tIvratanubhAvAnavasthAnAni jvarasya, jaraNAnte divasAnte nishAntegharmAnte vA jvarasyAbhyAgamanamabhivRuddhirvA, visheSheNa paruShAruNavarNatvaM nakhanayanavadanamUtrapurIShatvacAmatyarthaM klRuptIbhAvashca;anekavidhopamAshcalAcalAshca vedanAsteShAM teShAma~ggAvayavAnAM; tadyathA- pAdayoH suptatA, piNDikayorudveShTanaM, jAnunoH kevalAnAM casandhInAM vishleShaNam, UrvoH sAdaH, kaTIpArshvapRuShThaskandhabAhvaMsorasAM ca bhagnarugNamRuditamathitacaTitAvapATitAvanunnatvamiva [6] ,hanvoshcAprasiddhiH, svanashca karNayoH, sha~gkhayornistodaH, kaShAyAsyatA AsyavairasyaM vA, mukhatAlukaNThashoShaH, pipAsA, hRudayagrahaH,shuShkacchardiH, shuShkakAsaH, kShavathUdgAravinigrahaH, annarasakhedaH, prasekArocakAvipAkAH,viShAdajRumbhAvinAmavepathushramabhramapralApaprajAgararomaharShadantaharShAH, uShNAbhiprAyatA, nidAnoktAnAmanupashayo viparItopashayashcetivAtajvarasya [7] li~ggAni bhavanti||21||

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The symptoms of vata-dominant jwara are thus:

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tasyemAni li~ggAni bhavanti; tadyathA- viShamArambhavisargitvam, UShmaNo vaiShamyaM, tIvratanubhAvAnavasthAnAni jvarasya, jaraNAnte divasAnte nishAntegharmAnte vA jvarasyAbhyAgamanamabhivRuddhirvA, visheSheNa paruShAruNavarNatvaM nakhanayanavadanamUtrapurIShatvacAmatyarthaM klRuptIbhAvashca;anekavidhopamAshcalAcalAshca vedanAsteShAM teShAma~ggAvayavAnAM; tadyathA- pAdayoH suptatA, piNDikayorudveShTanaM, jAnunoH kevalAnAM casandhInAM vishleShaNam, UrvoH sAdaH, kaTIpArshvapRuShThaskandhabAhvaMsorasAM ca bhagnarugNamRuditamathitacaTitAvapATitAvanunnatvamiva [6] ,hanvoshcAprasiddhiH, svanashca karNayoH, sha~gkhayornistodaH, kaShAyAsyatA AsyavairasyaM vA, mukhatAlukaNThashoShaH, pipAsA, hRudayagrahaH,shuShkacchardiH, shuShkakAsaH, kShavathUdgAravinigrahaH, annarasakhedaH, prasekArocakAvipAkAH,viShAdajRumbhAvinAmavepathushramabhramapralApaprajAgararomaharShadantaharShAH, uShNAbhiprAyatA, nidAnoktAnAmanupashayo viparItopashayashcetivAtajvarasya [7] li~ggAni bhavanti||21||

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==== The symptoms of vata-dominant jwara are thus: ====

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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, faeces, 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, irrelevant talk, 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:

उष्णाम्ललवणक्षारकटुकाजीर्णभोजनेभ्योऽतिसेवितेभ्यस्तथा तीक्ष्णातपाग्निसन्तापश्रमक्रोधविषमाहारेभ्यश्च पित्तं प्रकोपमापद्यते||२२||

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