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==== ''Sadhya'' (curable) ''jwara'' ====
==== ''Sadhya'' (curable) ''jwara'' ====
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''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.
''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'' ====
==== ''Asadhya'' (incurable) ''jwara'' ====
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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 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.
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.
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]
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]
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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]
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]
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==== ''Anyedyushka jwara'' ====
==== ''Anyedyushka jwara'' ====
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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]
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]
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==== ''Tritiyaka'' and ''chaturthaka jwara'' ====
==== ''Tritiyaka'' and ''chaturthaka jwara'' ====
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When the ''dosha'' afflict the ''asthi dhatu'' (bone tissue) and ''majja dhatu'' (bone marrow), they cause the ''tritiyaka'' and ''chaturthaka jwara'' respectively.
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''.
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 ''[[mamsa 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]
''Anyedushka jwara'' occurs every day, while ''tritiyaka jwara'' occurs after a gap of one day and ''chaurthaka'' occurs after two days gap. [64-67]
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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.
As a seed remains dormant in the soil and germinates at a favorable time, similarly the ''[[dosha]]s'' 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 ''[[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 –
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 ''[[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
*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''.
*The head region is affected in the case of aggravation of ''[[vata]]'' and ''[[pitta dosha]]''.
Similarly ''chaturthaka jwara'' is also of two types –
Similarly ''chaturthaka jwara'' is also of two types –
*Calf region is afflicted in the in the beginning by the vitiation of ''kapha''
*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]
*Head region is afflicted in the beginning by the vitiation of ''[[vata]]''. [70-72]
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''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]
''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]
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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]
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 ''[[dosha]]s'' is generally attributed as the causative factors. [74]
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=== ''Dhatugata jwara'' ===
=== ''Dhatugata jwara'' ===
Manifestation of ''jwara'' at a particular time or a change in the time of manifestation takes place due to following factors:
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).
''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):
Manifestation of ''jwara'' in the different ''dhatu'' (body tissues):
#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.
#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.
#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.
#The vitiated ''[[dosha]]s'' 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.
#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''.
#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 ''[[dosha]]s'' causing ''jwara'' are lodged in the ''[[mamsa dhatu]]''.
#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.
#Vitiated ''[[dosha]]'' located in the ''[[meda 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.
#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) convulsive movements of the body and limbs.
#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) convulsive movements of the body and limbs.
#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.
#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.
#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'').
#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]
The ''jwara'' in which ''[[dosha]]s'' are located in the ''[[rasa]], [[rakta]], [[mamsa]]'' and ''[[meda 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]
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=== Clinical features of ''jwara'' due to combination of two ''dosha'' ===
=== Clinical features of ''jwara'' due to combination of two ''[[dosha]]'' ===
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Signs and symptoms of ''jwara'' by combination of ''vata'' and ''pitta'':
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:
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''.
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'':
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''.
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'':
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''.
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]
Thus, here the features of different types of ''jwara'' caused by the simultaneous vitiation of two ''[[dosha]]'' have been described. [84-89]
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=== ''Sannipataja jwara'' ===
=== ''Sannipataja jwara'' ===
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:
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 ''[[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 ''[[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 ''[[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 ''[[vata]]'' predominates over the other two ''[[dosha]]s'' 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 ''[[pitta]]'' predominates over the other two ''[[dosha]]s'' 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]]'' predominates over the other two ''[[dosha]]s'' 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 ''[[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 ''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 ''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]