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The treatment objective is not only to reduce body temperature, but also to maintain equilibrium of body components and preserve health.
The treatment objective is not only to reduce body temperature, but also to maintain equilibrium of body components and preserve health.
=Nava jwara (Acute stage)=
Jwara in initial and acute stage with recent onset (less than seven days) is nava jwara. The dosha are afflicted with [[ama]].
Synonyms: Tarunajwara, ama jwara, acute state
==Clinical features==
*Continuous features of jwara with or without rise in temperature and of acute onset
*Anorexia, indigestion, loss of appetite, excessive salivation, nausea, tastelessness in mouth, heaviness in stomach and in cardiac region; rigidity, numbness and heaviness of body.
*Constipation or passage of improperly formed stools, excessive urination.
*Presence of laziness and drowsiness without physical weakness.
*Absence of sweating [Cha.Sa.[[Chikitsa Sthana]].3/133-136]
==Management==
===Management principles===
Therapeutic fasting after considering the strength of patient and severity of disease. This helps to promote digestion, transform [[ama]](undigested toxins) and regain normal states of [[dosha]][Cha.Sa.[[Chikitsa Sthana]].3/140] Hot water, medicated gruels and herbs having bitter taste are prescribed to promote natural process of digestion and transformation of [[ama]] state [Cha.Sa.[[Chikitsa Sthana]].3/142]
===Medicinal preparations===
Medicated water with six herbs (shadangapaniya):
Six herbs viz. Cyperus rotundus (musta), Fumaria parviflora (parpata), Chrysopogonzizanioides (ushira), Santalum album (chandana), Plectranthus vettiveroides (udichya) and Zingiber officinale (nagara) are boiled in water and then cooled. This water is prescribed for drinking. It helps to normalize body temperature and satisfy thirst. [Cha.Sa.[[Chikitsa Sthana]].3/145]
Medicated gruels (yavagu):
Medicated gruels are prescribed after fasting. This dietary preparation is light to digest, promotes sweating, pacifies thirst and sustains vitality by providing nourishment. [Cha.Sa.[[Chikitsa Sthana]].3/152] This can be continued for 6 days.
The medicated gruel is contraindicated in cases of excessive intake of alcohol, bleeding disorders especially through the upper orifices, in summer season and aggravation of [[pitta]] and [[kapha]][[dosha]].[Cha.Sa.[[Chikitsa Sthana]].3/154] In such conditions, food including powdered roasted grains mixed with fruit juices, sugar or honey are prescribed for nourishment. [Cha.Sa.[[Chikitsa Sthana]] 3/155]
===Panchakarma procedures===
*Fomentation ([[swedana]]): Mild fomentation by using a thick blanket to cover body and induce sweating is advised. It removes obstruction in sweat pores, releases trapped body heat and promotes normal movement of [[dosha]].
*Therapeutic emesis ([[vamana]]): It is indicated only in conditions of jwara with excessively aggravated [[kapha]][[dosha]]. [Cha.Sa.[[Chikitsa Sthana]].3/147]
===Precautions in diet and lifestyle===
In this stage, the patient shall avoid daytime sleep, head bath, external application of oils, sexual intercourse, direct exposure to wind, excessive physical activities, heavy to digest food, overuse of astringent and sweet taste, food items with hot potency and unctuous property, anger. [Cha.Sa.[[Chikitsa Sthana]] 3/138-39] [Cha.Sa.[[Chikitsa Sthana]].3/195]
=Jeerna jwara (Chronic stage)=
Jwara lasting for more than seven days leading to a chronic disease is jeerna jwara. The acute stage is converted into chronic after therapeutic fasting is over and the [[dosha]] are not afflicted with [[ama]] state. [A.Hr.Nidana Sthana.2/56]<ref name=Hridaya/> Some opine a period of more than three weeks to term the condition as jeerna jwara [M.Ni.2/65]<ref name=Madava>Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>
==Clinical feature==
Presence of mild features of jwara with weak digestion.[M.Ni.2/65]<ref name=Madava/>
==Pathogenesis==
If the tolerance or immunity of body tissues ([[dhatu]]) is weak, the jwara affects them for a longer duration leading to chronic stage. [Cha.Sa.[[Chikitsa Sthana]] 3/291]
==Management==
Fasting is contraindicated in chronic stage. The weakened body tissues do not tolerate fasting. Therefore, nourishing and strength promoting diet is advised. [Cha.Sa.[[Chikitsa Sthana]].3/292]
In chronic stage due to aggravation of [[vata]] and [[pitta]] [[dosha]], internal administration of medicated ghee is recommended. [Cha.Sa.[[Chikitsa Sthana]].3/164] The unctuous property and cold potency of medicated ghee pacifiers [[vata]] and [[pitta]] dosha. [Cha.Sa.[[Nidana Sthana]].1/37]
Consumption of milk is also indicated in chronic stage. Choice of using it either hot or cold or processed with appropriate herbs depends on dominance of [[dosha]] in conditions. [Cha.Sa.[[Chikitsa Sthana]].3/239]
===Panchakarma procedures===
Purification therapies are indicated in chronic stage, only if the patient does not respond to pacification therapies. [Cha.Sa. [[Chikitsa Sthana]] 3/168]
Therapeutic purgation ([[virechana]]): It is indicated only if the patient’s muscle mass, digestion and strength are not depleted. [Cha.Sa. [[Chikitsa Sthana]] 3/169]
Decoction enema (niruha basti): It is indicated in chronic debilitated conditions where therapeutic emesis ([[vamana]]) and purgation ([[virechana]]) are contraindicated. It promotes strength and power of digestion. [Cha.Sa.[[Chikitsa Sthana]].3/170]
Unctuous enema (anuvasana basti): It is indicated in case of aggravation of [[vata]] [[dosha]], depletion of [[kapha]] and [[pitta]] [[dosha]]. It is suitable for those having strong digestive power, but dry stools and difficulty in defecation. [Cha.Sa.[[Chikitsa Sthana]].3/172-73]
Intranasal drug administration ([[nasya]]):It is indicated for patients having heaviness, headache and impaired sensoria. [Cha.Sa.[[Chikitsa Sthana]] 1/173-74]
Currently used herbal formulations: Dashaashtanga churna, Samshamani Vati.
Currently used herbo-mineral formulations: Laghumalinivasant, Jeernajwarankusha rasa, Suvarnamalini vasanta, Arogyavardhini rasa.
=References=
=References=