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Line 21: − + − + − + + + + + + + + + + + + + + + + − ==([[Nidana Sthana]] Chapter 1, Chapter on the Etiological Factors causing Fever)== − − === Abstract === − + − The first part of this chapter deals with tools necessary for acquiring a comprehensive knowledge of any disease. ''Nidana Panchaka'', an important concept introduced in this chapter, implies a set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis – that help in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the diseases and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. It is not possible to manage disease completely without knowing all aspects of the disease process. + − The second part of the chapter uses the tools described in the first part to explain ''jwara'' and its types (endogenous and exogenous), as well as methods to manage it. ''Jwara'' is caused by the accumulation of vitiated ''dosha'' at the site of digestion and further affliction of digestion and thermal regulation in the body. + + − Considering the foundational tools this chapter provides for a comprehensive understanding of disease, it is regarded as a critical chapter.+ − '''Keywords''': Diagnosis, ''nidana'', etiology, ''poorvarupa'', premonitory signs, ''rupa'', clinical signs, ''upashaya'', pacifying factors, ''samprapti'', pathogenesis, ''jwara'', ''nija'', ''aagantu jwara'', ''ghrita'' (ghee), fever.+ − === Introduction ===+ − Per Ayurvedic texts, a physician cannot treat a patient if he does not possess a complete understanding of a disease. [1] Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its ''nidana'' (etiology), ''poorvarupa'' (premonitory symptoms), ''linga'' (actual sign and symptoms), ''upashaya'' (pacifying factors) and ''samprapti'' (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of ''nidana''). [2] + − + − Today, physicians use diagnostic tests and medical investigations to study a condition. These tests could be supplemented with tools like the ''Nidana Panchaka'' described here. For example, access to complete knowledge of dietary and lifestyle activities of a person, specific disease provoking factors, clinical history or health records of past diseases or conditions, and a thorough clinical examination of all bodily systems would help provide a complete view of a patient’s condition. + − + − Thus, the first part of the chapter deals with the ''Nidana Panchaka''. The second part, then, takes this important concept and applies it on the most generic of conditions afflicting patients – ''jwara''. This also reveals how the [[Nidana Sthana]] section of the [[Charaka Samhita]] is structured – it starts with the generic or the foundational condition (that, in many cases, acts as a causative factor itself), and then moves on to discussing the vitiation of the ''dhatus'' that are causes of all somatic diseases – by the order of their importance (i.e., starting with ''rasa dhatus'') – and ends with a study of vitiation of ''Rajas'' and ''Tamas'' (i.e., causes of mental diseases). − − It is important to note here that ''jwara'' is an independent ailment, per [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], but also a secondary condition of other diseases, and also an etiology responsible for various diseases. For example, ''jwara'' gives rise to ''raktapitta'' (haemorrhagic disease), which in turn causes ''jwara'', and both cause ''shotha'' (phthisis). Thus, ''jwara'' is an etiology in this context, or a ''nidanarthakara''. Sushruta describes ''jwara'' at first as a complication of a wound in an afflicted person because it is the chief among diseases and has emerged “from the fiery wrath of Lord Rudra”, per Vedic mythology. Explaining its nature, he says that it influences an individual particularly at the time of his birth and death. But in this chapter, ''jwara'' is described as an independent disease which acts upon ''vata, pitta,'' and ''kapha'' as an immediate etiological factor to cause fever. Besides this (as a cause), various indirect causes have also been described to explain the vitiation of each ''dosha'', along with their pathogenesis and symptoms separately. However, it is important to note that while there could be any number or types of causes, ''amashaya'' (stomach) is common to all types of ''jwara''. Pathogenetic ''doshas'' combined with heat located in ''amashaya'' and accompanying the first ''dhatu'' created with the digestion of food (also known as ''rasa'') obstructs the passage of ''rasa'' and ''sweda'', causing them to spread all over the body in various ways raising the body temperature of a person. This rising temperature is the manifestation of fever. − − Depending upon the etiological factors, [https://en.wikipedia.org/wiki/Ayurveda 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''. − − ===Sanskrit Text, Transliteration and English Translation=== + Line 54:
Line 72: + − + − Thus said Lord Atreya. [1-2]+ − + + + + − ''Hetu'', ''nimitta'', ''ayatana'', ''karta'', ''karana'', ''pratyaya'' and ''samutthana'' are synonyms of ''nidana'' (causative factors). ''Nidana'' could be of three types:+ − + − + − + + + + + + − + + + + + + + + + + Line 91:
Line 127: + − ''Vyadhi, amaya, gada, atanka, yakshma, jwara, vikara'' and ''roga'' are synonyms of disease. [5]+ + + + − + − + + + + − ''Nidana'' is the etiological factor as described earlier. [7] + − + + + + − + − + + + Line 132:
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Line 195: + − + − + + + + + + − + − + − + + + + − ''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]+ + + + + + + + Line 174:
Line 241: + + + + + − ''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].+ + Line 183:
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Line 344: + + + + − + − + + + + − + + + + − + − + + + + − rūkṣalaghuśītavamanavirecanāsthāpanaśirovirecanātiyogavyāyāmavegasandhāraṇānaśanābhighātavyavāyodvegaśokaśoṇitātiṣekajāgaraṇaviṣamaśarīranyāsebhyotisevitebhyo vāyuḥ prakopamāpadyate||19||+ + + − + + + + + + − + + + − + + + + − + + + − 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]+ − + + + + + + + + + + + + + + + + + + − 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||+ + − uṣṇāmlalavaṇakṣārakaṭukājīrṇabhojanebhyotisevitebhyastathā tīkṣṇātapāgnisantāpaśramakrodhaviṣamāhārebhyaśca pittaṁ prakopamāpadyate||22||+ + + − tadyadā prakupitamāmāśayādūṣmāṇamupasr̥jyādyamāhāra-pariṇāmadhātuṁ rasanāmānamanvavetya rasasvedavahāni srotāṁsi pidhāya dravatvādagnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayat kevalaï śarīramanu-prapadyate, tadā jwaramabhinirvartayati||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||+ − uShNAmlalavaNakShArakaTukAjIrNabhojanebhyo~atisevitebhyastathA tIkShNAtapAgnisantApashramakrodhaviShamAhArebhyashca pittaMprakopamApadyate||22|| + − tadyadA prakupitamAmAshayAdUShmANamupasRujyAdyamAhArapariNAmadhAtuM [1] rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyadravatvAdagnimupahatya paktisthAnAdUShmANaM bahirnirasya [2] prapIDayat kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||23|| + + − Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''pitta''. The vitiated ''pitta'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' causes sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.+ + + − 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]+ − + + + + + + + + + + + + + + − + − snigdhagurumadhurapicchilaśītāmlalavaṇadivāsvapnaharṣāvyāyāmebhyo´tisēvitebhyaḥ śleṣmā prakōpamāpadyate ||25|| − − snigdhagurumadhurapicchilashItAmlalavaNadivAsvapnaharShAvyAyAmebhyo~atisevitebhyaH shleShmA prakopamApadyate||25|| + − Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''kapha''. [25] The vitiated ''kapha'' enters the ''amashaya'' and gets mixed with the initial ''dhatu'' formed in the process, ''rasa'', along with the digested food. This improperly formed ''rasa'' cause sluggish circulation and further block the micro channels of ''rasa'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''jwara''. 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Line 563: + + + + + − ''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''doshas'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''vata'' and ''pitta'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]+ + + Line 389:
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Line 918: − + − + − + − − Upashaya Aushadha Anna Vihara − Hetu viparita Usage of shunthi in sheeta kaphaja jwara due to its hotness.Intake of meat juice in case of vata jwara and fatigue Remaining awake at night in aggravation of kapha dosha due to day-sleeping − Vyadhi viparita Use of antidiarrheal drugs like Patha etc. in diarrhoea Intake of food like masur etc. in diarrhoea due to its antidiarrheal property. Pravahana improving downwards peristalsis is the treatment for udavarta rogi − Hetu-vyadhi viparita Usage of dashmoola qwath in case of vataja jwara due to its vatahara and shothhara property Usage of hot substances and antipyretic gruel against sheetottha jwara, which subsides cold and fever. Night awakening etc. which brings roughness in case of tandra, which is the result of consumption of Slimy substances followed by day sleeping. − Hetu viparitarthakari Usage of vrishya drugs like pippali, shunthi etc. in case of shukrakshaya due to intake of excess pungent substances. Usage of food substances which are hot in pachyamana shoth caused due to pitta dosha. Inducing fear to the patients who are suffering from vataja unmada. − Vyadhi viparitarthakari Usage of emetic drugs like madanaphala in case of chardi (vomitting) Intake of milk in case of atisar, which induces purgation. Inducing vomiting by external support in case of chardi. − Hetu-vyadhi viparitarthakari Use of hot drugs like agaru dravya lepa in case of agniplushta dagdha (burn due to fire). − + + + + + + + + + + + + + + + + + + + − + − + − + − + + + + + + + + + + + + + + + + + + + + + + + + − Vagbhata has defined these synonyms as: “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. (A H Ni. 1/8) [19][11]+ − In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter. [20]+ + − Vagbhata has not described vidhi samprapti. He has described only five kinds of samprapti i.e. samkhya, vikalpa, pradhanya, bala and kala samprapti. (A H Ni. 1/)[21] [12]. Pradhanya samprapti indicates the primacy of a samprapti (A H Ni. 1/)[22] When a dosha gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of vata for example may mean aggravation of its coldness, lightness or ununctuousness. + − Kala samprapti means the type that is governed by seasonal variations. Aggravation/ manifestation of shleshmika/kaphaja type of fever during winter season is the example of seasonal variation. Some Ayurveda practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define vidhi samprapti as an affliction attributed to such deeds. [23] The timing of disease manifestation shows variation in the samprapti or pathogenesis. This aspect of samprapti helps in clearly determining the specific characteristics of a disease. − Vagbhata describes that bala samprapti is important to assess the severity of disease. (A H Ni. 1/)[24] [12-5] − Significance of knowledge of nidana:+ − 1. Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. [26]+ − 2. Nidanaparivarjana i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult. [27] − 3. Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors. − 4. To treat the newly originated diseases, a physician should have the knowledge of the involved doshas, causative factors and the location of the disease. − Significance of knowledge of poorvarupa: − 1. Charaka Samhita suggests specific modalities for treatment of a patient at this stage. E.g. Light food and apatarpana treatment should be give when premonitory signs of fever are seen. − 2. Manifestation of all the premonitory signs indicates bad prognosis of the disease. − 3. Poorvarupa has significant role in the differential diagnosis of the disease. − Significance of knowledge of rupa: − 1. It has the same importance as that of nidana and poorvarupa in the prognosis of diseases. Rise in number of rupa makes the disease difficult to cure. − 2. Rupa denotes the complete manifestation of the disease along with its dosha predominance. The diseases can be treated in a proper way if one is having the knowledge of all the sign and symptoms and the dosha responsible for it. − 4. Significance of knowledge of upashaya: − 1. Knowledge of upashaya is helpful in differential diagnosis of diseases. − 2. It also helps in identifying the diseases which are not clearly manifested. − Significance of knowledge of samprapti: − 1. Samprapti provides the details of the diseases such as dosha predominance, predominance of one or the other fraction of the three doshas, specific time of aggravation, and manifestation of diseases which plays a pivotal role in the management of diseases. − 2. The important role of a physician in the management of diseases is sampraptibhanga i.e. to break the association of vitiated dosha and dushya (tissue that gets vitiated). This is not possible without proper knowledge of samprapti. − Nidana panchaka & shat kriyakala: − Sushruta described six stages of dosha vitiation and progression of disease known as shat kriya kala (periods of activity). They are as under: − 1. Sanchaya (accumulation): In this stage dosha undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the doshas can be brought to the normal condition without much effort. [29] − 2. Prakopa (aggravation): In this stage, doshas gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. [30] − 3. Prasara (spreading): The status of doshas again increases further and doshas spread nearby sites and invade the sites of other doshas to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. [31] − During the first three stages, the unhealthy food and activities increases the doshas and produces mild abnormalities. These three stages can be co-related with nidana (hetu) of nidanapanchaka. − 4. Sthanasanshraya (localisation): The increased doshas start accumulating at certain other places and lead to their abnormalities, especially in the srotasa. It leads to four kinds of abnormal changes in srotasa. [28] − a. Atipravritti – Increased functioning of channels − b. Sanga – Obstruction, blockage of channels − c. Sira-Granthi – Abnormal growths in the channels − d. Vimargagamana – Movement of fluids in wrong direction − The site where these doshas lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as poorvarupa. This stage can be co-related with poorvarupa of nidanapanchaka. [32] − 5. Vyakti (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as rupa. This stage can be co-related with rupa of nidanapanchaka. [33] − 6. Bheda (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes upadravas (complications) or arishta lakshanas (bad prognostic signs) can be seen in this stage. This stage also can be co-related with rupa of nidanapanchaka. [34] − The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as samprapti. This includes progress of the disease from first to sixth kriyakala. − Interrelation between nidanapanchaka and shatkriyakala − Sr. No. Shatkriyakala Nidanapanchaka − 1 Sanchaya Hetu (Nidana) SAMPRAPTI+ − 2 Prakopa − 3 Prasara − 4 Sthanasanshraya Poorvarupa − 5 Vyakti Rupa, Upashaya − 6 Bheda − + + + + + + + + + + − 1. Agnivesha, Charaka, Dridhabala, Charaka Samhita Vimanasthana Adhyaya 4/12, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 249.+ − 2. Agnivesha, Charaka, Dridhabala, Charaka Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. − 3. Agnivesha, Charaka, Dridhabala, Charaka Samhita Sutrasthana Adhyaya 10/7, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66. − 4. Agnivesha, Charaka, Dridhabala, Charaka Samhita Nidanasthana Adhyaya 8/23, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 228. − 5. Agnivesha, Charaka, Dridhabala, Charaka Samhita Sutrasthana Adhyaya 8/35, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 229. − 6. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/2, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 193. − 7. Chakrapani, Commentator, Charaka Samhita Nidanasthana Adhyaya 1/6, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 194. − 8. Vagbhata, Ashtang Hridayam, Sutrasthana Adhyaya 1/22, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 14 − 9. Madhavakar, Madhava Nidanam, Pancha Nidanalakshanam, Edited by Prof. Yadunandana Upadhyaya, Thirtyth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2000, 196. − 10. Chakrapani, Commentator, Charaka Samhita Nidanasthana Adhyaya 1/8, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. − 11. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/3, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 441 − 12. Gangadhar, Commentator, Charaka Samhita Nidansthana Adhyaya 1/5, Edited by Narendranath Sengupta, Reprint edition, Rashtriya Sanskrit Sansthana, Varanasi, 2002, 1213 − 13. Vagbhata, Ashtang Sangraham, Nidanasthana Adhyaya 1/11, Edited by Dr D V Pandit Rao, First Edition, CCRAS, New Delhi, 1991, 554 − 14. Chakrapani, Commentator, Charaka Samhita Nidanasthana Adhyaya 1/9, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 195. − 15. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,195. − 16. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. − 17. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/6, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 442 − 18. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. − 19. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/8, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 − 20. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/10, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,197. − 21. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/9, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 − 22. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/10, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 − 23. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 1/11, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001,196. − 24. Vagbhata, Ashtang Hridayam, Nidanasthana Adhyaya 1/11, Edited by Harishastri Paradkar Vaidya, Ninth Edition, Chaukhambha Orientalia, Varanasi, 2002, 443 − 25. Chakrapani, Commentator, Charaka Samhita Nidansthana Adhyaya 8/22, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 228 − 26. Agnivesha, Charaka, Dridhabala, Charaka Samhita Sutraasthana Adhyaya 10/14, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 66 − 27. Agnivesha, Charaka, Dridhabala, Charaka Samhita Vimanasthana Adhyaya 7/30, Edited by Jadavaji Trikamji, Fifth Edition Chaukhambha Sanskrit Sansthana, Varanasi, 2001, 261 − 28. Sushruta, Sushruta Samhita Sutrasthana Adhyaya 21/36, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. − 29. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/18, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,103. − 30. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/27, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,104. − 31. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/32, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,105. − 32. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/33, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. − 33. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/34, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. − 34. Dalhana, Commentator, Sushruta Samhita Sutrasthana Adhyaya 21/35, Seventh Edition, Chaukhambha Orientalia, Varanasi, 2002,106. − Types of Jwara:+ − Jwara+ + + + − Nija (Endogenous) Āgantuja (Exogenous)+ − Ekdōṣaja Dwidōṣaja Sannipātaja+ − Dominated by Dominated by Dominated by − one dōṣa two dōṣa three dōṣa Abhighataja Abhisangaja Abhicaraja A bhisapaja − Vishamajvar+ − Vātaja Pittaja Kaphaja Santata Satata Anyaduska Tritiyaka Cathurthaka+ − + − Vāta- Pittaja Kapha-Pittaj Vāta-Kaphaj+ + + + + + + + + + + + + + + + + + + + + − + − Sanchaya it is the stage of accumulation or the stage which represents the inceptive phase of the disease wherein the dosha are stated to have accumulated and stagnated in its own place+ + + + + + − it is the pyrogen which may be exogenous (bacterial substance lipopolysaccharide (LPS) present on bacterial cell wall) or endogenous (cytokines, Interleukin-1 and Interleukin-6 etc). These pyrogens enter the body and activate the immune cells (antigen presenting cell) for the formation of cytokines and other factors or due to endogenous cause too activation of immune system takes place.+ − Prakopa In this stage dosha gets vitiated or aggravated or the dosha previously accumulated/ stagnated get swollen and excited Vilayana here means bonding (samhata) is loss and dosha gets released.+ − . + − Exogenous factors contain immunological protein called lipo-polysaccharide binding protein (LBP) which binds to LPS. The LBP-LPS complex then binds to the CD14 receptors of a nearby macrophage. It causes synthesis and release of various endogenous cytokines factors such as IL-1, IL-6, Tumour Necrosing Factor alpha (TNFα).+ − Prasara The third phase signifies to spread which generally takes place with help of vata and rakta. Dosha are stated to spread over and extend to other parts of the body.+ − the cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated. Prostaglandin E2 (PGE2) is released which is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase.+ + + + + + + + + − sthana sansrayam It is prodromal phase or the phase of poorvarupa wherein disease is yet to be manifested fully. The excited dosha having extended to other parts of the body become localized and it marks the beginning of specific diseases pertaining to those sthan/ structures. It is also known as the stage of disease augmentation. Sthana samshraya means taking shelter in a place. + − PGE2 is the ultimate mediator of the febrile response. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus. Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermo-genesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervations from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.+ + + + + + + − Vyakti This stage may be stated to be that of manifestation of the fully developed disease- the resultant dosha dushya samurchana the brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. It causes increased heat production by increased muscle tone, shivering and hormones like epinephrine (adrenaline) and also prevents heat loss by way of vasoconstriction. − Bheda It is the stage in which the disease may become sub-acute and chronic or incurable. Different types or variant of disease gets manifested. In case of fever signs like increased blood pressure, neck stiffness, headache, giddiness, unconsciousness etc are seen in this phase.+ + + + +
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{{#seo:
|title=Jwara Nidana
|titlemode=append
|keywords=Diagnosis, nidana, etiology, poorvarupa, premonitory signs, rupa, clinical signs, upashaya, pacifying factors, samprapti, pathogenesis, jwara, nija, aagantu jwara, ghrita ,ghee , fever, Ayurveda, Indian system of medicine, charak samhita.
|description=Nidana Sthana Chapter 1. Fundamental Principles of Diagnosis and Fever
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image_alt=carak samhita
|type=article
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<big>'''Nidana Sthana Chapter 1. Fundamental Principles of Diagnosis and Jwara '''</big>
{{Infobox
{{Infobox
|title = Jwara Nidana
|title = Jwara Nidana
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|header3 =
|data6 = Dwivedi R.B.,Dubey S.D., Gujarathi R.,Singh A.Khandel S.K., Rai S.
|label7 = Reviewer
|data7 = Kar A.C.
|label8 = Editors
|data8 = Khandel S.K., Godatwar P., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s02.002 10.47468/CSNE.2020.e01.s02.002]
}}
}}
<big>'''Abstract'''</big>
<p style="text-align:justify;">Nidana Sthana deals with the etiology, symptomatology, and means of diagnosis of diseases.
It begins with a generalized set of fundamental principles of diagnosis and then proceeds to specialized studies of diseases. The first part of this chapter deals with the necessary tools for acquiring a comprehensive knowledge of any disease. A set of five important tools/components - etiology, premonitory signs, clinical features, pacifying factors and pathogenesis termed as ‘Nidana Panchaka’ helps in understanding a disease thoroughly. Each of these tools has a specific significance in diagnosis and explores an important aspect of the disease. Etiology helps to ascertain the causative factors of the disease and diagnosis helps in determining the nature of the disease by causative factors, premonitory signs, actual signs, exploratory signs, and pathogenesis. Comprehensive management of disease and restoration of health is not possible without complete knowledge of all aspects of the disease process. The second part of the chapter uses these tools to explain fever ([[jwara]]) and its types (endogenous and exogenous), as well as methods to manage it. [[Jwara]] is caused by the accumulation of vitiated [[dosha]] at the site of digestion and further affliction of digestion and thermal regulation in the body. Considering the basic tools for comprehensive understanding of disease, it is regarded as an important chapter.
<br/>
'''Keywords''': Diagnosis, [[nidana]], [[hetu]], etiology, [[poorvarupa]], premonitory signs, [[rupa]], clinical signs, [[upashaya]], pacifying factors, [[samprapti]], pathogenesis, [[jwara]], [[nija]], [[aagantu]] [[jwara]], [[ghrita]] ,ghee, endogenous causes, exogenous causes, fever.
</p>
[[Nidana Sthana]] deals with the etiology, symptomatology, and means of diagnosis of diseases. It begins with a generalized set of diseases and then progresses into specialized studies of diseases. This explains why the section begins with a study of etiological factors causing ''jwara'' (this chapter) – a generalized study of fever - and then proceeds onto the studies of vitiation of the various ''dhatus'', or tissues, that are addressed in the subsequent chapters.
== Introduction ==
<div style="text-align:justify;">
A physician cannot treat a patient if he does not possess a complete understanding of a disease. [Cha.Sa.[[Vimana Sthana]] 4/12] Accurate diagnosis of a disease is important before initiating any treatment, and any understanding of a disease’s manifestation is incomplete without understanding its [[nidana]] (etiology), [[poorvarupa]] (premonitory symptoms), [[linga]] (actual sign and symptoms), [[upashaya]] (pacifying factors) and [[samprapti]] (pathogenesis) – or the ''Nidana Panchaka'' (literally, the five components of [[nidana]]). [Cha.Sa.[[Nidana Sthana ]]1/6]
A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or [[samprapti]]. Between these two stages of the disease, the body shows various signs and symptoms that could be observed by any knowledgeable physician, using ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. [Cha.Sa.[[Sutra Sthana]] 10/7] A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s [[dosha]], [[dhatu]], and [[mala]] – since it is the vitiation of these body features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. [Cha.Sa.[[Nidana Sthana]] 8/23] Curable diseases can progress to incurable if they are not properly treated. [Cha.Sa.[[Nidana Sthana]] 8/35]
''Nidana Panchaka'' described here can be supplemented with diagnostic tests and medical investigations to study a condition. Access to complete knowledge of dietary and lifestyle activities of a person, specific disease provoking factors, clinical history or health records of past diseases or conditions, and a thorough clinical examination of all bodily systems would help provide a complete view of a patient’s condition.
Thus, the first part of the chapter deals with the ''Nidana Panchaka''. The second part, then, takes this important concept and applies it on the most generic of conditions afflicting patients – ''[[jwara]]''. This also reveals how the [[Nidana Sthana]] section of the [[Charak Samhita]] is structured – it starts with the generic or the foundational condition (that, in many cases, acts as a causative factor itself), and then moves on to discussing the vitiation of the [[dhatu]] that are causes of all somatic diseases – by the order of their importance (i.e., starting with [[rasa dhatu]]) – and ends with a study of vitiation of [[Rajas]] and [[Tamas]] (i.e., causes of mental diseases).
It is important to note here that ''[[jwara]]'' is an independent ailment, per [[Ayurveda]], but also a secondary condition of other diseases, and also an etiology responsible for various diseases. For example, ''[[jwara]]'' gives rise to ''raktapitta'' (haemorrhagic disease), which in turn causes ''[[jwara]]'', and both cause ''shotha'' (phthisis). Thus, ''[[jwara]]'' is an etiology in this context, or a ''nidanarthakara''. Sushruta describes ''[[jwara]]'' at first as a complication of a wound in an afflicted person because it is the chief among diseases and has emerged “from the fiery wrath of Lord Rudra”, per Vedic mythology. Explaining its nature, he says that it influences an individual particularly at the time of his birth and death. But in this chapter, ''[[jwara]]'' is described as an independent disease which acts upon ''[[vata]], [[pitta]],'' and ''[[kapha]]'' as an immediate etiological factor to cause fever. Besides this (as a cause), various indirect causes have also been described to explain the vitiation of each [[dosha]], along with their pathogenesis and symptoms separately. However, it is important to note that while there could be any number or types of causes, ''amashaya'' (stomach) is common to all types of ''[[jwara]]''. Pathogenetic [[dosha]] combined with heat located in ''amashaya'' and accompanying the first [[dhatu]] created with the digestion of food (also known as ''[[rasa]]'') obstructs the passage of ''[[rasa]]'' and ''sweda'', causing them to spread all over the body in various ways raising the body temperature of a person. This rising temperature is the manifestation of fever.
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 [[dosha]].
A disease’s lifecycle starts with certain premonitory symptoms and ends with its complete manifestation, or ''samprapti''. Between these two stages of the disease, the body shows various sign and symptoms that could be observed by any knowledgeable physician, using the ''Nidana Panchaka'' . Naturally, any disease, if diagnosed very early, could be prevented from manifesting itself through a variety of interventions. [3] A proper understanding of the ''Nidana Panchaka'' helps the physician using various therapies, to establish an equilibrium among the patient’s ''doshas'', ''dhatus'', and ''mala'' – since it is the vitiation of these bodily features that cause a disease. A therapy is considered pure or correct (''vishuddha'') when it cures the disease without giving rise to another disease. [4] Curable diseases can progress to incurable if they are not properly treated. [5]
</div>
==Sanskrit Text, Transliteration and English Translation==
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अथातो ज्वरनिदानं व्याख्यास्यामः||१||
अथातो ज्वरनिदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
इति ह स्माह भगवानात्रेयः||२||
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athātō jwaranidānaṁ vyākhyāsyāmaḥ||1||
athātō jwaranidānaṁ vyākhyāsyāmaḥ||1||
iti ha smAha bhagavAnAtreyaH||2||
iti ha smAha bhagavAnAtreyaH||2||
</div></div>
Now I shall expound upon the chapter on the “Diagnosis of ''Jwara'' (Fever).”
Now we shall expound the chapter "Jwara Nidana"(Fundamental Principles of Diagnosis and Fever). Thus said Lord Atreya. [1-2]
=== Principles of knowledge of disease ===
==== ''Nidana'' (etiology) and its synonyms ====
==== Synonyms of [[Nidana]] (causative factors) and its types ====
<div class="mw-collapsible mw-collapsed">
इह खलु हेतुर्निमित्तमायतनं कर्ता कारणं प्रत्ययः समुत्थानं निदानमित्यनर्थान्तरम् तत्त्रिविधम्- असात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति||३||
इह खलु हेतुर्निमित्तमायतनं कर्ता कारणं प्रत्ययः समुत्थानं निदानमित्यनर्थान्तरम् तत्त्रिविधम्- असात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति||३||
<div class="mw-collapsible-content">
iha khalu hēturnimittamāyatanaṁ kartā kāraṇaṁ pratyayaḥ samutthānaṁ nidānamityanarthāntaram tattrividham-asātmyēndriyārthasaṁyōgaḥ, prajñāparādhaḥ, pariṇāmaścēti||3||
iha khalu hēturnimittamāyatanaṁ kartā kāraṇaṁ pratyayaḥ samutthānaṁ nidānamityanarthāntaram tattrividham-asātmyēndriyārthasaṁyōgaḥ, prajñāparādhaḥ, pariṇāmaścēti||3||
iha khalu heturnimittamAyatanaM kartA kAraNaM pratyayaH samutthAnaM nidAnamityanarthAntaram| tattrividham- asAtmyendriyArthasaMyogaH, praj~jAparAdhaH, pariNAmashceti||3||
iha khalu heturnimittamAyatanaM kartA kAraNaM pratyayaH samutthAnaM nidAnamityanarthAntaram| tattrividham- asAtmyendriyArthasaMyogaH, praj~jAparAdhaH, pariNAmashceti||3||
</div></div>
*[[Hetu]], [[nimitta]], [[ayatana]], [[karta]], [[karana]], [[pratyaya]] and [[samutthana]] are synonyms of [[nidana]] (causative factors).
#''Asatmyendriyarthasamyoga'' (unsuitable contact of sense organs with their objects)
[[Nidana]] is of three types:
#''Pragyaparadha'' (knowingly engaging in harmful activities), and
#''Kala'' (seasonal, temporal factors). [3]
# Asatmyendriyarthasamyoga (unsuitable contact of sense organs with their objects)
# [[Prajnaparadha]] (intellectual errors or knowingly engaging in harmful activities), and
# [[Kala]] (time, seasonal, temporal factors). [3]
==== Types of diseases ====
==== Types of diseases ====
<div class="mw-collapsible mw-collapsed">
अतस्त्रिविधा व्याधयः प्रादुर्भवन्ति- आग्नेयाः, सौम्याः,वायव्याश्च;-द्विविधाश्चापरे- राजसाः, तामसाश्च||४||
अतस्त्रिविधा व्याधयः प्रादुर्भवन्ति- आग्नेयाः, सौम्याः,वायव्याश्च;-द्विविधाश्चापरे- राजसाः, तामसाश्च||४||
<div class="mw-collapsible-content">
atastrividhā vyādhayaḥ prādurbhavanti- āgnēyāḥ, saumyāḥ, vāyavyāśca; dvividhāścāparē- rājasāḥ, tāmasāśca||4||
atastrividhā vyādhayaḥ prādurbhavanti- āgnēyāḥ, saumyāḥ, vāyavyāśca; dvividhāścāparē- rājasāḥ, tāmasāśca||4||
atastrividhA vyAdhayaH prAdurbhavanti- AgneyAH, saumyAH, vAyavyAshca; dvividhAshcApare- rAjasAH, tAmasAshca||4||
atastrividhA vyAdhayaH prAdurbhavanti- AgneyAH, saumyAH, vAyavyAshca; dvividhAshcApare- rAjasAH, tAmasAshca||4||
</div></div>
(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]
The (Somatic) diseases manifest in three types, viz.
#Agneya ([[pitta]] [[dosha]] dominant diseases)
#Saumya ([[kapha]] [[dosha]] dominant diseases)
#Vayavya ([[vata]] [[dosha]] dominant diseases).
Others (psychic) are of two types viz.
#Rajas([[Rajas]] [[dosha]] dominant diseases)
#Tamas ([[Tamas]] [[dosha]] dominant diseases). [4]
==== Synonyms of disease ====
==== Synonyms of disease ====
<div class="mw-collapsible mw-collapsed">
तत्र व्याधिरामयो गद आतङ्को यक्ष्मा ज्वरो विकारो रोग इत्यनर्थान्तरम्||५||
तत्र व्याधिरामयो गद आतङ्को यक्ष्मा ज्वरो विकारो रोग इत्यनर्थान्तरम्||५||
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tatra vyādhirāmayō gada ātaṅkō yakṣmā jvarō vikārō rōga
tatra vyādhirāmayō gada ātaṅkō yakṣmā jvarō vikārō rōga
tatra vyAdhirAmayo gada Ata~gko yakShmA jvaro vikAro roga ityanarthAntaram||5||
tatra vyAdhirAmayo gada Ata~gko yakShmA jvaro vikAro roga ityanarthAntaram||5||
</div></div>
Vyadhi, amaya, gada, atanka, yakshma, jwara, vikara and roga are synonyms of disease. [5]
==== Means for knowledge of disease ====
==== Means for knowledge of disease ====
<div class="mw-collapsible mw-collapsed">
तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः||6 ||
तस्योपलब्धिर्निदानपूर्वरूपलिङ्गोपशयसम्प्राप्तितः||6 ||
<div class="mw-collapsible-content">
tasyōpalabdhirnidānapūrvarūpaliṅgōpaśayasamprāptitaḥ ||6 ||
tasyōpalabdhirnidānapūrvarūpaliṅgōpaśayasamprāptitaḥ ||6 ||
tasyopalabdhirnidAnapUrvarUpali~ggopashayasamprAptitaH||6||
tasyopalabdhirnidAnapUrvarUpali~ggopashayasamprAptitaH||6||
</div></div>
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]] (pacifying factors) and [[samprapti]] (pathogenesis).[6]
==== ''Nidana'' ====
==== Definition of [[Nidana]] ====
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तत्र निदानं कारणमित्युक्तमग्रे||७||
तत्र निदानं कारणमित्युक्तमग्रे||७||
<div class="mw-collapsible-content">
tatra nidānaṁ kāraṇamityuktamagrē ||7||
tatra nidānaṁ kāraṇamityuktamagrē ||7||
tatra nidAnaM kAraNamityuktamagre||7||
tatra nidAnaM kAraNamityuktamagre||7||
</div></div>
Nidana is the cause or etiological factor as described earlier. [7]
==== ''Poorvarupa'' (premonitory signs) ====
==== Definition of [[Poorvarupa]] (premonitory signs) ====
<div class="mw-collapsible mw-collapsed">
पूर्वरूपं प्रागुत्पत्ति लक्षणं व्याधेः||८||
पूर्वरूपं प्रागुत्पत्ति लक्षणं व्याधेः||८||
<div class="mw-collapsible-content">
pūrvarūpaṁ prāgutpatti lakṣaṇaṁ vyādhēḥ||8||
pūrvarūpaṁ prāgutpatti lakṣaṇaṁ vyādhēḥ||8||
pUrvarUpaM prAgutpatti lakShaNaM vyAdheH||8||
pUrvarUpaM prAgutpatti lakShaNaM vyAdheH||8||
</div></div>
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]
==== Linga (sign) and its synonyms ====
==== Definition of [[Linga]] (sign) and its synonyms ====
<div class="mw-collapsible mw-collapsed">
प्रादुर्भूतलक्षणं पुनर्लिङ्गम् तत्र लिङ्गमाकृतिर्लक्षणं चिह्नं संस्थानं व्यञ्जनं रूपमित्यनर्थान्तरम्||९||
प्रादुर्भूतलक्षणं पुनर्लिङ्गम् तत्र लिङ्गमाकृतिर्लक्षणं चिह्नं संस्थानं व्यञ्जनं रूपमित्यनर्थान्तरम्||९||
<div class="mw-collapsible-content">
prādurbhūtalakṣaṇaṁ punarliṅgam tatra liṅgamākr̥tirlakṣaṇaṁ cihnaṁ saṁsthānaṁ vyañjanaṁ rūpamityanarthāntaram ||9||
prādurbhūtalakṣaṇaṁ punarliṅgam tatra liṅgamākr̥tirlakṣaṇaṁ cihnaṁ saṁsthānaṁ vyañjanaṁ rūpamityanarthāntaram ||9||
prAdurbhUtalakShaNaM punarli~ggam| tatra li~ggamAkRutirlakShaNaM cihnaM
prAdurbhUtalakShaNaM punarli~ggam| tatra li~ggamAkRutirlakShaNaM cihnaM
saMsthAnaM vya~jjanaM rUpamityanarthAntaram||9||
saMsthAnaM vya~jjanaM rUpamityanarthAntaram||9||
</div></div>
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]
==== ''Upashaya'' (pacifying factors) ====
==== Definition of [[Upashaya]] (pacifying factors) ====
<div class="mw-collapsible mw-collapsed">
उपशयः पुनर्हेतुव्याधिविपरीतानां विपरीतार्थकारिणां चौषधाहारविहाराणामुपयोगः सुखानुबन्धः||१०||
उपशयः पुनर्हेतुव्याधिविपरीतानां विपरीतार्थकारिणां चौषधाहारविहाराणामुपयोगः सुखानुबन्धः||१०||
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upaśayaḥ punarhētuvyādhiviparītānāṁ viparītārthakāriṇāṁ
upaśayaḥ punarhētuvyādhiviparītānāṁ viparītārthakāriṇāṁ
upashayaH punarhetuvyAdhiviparItAnAM viparItArthakAriNAM
upashayaH punarhetuvyAdhiviparItAnAM viparItArthakAriNAM
cauShadhAhAravihArANAmupayogaH sukhAnubandhaH||10||
cauShadhAhAravihArANAmupayogaH sukhAnubandhaH||10||
</div></div>
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 factors).[10]
==== ''Samprapti'' (pathogenesis) ====
====[[Samprapti]] (pathogenesis)====
===== Definition =====
<div class="mw-collapsible mw-collapsed">
सम्प्राप्तिर्जातिरागतिरित्यनर्थान्तरं व्याधेः||११||
सम्प्राप्तिर्जातिरागतिरित्यनर्थान्तरं व्याधेः||११||
<div class="mw-collapsible-content">
samprāptirjātirāgatirityanarthāntaraṁ vyādhēḥ||11||
samprāptirjātirāgatirityanarthāntaraṁ vyādhēḥ||11||
samprAptirjAtirAgatirityanarthAntaraM vyAdheH||11||
samprAptirjAtirAgatirityanarthAntaraM vyAdheH||11||
</div></div>
''Samprapti, jati'' and ''agati'' are synonyms of pathogenesis of the disease.
''Jati'' and ''agati'' are synonyms of [[Samprapti]] (pathogenesis) of the disease.
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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सा सङ्ख्याप्राधान्यविधिविकल्पबलकालविशेषैर्भिद्यते|१२|
सा सङ्ख्याप्राधान्यविधिविकल्पबलकालविशेषैर्भिद्यते|१२|
<div class="mw-collapsible-content">
sā saṅkhyāprādhānyavidhivikalpabalakālaviśēṣairbhidyatē|12|
sā saṅkhyāprādhānyavidhivikalpabalakālaviśēṣairbhidyatē|12|
sA sa~gkhyAprAdhAnyavidhivikalpabalakAlavisheShairbhidyate|12|
sA sa~gkhyAprAdhAnyavidhivikalpabalakAlavisheShairbhidyate|12|
</div></div>
<div style="text-align:justify;">
[[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 [[dosha]]), and ''bala-kala vishesha'' (the time of manifestation or aggravation of the disease). [12]
</div>
====== Samkhya samprapti (numerical classification)======
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सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|
सङ्ख्या तावद्यथा- अष्टौ ज्वराः, पञ्च गुल्माः, सप्त कुष्ठान्येवमादिः|१२|
<div class="mw-collapsible-content">
saṅkhyā tāvadyathā-aṣṭau jvarāḥ, pañca gulmāḥ, sapta
saṅkhyā tāvadyathā-aṣṭau jvarāḥ, pañca gulmāḥ, sapta
sa~gkhyA tAvadyathA-aShTau jwaraH, pa~jca gulmAH, sapta kuShThAnyevamAdiH|12|
sa~gkhyA tAvadyathA-aShTau jwaraH, pa~jca gulmAH, sapta kuShThAnyevamAdiH|12|
</div></div>
''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].
====== Pradhanya samprapti (Classification on dominance) ======
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प्राधान्यं पुनर्दोषाणां तरतमाभ्यामुपलभ्यते तत्र द्वयोस्तरः, त्रिषु तम इति|१२|
प्राधान्यं पुनर्दोषाणां तरतमाभ्यामुपलभ्यते तत्र द्वयोस्तरः, त्रिषु तम इति|१२|
<div class="mw-collapsible-content">
prādhānyaṁ punardōṣāṇāṁ taratamābhyāmupalabhyatē| tatra dvayōstaraḥ, triṣu tama iti |12|
prādhānyaṁ punardōṣāṇāṁ taratamābhyāmupalabhyatē| tatra dvayōstaraḥ, triṣu tama iti |12|
prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH,
prAdhAnyaM punardoShANAM taratamAbhyAmupalabhyate| tatra dvayostaraH,
triShu tama iti|12|
triShu tama iti|12|
</div></div>
''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]
<div style="text-align:justify;">
''Pradhanya'' (dominance) indicates the dominance or primacy of one particular [[dosha]] above other [[dosha]]. If two [[dosha]] get vitiated, the comparative term ''tara'' is used to indicate the predominant one. If, all the three [[dosha]] get vitiated then the superlative term ''tama'' is used to indicate the most predominant one. [12.2]
</div>
====== Vidhi samprapti (Classification on prognosis) ======
<div class="mw-collapsible mw-collapsed">
विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|
विधिर्नाम- द्विविधा व्याधयो निजागन्तुभेदेन,त्रिविधास्त्रिदोषभेदेन, चतुर्विधाः साध्यासाध्यमृदुदारुणभेदेन|१२|
<div class="mw-collapsible-content">
vidhirnāma- dvividhā vyādhayō nijāgantubhēdēna, trividhāstridōṣabhēdēna, caturvidhāḥ sādhyāsādhyamr̥dudāruṇabhēdēna|12|
vidhirnāma- dvividhā vyādhayō nijāgantubhēdēna, trividhāstridōṣabhēdēna, caturvidhāḥ sādhyāsādhyamr̥dudāruṇabhēdēna|12|
vidhirnAma- dvividhAvyAdhayonijAgantubhedena, trividhAstridoShabhedena, caturvidhAH
vidhirnAma- dvividhAvyAdhayonijAgantubhedena, trividhAstridoShabhedena, caturvidhAH
sAdhyAsAdhyamRududAruNabhedena|12|
sAdhyAsAdhyamRududAruNabhedena|12|
</div></div>
==== ''Vidhi'' or types of diseases can be illustrated as follows ====
<div style="text-align:justify;">
Diseases are of two varieties - ''nija'' (endogenous) or ''agantu'' (exogenous). On the basis of vitiation of the ''[[dosha]]s'', 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]
</div>
====== Vikalpa samprapti (pathogenesis on fraction of [[dosha]]) ======
<div class="mw-collapsible mw-collapsed">
समवेतानां पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|
समवेतानां पुनर्दोषाणामंशांशबलविकल्पो विकल्पोऽस्मिन्नर्थे|१२|
<div class="mw-collapsible-content">
samavētānāṁ [1] punardōṣāṇāmaṁśāṁśabalavikalpō vikalpō'sminnarthē|12|
samavētānāṁ [1] punardōṣāṇāmaṁśāṁśabalavikalpō vikalpō'sminnarthē|12|
samavetAnAM punardoShANAmaMshAMshabalavikalpo vikalpo~asminnarthe|12|
samavetAnAM punardoShANAmaMshAMshabalavikalpo vikalpo~asminnarthe|12|
</div></div>
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 [[dosha]] (in the manifestation of the disease) is known as ''vikalpa'' here. [12.4]
======Bala Kala (time of aggravation) [[samprapti]]======
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बलकालविशेषः पुनर्व्याधीनामृत्वहोरात्राहारकालविधिविनियतो भवति||१२||
बलकालविशेषः पुनर्व्याधीनामृत्वहोरात्राहारकालविधिविनियतो भवति||१२||
<div class="mw-collapsible-content">
balakālaviśēṣaḥ punarvyādhīnāmr̥tvahōrātrāhārakālavidhiviniyatō
balakālaviśēṣaḥ punarvyādhīnāmr̥tvahōrātrāhārakālavidhiviniyatō
balakAlavisheShaH punarvyAdhInAmRutvahorAtrAhArakAlavidhiviniyato bhavati||12||
balakAlavisheShaH punarvyAdhInAmRutvahorAtrAhArakAlavidhiviniyato bhavati||12||
</div></div>
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]
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]
<div class="mw-collapsible mw-collapsed">
तस्माद्व्याधीन् भिषगनुपहतसत्त्वबुद्धिर्हेत्वादिभिर्भावैर्यथावदनुबुद्ध्येत||१३||
तस्माद्व्याधीन् भिषगनुपहतसत्त्वबुद्धिर्हेत्वादिभिर्भावैर्यथावदनुबुद्ध्येत||१३||
<div class="mw-collapsible-content">
tasmādvyādhīn
tasmādvyādhīn
tasmAdvyAdhIn bhiShaganupahatasattvabuddhirhetvAdibhirbhAvairyathAvadanubuddhyeta||13||
tasmAdvyAdhIn bhiShaganupahatasattvabuddhirhetvAdibhirbhAvairyathAvadanubuddhyeta||13||
</div></div>
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]
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]
<div class="mw-collapsible mw-collapsed">
इत्यर्थसङ्ग्रहो निदानस्थानस्योद्दिष्टो भवति तं विस्तरेणोपदिशन्तो भूयस्तरमतोऽनुव्याख्यास्यामः||१४||
इत्यर्थसङ्ग्रहो निदानस्थानस्योद्दिष्टो भवति तं विस्तरेणोपदिशन्तो भूयस्तरमतोऽनुव्याख्यास्यामः||१४||
<div class="mw-collapsible-content">
ityarthasaṅgrahō nidānasthānasyōddiṣṭō bhavati| taṁ vistarēṇōpadiśantō
ityarthasaṅgrahō nidānasthānasyōddiṣṭō bhavati| taṁ vistarēṇōpadiśantō
ityarthasa~ggraho nidAnasthAnasyoddiShTo bhavati| taM vistareNopadishanto
ityarthasa~ggraho nidAnasthAnasyoddiShTo bhavati| taM vistareNopadishanto
bhUyastaramato~anuvyAkhyAsyAmaH||14||
bhUyastaramato~anuvyAkhyAsyAmaH||14||
</div></div>
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'' ====
== Knowledge of [[Jwara]] (fever) ==
==== Origin ====
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तत्र प्रथमत एव तावदाद्याँल्लोभाभिद्रोहकोपप्रभवानष्टौ व्याधीन्निदानपूर्वेण क्रमेण व्याख्यास्यामः, तथा सूत्रसङ्ग्रहमात्रं चिकित्सायाः| चिकित्सितेषु चोत्तरकालं यथोपचितविकाराननुव्याख्यास्यामः ||१५||
तत्र प्रथमत एव तावदाद्याँल्लोभाभिद्रोहकोपप्रभवानष्टौ व्याधीन्निदानपूर्वेण क्रमेण व्याख्यास्यामः, तथा सूत्रसङ्ग्रहमात्रं चिकित्सायाः| चिकित्सितेषु चोत्तरकालं यथोपचितविकाराननुव्याख्यास्यामः ||१५||
<div class="mw-collapsible-content">
tatra prathamata ēva tāvadādyāmँllōbhābhidrōhakōpaprabhavānaṣṭau vyādhīnnidānapūrvēṇa kramēṇa vyākhyāsyāmaḥ,
tatra prathamata ēva tāvadādyāmँllōbhābhidrōhakōpaprabhavānaṣṭau vyādhīnnidānapūrvēṇa kramēṇa vyākhyāsyāmaḥ,
vyAdhInnidAnapUrveNa krameNa vyAkhyAsyAmaH, tathA sUtrasa~ggrahamAtraM
vyAdhInnidAnapUrveNa krameNa vyAkhyAsyAmaH, tathA sUtrasa~ggrahamAtraM
cikitsAyAH| cikitsiteShu cottarakAlaM yathopacitavikArAnanuvyAkhyAsyAmaH||15||
cikitsAyAH| cikitsiteShu cottarakAlaM yathopacitavikArAnanuvyAkhyAsyAmaH||15||
</div></div>
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]
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]
<div class="mw-collapsible mw-collapsed">
इह खलु ज्वर एवादौ विकाराणामुपदिश्यते, तत्प्रथमत्वाच्छारीराणाम्||१६||
इह खलु ज्वर एवादौ विकाराणामुपदिश्यते, तत्प्रथमत्वाच्छारीराणाम्||१६||
<div class="mw-collapsible-content">
iha khalu jwara evādau vikārāṇāmupadiśyate, tatprathamatvācchārīrāṇām||16||
iha khalu jwara evādau vikārāṇāmupadiśyate, tatprathamatvācchārīrāṇām||16||
iha khalu jvara evAdau vikArANAmupadishyate, tatprathamatvAcchArIrANAm||16||
iha khalu jvara evAdau vikArANAmupadishyate, tatprathamatvAcchArIrANAm||16||
</div></div>
''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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अथ खल्वष्टाभ्यः कारणेभ्यो ज्वरः सञ्जायते मनुष्याणां; तद्यथा- वातात्, पित्तात्, कफात्, वातपित्ताभ्यां, वातकफाभ्यां, पित्तकफाभ्यां, वातपित्तकफेभ्यः, आगन्तोरष्टमात् कारणात्||१७||
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||
atha khalvaṣṭābhyaḥ kāraṇebhyo jwaraḥ sañjāyate manuṣyāṇām; tadyathā- vātāt, pittāt, kaphāt, vātapittābhyāṁ, vātakaphābhyāṁ, pittakaphābhyām, vātapittakaphebhyaḥ, āgantoraṣṭamāt kāraṇāt||17||
atha khalvaShTAbhyaH kAraNebhyo jvaraH sa~jjAyate manuShyANAM; tadyathA- vAtAt, pittAt, kaphAt, vAtapittAbhyAM, vAtakaphAbhyAM, pittakaphAbhyAM,vAtapittakaphebhyaH, AgantoraShTamAt kAraNAt||17||
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]
''[[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||
तस्य निदानपूर्वरूपलिङ्गोपशयविशेषाननुव्याख्यास्याम||१८||
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tasya nidānapūrvarūpaliṅgopaśayaviśeṣānanuvyākhyāsyāmaḥ ||18||
tasya nidānapūrvarūpaliṅgopaśayaviśeṣānanuvyākhyāsyāmaḥ ||18||
tasya nidAnapUrvarUpali~ggopashayavisheShAnanuvyAkhyAsyAmaH [1] ||18||
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]
Now I shall expound the specific ''nidana'' (etiology), ''poorvarupa'' (prodromal symptoms), ''rupa'' (symptoms) and ''upashaya'' (pacifying factors) of ''[[jwara]]''. [18]
==== Etio-pathogenesis of ''vata''-dominant ''jwara'' ====
==== [[Vata]] dominant [[jwara]] ====
===== Causes =====
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रूक्षलघुशीतवमनविरेचनास्थापनशिरोविरेचनातियोगव्यायामवेगसन्धारणानशनाभिघातव्यवायोद्वेगशोकशोणितातिषेकजागरणविषमशरीरन्यासेभ्योऽतिसेवितेभ्यो वायुः प्रकोपमापद्यते||१९||
रूक्षलघुशीतवमनविरेचनास्थापनशिरोविरेचनातियोगव्यायामवेगसन्धारणानशनाभिघातव्यवायोद्वेगशोकशोणितातिषेकजागरणविषमशरीरन्यासेभ्योऽतिसेवितेभ्यो वायुः प्रकोपमापद्यते||१९||
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rūkṣalaghuśītavamanavirecanāsthāpanaśirovirecanātiyogavyāyāmavegasandhāraṇānaśanābhighātavyavāyodvegaśokaśoṇitātiṣekajāgaraṇaviṣamaśarīranyā<br>sebhyotisevitebhyo vāyuḥ prakopamāpadyate||19||
rUkShalaghushItavamanavirecanAsthApanashirovirecanAtiyogavyAyAmavegasandhAraNAnashanAbhighAta-vyavAyodvegashokashoNitAtiShekajAgaraNaviShamasharIranyAsebhyo~atisevitebhyo vAyuH prakopamApadyate||19||
rUkShalaghushItavamanavirecanAsthApanashirovirecanAtiyogavyAyAmavegasandhAraNAnashanAbhighAta-vyavAyodvegashokashoNitAtiShekajAgaraNaviShamasharIranyAsebhyo~atisevitebhyo vAyuH prakopamApadyate||19||
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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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===== Pathogenesis =====
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स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२०||
स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२०||
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sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībhūyādyamāhārapariṇāmadhātuṁrasanāmānamanvavetya rasasvedavahāni srōtāṁsi pidhāyāgnimupahatya paktisthānādūṣmāṇaṁ bahirnirasya kevalaṁ śarīramanuprapadyate, tadā jwaramabhinirvartayati ||20||
sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībhūyādyamāhārapariṇāmadhātuṁrasanāmānamanvavetya rasasvedavahāni srōtāṁsi pidhāyāgnimupahatya paktisthānādūṣmāṇaṁ bahirnirasya kevalaṁ śarīramanuprapadyate, tadā jwaramabhinirvartayati ||20||
sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||
sa yadA prakupitaH pravishyAmAshayamUShmaNA [2] saha mishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||20||
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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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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 ====
===== 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||
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||
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||
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||
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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==== Symptoms of ''vata''-dominant ''jwara'' ====
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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]
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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||
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uṣṇāmlalavaṇakṣārakaṭukājīrṇabhojanebhyotisevitebhyastathā tīkṣṇātapāgnisantāpaśramakrodhaviṣamāhārebhyaśca pittaṁ prakopamāpadyate||22||
uShNAmlalavaNakShArakaTukAjIrNabhojanebhyo~atisevitebhyastathA tIkShNAtapAgnisantApashramakrodhaviShamAhArebhyashca pittaMprakopamApadyate||22||
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Excess use of hot, sour, salty, alkali, pungent and bitter food and intake of meals before the digestion of the previous meal, contact with intense heat, fire, exhaustion due to excessive exercise, anger, untimely meals – vitiate ''[[pitta]]''.[22]
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===== Pathogeneis =====
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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||
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tadyadā prakupitamāmāśayādūṣmāṇamupasr̥jyādyamāhāra-pariṇāmadhātuṁ rasanāmānamanvavetya rasasvedavahāni srotāṁsi pidhāya dravatvādagnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayat kevalaï śarīramanu-prapadyate, tadā jwaramabhinirvartayati||23||
tadyadA prakupitamAmAshayAdUShmANamupasRujyAdyamAhArapariNAmadhAtuM [1] rasanAmAnamanvavetya rasasvedavahAni srotAMsi pidhAyadravatvAdagnimupahatya paktisthAnAdUShmANaM bahirnirasya [2] prapIDayat kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||23||
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The vitiated ''[[pitta]]'' enters the ''amashaya'' and gets mixed with the initial ''[[dhatu]]'' formed in the process, ''[[rasa]]'', along with the digested food. This improperly formed ''[[rasa]]'' causes sluggish circulation and further block the micro channels of ''[[rasa]]'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. Due to blocked channels of sweat, heat dissipation is adversely affected, causing the temperature to rise all over the body and manifest as ''paittika jwara''.[23]
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===== Clinical features =====
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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||
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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||
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]
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==== [[Kapha]] dominant jwara ====
===== ''Kapha''-dominant ''jwara'' =====
=====Causes=====
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स्निग्धगुरुमधुरपिच्छिलशीताम्ललवणदिवास्वप्नहर्षाव्यायामेभ्योऽतिसेवितेभ्यः श्लेष्मा प्रकोपमापद्यते||२५||
स्निग्धगुरुमधुरपिच्छिलशीताम्ललवणदिवास्वप्नहर्षाव्यायामेभ्योऽतिसेवितेभ्यः श्लेष्मा प्रकोपमापद्यते||२५||
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snigdhagurumadhurapicchilaśītāmlalavaṇadivāsvapnaharṣāvyāyāmebhyo´tisēvitebhyaḥ śleṣmā prakōpamāpadyate ||25||
snigdhagurumadhurapicchilashItAmlalavaNadivAsvapnaharShAvyAyAmebhyo~atisevitebhyaH shleShmA prakopamApadyate||25||
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Excessive use of unctuous, heavy, sweet, slimy, cold, sour, salty substances, day sleep, joy and a sedentary lifestyle –vitiate ''sleshma'' or ''[[kapha]]''. [25]
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=====Pathogenesis=====
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स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं
स यदा प्रकुपितः प्रविश्यामाशयमूष्मणा सह मिश्रीभूयाद्यमाहारपरिणामधातुं
रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयन् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२६||
रसनामानमन्ववेत्य रसस्वेदवहानि स्रोतांसि पिधायाग्निमुपहत्य पक्तिस्थानादूष्माणं बहिर्निरस्य प्रपीडयन् केवलं शरीरमनुप्रपद्यते, तदा ज्वरमभिनिर्वर्तयति||२६||
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sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībh- ūyādyamāhārapariṇāmadhātuï rasanāmānamanvavetya rasa-svedavahāni srotāṁsi pidhāyāgnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayan kevalaï śarīramanupra-padyate, tadā jwaramabhinirvartayati||26||
sa yadā prakupitaḥ praviśyāmāśayamūṣmaṇā saha miśrībh- ūyādyamāhārapariṇāmadhātuï rasanāmānamanvavetya rasa-svedavahāni srotāṁsi pidhāyāgnimupahatya paktisthānādūṣ-māṇaï bahirnirasya prapīḍayan kevalaï śarīramanupra-padyate, tadā jwaramabhinirvartayati||26||
sa yadA prakupitaH pravishyAmAshayamUShmaNA sahamishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya prapIDayan kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||26||
sa yadA prakupitaH pravishyAmAshayamUShmaNA sahamishrIbhUyAdyamAhArapariNAmadhAtuM rasanAmAnamanvavetya rasasvedavahAni srotAMsipidhAyAgnimupahatya paktisthAnAdUShmANaM bahirnirasya prapIDayan kevalaM sharIramanuprapadyate, tadA jvaramabhinirvartayati||26||
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<div style="text-align:justify;">
The vitiated ''[[kapha]]'' enters the ''amashaya'' and gets mixed with the initial ''[[dhatu]]'' formed in the process, ''[[rasa]]'', along with the digested food. This improperly formed ''[[rasa]]'' cause sluggish circulation and further block the micro channels of ''[[rasa]]'' and ''sweda''. The core digestive ''agni'' gets displaced out of its original site (''pakti sthana''), spreading out through the body. As channels of sweat are blocked and are unable to dissipate the heat, temperature rises all over the body, causing ''[[jwara]]''. [26]
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=====Clinical features =====
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तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तमात्रे पूर्वाह्णे पूर्वरात्रे वसन्तकाले वा विशेषेण, गुरुगात्रत्वम्, अनन्नाभिलाषः, श्लेष्मप्रसेकः, मुखमाधुर्यं, हृल्लासः, हृदयोपलेपः, स्तिमितत्वं, छर्दिः, मृद्वग्निता, निद्राधिक्यं, स्तम्भः,तन्द्रा, कासः, श्वासः, प्रतिश्यायः, शैत्यं, श्वैत्यं च नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थं च शीतपिडका भृशमङ्गेभ्य उत्तिष्ठन्ति, उष्णाभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्च; इति(श्लेष्मज्वरलिङ्गानि भवन्ति)||२७||
तस्येमानि लिङ्गानि भवन्ति; तद्यथा- युगपदेव केवले शरीरे ज्वरस्याभ्यागमनमभिवृद्धिर्वा भुक्तमात्रे पूर्वाह्णे पूर्वरात्रे वसन्तकाले वा विशेषेण, गुरुगात्रत्वम्, अनन्नाभिलाषः, श्लेष्मप्रसेकः, मुखमाधुर्यं, हृल्लासः, हृदयोपलेपः, स्तिमितत्वं, छर्दिः, मृद्वग्निता, निद्राधिक्यं, स्तम्भः,तन्द्रा, कासः, श्वासः, प्रतिश्यायः, शैत्यं, श्वैत्यं च नखनयनवदनमूत्रपुरीषत्वचाम्, अत्यर्थं च शीतपिडका भृशमङ्गेभ्य उत्तिष्ठन्ति, उष्णाभिप्रायता, निदानोक्तानुपशयो विपरीतोपशयश्च; इति(श्लेष्मज्वरलिङ्गानि भवन्ति)||२७||
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tasyemāni liṅgāni bhavanti; tadyathā-yugapadeva kevale śarīre Jwarasyābhyāgamanamabhivr̥ddhirvā bhuktamātre pūrvāhṇe pūrvarātre vasantakāle vā viśeṣeṇa,gurugātratvaṁ,anannābhilāṣaḥ,śleṣmaprasekaḥ,mukhamādhuryaṁ,hr̥llāsaḥ,hr̥dayopalepaḥ,stimitatvaṁ,chardiḥ,mr̥dvagnitā,nidrādhikyaṁ,stambhaḥ,tandrā,kāsaḥ,śvāsaḥ,pratiśyāyaḥ,śaityaṁ,śvaityaṁ ca nakhanayanavadanamūtrapurīṣatvacāṁ, atyarthaṁ ca śītapiḍakā bhr̥śamaṅgebhya uttiṣṭhanti, uṣṇābhiprāyatā, nidānoktānupaśayo viparītopaśayaśca; iti (śleṣmajwaraliṅgāni bhavanti)||27||
tasyemāni liṅgāni bhavanti; tadyathā-yugapadeva kevale śarīre Jwarasyābhyāgamanamabhivr̥ddhirvā bhuktamātre pūrvāhṇe pūrvarātre vasantakāle vā viśeṣeṇa,gurugātratvaṁ,anannābhilāṣaḥ,śleṣmaprasekaḥ,mukhamādhuryaṁ,hr̥llāsaḥ,hr̥dayopalepaḥ,stimitatvaṁ,chardiḥ,mr̥dvagnitā,nidrādhikyaṁ,stambhaḥ,tandrā,kāsaḥ,<br>śvāsaḥ,pratiśyāyaḥ,śaityaṁ,śvaityaṁ ca nakhanayanavadanamūtrapurīṣatvacāṁ, atyarthaṁ ca śītapiḍakā bhr̥śamaṅgebhya uttiṣṭhanti, uṣṇābhiprāyatā, nidānoktānupaśayo viparītopaśayaśca; iti (śleṣmajwaraliṅgāni bhavanti)||27||
tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktamAtre pUrvAhNe pUrvarAtre vasantakAle vAvisheSheNa, gurugAtratvam, anannAbhilAShaH, shleShmaprasekaH, mukhamAdhuryaM, hRullAsaH, hRudayopalepaH, stimitatvaM, chardiH, mRudvagnitA,nidrAdhikyaM, stambhaH, tandrA, kAsaH, shvAsaH, pratishyAyaH, shaityaM, shvaityaM ca nakhanayanavadanamUtrapurIShatvacAm, atyarthaM ca shItapiDakAbhRushama~ggebhya [2] uttiShThanti, uShNAbhiprAyatA, nidAnoktAnupashayo viparItopashayashca; iti (shleShmajvarali~ggAni [3] bhavanti)||27||
tasyemAni li~ggAni bhavanti; tadyathA- yugapadeva kevale sharIre jvarasyAbhyAgamanamabhivRuddhirvA bhuktamAtre pUrvAhNe pUrvarAtre vasantakAle vAvisheSheNa, gurugAtratvam, anannAbhilAShaH, shleShmaprasekaH, mukhamAdhuryaM, hRullAsaH, hRudayopalepaH, stimitatvaM, chardiH, mRudvagnitA,nidrAdhikyaM, stambhaH, tandrA, kAsaH, shvAsaH, pratishyAyaH, shaityaM, shvaityaM ca nakhanayanavadanamUtrapurIShatvacAm, atyarthaM ca shItapiDakAbhRushama~ggebhya [2] uttiShThanti, uShNAbhiprAyatA, nidAnoktAnupashayo viparItopashayashca; iti (shleShmajvarali~ggAni [3] bhavanti)||27||
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<div style="text-align:justify;">
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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विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावrयोगाrथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपrकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||
==== Sannipatika jwara ====
===== Causes =====
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विषमाशनादनशनादन्नपरिवर्तादृतुव्यापत्तेरसात्म्यगन्धोपघ्राणाद्विषोपहतस्य चोदकस्योपयोगाद्गरेभ्यो गिरीणां चोपश्लेषात् स्वेदवमनविरेचनास्थापनानुवासनशिरोविरेचनानामयथावत्प्रयोगात् मिथ्यासंसर्जनाद्वा स्त्रीणां च विषमप्रजननात् प्रजातानां च मिथ्योपचाराद्यथोक्तानां च हेतूनां मिश्रीभावाद्यथानिदानं द्वन्द्वानामन्यतमः सर्वे वा त्रयो दोषा युगपत् प्रकोपमापद्यन्ते,ते प्रकुपितास्तयैवानुपूर्व्या ज्वरमभिनिर्वर्तयन्ति||२८||
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viṣamāśanādanaśanādannaparivartādr̥tuvyāpatterasātmyagandhopaghrāṇādviṣopahatasyacodakasyopayogādgarebhyo girīṇāṁ copaśleṣāt snehasvedavamanavirecanāsthāpanānuvāsanaśirovirecanānāmayathāvatprayogāt mithyāsaṁsarjanādvā strīṇāṁ ca viṣamaprajananāt prajātānāṁ ca mithyopacārādyathoktānāṁ ca hetūnāṁ miśrībhāvādyathānidānaṁ dvandvānāmanyatamaḥ sarve vā trayodoṣā yugapat prakopamāpadyante,te prakupitāstayaivānupūrvyājwaramabhinirvartayanti ||28||
viṣamāśanādanaśanādannaparivartādr̥tuvyāpatterasātmyagandhopaghrāṇādviṣopahatasyacodakasyopayogādgarebhyo girīṇāṁ copaśleṣāt snehasvedavamanavirecanāsthāpanānuvāsanaśirovirecanānāmayathāvatprayogāt mithyāsaṁsarjanādvā strīṇāṁ ca viṣamaprajananāt prajātānāṁ ca mithyopacārādyathoktānāṁ ca hetūnāṁ miśrībhāvādyathānidānaṁ dvandvānāmanyatamaḥ sarve vā trayodoṣā yugapat prakopamāpadyante,te prakupitāstayaivānupūrvyājwaramabhinirvartayanti ||28||
viShamAshanAdanashanAdannaparivartAdRutuvyApatterasAtmyagandhopaghrANAdviShopahatasya codakasyopayogAdgarebhyo girINAM copashleShAtsnehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAt mithyAsaMsarjanAdvA strINAM ca viShamaprajananAt prajAtAnAM camithyopacArAd yathoktAnAM ca hetUnAM mishrIbhAvAdyathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doShA yugapat prakopamApadyante, teprakupitAstayaivAnupUrvyA jvaramabhinirvartayanti||28||
viShamAshanAdanashanAdannaparivartAdRutuvyApatterasAtmyagandhopaghrANAdviShopahatasya codakasyopayogAdgarebhyo girINAM copashleShAtsnehasvedavamanavirecanAsthApanAnuvAsanashirovirecanAnAmayathAvatprayogAt mithyAsaMsarjanAdvA strINAM ca viShamaprajananAt prajAtAnAM camithyopacArAd yathoktAnAM ca hetUnAM mishrIbhAvAdyathAnidAnaM dvandvAnAmanyatamaH sarve vA trayo doShA yugapat prakopamApadyante, teprakupitAstayaivAnupUrvyA jvaramabhinirvartayanti||28||
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Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''doshas'', that cause fever. [28]
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Irregular diet, fasting, change in regular meals, seasonal derangement, unsuitable odors, use of hilly water full of poisonous sediments, improper medication by ghee, oils and fats, medical fomentations, emesis, purgation, oily or decoction enema, nasal instillations, faulty diets after purification therapies, women undergoing abnormal delivery and inappropriate post-partum management - these are some of the etiological factors that have already been mentioned as causes of vitiation of ''[[dosha]]s'', that cause fever. [28]
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===== ''Sannipatika jwara'' =====
====== Clinical features ======
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तत्र तथोक्तानां ज्वरलिङ्गानां मिश्रीभावविशेषदर्शनाद्द्वान्द्विकमन्यतमं ज्वरं सान्निपातिकं वा विद्यात्||२९||
तत्र तथोक्तानां ज्वरलिङ्गानां मिश्रीभावविशेषदर्शनाद्द्वान्द्विकमन्यतमं ज्वरं सान्निपातिकं वा विद्यात्||२९||
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Tatra tathoktānāṁ jwaraliṅgānāṁ miśrībhāvaviśeṣadarśanāddvāndvikamanyatamaṁ Jwaraṁ sānnipātikaṁ vā vidyāt ||29||
Tatra tathoktānāṁ jwaraliṅgānāṁ miśrībhāvaviśeṣadarśanāddvāndvikamanyatamaṁ Jwaraṁ sānnipātikaṁ vā vidyāt ||29||
tatra tathoktAnAM jvarali~ggAnAM mishrIbhAvavisheShadarshanAddvAndvikamanyatamaM jvaraM sAnnipAtikaM vA vidyAt||29||
tatra tathoktAnAM jvarali~ggAnAM mishrIbhAvavisheShadarshanAddvAndvikamanyatamaM jvaraM sAnnipAtikaM vA vidyAt||29||
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When the symptoms exhibit the dominance of two ''doshas'', it is called ''sansrishta'' (''dwandaja'') ''jwara'' and in case all three ''doshas'' are vitiated, it is called ''sannipatika jwara'' (tridoshic fever). [29]
When the symptoms exhibit the dominance of two ''[[dosha]]s'', it is called ''sansrishta'' (''dwandaja'') ''jwara'' and in case all three ''[[dosha]]s'' are vitiated, it is called ''sannipatika jwara'' (tridoshic fever). [29]
===== ''Agantu jwara'' (fever of exogenous origin) =====
==== [[Agantu]] jwara (Exogenous fever) ====
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अभिघाताभिषङ्गाभिचाराभिशापेभ्य आगन्तुर्हि व्यथापूर्वोऽष्टमो ज्वरो भवति| स किञ्चित्कालमागन्तुः केवलो भूत्वा पश्चाद्दोषैरनुबध्यते|तत्राभिघातजो वायुना दुष्टशोणिताधिष्ठानेन,अभिषङ्गजःपुनर्वातपित्ताभ्याम्,अभिचाराभिशापजौ तु सन्निपातेनानुबध्येते||३०||
अभिघाताभिषङ्गाभिचाराभिशापेभ्य आगन्तुर्हि व्यथापूर्वोऽष्टमो ज्वरो भवति| स किञ्चित्कालमागन्तुः केवलो भूत्वा पश्चाद्दोषैरनुबध्यते|तत्राभिघातजो वायुना दुष्टशोणिताधिष्ठानेन,अभिषङ्गजःपुनर्वातपित्ताभ्याम्,अभिचाराभिशापजौ तु सन्निपातेनानुबध्येते||३०||
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abhighātābhiṣaṅgābhicārābhiśāpebhya
abhighātābhiṣaṅgābhicārābhiśāpebhya
sa ki~jcitkAlamAgantuH kevalo bhUtvA pashcAddoShairanubadhyate|
sa ki~jcitkAlamAgantuH kevalo bhUtvA pashcAddoShairanubadhyate|
tatrAbhighAtajo vAyunA duShTashoNitAdhiShThAnena, abhiSha~ggajaH punarvAtapittAbhyAm, abhicArAbhishApajau tu sannipAtenAnubadhyete||30||
tatrAbhighAtajo vAyunA duShTashoNitAdhiShThAnena, abhiSha~ggajaH punarvAtapittAbhyAm, abhicArAbhishApajau tu sannipAtenAnubadhyete||30||
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''Agantuja jwara'' (''jwara'' caused due to exogenous factors) is the eighth type of fever. This fever is accompanied with pain and is often caused by trauma, association with evil, fascination, and wrath (of the wise and the elders). These causes directly manifest as fever without any prodromal symptoms for a transitional duration. Slowly, with the passage of time, ''[[dosha]]s'' get vitiated and their effects manifest as above. Fevers caused due to trauma influence blood pathology, while association with evil afflicts ''[[vata]]'' and ''[[pitta]]'', and fascination and wrath causes ''sannipata'' (and therefore, leads to an incurable condition). [30]
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==== Specification of each type of jwara ====
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स सप्तविधाज्ज्वराद्विशिष्टलिङ्गोपक्रमसमुत्थानत्वाद्विशिष्टो वेदितव्यः,कर्मणा साधारणेन चोपचर्यते इत्यष्टविधा ज्वरप्रकृतिरुक्ता||३१||
स सप्तविधाज्ज्वराद्विशिष्टलिङ्गोपक्रमसमुत्थानत्वाद्विशिष्टो वेदितव्यः,कर्मणा साधारणेन चोपचर्यते इत्यष्टविधा ज्वरप्रकृतिरुक्ता||३१||
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sasaptavidhājjvarādviśiṣṭaliṅgopakramasamutthānatvādviśiṣṭo veditavyaḥ,karmaṇÁ āsādhāraṇena copacaryate.Ityaṣṭavidhā jwaraprakr̥tiruktā||31||
sasaptavidhājjvarādviśiṣṭaliṅgopakramasamutthānatvādviśiṣṭo veditavyaḥ,karmaṇÁ āsādhāraṇena copacaryate.Ityaṣṭavidhā jwaraprakr̥tiruktā||31||
sa saptavidhAjjvarAdvishiShTali~ggopakramasamutthAnatvAdvishiShTo veditavyaH, karmaNA sAdhAraNena copacaryate [1] |
sa saptavidhAjjvarAdvishiShTali~ggopakramasamutthAnatvAdvishiShTo veditavyaH, karmaNA sAdhAraNena copacaryate [1] |
ityaShTavidhA jvaraprakRutiruktA||31||
ityaShTavidhA jvaraprakRutiruktA||31||
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All the seven doshic ''jwara'' have their own doshic specifications with respect to the onset, symptomatology, and treatment principles. The exception is the ''agantuja jwara'' (exogenous), which should be treated with appropriate consideration to the ''jwara''’s specific etiology. [31]
All the seven doshic ''jwara'' have their own doshic specifications with respect to the onset, symptomatology, and treatment principles. The exception is the ''agantuja jwara'' (exogenous), which should be treated with appropriate consideration to the ''jwara''’s specific etiology. [31]
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====Specific feature and classification of jwara====
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ज्वरस्त्वेकएवसन्तापलक्षणः|तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चiतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||
ज्वरस्त्वेकएवसन्तापलक्षणः| तमेवाभिप्रायविशेषाद्द्विविधमाचक्षते,निजागन्तुविशेषाच्च|तत्र निजं द्विविधं त्रिविधं चतुर्विधं सप्तविधं चाहुर्भिषजो वातादिविकल्पात्||३२||
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Jwarastvekaevasantāpalakṣaṇaḥ.Tamevābhiprāyaviśeṣāddvividhamācakṣate,nijāgantuviśeṣācca.Tatra nijaṁ dvividhaṁ trividhaṁ caturvidhaṁ saptavidhaṁ cāhurbhiṣajo vatādivikalpāt||32||
Jwarastvekaevasantāpalakṣaṇaḥ.Tamevābhiprāyaviśeṣāddvividhamācakṣate,nijāgantuviśeṣācca.Tatra nijaṁ dvividhaṁ trividhaṁ caturvidhaṁ saptavidhaṁ cāhurbhiṣajo vatādivikalpāt||32||
tamevAbhiprAyavisheShAddvividhamAcakShate, nijAgantuvisheShAcca|
tamevAbhiprAyavisheShAddvividhamAcakShate, nijAgantuvisheShAcca|
tatra nijaM dvividhaM trividhaM caturvidhaM saptavidhaM cAhurbhiShajo vAtAdivikalpAt||32||
tatra nijaM dvividhaM trividhaM caturvidhaM saptavidhaM cAhurbhiShajo vAtAdivikalpAt||32||
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Per doshic classification of ''jwara, santapa'' (excessively hot sensation) is of only one type common to all ''jwara''. But according to other classifications it is of two types - ''nija'' (endogenous) and ''agantuja'' (exogenous). ''Nija'' again could be classified into two types (''saumya'' or mild) and ''agneya'' (high grade fever)), three types (''vatika, paitika, shleshmika''), four types (''vatika, paittika'', ''sleshmika'' and ''agantuja''), or seven types (''vatika, paittika, shleshmika, vata-paittika, vata-shleshmika, pitta-shleshmika''). [32]
Per doshic classification of ''jwara, santapa'' (excessively hot sensation) is of only one type common to all ''jwara''. But according to other classifications it is of two types - ''nija'' (endogenous) and ''agantuja'' (exogenous). ''Nija'' again could be classified into two types (''saumya'' or mild) and ''agneya'' (high grade fever)), three types (''vatika, paitika, shleshmika''), four types (''vatika, paittika'', ''sleshmika'' and ''agantuja''), or seven types (''vatika, paittika, shleshmika, vata-paittika, vata-shleshmika, pitta-shleshmika''). [32]
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==== General premonitory signs of all ''jwara'' ====
==== General premonitory features of all jwara ====
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तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा-मुखवैरस्यं,गुरुगात्रत्वम्, अनन्नाभिलाषः, चक्षुषोराकुलत्वम्,अश्र्वागमनं, निद्राधिक्यम्, अरतिः, जृम्भा, विनामः, वेपथुः,श्रमभ्रमप्रलापजागरणरोमहर्षदन्तहर्षाः,शब्दशीतवातातपसहत्वासहत्वम्,
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा-मुखवैरस्यं,गुरुगात्रत्वम्, अनन्नाभिलाषः, चक्षुषोराकुलत्वम्,अश्र्वागमनं, निद्राधिक्यम्, अरतिः, जृम्भा, विनामः, वेपथुः,श्रमभ्रमप्रलापजागरणरोमहर्षदन्तहर्षाः,शब्दशीतवातातपसहत्वासहत्वम्,
अल्पप्राणता, दीर्घसूत्रता, आलस्यम्, उचितस्य कर्मणो हानिः, प्रतीपता स्वकार्येषु, गुरूणां वाक्येष्वभ्यसूया, बालेभ्यः प्रद्वेषः, स्वधर्मेष्वचिन्ता, माल्यानुलेपनभोजनपरिक्लेशनं,मधुरेभ्य भक्षेभ्यः प्रद्वेषः, अम्ललवणकटुकप्रियता
अल्पप्राणता, दीर्घसूत्रता, आलस्यम्, उचितस्य कर्मणो हानिः, प्रतीपता स्वकार्येषु, गुरूणां वाक्येष्वभ्यसूया, बालेभ्यः प्रद्वेषः, स्वधर्मेष्वचिन्ता, माल्यानुलेपनभोजनपरिक्लेशनं,मधुरेभ्य भक्षेभ्यः प्रद्वेषः, अम्ललवणकटुकप्रियता
च,इति ज्वरस्य पूर्वरूपाणि भवन्ति प्राक्सन्तात्;अपिचैनंसन्तापार्तमनुब||३३||
च,इति ज्वरस्य पूर्वरूपाणि भवन्ति प्राक्सन्तात्;अपिचैनंसन्तापार्तमनुब||३३||
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tasyemāni pūrvarūpāṇi bhavanti; tadyathā-
tasyemāni pūrvarūpāṇi bhavanti; tadyathā-
tasyemAni pUrvarUpANi bhavanti; tadyathA- mukhavairasyaM, gurugAtratvam, anannAbhilAShaH, cakShuShorAkulatvam, ashrvAgamanaM, nidrAdhikyam, aratiH,jRumbhA, vinAmaH, vepathuH, shramabhramapralApajAgaraNaromaharShadantaharShAH, shabdashItavAtAtapasahatvAsahatvam, arocakAvipAkau, daurbalyam,a~ggamardaH, sadanam, alpaprANatA, dIrghasUtratA, Alasyam, ucitasya karmaNo hAniH, pratIpatA svakAryeShu, gurUNAM vAkyeShvabhyasUyA, bAlebhyaHpradveShaH, svadharmeShvacintA, mAlyAnulepanabhojanaparikleshanaM, madhurebhyashca bhakShebhyaH pradveShaH, amlalavaNakaTukapriyatA ca, iti jvarasyapUrvarUpANi bhavanti prAksantApAt; api cainaM santApArtamanubadhnanti||33||
tasyemAni pUrvarUpANi bhavanti; tadyathA- mukhavairasyaM, gurugAtratvam, anannAbhilAShaH, cakShuShorAkulatvam, ashrvAgamanaM, nidrAdhikyam, aratiH,jRumbhA, vinAmaH, vepathuH, shramabhramapralApajAgaraNaromaharShadantaharShAH, shabdashItavAtAtapasahatvAsahatvam, arocakAvipAkau, daurbalyam,a~ggamardaH, sadanam, alpaprANatA, dIrghasUtratA, Alasyam, ucitasya karmaNo hAniH, pratIpatA svakAryeShu, gurUNAM vAkyeShvabhyasUyA, bAlebhyaHpradveShaH, svadharmeShvacintA, mAlyAnulepanabhojanaparikleshanaM, madhurebhyashca bhakShebhyaH pradveShaH, amlalavaNakaTukapriyatA ca, iti jvarasyapUrvarUpANi bhavanti prAksantApAt; api cainaM santApArtamanubadhnanti||33||
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Premonitory symptoms of ''jwara'' include abnormal taste in the mouth, heaviness in the body, aversion to food, restless eyes, lacrymation, excessive sleep, restlessness body, yawning, bending, shivering, exhaustion (without exercise), giddiness, delirium, sometimes sleeplessness, horripilation, oversensitive teeth, tolerance and intolerance to sound, cold, wind and heat, anorexia, indigestion, weakness, body-ache, malaise, reduced vitality, mental agitations, lethargic, idleness, lack of natural activities, apathy to daily regimen, disrespect to the words of elders, agitation with children, aversion to doing work, uncomfortable with flowers and perfumes, aversion to sweet edibles, and desirous for sour, salty and pungent things. These premonitory symptoms rise before the onset of ''jwara'' and may continue through the course of the fever. [33]
<div style="text-align:justify;">
Premonitory features of ''jwara'' include abnormal taste in the mouth, heaviness in the body, aversion to food, restless eyes, lacrymation, excessive sleep, restlessness body, yawning, bending, shivering, exhaustion (without exercise), giddiness, delirium, sometimes sleeplessness, horripilation, oversensitive teeth, tolerance and intolerance to sound, cold, wind and heat, anorexia, indigestion, weakness, body-ache, malaise, reduced vitality, mental agitations, lethargic, idleness, lack of natural activities, apathy to daily regimen, disrespect to the words of elders, agitation with children, aversion to doing work, uncomfortable with flowers and perfumes, aversion to sweet edibles, and desirous for sour, salty and pungent things. These premonitory symptoms rise before the onset of ''jwara'' and may continue through the course of the fever. [33]
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इत्येतान्येकैकशो ज्वरलिङ्गानि व्याख्यातानि भवन्ति विस्तरसमासाभ्याम्||३४||
इत्येतान्येकैकशो ज्वरलिङ्गानि व्याख्यातानि भवन्ति विस्तरसमासाभ्याम्||३४||
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ityetānyekaikaśo Jwaraliṅgāni vyākhyātāni bhavanti vistarasamāsābhyām||34||
ityetānyekaikaśo Jwaraliṅgāni vyākhyātāni bhavanti vistarasamāsābhyām||34||
ityetAnyekaikasho jvarali~ggAni vyAkhyAtAni bhavanti vistarasamAsAbhyAm||34||
ityetAnyekaikasho jvarali~ggAni vyAkhyAtAni bhavanti vistarasamAsAbhyAm||34||
</div></div>
Thus the symptoms of separate single doshic ''jwara'' are described in details and double and triple doshic ''jwara'' are described in brief [34].
Thus the symptoms of separate single doshic ''jwara'' are described in details and double and triple doshic ''jwara'' are described in brief [34].
==== Consequence of ''jwara'' ====
==== Consequences of jwara ====
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ज्वरस्तु खलु महेश्वरकोपप्रभवः,सर्वप्राणभृतां प्राणहरो,देहेन्द्रियमनस्तापकरः,प्रज्ञाबलवर्णहर्षोत्साहह्रासकरः,श्रमक्लममोहाहारोपरोधसञ्जननः; ज्वरयति शरीराणीति ज्वरः, नान्ये व्याधयस्तथा दारुणा बहूपद्रवा दुश्चिकित्स्याश्च यथाऽयम्| स सर्वरोगाधिपतिः, नानातिर्यग्योनिषु च बहुविधैः शब्दैरभिधीयते|सर्वे प्राणभृतः सज्वरा एव जायन्ते सज्वरा एव म्रियन्ते च; स महामोहः, तेनाभिभूताः प्राग्दैहिकं देहिनः कर्म किञ्चिदपि न स्मरन्ति, सर्वप्राणभृतां च ज्वर एवान्ते प्राणानादत्ते||३५||
ज्वरस्तु खलु महेश्वरकोपप्रभवः,सर्वप्राणभृतां प्राणहरो,देहेन्द्रियमनस्तापकरः,प्रज्ञाबलवर्णहर्षोत्साहह्रासकरः,श्रमक्लममोहाहारोपरोधसञ्जननः; ज्वरयति शरीराणीति ज्वरः, नान्ये व्याधयस्तथा दारुणा बहूपद्रवा दुश्चिकित्स्याश्च यथाऽयम्| स सर्वरोगाधिपतिः, नानातिर्यग्योनिषु च बहुविधैः शब्दैरभिधीयते|सर्वे प्राणभृतः सज्वरा एव जायन्ते सज्वरा एव म्रियन्ते च; स महामोहः, तेनाभिभूताः प्राग्दैहिकं देहिनः कर्म किञ्चिदपि न स्मरन्ति, सर्वप्राणभृतां च ज्वर एवान्ते प्राणानादत्ते||३५||
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JwarastukhaluMaheśvarakopaprabhavaḥ,sarvaprāṇabhr̥tāṁprāṇaharo,dehendriyamanastāpakaraḥ,prajñābalavarṇaharṣotsāhahrāsakaraḥśramaklamamohāhāroparodhasañjananaḥ; jwarayati śarīrāṇīti jwaraḥ, nānye vyādhayastathā dāruṇā bahūpadravā duścikitsyāśca yathāyam.
JwarastukhaluMaheśvarakopaprabhavaḥ,sarvaprāṇabhr̥tāṁprāṇaharo,dehendriyamanastāpakaraḥ,prajñābalavarṇaharṣotsāhahrāsakaraḥśramaklamamohā<br>hāroparodhasañjananaḥ; jwarayati śarīrāṇīti jwaraḥ, nānye vyādhayastathā dāruṇā bahūpadravā duścikitsyāśca yathāyam.
Sa sarvarogādhipatiḥ, nānātiryagyoniṣu ca bahuvidhaiḥ śabdairabhidhīyate.Sarve prāṇabhr̥taḥ sajvarā eva jāyante sajvarā eva mriyante ca; sa mahāmohaḥ, tenābhibhūtāḥ prāgdaihikaṁ dehinaḥ karma kiñcidapi na smaranti, sarvaprāṇabhr̥tāṁ ca jwara evānte prāṇānādatte||35||
Sa sarvarogādhipatiḥ, nānātiryagyoniṣu ca bahuvidhaiḥ śabdairabhidhīyate.Sarve prāṇabhr̥taḥ sajvarā eva jāyante sajvarā eva mriyante ca; sa mahāmohaḥ, tenābhibhūtāḥ prāgdaihikaṁ dehinaḥ karma kiñcidapi na smaranti, sarvaprāṇabhr̥tāṁ ca jwara evānte prāṇānādatte||35||
jvarastu khalu maheshvarakopaprabhavaH, sarvaprANabhRutAM prANaharo, dehendriyamanastApakaraH, praj~jAbalavarNaharShotsAhahrAsakaraH [1] ,shramaklamamohAhAroparodhasa~jjananaH; jvarayati sharIrANIti jvaraH, nAnye vyAdhayastathA dAruNA bahUpadravA dushcikitsyAshca yathA~ayam|
jvarastu khalu maheshvarakopaprabhavaH, sarvaprANabhRutAM prANaharo, dehendriyamanastApakaraH, praj~jAbalavarNaharShotsAhahrAsakaraH [1] ,shramaklamamohAh<br>Aroparodhasa~jjananaH; jvarayati sharIrANIti jvaraH, nAnye vyAdhayastathA dAruNA bahUpadravA dushcikitsyAshca yathA~ayam|
sa sarvarogAdhipatiH, nAnAtiryagyoniShu ca bahuvidhaiH shabdairabhidhIyate|
sa sarvarogAdhipatiH, nAnAtiryagyoniShu ca bahuvidhaiH shabdairabhidhIyate|
sarve prANabhRutaH sajvarA eva jAyante sajvarA eva mriyante ca; sa mahAmohaH, tenAbhibhUtAH prAgdaihikaM dehinaH karma ki~jcidapi na smaranti,sarvaprANabhRutAM ca jvara evAnte prANAnAdatte||35||
sarve prANabhRutaH sajvarA eva jAyante sajvarA eva mriyante ca; sa mahAmohaH, tenAbhibhUtAH prAgdaihikaM dehinaH karma ki~jcidapi na smaranti,sarvaprANabhRutAM ca jvara evAnte prANAnAdatte||35|| </div></div>
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''Jwara'' occurs due to the wrath of Maheshwara. It could take away the life of all creatures, causes ''santapa'' (grief) in body, sense organs and mind. It reduces intellect, strength, complexion, feeling of happiness and enthusiasm and produces tiredness, fatigue, confusion, aversion to food. In fact, it is called ''jwara'' because it produces unhealthy effect in the body. No other disease is as frightful, complicated and difficult in treatment as this. That is why it is considered the king of all diseases. It is considered a life-giving force, since all living beings are born with fever (body temperature) and die with fever. It causes delirium. Afflicted living beings lose their memory of any event of their previous lives. In the end fever takes away the life of all creatures. [35]
''Jwara'' occurs due to the wrath of Maheshwara. It could take away the life of all creatures, causes ''santapa'' (grief) in body, sense organs and mind. It reduces intellect, strength, complexion, feeling of happiness and enthusiasm and produces tiredness, fatigue, confusion, aversion to food. In fact, it is called ''jwara'' because it produces unhealthy effect in the body. No other disease is as frightful, complicated and difficult in treatment as this. That is why it is considered the king of all diseases. It is considered a life-giving force, since all living beings are born with fever (body temperature) and die with fever. It causes delirium. Afflicted living beings lose their memory of any event of their previous lives. In the end fever takes away the life of all creatures. [35]
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==== Management of ''jwara'' ====
==== Principles of management of jwara ====
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तत्र पूर्वरूपदर्शने ज्वरादौ वा हितं लघ्वशनमपतर्पणं वा, ज्वरस्यामाशयसमुत्थत्वात्;ततःकषायपानाभ्यङ्गस्नेहस्वेदप्रदेहपरिषेकानुलेपनवमनविरेचनास्थापनानुवासनोपशमननस्तःकर्म-धूपधूमपानाञ्जनक्षीरभोजनविधानं च यथास्वं युक्त्या प्रयोज्यम्||३६||
तत्र पूर्वरूपदर्शने ज्वरादौ वा हितं लघ्वशनमपतर्पणं वा, ज्वरस्यामाशयसमुत्थत्वात्;ततःकषायपानाभ्यङ्गस्नेहस्वेदप्रदेहपरिषेकानुलेपनवमनविरेचनास्थापनानुवासनोपशमननस्तःकर्म-धूपधूमपानाञ्जनक्षीरभोजनविधानं च यथास्वं युक्त्या प्रयोज्यम्||३६||
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tatra pūrvarūpadarśane jwarādau vā hitaṁ laghvaśanamapatarpaṇaṁ vā,jwarasyāmāśayasamutthatvāt; tataḥ
tatra pūrvarūpadarśane jwarādau vā hitaṁ laghvaśanamapatarpaṇaṁ vā,jwarasyāmāśayasamutthatvāt; tataḥ
tatra pUrvarUpadarshane jvarAdau vA hitaM laghvashanamapatarpaNaM vA, jvarasyAmAshayasamutthatvAt; tataHkaShAyapAnAbhya~ggasnehasvedapradehapariShekAnulepanavamanavirecanAsthApanAnuvAsanopashamana-nastaHkarmadhUpadhUmapAnA~jjanakShIrabhojanavidhAnaM ca yathAsvaM yuktyA prayojyam||36||
tatra pUrvarUpadarshane jvarAdau vA hitaM laghvashanamapatarpaNaM vA, jvarasyAmAshayasamutthatvAt; tataHkaShAyapAnAbhya~ggasnehasvedapradehapariShekAnulepanavamanavirecanAsthApanAnuvAsanopashamana-nastaHkarmadhUpadhUmapAnA~jjanakShIrabhojanavidhAnaM ca yathAsvaM yuktyA prayojyam||36||
</div></div>
When premonitory symptoms manifest or at the onset of the fever, dieting or fasting is useful because the disease originates from the ''amashaya''. In such a case, intake of ''kashaya'' (decoctions), massage, oleation, fomentation, ''pradeha'' (sprinkling), ''anulepana'' (anointing with pastes), emesis, purgation, decoction and oily enema, pacificatory measures, snuffing, fumigation, smoking, collyrium, medicated milk and a specific dietetic regimen should be indicated as per the condition. [36]
<div style="text-align:justify;">
When premonitory symptoms manifest or at the onset of the fever, dieting or fasting is useful because the disease originates from the ''amashaya''. In such a case, intake of kashaya (decoctions), massage, oleation ([[snehana]]), fomentation ([[swedana]]), thick ointment ([[pradeha]]), sprinkling ([[parisheka]]), [[anulepana]] (anointing with pastes), [[emesis]], [[purgation]], decoction and oily [[enema]], pacification measures, [[nasal errhines]], [[fumigation]], medicated smoking, collyrium, medicated milk and a specific dietetic regimen should be indicated as per the condition. [36]
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==== Management of chronic ''jwara'' ====
==== Management principles of jeerna jwara (chronic fever) ====
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जीर्णज्वरेषु तु सर्वेष्वेव सर्पिषः पानं प्रशस्यते यथास्वौषधसिद्धस्य; सर्पिर्हि स्नेहाद्वातं शमयति, संस्कारात् कफं, शैत्यात् पित्तमूष्माणं च; तस्माज्जीर्णज्वरेषु सर्वेष्वेव सर्पिर्हितमुदकमिवाग्निप्लुष्टेषु द्रव्येष्विति||३७||
जीर्णज्वरेषु तु सर्वेष्वेव सर्पिषः पानं प्रशस्यते यथास्वौषधसिद्धस्य; सर्पिर्हि स्नेहाद्वातं शमयति, संस्कारात् कफं, शैत्यात् पित्तमूष्माणं च; तस्माज्जीर्णज्वरेषु सर्वेष्वेव सर्पिर्हितमुदकमिवाग्निप्लुष्टेषु द्रव्येष्विति||३७||
नान्यः स्नेहस्तथा कश्चित् संस्कारमनुवर्तते|
नान्यः स्नेहस्तथा कश्चित् संस्कारमनुवर्तते|
यथा सर्पिरतः सर्पिः सर्वस्नेहोत्तमं मतम्||४०||
यथा सर्पिरतः सर्पिः सर्वस्नेहोत्तमं मतम्||४०||
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JÍrṇajwareṣu tu sarveṣveva sarpiṣaḥ pānaṁ praśasyate yathāsvauṣadhasiddhasya; sarpirhi snehādvātaṁ śamayati,saṁskārāt kaphaṁ,śaityāt pittamūṣmāṇaṁ ca;tasmājjīrṇajwareṣu sarveṣveva sarpirhitamudakamivāgnipluṣṭeṣu dravyeṣviti||37||
JÍrṇajwareṣu tu sarveṣveva sarpiṣaḥ pānaṁ praśasyate yathāsvauṣadhasiddhasya; sarpirhi snehādvātaṁ śamayati,saṁskārāt kaphaṁ,śaityāt pittamūṣmāṇaṁ ca;tasmājjīrṇajwareṣu sarveṣveva sarpirhitamudakamivāgnipluṣṭeṣu dravyeṣviti||37||
nAnyaH snehastathA kashcit saMskAramanuvartate|
nAnyaH snehastathA kashcit saMskAramanuvartate|
yathA sarpirataH sarpiH sarvasnehottamaM matam||40||
yathA sarpirataH sarpiH sarvasnehottamaM matam||40||
</div></div>
In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''vata'' by its unctuousness, ''kapha'' by (ghee infused with) ''kapha'' pacifying drugs, and ''pitta'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]
<div style="text-align:justify;">
In all types of ''jirna jwara'' (chronic fever), internal use of medicated ghee prepared is recommended. Medicated ghee pacifies ''[[vata]]'' by its unctuousness, ''[[kapha]]'' by (ghee infused with) ''[[kapha]]'' pacifying drugs, and ''[[pitta]]'' by its coldness. Therefore, ghee is useful in all forms of ''jirna jwara'' like fire subsides with water. [37]
Here are (the verses) –
Here are (the verses) –
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]
As water is sprinkled on burning houses to douse (the fire), ghee is administered to manage chronic fever. No other ''sneha'' (oil etc.) brings the refinement properties of ''sanskara'' (processing with drugs) as ghee and therefore it is said the best one of all the ''snehas''. [38-40]
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====Rule of exception for repetition of text====
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गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|
गद्योक्तो यः पुनः श्लोकैरर्थः समनुगीयते|
तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||
तद्व्यक्तिव्यवसायार्थं द्विरुक्तं तन्न गर्ह्यते||४१||
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Gadyokto yaḥ punaḥ ślokairarthaḥ samanugīyate.
Gadyokto yaḥ punaḥ ślokairarthaḥ samanugīyate.
gadyokto yaH punaH shlokairarthaH samanugIyate|
gadyokto yaH punaH shlokairarthaH samanugIyate|
tadvyaktivyavasAyArthaM dviruktaM tanna garhyate||41||
tadvyaktivyavasAyArthaM dviruktaM tanna garhyate||41||
</div></div>
This subject of ''jwara'' has been put here in prose and is again put into the form of verses. The intention is to make the subject clear and understandable. Such repetitions should not be dismissed in disgust. [41]
This subject of ''jwara'' has been put here in prose and is again put into the form of verses. The intention is to make the subject clear and understandable. Such repetitions should not be dismissed in disgust. [41]
तत्र श्लोकाः-
==== Summary ====
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तत्र श्लोकाः-
त्रिविधं नामपर्यायैर्हेतुं पञ्चविधं गदम्|
त्रिविधं नामपर्यायैर्हेतुं पञ्चविधं गदम्|
गदलक्षणपर्यायान् व्याधेः पञ्चविधं ग्रहम्||४२||
गदलक्षणपर्यायान् व्याधेः पञ्चविधं ग्रहम्||४२||
व्याजहार ज्वरस्याग्रे निदाने विगतज्वरः|
व्याजहार ज्वरस्याग्रे निदाने विगतज्वरः|
भगवानग्निवेशाय प्रणताय पुनर्वसुः||४४||
भगवानग्निवेशाय प्रणताय पुनर्वसुः||४४||
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Tatra ślōkāḥ-
Tatra ślōkāḥ-
vyAjahAra jvarasyAgre nidAne vigatajvaraH|
vyAjahAra jvarasyAgre nidAne vigatajvaraH|
bhagavAnagniveshAya praNatAya punarvasuH||44||
bhagavAnagniveshAya praNatAya punarvasuH||44||
</div></div>
To summarize,
To summarize,
Three types of ''nidana'' of ''jwara'', along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of ''jwara''. [42-44]
Three types of ''nidana'' of ''jwara'', along with their synonyms, five types of diseases, symptoms and synonyms of diseases, five means to know the diseases, eight types of fever, its distant and immediate causes, premonitory symptoms, symptoms and medicament in short – all these were expounded by Lord Punarvasu (Atreya) to Agnivesha in this first chapter on the diagnosis of ''jwara''. [42-44]
Thus ends the first chapter on diagnosis of fever in [[Nidana Sthana]] in the treatise composed by Agnivesha and reducted by Charaka. (1)
Thus ends the first chapter on diagnosis of fever in [[Nidana Sthana]] in the treatise composed by Agnivesha and reducted by Charak. (1)
== Tattva Vimarsha (Fundamental principles) ==
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*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]
*The causative factors, favorable conditions, dominant factors, and origins of ''jwara'' are important in the context of ''nidana''. [3]
*Somatic diseases could be caused due to ''soma'' (''kapha''), ''agni'' (''pitta''), and ''vayu'' (''vata'') – due to vitiation of single ''dosha'', two ''doshas'', or all three ''doshas''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]
*Somatic diseases could be caused due to ''soma'' (''[[kapha]]''), ''agni'' (''[[pitta]]''), and ''vayu'' (''[[vata]]'') – due to vitiation of single ''[[dosha]]'', two ''[[dosha]]s'', or all three ''[[dosha]]s''. Psychiatric diseases are attributed to vitiation of ''rajas'' and ''tamas''. [4]
*A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5]
*A disease can be seen clinically as a consequence of toxins inside the body, and could be defined as that which inflicts fear, hampers quality of life, manifests with many signs, decreases life, affects the senses, cause pain, and makes life hard. [5]
*The five key factors of ''jwara nidana'' that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]
*The five key factors of ''jwara nidana'' that provide a complete view of a disease are etiology, premonitory signs, clinical features, pacifying factors, and pathogenesis. [6]
*The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season).
*The pathogenesis of a disease includes numerical classification, types of diseases, knowledge of a dominant factor, and temporal factors (aggravation time and season).
*''Jwara'' is the primary change observed in body that initiates a disease process. [16]
*''Jwara'' is the primary change observed in body that initiates a disease process. [16]
*All forms of ''jwara'' are caused due to vitiation of ''doshas'', which in turn have various causative factors (for their vitiation). [17]
*All forms of ''jwara'' are caused due to vitiation of [[dosha]], which in turn have various causative factors (for their vitiation). [17]
*The important pathological events in process of ''jwara'' are as below:
*The important pathological events in process of ''jwara'' are as below:
**Vitiated ''doshas'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion
**Vitiated ''[[dosha]]s'' get accumulated in the ''amashaya'' i.e. site of first phase of digestion
**Next, these ''doshas'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)
**Next, these ''[[dosha]]s'' mix with the undigested food material, in that heated environment, in the ''amashaya'', vitiating the ''ahara rasa'' (just digested food)
**This vitiated ''rasa'' blocks the ''rasavaha'' and ''swedavaha strotas'' (channels) that regulate body heat.
**This vitiated ''rasa'' blocks the ''rasavaha'' and ''swedavaha strotas'' (channels) that regulate body heat.
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
Consequently, there is an affliction of the digestion process and spreading of heat outside its natural location, causing a rise in body temperature [19-28]
*Exogenous factors may cause ''jwara'' by vitiating ''rakta'' (blood), and/or ''dosha''. [30]
*Exogenous factors may cause ''jwara'' by vitiating ''[[rakta]]'' (blood), and/or ''[[dosha]]''. [30]
*Rise in temperature? is a confirmative sign of ''jwara''. [32]
*Rise in temperature is a confirmative sign of ''jwara''. [32]
*The light to digest diet and reduction therapy shall be started as soon as premonitory signs of ''jwara'' are observed. [36]
*The light to digest diet and reduction therapy shall be started as soon as premonitory signs of ''jwara'' are observed. [36]
*The best advocated medicine for chronic ''jwara'' is Ghee due to its therapeutic efficacy of pacifying all three ''dosha''. [37]
*The best advocated medicine for chronic ''jwara'' is Ghee due to its therapeutic efficacy of pacifying all three ''[[dosha]]''. [37]
=== ''Vidhi Vimarsha'' ===
== Vidhi Vimarsha (Applied Inferences) ==
Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in [[Nidana Sthana]] should be incorporated in the ''upashaya'' (pacification factors). ''Nidana'' means the causative factor of the diseases. The term ''vyadhibodhakam'' means the diagnosis of diseases with the help of ''nidana, poorvarupa, rupa, upashaya'' and ''samprapti''. 1-2 [6]
Treatment of any disease is possible only after the proper knowledge of causative factors and sign and symptoms. Treatment principles described in [[Nidana Sthana]] should be incorporated in the ''upashaya'' (pacification factors). ''Nidana'' means the causative factor of the diseases. The term ''vyadhibodhakam'' means the diagnosis of diseases with the help of ''nidana, poorvarupa, rupa, upashaya'' and ''samprapti''. 1-2 [6]
If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. [7]
If diseases are not properly known, one cannot start the treatment. Therefore, ''Nidanapanchaka'' (the five factors associated with understanding an affliction) is described as the specific measures to diagnose the disease. [Cha.Sa.[[Nidana Sthana]] 1/6]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
Vagbhata also endorsed these five components as the means of understanding the disease. [6] [8]
#'''''Sannikrishta''''' (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of ''doshaprakopa'' like ''chaya'' etc., are known as ''sannikrishta''. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either.
#'''''Sannikrishta''''' (immediate causative factor): Immediate factors that cause afflication of a disease in a short span of time and do not require to wait for the different stages of ''doshaprakopa'' like ''chaya'' etc., are known as ''sannikrishta''. Such factors do not require any help of other causative factors to produce the disease, though it is not an independent agent either.
#'''''Viprakrishta''''' (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of ''doshas'' to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of ''kapha dosha'' during ''Hemanta ritu'' (early winter season), causing diseases seen in ''Vasanta ritu''(spring season). ''Sannikrishta'' factors tend to use this foundation prepared by ''viprakrishta'' factors. As the diseases are immediately seen after the consumption of ''Sannikrishta'' factors, it gives the impression that the disease is caused only due to ''Sannikrishta'' factors. Thus, a disease cannot manifest independently by either ''Viprakrishta'' or ''Sannikrishta'' factors – it would require both.
#'''''Viprakrishta''''' (delayed/ chronic causative factor): These factors do not cause the disease in a short span of time. These causative factors have to wait for increased, gradual accumulation of ''[[dosha]]s'' to get strength. A threshold, once reached, triggers the onset of the disease. The example of this is the accumulation of ''[[kapha dosha]]'' during ''Hemanta ritu'' (early winter season), causing diseases seen in ''Vasanta ritu''(spring season). ''Sannikrishta'' factors tend to use this foundation prepared by ''viprakrishta'' factors. As the diseases are immediately seen after the consumption of ''Sannikrishta'' factors, it gives the impression that the disease is caused only due to ''Sannikrishta'' factors. Thus, a disease cannot manifest independently by either ''Viprakrishta'' or ''Sannikrishta'' factors – it would require both.
#'''''Vyabhichari''''' (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable.
#'''''Vyabhichari''''' (weak causative factors or doubtful causative factors): These types of causative factors are weak and they may or may not be the etiological factors responsible for the disease. These could be secondary factors that require some other factor to afflict the patient, or could become a primary factor if the time is favorable.
#'''''Pradhanika''''' (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as ''pradhanika hetu''.
#'''''Pradhanika''''' (primary causative factor): These types of causes are the definite causes of disease due to their own strength. For example, poisons, severe trauma, etc. are considered as ''pradhanika hetu''.
#'''''Asatmyendriyartha Samyoga''''' (Abnormal contact of the ''Indriyas'', i.e., sensory and motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as ''Asatmyendriyarth Samyoga''.
#'''''Asatmyendriyartha Samyoga''''' (Abnormal contact of the ''Indriyas'', i.e., sensory and motor organs): Excessive utilization, underutilization or improper utilization of sensory and motor organs with their objects is called as ''Asatmyendriyarth Samyoga''.
#'''''Pragyaparadha''''' (intellectual errors): The errors in one’s ''dhee'' (intellect), ''dhriti'' (restraint) and ''smriti'' (memory) lead to improper activitites. These result in improper activities of body, mind and speech leading to vitiation of ''dosha''.
#'''''[[Prajnaparadha]]''''' (intellectual errors): The errors in one’s ''dhee'' (intellect), ''dhriti'' (restraint) and ''[[smriti]]'' (memory) lead to improper activitites. These result in improper activities of body, mind and speech leading to vitiation of ''[[dosha]]''.
#'''''Parinama''''' (changes in the timings and in age): Changes in weather conditions or climate could lead to changes in environment that cause disease. Also, as one ages, exposure to environmental elements could afflict a person adversely. These are collectively termed ''parinama''.
#'''''Parinama''''' (changes in the timings and in age): Changes in weather conditions or climate could lead to changes in environment that cause disease. Also, as one ages, exposure to environmental elements could afflict a person adversely. These are collectively termed ''parinama''.
Another classification is as follows:
Another classification is as follows:
#'''''Doshahetu''''' – These causes are directly responsible for the vitiation of ''doshas'' and that particular vitiated ''dosha'' becomes the cause of the disease.
#'''''Doshahetu''''' – These causes are directly responsible for the vitiation of ''[[dosha]]s'' and that particular vitiated ''[[dosha]]'' becomes the cause of the disease.
#'''''Vyadhihetu''''' – Such specific causative factors are directly responsible for the specific type of diseases. E.g., the use of ''sheetoshnaviparyaya'' (using hot and cold things at same time repeatedly) is a specific cause of ''kushtha'' (skin disease).
#'''''Vyadhihetu''''' – Such specific causative factors are directly responsible for the specific type of diseases. E.g., the use of ''sheetoshnaviparyaya'' (using hot and cold things at same time repeatedly) is a specific cause of ''kushtha'' (skin disease).
#'''''Ubhayahetu''''' – These causes are responsible for the vitiation of ''doshas'' as well as specific diseases e.g. continuous intake of sweets, unctuous and heavy diet is the cause of ''kaphadushti'' (''doshahetu''), as well as for ''kapha dosha'' dominant disorders (''vyadhihetu'') like ''sthaulya'' (obesity) and ''madhumeha'' (diabetes).
#'''''Ubhayahetu''''' – These causes are responsible for the vitiation of ''[[dosha]]s'' as well as specific diseases e.g. continuous intake of sweets, unctuous and heavy diet is the cause of ''[[kapha]] dushti'' (''doshahetu''), as well as for ''[[kapha dosha]]'' dominant disorders (''vyadhihetu'') like ''sthaulya'' (obesity) and ''madhumeha'' (diabetes).
==== D.Fourth classification ====
==== D. Fourth classification ====
This classification describes ''nidana'' to be of two types:
This classification describes ''nidana'' to be of two types:
#'''''Utpadakahetu''''': These are the direct and primary causes of diseases which do not require the support of any other causes like dietetic, behavioral, psychological, accident, poisons etc.
#'''''Utpadakahetu''''': These are the direct and primary causes of diseases which do not require the support of any other causes like dietetic, behavioral, psychological, accident, poisons etc.
#'''''Vyanjakahetu''''' – (The supportive causes of the diseases): These are the indirect causes of the diseases and become supportive to the ''utpadaka hetu''. For example, the seasons, or time of the day (early morning, midday, evening, midnight) are the ''vyanjakahetu'' for various diseases.
#'''''Vyanjakahetu''''' – (The supportive causes of the diseases): These are the indirect causes of the diseases and become supportive to the ''utpadaka [[hetu]]''. For example, the seasons, or time of the day (early morning, midday, evening, midnight) are the ''vyanjakahetu'' for various diseases.
==== E.Fifth Classification ====
==== E.Fifth Classification ====
#'''''Bahyahetu''''' (external causative factors): The causative factors like abnormal diet, activities and seasonal effects which create the disease are termed as ''bahyahetu''.
#'''''Bahyahetu''''' (external causative factors): The causative factors like abnormal diet, activities and seasonal effects which create the disease are termed as ''bahyahetu''.
#'''''Abhyantarahetu''''' (Internal causative factors): Imbalance of the ''dosha, dhatu'' and ''mala'' along with psycho-sensory dysfunctions as well malfunctions of ''agni'' are termed as ''abhyantarahetu''.
#'''''Abhyantarahetu''''' (Internal causative factors): Imbalance of the ''[[dosha]], [[dhatu]]'' and ''[[mala]]'' along with psycho-sensory dysfunctions as well malfunctions of ''agni'' are termed as ''abhyantarahetu''.
==== F.Sixth Classification ====
==== F.Sixth Classification ====
This classifies ''nidana'' into the following types:
This classifies ''nidana'' into the following types:
#'''''Prakritahetu''''': Natural aggravation of ''doshas'' in the respective seasons and age is called as ''prakritahetu'' which does not cause the disease alone but with the help of other aggravating factors may cause the disease.
#'''''Prakritahetu''''': Natural aggravation of ''[[dosha]]s'' in the respective seasons and age is called as ''prakritahetu'' which does not cause the disease alone but with the help of other aggravating factors may cause the disease.
#'''''Vaikritahetu''''': If ''doshas'' are aggravated in the seasons other than their natural aggravation time and create the disease then they are termed as ''vaikritahetu''. E.g. Aggravation of ''pitta dosha'' in ''Vasanta'' (spring) season. (natural aggravation time of ''pitta dosha'' is ''Sharada ritu''.)(7) [9]
#'''''Vaikritahetu''''': If ''[[dosha]]s'' are aggravated in the seasons other than their natural aggravation time and create the disease then they are termed as ''vaikritahetu''. E.g. Aggravation of ''[[pitta dosha]]'' in ''Vasanta'' (spring) season. (natural aggravation time of ''[[pitta dosha]]'' is ''Sharada ritu''.)(7) <ref>Madhavakar, Madhava Nidanam, Chap.1, Pancha Nidanalakshanam, Verse 8. In: Prof. Yadunandana Upadhyaya, Editor. Madhava Nidanam. 30th ed. Varanasi: Chaukhambha Sanskrit Sansthana; 2000.p.196. </ref>
==== ''Poorvarupa'' (premonitory signs) ====
==== ''Poorvarupa'' (premonitory signs) ====
There are two types of ''Poorvarupa'':
There are two types of ''Poorvarupa'':
#Incomplete manifestation of the symptoms before the appearance of the disease.
#Incomplete manifestation of the symptoms before the appearance of the disease.
#''Poorvarupa'' caused due to ''doshadushyasammurchana'' (interaction of vitiated ''dosha'' and ''dushya'') that are different from the previous ones. e.g. feeling of hatred towards children or horripilation seen in ''jwara''. These types of ''poorvarupas'' are not seen when the ''jwara'' is manifested completely. But if they are seen then the prognosis of the disease is ''asadhyata'' (incurable). These signs are symptomatic of the diseases to be seen in the near future and do not indicate ''dosha'' predominance in that disease.
#''Poorvarupa'' caused due to ''doshadushyasammurchana'' (interaction of vitiated ''[[dosha]]'' and ''[[dushya]]'') that are different from the previous ones. e.g. feeling of hatred towards children or horripilation seen in ''[[jwara]]''. These types of ''poorvarupas'' are not seen when the ''[[jwara]]'' is manifested completely. But if they are seen then the prognosis of the disease is ''asadhyata'' (incurable). These signs are symptomatic of the diseases to be seen in the near future and do not indicate ''[[dosha]]'' predominance in that disease.
In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease. [10]
In some acute diseases, the disease is presented directly with signs and symptoms. In these cases, the unmanifested form of the actual symptoms (''rupa'') described in the text should be treated as the ''poorvarupa'' of a disease. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/8]
Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''doshas'' as they are mild (not clearly recognizable) and few in number. (A. H. Ni. 1/) [11]. This is also substantiated in the Ashtanga Sangraha (A S Ni 1/8) [13]
Vagbhata opines that ''poorvarupa'' are signs and symptoms that appear earlier to the actual disease, not specifically assignable to the ''[[dosha]]s'' as they are mild (not clearly recognizable) and few in number. [A.H. Nidhana Sthana. 1/3] This is also substantiated in the Ashtanga Sangraha <ref>Vridha Vagbhata. Nidana Sthana, Cha.1 Sarvaroganidana Adhyaya verse 11. In: D V Pandit Rao, Editor. Ashtanga Sangraha. 1st ed. New Delhi: CCRAS;1991 </ref>
Gangadhara, commentator of [[Charak Samhita]], describes two types of ''Poorvarupa'':
Gangadhara, commentator of [[Charaka Samhita]], describes two types of ''Poorvarupa'':
#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''[[dosha]]s''.
#'''''Samanya Poorvarupa''''' (general premonitory features): These are the general symptoms of disease which appear before the manifestation of the disease but do not indicate affliction of ''doshas''.
#'''''Vishesha Poorvarupa''''' (specific premonitory features): These are the general symptoms of disease which manifest before the manifestation of the disease and indicate involvement of ''[[dosha]]s''.[Gangadhar on Cha.Sa.[[Nidana Sthana]].1/5]
#'''''Vishesha Poorvarupa''''' (specific premonitory features): These are the general symptoms of disease which manifest before the manifestation of the disease and indicate involvement of ''doshas''. [12]
==== ''Rupa'' (clinical signs and symptoms) ====
==== ''Rupa'' (clinical signs and symptoms) ====
''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''doshas'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''. [14].
''Rupa'' indicates the specific characteristics of the disease as it progresses, such as the dominance of ''[[dosha]]s'', various stages viz., ''ama'' (immature), ''pakva'' (mature), etc. They however, do not include such other factors of diagnosis of the diseases like ''nidana, upashaya'' and ''samprapti''.[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/9]
''Rupa'' includes the following signs and symptoms:
''Rupa'' includes the following signs and symptoms:
#Invariable symptoms of the diseases like hyperpyrexia.
#Invariable symptoms of the diseases like hyperpyrexia.
#Symptoms caused by the vitiation of ''doshas'' like irregularity in onset and relief of attacks which is characteristic feature of fever caused by the vitiation of ''vata dosha''.
#Symptoms caused by the vitiation of ''[[dosha]]s'' like irregularity in onset and relief of attacks which is characteristic feature of fever caused by the vitiation of ''[[vata dosha]]''.
#Symptoms indicative of specific stages of the diseases like those observed during ''ama'' (immature), ''pakva'' (mature), and ''jeerna'' (chronic) stage.
#Symptoms indicative of specific stages of the diseases like those observed during ''ama'' (immature), ''pakva'' (mature), and ''jeerna'' (chronic) stage.
#Symptoms arise due to the complication of the diseases indicating their incurability.
#Symptoms arise due to the complication of the diseases indicating their incurability.
Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]
Hence, all these above synonyms quoted are indicative of such symptomatology which is scattered in different diseases. Any one term is not sufficient to define the ''rupa'' or ''lakshana'' entirely therefore these different terms have been collectively described here. [9]
''Upashaya'' (pacification):
===''Upashaya'' (pacification):===
''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups: [15]
''Upashaya'' implies such factors that bring about happiness. It provides diagnostic aid for diseases which are otherwise difficult to diagnose. ''Upashaya'' is broadly divided in two groups:[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/10]
#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.
#Drugs etc. that are antagonistic to the cause of the disease or the disease itself.
#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.
#Drugs etc. that are not antagonistic either to the cause of the disease or to the disease itself but when employed, they actually alleviate the condition by counteracting either the disease or the cause of it.
#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)
#''Hetu-vyadhi viparitarthakari aushadha'' (drugs which seem to be working against the causative factors and the disease though not actually so; i.e., working as placebos)
#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)
#''Hetu-vyadhi viparitarthakari anna'' (food which is working against the causative factors and the disease though not actually, i.e., working as placebo)
#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [16]
#''Hetu-vyadhi viparitarthakari vihara'' (regimen which is working against the causative factors and the disease though not actually against.) [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/10]
</div>
Various examples of ''upashaya'':
=====Various examples of ''upashaya'':=====
Usage of intoxicating alcohol against alcoholism induced due to consumption of excessive alcohol. Swimming therapy advised in the form of exercise in case of vatavyadhi manifested due to excessive exercise
{| class="wikitable"
! rowspan="1"| Upashaya
! rowspan="1"| Aushadha
! rowspan="1"| Anna
! rowspan="1"| Vihar
|-
| Hetu viparita || Usage of shunthi in sheeta kaphaja jwara due to its hotness. || Intake of meat juice in case of [[vata]] [[jwara]] and fatigue ||Remaining awake at night in aggravation of kapha dosha due to day sleeping
|-
| Vyadhi viparita || Use of antidiarrheal drugs like Patha etc. in diarrhea || Intake of food like masur etc. in diarrhoea due to its antidiarrheal property. || Pravahana improving downwards peristalsis is the treatment for udavarta rogi
|-
| Hetu-vyadhi viparita || Usage of dashmoola qwath in case of vataja jwara due to its vatahara and shothhara property || Usage of hot substances and antipyretic gruel against sheetotthajwara, which subsides cold and fever. ||Night awakening etc. which brings roughness in case of tandra, which is the result of consumption of Slimy substances followed by day sleeping.
|-
| Hetu viparitarthakari || Usage of vrishya drugs like pippali, shunthi etc. in case of shukrakshaya due to intake of excess pungent substances. || Usage of food substances which are hot in pachyamana shoth caused due to [[pitta dosha]]. || Inducing fear to the patients who are suffering from vataja unmada.
|-
| Vyadhi viparitarthakari || Usage of emetic drugs like madanaphala in case of chardi (vomitting) || Intake of milk in case of atisar, which induces purgation. || Inducing vomiting by external support in case of chardi.
|-
| Hetu-vyadhi viparitarthakari || Use of hot drugs like agaru dravya lepa in case of agniplushta dagdha (burn due to fire). || Usage of intoxicating alcohol against alcoholism induced due to consumption of excessive alcohol. || Swimming therapy advised in the form of exercise in case of vatavyadhi manifested due to excessive exercise
|-
|}
Vagbhata defines upashaya as satmya (compatible). (A H Ni. 1/).[17]
Vagbhata defines upashaya as satmya (compatible). [A.H Nidana Sthana.1/6]
In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]
In nutshell, upashaya is the therapeutic test that is helpful in diagnosing the doubtful stages of different diseases. This is adopted during differential diagnoses of the disease. [10]
==== ''Samprapti'' (pathogenesis) ====
==== ''Samprapti'' (pathogenesis) ====
<div style="text-align:justify;">
''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''dosha'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.
''Samprapti'' is a compound word meaning ''samyak aapti''/ ''prapti'' i.e. complete manifestation of a disease or the stage where the disease could be understood well. This pathogenesis explains the pattern of disequilibrium of ''[[dosha]]'' interacting with body tissues and thus, gives a clearer picture of disease. This covers all the six stages (''chayaprakopadi'') of the disease as told by Sushruta and the physician gets a complete understanding of the ''nidanas'' (causes), ''poorvarupas, rupas'' and ''upashayanupashaya'' with the help of ''samprapti''. Mostly patients come to physician when the process of ''samprapti'' is completed and at that time there may not be any existence of ''nidanas'' or ''poorvarupas''.
''Jati'' is a synonym of ''samprapti'' that indicates the ''janan'' (genesis) of the disease as explained above.
''Jati'' is a synonym of ''samprapti'' that indicates the ''janan'' (genesis) of the disease as explained above.
''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.
''Aagati'': Literally means the manifestation and remission of the disease. In this process of disease manifestation (''samprapti''), the physician gets the knowledge in the form of qualitative and quantitative progress of the disease.
While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end. [18]
While the symptoms of a disease manifest completely after pathogenesis (''samprapti''), still for the purpose of diagnosis, the knowledge of ''samprapti'' is not as important as the knowledge of ''linga'' (symptoms). Hence ''samprapti'' is described at the end. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11]
Vagbhata has defined these synonyms as: “The process of manifestation of the disease, by the morbid ''doshas'' (humors) which are circulating all over the body, is known as ''samprapti'' or ''jati'' or ''agati''. [A.H Nidana Sthana 1/8]<ref name=Hridaya>Vagbhata. Ashtanga Hridayam. Edited by Harishastri Paradkar Vaidya. 1st ed. Varanasi: Krishnadas Academy;2000.</ref> [11]
In order to allay the apprehension of incomplete description of ''samprapti'' for each disease, the ''samprapti'' in general of all diseases is described here in this chapter.[Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11]
Vagbhata has not described ''vidhi samprapti''. He has described only five kinds of ''samprapti'' i.e. ''samkhya, vikalpa, pradhanya, bala'' and ''kala samprapti''. [A.H Nidana Sthana 1/9]<ref name=Hridaya/> ''Pradhanya samprapti'' indicates the primacy of a ''samprapti''. [A.H Nidana Sthana 1/10]<ref name=Hridaya/> When a ''[[dosha]]'' gets vitiated and becomes a causative factor of a disease, it does not necessarily mean that all its attributes also get vitiated. Vitiation of ''[[vata]]'' for example may mean aggravation of its coldness, lightness or ununctuousness.
''Kala samprapti'' means the type that is governed by seasonal variations. Aggravation/ manifestation of ''shleshmika/kaphaja'' type of fever during winter season is the example of seasonal variation. Some [[Ayurveda]] practitioners attribute an extreme form of manifestation to deeds in the patient’s past life, and define ''vidhi samprapti'' as an affliction attributed to such deeds. [Chakrapani on Cha.Sa.[[Nidana Sthana]] 1/11] The timing of disease manifestation shows variation in the ''samprapti'' or pathogenesis. This aspect of ''samprapti'' helps in clearly determining the specific characteristics of a disease.
Vagbhata describes that ''bala samprapti'' is important to assess the severity of disease. [A.H Nidana Sthana 1/11]<ref name=Hridaya/> [12-5]
==== Significance of knowledge of ''nidana'' ====
#Knowledge of causative factors plays an important role in the prognosis of diseases. A disease becomes more difficult to cure with the rise in number of causative factors responsible for the diseases. [Cha.Sa.[[Sutra Sthana]] 10/14]
#''Nidanaparivarjana'' i.e. avoiding the causative factors of disease is the key principle professed here for the management of diseases. So in the absence of knowledge of causative factors, the management of the diseases will become difficult. [Cha.Sa.[[Vimana Sthana]] 7/30]
#Treatment of disease incorporates the use of drugs, food articles and regimen having opposite properties to that of causative factors which is not possible without knowledge of causative factors.
#To treat the newly originated diseases, a physician should have the knowledge of the involved ''[[dosha]]s'', causative factors and the location of the disease.
==== Significance of knowledge of ''poorvarupa'' ====
#[[Charak Samhita]] suggests specific modalities for treatment of a patient at this stage. E.g. Light food and ''apatarpana'' treatment should be give when premonitory signs of fever are seen.
#Manifestation of all the premonitory signs indicates bad prognosis of the disease.
#''Poorvarupa'' has significant role in the differential diagnosis of the disease.
==== Significance of knowledge of ''rupa'' ====
#It has the same importance as that of ''nidana'' and ''poorvarupa'' in the prognosis of diseases. Rise in number of ''rupa'' makes the disease difficult to cure.
#''Rupa'' denotes the complete manifestation of the disease along with its ''[[dosha]]'' predominance. The diseases can be treated in a proper way if one is having the knowledge of all the sign and symptoms and the ''[[dosha]]'' responsible for it.
==== Significance of knowledge of ''upashaya'' ====
#Knowledge of ''upashaya'' is helpful in differential diagnosis of diseases.
#It also helps in identifying the diseases which are not clearly manifested.
==== Significance of knowledge of ''samprapti'' ====
=== References ===
#''Samprapti'' provides the details of the diseases such as ''[[dosha]]'' predominance, predominance of one or the other fraction of the three ''[[dosha]]s'', specific time of aggravation, and manifestation of diseases which plays a pivotal role in the management of diseases.
#The important role of a physician in the management of diseases is ''sampraptibhanga'' i.e. to break the association of vitiated ''[[dosha]]'' and ''[[dushya]]'' (tissue that gets vitiated). This is not possible without proper knowledge of ''samprapti''.
==== ''Nidanapanchaka'' and ''shat kriyakala'' ====
Sushruta described six stages of ''[[dosha]]'' vitiation and progression of disease known as ''shat kriyakala'' (periods of activity). They are as under:
*''Sanchaya'' (accumulation): In this stage ''[[dosha]]'' undergo mild increase at their own site. This accumulation produces mild symptoms. If the person recognises these instincts and acts accordingly, the ''[[dosha]]s'' can be brought to the normal condition without much effort. [Su.Sa.Sutra Sthana 21/18]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>
*''Prakopa'' (aggravation): In this stage, ''[[dosha]]s'' gets vitiated further at their own site and exhibit some specific symptoms. By suitable changes in daily routine one can overcome these conditions. [Su.Sa.Sutra Sthana 21/27]<ref name=Susruta/>
*''Prasara'' (spreading): The status of ''[[dosha]]s'' again increases further and ''[[dosha]]s'' spread nearby sites and invade the sites of other ''[[dosha]]s'' to produce symptoms. If the person continues to indulge in unhealthy food and regimen, then the disease progresses to the next stage. [Dalhana on Su.Sa.Sutra Sthana 21/32]<ref name=Susruta/>
During the first three stages, the unhealthy food and activities increases the ''[[dosha]]s'' and produces mild abnormalities. These three stages can be co-related with ''nidana'' (''hetu'') of ''nidanapanchaka''.
*''Sthanasanshraya'' (localisation): The increased ''[[dosha]]s'' start accumulating at certain other places and lead to their abnormalities, especially in the ''srotasa''. It leads to four kinds of abnormal changes in ''srotasa''. [Su.Sa.Sutra Sthana 21/36]
**''Atipravritti'' – Increased functioning of channels
**''Sanga'' – Obstruction, blockage of channels
**''Sira-Granthi'' – Abnormal growths in the channels
**''Vimargagamana'' – Movement of fluids in wrong direction
The site where these ''[[dosha]]s'' lodge together to progress towards disease, is the site of origin of disease. This is the stage of actual commencement of the disease. It is characterized by manifestation of some moderate symptoms which indicate the forthcoming disease. These are known as ''poorvarupa''. This stage can be co-related with ''poorvarupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/33]<ref name=Susruta/>
*''Vyakti'' (manifestation): This is the stage of full manifestation of the disease with all its characteristic sign and symptoms. These sign and symptoms are known as ''rupa''. This stage can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/34]<ref name=Susruta/>
*''Bheda'' (complication): In this stage, the abnormalities become more profound and irreversible in spite of the best treatment. Sometimes ''upadravas'' (complications) or ''arishta lakshanas'' (bad prognostic signs) can be seen in this stage. This stage also can be co-related with ''rupa'' of ''nidanapanchaka''. [Dalhana on Su. Sa. Sutra Sthana 21/35]<ref name=Susruta/>
The abnormal changes taking place in the body after exposure to the causative factors up to the manifestation of the disease is called as ''samprapti''. This includes progress of the disease from first to sixth ''kriyakala''.
</div>
====Interrelation between ''nidanapanchaka'' and ''shatkriyakala'' ====
{| class="wikitable"
! rowspan="1"| Sr. No.
! rowspan="1"| Shatkriyakala
! colspan="2"| Nidanapanchaka
|-
| 1 || Sanchaya || rowspan="3" |Hetu (Nidana) || rowspan="6" | SAMPRAPTI<p style="text-align:center;font-size:50px">⇩</p>
|-
| 2 || Prakopa
|-
| 3 || Prasara
|-
| 4 || Sthanasanshraya || Poorvarupa
|-
| 5 || Vyakti ||rowspan="3" | Rupa, Upashaya
|-
| 6 || Bheda
|-
|}
==== Shatkriyakala of ''Jwara'' as compared with pathogenesis of fever ====
<div style="text-align:justify;">
Sr. No. Shatkriyakala Condition as per dosha In Fever
{| class="wikitable"
! rowspan="1"| Sr. No.
! rowspan="1"| Shatkriyakala
! rowspan="1"| Condition as per dosha
! rowspan="1"| In Fever
|-
| || Sanchaya || it is the stage of accumulation or the stage which represents the inceptive phase of the disease wherein the [[dosha]] are stated to have accumulated and stagnated in its own place
instead of freely circulating as in its normal avastha or phase.
instead of freely circulating as in its normal avastha or phase.
|| it is the pyrogen which may be exogenous (bacterial substance lipopolysaccharide (LPS) present on bacterial cell wall) or endogenous (cytokines, Interleukin-1 and Interleukin-6 etc). These pyrogens enter the body and activate the immune cells (antigen presenting cell) for the formation of cytokines and other factors or due to endogenous cause too activation of immune system takes place.
|-
| || Prakopa || In this stage [[dosha]] gets vitiated or aggravated or the [[dosha]] previously accumulated/ stagnated get swollen and excited Vilayana here means bonding (samhata) is loss and [[dosha]] gets released. || Exogenous factors contain immunological protein called lipo-polysaccharide binding protein (LBP) which binds to LPS. The LBP-LPS complex then binds to the CD14 receptors of a nearby macrophage. It causes synthesis and release of various endogenous cytokines factors such as IL-1, IL-6, Tumour Necrosing Factor alpha (TNFα).
|-
| || Prasara || The third phase signifies to spread which generally takes place with help of [[vata]] and [[rakta]]. [[Dosha]] are stated to spread over and extend to other parts of the body. || the cytokine factors are released into general circulation, where they migrate to the cytokine factors are released into general circulation, where they migrate to the circumventricular organs of the brain due to easier absorption caused by the blood–brain barrier's reduced filtration action there. The cytokine factors then bind with endothelial receptors on vessel walls, or interact with local microglial cells. When these cytokine factors bind, the arachidonic acid pathway is then activated. Prostaglandin E2 (PGE2) is released which is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase.
|-
| || sthanasanshrayam || It is prodromal phase or the phase of poorvarupa wherein disease is yet to be manifested fully. The excited [[dosha]] having extended to other parts of the body become localized and it marks the beginning of specific diseases pertaining to those sthan/ structures. It is also known as the stage of disease augmentation. Sthana samshraya means taking shelter in a place. || PGE2 is the ultimate mediator of the febrile response. PGE2 acts on neurons in the preoptic area (POA) through the prostaglandin E receptor 3 (EP3). EP3-expressing neurons in the POA innervate the dorsomedial hypothalamus (DMH), the rostral raphe pallidus nucleus in the medulla oblongata (rRPa), and the paraventricular nucleus (PVN) of the hypothalamus. Fever signals sent to the DMH and rRPa lead to stimulation of the sympathetic output system, which evokes non-shivering thermo-genesis to produce body heat and skin vasoconstriction to decrease heat loss from the body surface. It is presumed that the innervations from the POA to the PVN mediates the neuroendocrine effects of fever through the pathway involving pituitary gland and various endocrine organs.
|-
| || Vyakti || This stage may be stated to be that of manifestation of the fully developed disease- the resultant [[dosha]] [[dushya]] samurchana || the brain ultimately orchestrates heat effector mechanisms via the autonomic nervous system. It causes increased heat production by increased muscle tone, shivering and hormones like epinephrine (adrenaline) and also prevents heat loss by way of vasoconstriction.
|-
| || Bheda || It is the stage in which the disease may become sub-acute and chronic or incurable. Different types or variant of disease gets manifested. || In case of fever signs like increased blood pressure, neck stiffness, headache, giddiness, unconsciousness etc are seen in this phase.
|-
|}
</div>
=== Related Chapters ===
[[Jwara Chikitsa]], [[Jwara]]
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