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Line 1,124: + + − These aggravated dosha either alone or in the combination of two or three, spread along with the rasa dhatu (the first dhatu responsible for nourishment of the body) and displace the jatharagni from its own place. Supplemented by the dosha’s own heat and the heat of the jatharagni, the heat of the body gets accentuated and they are further aggravated by the blockage of the circulatory channels. It then pervades the entire body to produce excessive heat. Therefore, the temperature increases all over the body and this condition is called jwara.(129-132) − Cause of lack of sweating: − Line 1,126:
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→Five types of jwara as per frequency
==== Five types of jwara as per frequency ====
==== Five types of jwara as per frequency ====
Santata jwara:
===== Santata jwara =====
स्रोतोभिर्विसृता दोषा गुरवो रसवाहिभिः||५३||
स्रोतोभिर्विसृता दोषा गुरवो रसवाहिभिः||५३||
सर्वदेहानुगाः स्तब्धा ज्वरं कुर्वन्ति सन्ततम्|
सर्वदेहानुगाः स्तब्धा ज्वरं कुर्वन्ति सन्ततम्|
Additionally, the other dhatu, urine, stool and vata etc. dosha, also get affected simultaneously in this fever. If the involved factors like rasa are purified optimally the fever gets subsided in either 7 or 10 or 12 days, otherwise, the fever kills the patient within that period.
Additionally, the other dhatu, urine, stool and vata etc. dosha, also get affected simultaneously in this fever. If the involved factors like rasa are purified optimally the fever gets subsided in either 7 or 10 or 12 days, otherwise, the fever kills the patient within that period.
If, some of the 12 constituents of this fever get purified, while some others remain unpurified, then the fever goes in latent stage on the 12th day and reappears on the 13th day and may persist for longer duration. In this way, a physician should understand the causes and features of this type of fever and should initiate the treatment only after a proper understanding of these factors, mostly by the methods beginning with apatarpana. (53-61)
If, some of the 12 constituents of this fever get purified, while some others remain unpurified, then the fever goes in latent stage on the 12th day and reappears on the 13th day and may persist for longer duration. In this way, a physician should understand the causes and features of this type of fever and should initiate the treatment only after a proper understanding of these factors, mostly by the methods beginning with apatarpana. (53-61)
Satata jwara:
===== Satata jwara =====
रक्तधात्वाश्रयः प्रायो दोषः सततकं ज्वरम्||६१||
रक्तधात्वाश्रयः प्रायो दोषः सततकं ज्वरम्||६१||
सप्रत्यनीकः कुरुते कालवृद्धिक्षयात्मकम्|
सप्रत्यनीकः कुरुते कालवृद्धिक्षयात्मकम्|
ahorAtre satatako dvau kAlAvanuvartate||62||
ahorAtre satatako dvau kAlAvanuvartate||62||
The aggravated dosha when generally lodges in the rakta dhatu, then they manifest with fever twice in 24 hours (Nycthemeron) depending on the time of dosha aggravation or subsidence. The dosha in this type of jwara can be counteracted. (61-62)
The aggravated dosha when generally lodges in the rakta dhatu, then they manifest with fever twice in 24 hours (Nycthemeron) depending on the time of dosha aggravation or subsidence. The dosha in this type of jwara can be counteracted. (61-62)
Anyedyushka jwara:
===== Anyedyushka jwara =====
कालप्रकृतिदूष्याणां प्राप्यैवान्यतमाद्बलम्|
कालप्रकृतिदूष्याणां प्राप्यैवान्यतमाद्बलम्|
अन्येद्युष्कं ज्वरं दोषो रुद्ध्वा मेदोवहाः सिराः||६३||
अन्येद्युष्कं ज्वरं दोषो रुद्ध्वा मेदोवहाः सिराः||६३||
sapratyanIko janayatyekakAlamaharnishi|
sapratyanIko janayatyekakAlamaharnishi|
Vitiated dosha produce anyedushka type of jwara with the support of any one factor amongst the kala (time), prakriti (physical constitution) and dushya (vitiated factors) leading to obstruction in medo vaha sira (the channel of circulation of medasa (fat)). It can be counteracted. This jwara occurs only once during day and night. (63-64)
Vitiated dosha produce anyedushka type of jwara with the support of any one factor amongst the kala (time), prakriti (physical constitution) and dushya (vitiated factors) leading to obstruction in medo vaha sira (the channel of circulation of medasa (fat)). It can be counteracted. This jwara occurs only once during day and night. (63-64)
Tritiyaka and chaturthaka jwara:
===== Tritiyaka and chaturthaka jwara =====
दोषोऽस्थिमज्जगः कुर्यात्तृतीयकचतुर्थकौ||६४||
दोषोऽस्थिमज्जगः कुर्यात्तृतीयकचतुर्थकौ||६४||
गतिर्द्व्येकान्तराऽन्येद्युर्दोषस्योक्ताऽन्यथा परैः|
गतिर्द्व्येकान्तराऽन्येद्युर्दोषस्योक्ताऽन्यथा परैः|
Some scholars opine that the different types of jwara viz the anyedushaka, tritiyaka and chaturthaka jwara manifest because of the affliction of the some alternate dhatu by the dosha. Anyedushyaka jwara is caused by the affliction of rakta dhatu (blood) also. Tritiyaka jwara manifests when the dosha afflict the mansa dhatu (muscular tissues). Dosha lodging in the channels of circulation of medo dhatu cause chaturthaka jwara.
Some scholars opine that the different types of jwara viz the anyedushaka, tritiyaka and chaturthaka jwara manifest because of the affliction of the some alternate dhatu by the dosha. Anyedushyaka jwara is caused by the affliction of rakta dhatu (blood) also. Tritiyaka jwara manifests when the dosha afflict the mansa dhatu (muscular tissues). Dosha lodging in the channels of circulation of medo dhatu cause chaturthaka jwara.
Anyedushka jwara occurs every day, while tritiyaka jwara occurs after a gap of one day and chaurthaka occurs after two days gap. (64-67)
Anyedushka jwara occurs every day, while tritiyaka jwara occurs after a gap of one day and chaurthaka occurs after two days gap. (64-67)
Cause of alterations in jwara episodes:
==== Cause of alterations in jwara episodes ====
अधिशेते यथा भूमिं बीजं काले च रोहति|
अधिशेते यथा भूमिं बीजं काले च रोहति|
अधिशेते तथा धातुं दोषः काले च कुप्यति||६८||
अधिशेते तथा धातुं दोषः काले च कुप्यति||६८||
¨ Calf region is afflicted in the in the beginning by the vitiation of kapha
¨ Calf region is afflicted in the in the beginning by the vitiation of kapha
¨ Head region is afflicted in the beginning by the vitiation of vata. (70-72)
¨ Head region is afflicted in the beginning by the vitiation of vata. (70-72)
विषमज्वर एवान्यश्चतुर्थकविपर्ययः|
त्रिविधो धातुरेकैको द्विधातुस्थः करोति यम्||७३||
त्रिविधो धातुरेकैको द्विधातुस्थः करोति यम्||७३||
viṣamajwara ēvānyaścaturthakaviparyayaḥ|
viṣamajwara ēvānyaścaturthakaviparyayaḥ|
Chaturthaka viparyaya jwara is another variety of vishama jwara. Each of the three dosha i.e. vata, pitta and kapha cause this disease by afflicting the two dhatu viz asthi (bone) and majja (bone marrow).(73)
Chaturthaka viparyaya jwara is another variety of vishama jwara. Each of the three dosha i.e. vata, pitta and kapha cause this disease by afflicting the two dhatu viz asthi (bone) and majja (bone marrow).(73)
प्रायशः सन्निपातेन दृष्टः पञ्चविधो ज्वरः|
प्रायशः सन्निपातेन दृष्टः पञ्चविधो ज्वरः|
सन्निपाते तु यो भूयान् स दोषः परिकीर्तितः||७४||
सन्निपाते तु यो भूयान् स दोषः परिकीर्तितः||७४||
sannipAte tu yo bhUyAn sa doShaH parikIrtitaH||74||
sannipAte tu yo bhUyAn sa doShaH parikIrtitaH||74||
These five types of jwara are mostly caused by sannipata (simultaneous vitiation of the three dosha), however, the dosha, which is predominant among the three doshas is generally attributed as the causative factors. (74)
These five types of jwara are mostly caused by sannipata (simultaneous vitiation of the three dosha), however, the dosha, which is predominant among the three doshas is generally attributed as the causative factors. (74)
Dhatugata jwara:
==== Dhatugata jwara =====
ऋत्वहोरात्रदोषाणां मनसश्च बलाबलात्|
ऋत्वहोरात्रदोषाणां मनसश्च बलाबलात्|
कालमर्थवशाच्चैव ज्वरस्तं तं प्रपद्यते||७५||
कालमर्थवशाच्चैव ज्वरस्तं तं प्रपद्यते||७५||
rasaraktāśritaḥ sādhyō mēdōmāṁsagataśca yaḥ|
rasaraktāśritaḥ sādhyō mēdōmāṁsagataśca yaḥ|
asthimajjagataḥ kr̥cchraḥ śukrasthō naiva siddhyati||83||
asthimajjagataḥ kr̥cchraḥ śukrasthō naiva siddhyati||83||
RutvahorAtradoShANAM manasashca balAbalAt|
RutvahorAtradoShANAM manasashca balAbalAt|
vi. When the vitiated dosha are located in the majja dhatu then the following signs and symptoms appear – hiccup, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation.
vi. When the vitiated dosha are located in the majja dhatu then the following signs and symptoms appear – hiccup, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation.
vii. Vitiated dosha causing jwara located in the sukra dhatu cause ejaculation and destruction of shukra resulting in the extinction of life along with vayu, agni and soma of the subtle body (sukshma sharira).
vii. Vitiated dosha causing jwara located in the sukra dhatu cause ejaculation and destruction of shukra resulting in the extinction of life along with vayu, agni and soma of the subtle body (sukshma sharira).
The jwara in which doshas are located in the rasa, rakta, mamsa and medas dhatu are curable, while those in which the location is in the asthi and majja dhatu are difficult to treat. The jwara in which the vitiated dosha are located in shukra dhatu is incurable. (75-83)
The jwara in which doshas are located in the rasa, rakta, mamsa and medas dhatu are curable, while those in which the location is in the asthi and majja dhatu are difficult to treat. The jwara in which the vitiated dosha are located in shukra dhatu is incurable. (75-83)
Clinical features of jwara due to combination of two dosha:
==== Clinical features of jwara due to combination of two dosha ====
हेतुभिर्लक्षणैश्चोक्तः पूर्वमष्टविधो ज्वरः|
हेतुभिर्लक्षणैश्चोक्तः पूर्वमष्टविधो ज्वरः|
समासेनोपदिष्टस्य व्यासतः शृणु लक्षणम्||८४||
समासेनोपदिष्टस्य व्यासतः शृणु लक्षणम्||८४||
Frequently changing sensation of hot and cold, frequent increased or decreased sweating, delusions, cough, anorexia, thirst, elimination of phlegm and bile, coating and bitterness in the mouth and drowsiness – all are the clinical features of jwara caused by kapha and pitta.
Frequently changing sensation of hot and cold, frequent increased or decreased sweating, delusions, cough, anorexia, thirst, elimination of phlegm and bile, coating and bitterness in the mouth and drowsiness – all are the clinical features of jwara caused by kapha and pitta.
Thus, here the features of different types of jwara caused by the simultaneous vitiation of two dosa have been described. (84-89)
Thus, here the features of different types of jwara caused by the simultaneous vitiation of two dosa have been described. (84-89)
Sannipataja jwara:
==== Sannipataja jwara ====
... सन्निपातज उच्यते||८९||
... सन्निपातज उच्यते||८९||
सन्निपातज्वरस्योर्ध्वं त्रयोदशविधस्य हि|
सन्निपातज्वरस्योर्ध्वं त्रयोदशविधस्य हि|
mUkatvaM srotasAM pAko gurutvamudarasya ca||108||
mUkatvaM srotasAM pAko gurutvamudarasya ca||108||
cirAt pAkashca doShANAM sannipAtajwarakRutiH|109|
cirAt pAkashca doShANAM sannipAtajwarakRutiH|109|
Description of sannipataja jwara (caused by combined tridosha):
Description of sannipataja jwara (caused by combined tridosha):
¨ Heaviness in the abdomen
¨ Heaviness in the abdomen
¨ The doshas undergo paka after a very long time (conversion into the healthy state of the doshas do not occur early). (103-109)
¨ The doshas undergo paka after a very long time (conversion into the healthy state of the doshas do not occur early). (103-109)
Prognosis of sannipata jwara:
==== Prognosis of sannipata jwara ====
दोषे विबद्धे नष्टेऽग्नौ सर्वसम्पूर्णलक्षणः||१०९||
दोषे विबद्धे नष्टेऽग्नौ सर्वसम्पूर्णलक्षणः||१०९||
सन्निपातज्वरोऽसाध्यः कृच्छ्रसाध्यस्त्वतोऽन्यथा|११०|
सन्निपातज्वरोऽसाध्यः कृच्छ्रसाध्यस्त्वतोऽन्यथा|११०|
निदाने त्रिविधा प्रोक्ता या पृथग्जज्वराकृतिः||११०||
निदाने त्रिविधा प्रोक्ता या पृथग्जज्वराकृतिः||११०||
संसर्गसन्निपातानां तया चोक्तं स्वलक्षणम्|१११|
संसर्गसन्निपातानां तया चोक्तं स्वलक्षणम्|१११|
dōṣē vibaddhē naṣṭē'gnau sarvasampūrṇalakṣaṇaḥ||109||
dōṣē vibaddhē naṣṭē'gnau sarvasampūrṇalakṣaṇaḥ||109||
If there is obstruction (or non – elimination) of the dosha, the agnis are completely destroyed and if all the signs and symptoms are fully manifested, then sannipata jwara is incurable; otherwise it is treatable with difficulty.
If there is obstruction (or non – elimination) of the dosha, the agnis are completely destroyed and if all the signs and symptoms are fully manifested, then sannipata jwara is incurable; otherwise it is treatable with difficulty.
The clinical features of jwaras caused by the individual doshas vata, pitta and kapha have been described separately in the nidana sthana. From these sign and symptoms, the features of dwandaja types and the sannipataja typs can be known and decided. (109-110)
The clinical features of jwaras caused by the individual doshas vata, pitta and kapha have been described separately in the nidana sthana. From these sign and symptoms, the features of dwandaja types and the sannipataja typs can be known and decided. (109-110)
Classification of agantuja jwara:
==== Classification of agantuja jwara ====
आगन्तुरष्टमो यस्तु स निर्दिष्टश्चतुर्विधः||१११||
आगन्तुरष्टमो यस्तु स निर्दिष्टश्चतुर्विधः||१११||
अभिघाताभिषङ्गाभ्यामभिचाराभिशापतः|
अभिघाताभिषङ्गाभ्यामभिचाराभिशापतः|
abhighAtAbhiSha~ggAbhyAmabhicArAbhishApataH|
abhighAtAbhiSha~ggAbhyAmabhicArAbhishApataH|
The eighth type of jwara i.e. agantuja type (that caused due to external/exogenous factors) is of four types, viz: abhihataja, abhishangaja, abhicharaja and abhishapaja.(111)
The eighth type of jwara i.e. agantuja type (that caused due to external/exogenous factors) is of four types, viz: abhihataja, abhishangaja, abhicharaja and abhishapaja.(111)
Abhighataja jwara (due to injury or trauma):
==== Abhighataja jwara (due to injury or trauma) ====
शस्त्रलोष्टकशाकाष्ठमुष्ट्यरत्नितलद्विजैः||११२||
शस्त्रलोष्टकशाकाष्ठमुष्ट्यरत्नितलद्विजैः||११२||
तद्विधैश्च हते गात्रे ज्वरः स्यादभिघातजः|
तद्विधैश्च हते गात्रे ज्वरः स्यादभिघातजः|
savyathAshophavaivarNyaM karoti sarujaM jvaram|114|
savyathAshophavaivarNyaM karoti sarujaM jvaram|114|
The jwara caused by the injury from weapons, stones, hunters, wood, fist, palm of the sole, teeth and such other things is called abhighataja. In this type, vitiated vata affects predominantly rakta (blood) to resulting in jwara with discomfort, swelling, discoloration and pain.(112-114)
The jwara caused by the injury from weapons, stones, hunters, wood, fist, palm of the sole, teeth and such other things is called abhighataja. In this type, vitiated vata affects predominantly rakta (blood) to resulting in jwara with discomfort, swelling, discoloration and pain.(112-114)
Abhishangaja, abhishapaja and abhicharaja jwara:
==== Abhishangaja, abhishapaja and abhicharaja jwara ====
कामशोकभयक्रोधैरभिषक्तस्य यो ज्वरः||११४||
कामशोकभयक्रोधैरभिषक्तस्य यो ज्वरः||११४||
सोऽभिषङ्गाज्वरो ज्ञेयो यश्च भूताभिषङ्गजः|
सोऽभिषङ्गाज्वरो ज्ञेयो यश्च भूताभिषङ्गजः|
ते पूर्वं केवलाः पश्चान्निजैर्व्यामिश्रलक्षणाः||१२८||
ते पूर्वं केवलाः पश्चान्निजैर्व्यामिश्रलक्षणाः||१२८||
हेत्वौषधविशिष्टाश्च भवन्त्यागन्तवो ज्वराः|१२९|
हेत्वौषधविशिष्टाश्च भवन्त्यागन्तवो ज्वराः|१२९|
kāmaśōkabhayakrōdhairabhiṣaktasya yō jvaraḥ||114||
kāmaśōkabhayakrōdhairabhiṣaktasya yō jvaraḥ||114||
The jwara caused by external causes are at first independent but later they get mixed up with the signs and symptoms of nija jwara (endogenous fevers). However, these agantuja jwaras have their own aetiological factors and treatments. (114-129)
The jwara caused by external causes are at first independent but later they get mixed up with the signs and symptoms of nija jwara (endogenous fevers). However, these agantuja jwaras have their own aetiological factors and treatments. (114-129)
==== General patho-physiology of jwara ====
संसृष्टाः सन्निपतिताः पृथग्वा कुपिता मलाः||१२९||
संसृष्टाः सन्निपतिताः पृथग्वा कुपिता मलाः||१२९||
रसाख्यं धातुमन्वेत्य पक्तिं स्थानान्निरस्य च|
रसाख्यं धातुमन्वेत्य पक्तिं स्थानान्निरस्य च|
bhavatyatyuShNasarvA~ggo jvaritastena cocyate|132|
bhavatyatyuShNasarvA~ggo jvaritastena cocyate|132|
These aggravated dosha either alone or in the combination of two or three, spread along with the rasa dhatu (the first dhatu responsible for nourishment of the body) and displace the jatharagni from its own place. Supplemented by the dosha’s own heat and the heat of the jatharagni, the heat of the body gets accentuated and they are further aggravated by the blockage of the circulatory channels. It then pervades the entire body to produce excessive heat. Therefore, the temperature increases all over the body and this condition is called jwara.(129-132)
==== Cause of lack of sweating ====
स्रोतसां सन्निरुद्धत्वात् स्वेदं ना नाधिगच्छति||१३२||
स्रोतसां सन्निरुद्धत्वात् स्वेदं ना नाधिगच्छति||१३२||
स्वस्थानात् प्रच्युते चाग्नौ प्रायशस्तरुणेज्वरे|१३३|
स्वस्थानात् प्रच्युते चाग्नौ प्रायशस्तरुणेज्वरे|१३३|
srōtasāṁ sanniruddhatvāt svēdaṁ nā nādhigacchati||132||
srōtasāṁ sanniruddhatvāt svēdaṁ nā nādhigacchati||132||
svasthānāt pracyutē cāgnau prāyaśastaruṇējvarē|133|
svasthānāt pracyutē cāgnau prāyaśastaruṇējvarē|133|
srotasAM sanniruddhatvAt svedaM nA nAdhigacchati||132||
srotasAM sanniruddhatvAt svedaM nA nAdhigacchati||132||
A person suffering from taruna jwara (the initial stage of jwara) does not sweat because of the obstruction of the channels of circulation and the displacement of agni. (132-133)
A person suffering from taruna jwara (the initial stage of jwara) does not sweat because of the obstruction of the channels of circulation and the displacement of agni. (132-133)
==== Clinical features of ama Jwara (first stage of jwara) ====
Clinical features of ama Jwara (first stage of jwara):
अरुचिश्चाविपाकश्च गुरुत्वमुदरस्य च||१३३||
अरुचिश्चाविपाकश्च गुरुत्वमुदरस्य च||१३३||
हृदयस्याविशुद्धिश्च तन्द्रा चालस्यमेव च|
हृदयस्याविशुद्धिश्च तन्द्रा चालस्यमेव च|
malapravr̥ttirutklēśaḥ pacyamānasya lakṣaṇam|137|
malapravr̥ttirutklēśaḥ pacyamānasya lakṣaṇam|137|
jvaravego~adhikastRuShNA pralApaH shvasanaM bhramaH||136||
jvaravego~adhikastRuShNA pralApaH shvasanaM bhramaH||136||
malapravRuttirutkleshaH pacyamAnasya lakShaNam|137|
malapravRuttirutkleshaH pacyamAnasya lakShaNam|137|
The features of pachyamana jwara (second stage of fever) are as follows – high grade fever and excess thirst, delirium, dyspnoea, giddiness and excess evacuation of wastes (136)
The features of pachyamana jwara (second stage of fever) are as follows – high grade fever and excess thirst, delirium, dyspnoea, giddiness and excess evacuation of wastes (136)
Clinical features of nirama jwara (third stage of jwara):
==== Clinical features of nirama jwara (third stage of jwara) ====
क्षुत् क्षामता लघुत्वं च गात्राणां ज्वरमार्दवम्||१३७||
क्षुत् क्षामता लघुत्वं च गात्राणां ज्वरमार्दवम्||१३७||
दोषप्रवृत्तिरष्टाहो निरामज्वरलक्षणम्|१३८|
दोषप्रवृत्तिरष्टाहो निरामज्वरलक्षणम्|१३८|
doShapravRuttiraShTAho nirAmajvaralakShaNam|138|
doShapravRuttiraShTAho nirAmajvaralakShaNam|138|
Restoration of hunger, debility, lightness in the body, reduced fever, elimination of the dosha along with the waste products from the body – are all the clinical features of nirama jwara (condition when the patient’s body becomes free from the ama). These features generally appear on the 8th day. (137-138)
Restoration of hunger, debility, lightness in the body, reduced fever, elimination of the dosha along with the waste products from the body – are all the clinical features of nirama jwara (condition when the patient’s body becomes free from the ama). These features generally appear on the 8th day. (137-138)
==== Precaution at first stage of fever ====
नवज्वरे दिवास्वप्नस्नानाभ्यङ्गान्नमैथुनम्||१३८||
नवज्वरे दिवास्वप्नस्नानाभ्यङ्गान्नमैथुनम्||१३८||
क्रोधप्रवातव्यायामान् कषायांश्च विवर्जयेत्|१३९|
क्रोधप्रवातव्यायामान् कषायांश्च विवर्जयेत्|१३९|
krodhapravAtavyAyAmAn kaShAyAMshca vivarjayet|139|
krodhapravAtavyAyAmAn kaShAyAMshca vivarjayet|139|
The patient, in the state of nava jwara (first stage fever) should avoid certain things as – daytime sleep, bath, massage, heavy to digest food, sexual intercourse, anger, direct exposure to wind, exercise, and kashaya (astringent foods). (138-139)
The patient, in the state of nava jwara (first stage fever) should avoid certain things as – daytime sleep, bath, massage, heavy to digest food, sexual intercourse, anger, direct exposure to wind, exercise, and kashaya (astringent foods). (138-139)
Contra-indications of langhana (fasting):
==== Contra-indications of langhana (fasting) ====
ज्वरे लङ्घनमेवादावुपदिष्टमृते ज्वरात्||१३९||
ज्वरे लङ्घनमेवादावुपदिष्टमृते ज्वरात्||१३९||
क्षयानिलभयक्रोधकामशोकश्रमोद्भवात् |१४०|
क्षयानिलभयक्रोधकामशोकश्रमोद्भवात् |१४०|