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Jwara Chikitsa (view source)

Revision as of 19:50, 8 February 2018

382 bytes added , 19:50, 8 February 2018

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Ghṛit should be added to all those decoctions described above for the alleviation of jwara. They stimulate the power of digestion and endow auspiciousness. (218)

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Various medicated ghee formulations:

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==== Various medicated ghee formulations ====

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पिप्पल्यश्चन्दनं मुस्तमुशीरं कटुरोहिणी|

कलिङ्गकास्तामलकी सारिवाऽतिविषा स्थिरा||२१९||

Line 2,013: Line 2,015:

क्षयं कासं शिरःशूलं पार्श्वशूलं हलीमकम्|

अंसाभितापमाग्निं च विषमं सन्नियच्छति||२२१||

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pippalyaścandanaṁ mustamuśīraṁ kaṭurōhiṇī|

kaliṅgakāstāmalakī sārivā'tiviṣā sthirā||219||

Line 2,026: Line 2,029:

kShayaM kAsaM shiraHshUlaM pArshvashUlaM halImakam|

aMsAbhitApamAgniM ca viShamaM sanniyacchati||221||

+

Medicated ghṛit prepared by boiling with pipalī, candana, mustā, katurohiṇī, kalingaka, tāmalakī (bhūmyāmalakī), sārivā, ativishā, sthirā, drākṡā, āmalaka, bilva, trāyamāṇa and nidigdhikā cure chronic types of jwara instantaneously. It also cures kṡaya (consumption), kāsa (coughs), shiraḥshula (headache), pārshvasūla (pain in the sides of chest), halīmaka (a type of jaundice), ansābhitāpa (burning sensation in the scapular region) and viṡama agnī (irregularity in the power of digestion). (219-221)

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वासां गुडूचीं त्रिफलां त्रायमाणां यवासकम्|

पक्त्वा तेन कषायेण पयसा द्विगुणेन च||२२२||

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पिप्पलीमुस्तमृद्वीकाचन्दनोत्पलनागरैः|

कल्कीकृतैश्च विपचेद्धृतं जीर्णज्वरापहम्||२२३||

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vāsāṁ guḍūcīṁ triphalāṁ trāyamāṇāṁ yavāsakam|

paktvā tēna kaṣāyēṇa payasā dviguṇēna ca||222||

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pippalīmustamr̥dvīkācandanōtpalanāgaraiḥ|

kalkīkr̥taiśca vipacēddhr̥taṁ jīrṇajvarāpaham||223||

Line 2,038: Line 2,046:

vAsAM guDUcIM triphalAM trAyamANAM yavAsakam|

paktvA tena kaShAyeNa payasA dviguNena ca||222||

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pippalImustamRudvIkAcandanotpalanAgaraiH|

kalkIkRutaishca vipaceddhRutaM jIrNajvarApaham||223||

−

Ghṛit prepared from the decoction made by boiling vāsa, guḍucī, triphalā, trāyamāṇa and yavāsaka, milk in double the quantity, paste of pippalī, mustā, mṛdvīkā, candana, utpala and nagara cures chronic fevers.(222-223)

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Ghṛit prepared from the decoction made by boiling vāsa, guḍucī, triphalā, trāyamāṇa and yavāsaka, milk in double the quantity, paste of pippalī, mustā, mṛdvīkā, candana, utpala and nagara cures chronic fevers.(222-223)

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बलां श्वदंष्ट्रां बृहतीं कलसीं धावनीं स्थिराम्|

निम्बं पर्पटकं मुस्तं त्रायमाणां दुरालभाम्||२२४||

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कृत्वा कषायं पेष्यार्थे दद्यात्तामलकीं शटीम्|

द्राक्षां पुष्करमूलं च मेदामामलकानि च||२२५||

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घृतं पयश्च तत् सिद्धं सर्पिर्ज्वरहरं परम्|

क्षयकासशिरःशूलपार्श्वशूलांसतापनुत् ||२२६||

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balāṁ śvadaṁṣṭrāṁ br̥hatīṁ kalasīṁ dhāvanīṁ sthirām|

nimbaṁ parpaṭakaṁ mustaṁ trāyamāṇāṁ durālabhām||224||

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kr̥tvā kaṣāyaṁ pēṣyārthē dadyāttāmalakīṁ śaṭīm|

drākṣāṁ puṣkaramūlaṁ ca mēdāmāmalakāni ca||225||

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ghr̥taṁ payaśca tat siddhaṁ sarpirjvaraharaṁ param|

kṣayakāsaśiraḥśūlapārśvaśūlāṁsatāpanut ||226||

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balAM shvadaMShTrAM bRuhatIM kalasIM dhAvanIM sthirAm|

nimbaM parpaTakaM mustaM trAyamANAM durAlabhAm||224||

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kRutvA kaShAyaM peShyArthe dadyAttAmalakIM shaTIm|

drAkShAM puShkaramUlaM ca medAmAmalakAni ca||225||

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ghRutaM payashca tat siddhaM sarpirjvaraharaM param|

kShayakAsashiraHshUlapArshvashUlAMsatApanut ||226||

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Ghṛit prepared from boiling the decoction of balā, shvadamṡtrā, bṛhatī, kalasī, dhāvānī, sthirā, nimba, parpaṭaka, musta, trāyamāṇā and durālabhā; paste of tāmalakī, shatī, drāksā, puṡkarmūla, medā and āmalakī, ghee and milk; is an excellent medicine for the treatment of jwara. It also cures kṡaya (consumption), kāsa (coughs), shiraḥshula (headache), pārshvasūla (pain in the sides of chest), halīmaka (a type of jaundice), ansābhitāpa (burning sensation in the scapular region. (224-226)

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Formulations used in purification therapies:

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==== Formulations used in purification therapies ====

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ज्वरिभ्यो बहुदोषेभ्य ऊर्ध्वं चाधश्च बुद्धिमान्|

दद्यात् संशोधनं काले कल्पे यदुपदेक्ष्यते||२२७||

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¨ tṛvrita and trāyamāṇa along with milk

¨ mṛdvikā and abhayā along with warm milk or the juice of drākṡā as anupāna. (227-233)

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Formulations with medicated milk:

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==== Formulations with medicated milk ====

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कासाच्छ्वासाच्छिरःशूलात्पार्श्वशूलाच्चिरज्वरात्|

मुच्यते ज्वरितः पीत्वा पञ्चमूलीशृतं पयः||२३४||

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jīrṇajvarāṇāṁ sarvēṣāṁ payaḥ praśamanaṁ param|

pēyaṁ taduṣṇaṁ śītaṁ vā yathāsvaṁ bhēṣajaiḥ śr̥tam||239||

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kAsAcchvAsAcchiraHshUlAtpArshvashUlAccirajvarAt|

Line 2,165: Line 2,188:

Dhāroshṇa mlk (freshly milked from the cow, when its still hot) immediately cures jwara caused by the aggravation of vāta and pitta.

All types of chronic fevers are alleviated by milk. It can be taken either hot, cold or after boiling with drugs apropriate to the kind of fever. (234-239)

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Medicated enemas:

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==== Medicated enemas ====

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प्रयोजयेज्ज्वरहरान्निरूहान् सानुवासनान्|

पक्वाशयगते दोषे वक्ष्यन्ते ये च सिद्धिषु||२४०||

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The sneha (ghṛit and oil) boiled with paṭola, picumarda, guḍucī, madhūka and madana should also be used as anuvāsana vastī for the treatment of jwara.

The sneha boiled with candana, agurū, kāshmarya, paṭola, madhūka and utpala is exceedingly useful for the administration as anuvāsana vastī to cure jwara. (241-253)

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Indications of shiro-virechana (nasal errhines):

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==== Indications of shiro-virechana (nasal errhines) ====

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यदुक्तं भेषजाध्याये विमाने रोगभेषजे|

शिरोविरेचनं कुर्याद्युक्तिज्ञस्तज्ज्वरापहम्||२५४||

Line 2,274: Line 2,301:

Drugs for shirovirechana therapy (module of taking out the doshās from the uttamānga - shira) are already described in the Bheṡajādhyāya of Sūtra sthāna and Rog bhiṡagjitīya chapter of vimāna sthāna. A physician well versed in these treatment modules should apply them for the treatment of jwara.

The medicated oil and the dhuma vartī described for application as nasal drop and dhuma varti respectively in the mātrāshitīya chapter, should also be used for the treatment of jwara.(254-255)

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External aplications:

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==== External aplications ====

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अभ्यङ्गांश्च प्रदेहांश्च परिषेकांश्च कारयेत्|

यथाभिलाषं शीतोष्णं विभज्य द्विविधं ज्वरम्||२५६||

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Abhyanga (massage), pradeha (unction) and pariṡeka (medicated bath) should be given to the patient, either hot or cold, according to the appropriateness of the two types of jwara of the patient.

Medicated ghṛit called as Sahasra dhauta ghṛta and medicated oil called chandanadya taila should be given for massage to the patient, as these alleviate jwara associated with burning. (256-257)

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Chandanadya taila:

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==== Chandanadya taila ====

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अथ चन्दनाद्यं तैलमुपदेक्ष्यामः-चन्दनभद्रश्रीकालानुसार्यकालीयकपद्मापद्मकोशीरसारिवामधुकप्रपौण्डरीकनागपुष्पोदीच्यवन्यपद्मोत्पलनलिनकुमुद-सौगन्धिकपुण्डरीकशतपत्रबिसमृणालशालूकशैवालकशेरुकानन्ताकुशकाशेक्षुदर्भशरनलशालिमूलजम्बुवेतसवानीरगुन्द्रा-ककुभासनाश्वकर्णस्यन्दनवातपोथशालतालधवतिनिशखदिरकदरकदम्बकाश्मर्यफलसर्जप्लक्षवटकपीतनोदुम्बराश्वत्थ-न्यग्रोधधातकीदूर्वेत्कटशृङ्गाटकमञ्जिष्ठाज्योतिष्मतीपुष्करबीजक्रौञ्चादनबदरीकोविदारकदली-संवर्तकारिष्टशतपर्वाशीतकुम्भिकाशतावरीश्रीपर्णीश्रावणीमहाश्रावणीरोहिणीशीतपाक्योदनपाकीकालबलापयस्याविदारी-जीवकर्षभकमेदामहामेदामधुरसर्ष्यप्रोक्तातृणशून्यमोचरसाटरूषकबकुलकुटजपटोलनिम्बशाल्मलीनारिकेल-खर्जूरमृद्वीकाप्रियालप्रियङ्गुधन्वनात्मागुप्तामधूकानामन्येषां च शीतवीर्याणां यथालाभमौषधानां कषायं कारयेत्|

तेन कषायेण द्विगुणितपयसा तेषामेव च कल्केन कषायार्धमात्रं मृद्वग्निना साधयेत्तैलम्|

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The above mentioned drugs should be made in the form of a fine paste and then used as a pradeha when it has cooled. The water boiled with these drugs should be used when cooled for avagāha and pariṡeka (bathing and sprinkling over the body respectively).

The seka and avagāha (sprinkling of water and bathing) with madhu, āranāla (sour gruel), milk, curd, ghṛita and water cure dāha jwara instantaneously, because of their cold touch.(258-259)

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Guidelines for a patient with burning sensation:

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==== Guidelines for a patient with burning sensation ====

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भवन्ति चात्र-

पौष्करेषु सुशीतेषु पद्मोत्पलदलेषु च|

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Such patient should also be comforted with the touch of ladies smeared with sandalwood paste, wearing desirable jewels and pearls; which are affectionate and skilled with polite manners.

Diet and drinks which are cold, cooling gardens, cold wind and cold rays of the moon; alleviate jwara with burning sensation. (260-266)

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Agurvadya tailam:

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==== Agurvadya tailam ====

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अथोष्णाभिप्रायिणां ज्वरितानामभ्यङ्गादीनुपक्रमानुपदेक्ष्यामः-अगुरुकुष्ठतगरपत्रनलदशैलेयध्यामकहरेणुकास्थौणेयकक्षेमकैलावराङ्गदलपुरतमालपत्रभूतीकरोहिषसरलशल्लकी-देवदार्वग्निमन्थबिल्वस्योनाककाश्मर्यपाटलापुनर्नवावृश्चीरकण्टकारीबृहतीशालपर्णीपृश्निपर्णीमाषपर्णीमुद्गपर्णीगोक्षुरकैरण्ड-शोभाञ्जनकवरुणार्कचिरबिल्वतिल्वकशटीपुष्करमूलगण्डीरोरुबूकपत्तूराक्षीवाश्मान्तकशिग्रुमातुलुङ्गपीलुकमूलकपर्णी-तिलपर्णीपीलुपर्णीमेषशृङ्गीहिंस्रादन्तशठैरावतकभल्लातकास्फोतकाण्डीरात्मजैकेषीकाकरञ्जधान्यकाजमोद-पृथ्वीकासुमुखसुरसकुठेरककालमालकपर्णासक्षवकफणिज्झकभूस्तृणशृङ्गवेरपिप्पलीसर्षपाश्वगन्धारास्नारुहारोहावचाबलातिबला-गुडूचीशतपुष्पाशीतवल्लीनाकुलीगन्धनाकुलीश्वेताज्योतिष्मतीचित्रकाध्यण्डाम्लचाङ्गेरी-तिलबदरकुलत्थमाषाणामेवंविधानामन्येषां चोष्णवीर्याणां यथालाभमौषधानां कषायं कारयेत्, तेन कषायेण तेषामेव चकल्केन सुरासौवीरकतुषोदकमैरेयमेदकदधिमण्डारनालकट्वरप्रतिविनीतेन तैलपात्रं विपाचयेत्|

तेन सुखोष्णेन तैलेनोष्णाभिप्रायिणं ज्वरितमभ्यञ्ज्यात्, तथा शीतज्वरः प्रशाम्यति; एतैरेव चौषधैः श्लक्ष्णपिष्टैः सुखोष्णैः प्रदेहंकारयेत्, एतैरेव च शृतं सुखोष्णं सलिलमवगाहनार्थं परिषेकार्थं च प्रयुञ्जीत शीतज्वरप्रशमार्थम्||२६७||

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A decoction and paste should be prepared from all the drugs described or those amongst them which are available. These decoction and paste should be added with surā (alcoholic drinks), sauvīraka (vinegar), tuṡodaka (a type of vinegar), maireya (an alcoholic drink), dadhi manḍa (scum of curd), ārnāla (sour gruel recipe), kaṭvara (watery curd along with the fat content) should be boiled in one pātra of oil (3.072 l). When this oil is still luke warm, it should be massaged to the patient suffering from jwara for whom hot therapy is indicated. This will cure shīta jwara .

The above mentioned drugs should be made in the form of a fine paste and then used as a pradeha when it is cooled. The water boiled with these drugs should be used when cooled for avagāha and pariṡeka (bathing and sprinkling over the body respectively). (267)

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Indications of fomentation for alleviating cold:

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==== Indications of fomentation for alleviating cold ====

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भवन्ति चात्र-

त्रयोदशविधः स्वेदः स्वेदाध्याये निदर्शितः|

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Shīta jwara is also cured by the embrace of passionate ladies who are beautiful, have plump body and are young, due to their youthful heat.

Different types of diet and drinks which cause fomentation and alleviate vāta and kapha, instantaneously alleviate shīta jwara. These should be administered keeping in view of the saṁsarga (combination of two doshhās) and the bala of each doshha. (268-271)

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Contra-indications of langhana:

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====Contra-indications of langhana ====

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वातजे श्रमजे चैव पुराणे क्षतजे ज्वरे|

लङ्घनं न हितं विद्याच्छमनैस्तानुपाचरेत्||२७२||

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vātajē śramajē caiva purāṇē kṣatajē jvarē|

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vātajē śramajē caiva purāṇē kṣatajē jvarē|

laṅghanaṁ na hitaṁ vidyācchamanaistānupācarēt||272||

vAtaje shramaje caiva purANe kShataje jvare|

la~gghanaM na hitaM vidyAcchamanaistAnupAcaret||272||

Langhana (fasting) is not useful for patients suffering from jwara caused by aggravated vata, by exhaustion, in chronic fevers, in fevers caused by kshata (external and internal injuries). Such patients should be treated by shamana therapy (alleviation therapy). (272)

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Guidelines for improving agni (digestive strength):

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==== Guidelines for improving agni (digestive strength) ====

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विक्षिप्यामाशयोष्माणं यस्माद्गत्वा रसं नृणाम्|

ज्वरं कुर्वन्ति दोषास्तु हीयतेऽग्निबलं ततः||२७३||

Line 2,449: Line 2,491:

तं क्रमेण यथोक्तेन लङ्घनाल्पाशनादिना||२८२||

आदशाहमुपक्रम्य कषायाद्यैरुपाचरेत्|२८३|

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vikṣipyāmāśayōṣmāṇaṁ yasmādgatvā rasaṁ nr̥ṇām|

Line 2,499: Line 2,540:

If a person takes heavy food in the stage when the doshās are aggravated and the power of digestion is suppressed, he succumbs to death immediately, or becomes miserable for a long time. Therefore, a wise physician should not immediately give either heavy or unctuous food in the beginning stage of jwara, even if it is caused by the aggravation of vāta.

If the jwara is caused by vāta and is not associated with the other two doshas then, in exception to the above rule the patient should be given massage and such other therapies. He should be given decoctions and meat or vegetable soups to drink. All the therapies described for chronic fever are useful for the management of this kind of fever. (273-283)

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Guidelines for management in sannipata conditions:

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==== Guidelines for management in sannipata conditions ====

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सामा ये ये च कफजाः कफपित्तज्वराश्च ये||२८३||

लङ्घनं लङ्घनीयोक्तं तेषु कार्यं प्रति प्रति|२८४|

Line 2,533: Line 2,576:

In the case of saṁsṛṡṭra and sannīpātaja (in case of combination of two or all the three doshas) type of jwara, the tara, tama and sama (lesser, greater or equal) status of the vitiated doshās should be ascertained and the treatment planned according to the line of treatment and drugs prescribed for that dosha.

Sannipātaja jwara should be treated by increasing one dosha, reducing the excessively aggravated one or by correcting the sites of the doshās in order, beginning with the site of kapha.(283-287)

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Management of karnamulika shotha (inflammatoion near the root of the ears):

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==== Management of karnamulika shotha (inflammatoion near the root of the ears) ====

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सन्निपातज्वरस्यान्ते कर्णमूले सुदारूणः||२८७||

शोथः सञ्जायते तेन कश्चिदेव प्रमुच्यते|

Line 2,549: Line 2,594:

A seious sequale of sannipataja jwara is inflammation near the root of the ears which is a very serious condition and very few of such paients survive. Thus, efforts must be made immediately to cure it through therapeutic measures which alleviate kapha and pitta like blood letting, intake of ghee, pradeha (application of unction), nāvana (nasal instillation) and kavala graham (mouthful of liquid medication).(287-289)

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Indications of blood letting:

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==== Indications of blood letting ====

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शीतोष्णस्निग्धरूक्षाद्यैर्ज्वरो यस्य न शाम्यति||२८९||

शाखानुसारी रक्तस्य सोऽवसेकात् प्रशाम्यति|२९०|

Line 2,557: Line 2,604:

shAkhAnusArI raktasya so~avasekAt prashAmyati|290|

When the jwara doesn’t get cured by either hot or cold or unctuous or ununctuous therapies etc., then it should be understood as śākhānusāri (that which is located in the peripheral tissues). Such type of fever gets cured by the administration of blood letting therapy. (289-290)

−

Indication of consumption of ghee:

+

==== Indication of consumption of ghee ====

+

विसर्पेणाभिघातेन यश्च विस्फोटकैर्ज्वरः||२९०||

तत्रादौ सर्पिषः पानं कफपित्तोत्तरो न चेत्|२९१|

Line 2,566: Line 2,615:

If jwara arises in a patient as a complication of visarpa (erysipelas like disease), abhighāta (injury) and visphoṭaka (eruptions in the body), the patient in such case should be given ghee to drink provided kapha and pitta dośha are not aggravated. (290-291)

−

Management of jeerna jwara (chronic stage):

+

==== Management of jeerna jwara (chronic stage) ====

+

दौर्बल्याद्देहधातूनां ज्वरो जीर्णोऽनुवर्तते||२९१||

बल्येः सम्बृंहणैस्तस्मादाहारैस्तमुपाचरेत्|२९२|

Line 2,574: Line 2,625:

balyeH sambRuMhaNaistasmAdAhAraistamupAcaret|292|

The fever turns chronic if there is weakness in the tissues of the body. Hence such patients should be given foods which promote the strength and are nourishing. (291-292)

−

Management of dosha dominance in vishamajwara:

+

==== Management of dosha dominance in vishamajwara ====

+

कर्म साधारणं जह्यात्तृतीयकचतुर्थकौ ||२९२||

आगन्तुरनुबन्धो हि प्रायशो विषमज्वरे|

Line 2,601: Line 2,654:

The general line of treatment of jwaras should not be followed for the management of tṛtīyaka and chaturthaka jwara as these two types of fever are mostly associated with āgantu or extraneous factors as būtās or evil spirits including germs. When vāyu is predominantly aggravated in these two types of jwara, then they should be cured by the administration of ghee, niruha and anuvāsana vastīs (medicated enemas), unctuous and hot diet and drinks. When the pitta doshha is dominant the patient should be given purgation therapy, medicated milk, ghee and articles which are bitter and cold. In state of kapha predominance, then the patient should be administered emetic therapy, pācana (therapy which promotes the digestion and metabolism), ununctuos diet and drinks, fasting and hot decoctions are useful. (292-296)

−

Guidelines and various formulations in vishama jwara:

+

==== Guidelines and various formulations in vishama jwara ====

+

योगाः पराः प्रवक्ष्यन्ते विषमज्वरनाशनाः||२९६||

प्रयोक्तव्या मतिमता दोषादीन् प्रविभज्य ते|

Line 2,706: Line 2,761:

¨ Wearing of maṇis (precious stones and jewels), auṡadha (drugs), mangalya (auspicious talisman) and viṡa (poisonous substances)

¨ Intake of agada (antidote like drugs).(296-309)

−

Spiritual therapy:

+

==== Spiritual therapy ====

+

सोमं सानुचरं देवं समातृगणमीश्वरम्||३१०||

पूजयन् प्रयतः शीघ्रं मुच्यते विषमज्वरात्|

Line 2,740: Line 2,797:

Offering prayers through iṡṭī or yajña (fire ritual) to Brahmā, the Ashvinīs, īndra, āgni, the Himalayās, the Ganges and the followers of Māruts cures the jwara.

Devotion to father and mother, prayer to gurūs, observance of celibacy, practice of tapa (penance), truthfulness and niyama (religious rites), japa (incantations), homa (like yajña – offering oblation to fire), hearing the recitation of the vedās and the darshana (visiting) of saints immediately cures jwara. (310-314)

−

Management of jwara located in various dhatu:

+

==== Management of jwara located in various dhatu ====

+

ज्वरे रसस्थे वमनमुपवासं च कारयेत्||३१५||

सेकप्रदेहौ रक्तस्थे तथा संशमनानि च|

Line 2,762: Line 2,821:

¨ in the mānsa and the medas virecana and upavāsa should be done.

¨ in the asthī and majjā dhātūs, nirūha and anuvāsana bastīs should be given. (315-317)

−

Management of abhicharaja and abhishangaja jwara:

+

==== Management of abhicharaja and abhishangaja jwara ====

+

शापाभिचाराद्भूतानामभिषङ्गाच्च यो ज्वरः||३१७||

दैवव्यपाश्रयं तत्र सर्वमौषधमिष्यते|

Line 2,770: Line 2,831:

daivavyapAshrayaM tatra sarvamauShadhamiShyate|

The jwara caused by shapa (curse), abhichara (tantric rituals with evil purpose), bhutabhishanga (afflication by micro organisms or evil spirits), daiva vyapashraya chikitsa (performance of spiritual therapies) is the most desired therapy. (317)

−

Management of abhighataja jwara:

+

==== Management of abhighataja jwara ====

+

अभिघातज्वरो नश्येत् पानाभ्यङ्गेन सर्पिषः||३१८||

रक्तावसेकैर्मद्यैश्च सात्म्यैर्मांसरसौदनैः|

Line 2,784: Line 2,847:

kShatAnAM vraNitAnAM ca kShatavraNacikitsayA|

Jwara caused by abhighāta (external injury) gets cured by the intake and massage of ghee, blood letting, in take of rice with wholesome meat soup. If such patients of abhighata jwara, are suffering from anaha (gaseous distention of abdomen) and are accustomed to alcohol, then they should be given food with alcohol and meat soup. For the treatment of jwara caused by kshata (injury like cuts, stabs etc.) and vraṇa (ulcers) line of treatment suggested for kshata and vrana should be adopted. (318-320)

−

Management of agantuja jwara due to mental factors:

+

==== Management of agantuja jwara due to mental factors ====

+

आश्वासेनेष्टलाभेन वायोः प्रशमनेन च||३२०||

हर्षणैश्च शमं यान्ति कामशोकभयज्वराः|

Line 2,813: Line 2,878:

The jwara caused by krodha gets subsided by kama and that caused by kama gets cured by krodha. Jwara caused by bhaya (fear) and shoka (grief or sorrow) gets subsided by both kama and krodha.

If a patient gets jwara just by thinking about its episode, then his mind should be diverted to desirable, different and surprising incidents (vishaya).(320-323)

−

Signs of remission of jwara:

+

==== Signs of remission of jwara ====

+

ज्वरप्रमोक्षे पुरुषः कूजन् वमति चेष्टते|

श्वसन्विवर्णः स्विन्नाङ्गो वेपते लीयते मुहुः||३२४||

Line 2,847: Line 2,914:

If a severe condition of jwara with excessively aggravated doshas and recent onset, is treated with appropriate therapy, then dosha paka occurs. Because of this, the sudden remmision of jwara occurs with difficulty. (daruna moksha).

In chronic stage of jwara, the episodes are remitted depending upon strength of dosha. The remission occurs slowly without difficulty. (324-328)

−

Signs of completely cured jwara patient:

+

==== Signs of completely cured jwara patient ====

+

विगतक्लमसन्तापमव्यथं विमलेन्द्रियम्|

युक्तं प्रकृतिसत्त्वेन विद्यात् पुरुषमज्वरम्||३२९||

Line 2,857: Line 2,926:

Disappearance of klama (mental fatigue) and santapa (temperature), absence of pain, clarity of senses, gaining natural mental faculties – are all the signs and symptoms of a person who has become free from jwara.(329)

−

Precautions after being cured from jwara:

+

==== Precautions after being cured from jwara ====

+

सज्वरो ज्वरमुक्तश्च विदाहीनि गुरूणि च|

असात्म्यान्यन्नपानानि विरुद्धानि च वर्जयेत्||३३०||

Line 2,879: Line 2,950:

A person suffering from jwara and the one who has become free from it should not indulge in and avoid the following - the intake of food and drinks which are vidahi (causing burning sensation), guru (heavy), asatmya (unwholesome) and viruddha (mutually contradictory); sexual intercourse, excessive exhaustion, bath and excessive walking. By observing these rules the fever gets alleviated and does not occur again.

Exercise, sexual intercourse, bath, chankramana (brisk walk) – these should be avoided by the person who has become free from jwara till he regains strength. (330-332)

−

Punaravarti jwara (recurrent jwara):

+

==== Punaravarti jwara (recurrent jwara) ====

+

असञ्जातबलो यस्तु ज्वरमुक्तो निषेवते|

वर्ज्यमेतन्नरस्तस्य पुनरावर्तते ज्वरः||३३३||

Line 2,951: Line 3,024:

Therefore, the dośhās should be eliminated from the body either by elimination or alleviation therapies depending upon the stage and strength of the dośhās, even after the fever subsides in a patient of jwara. For this purpose mild elimination therapies and yāpanā bastīs should be administered. Yūśa (vegetable soups) and rasa (meat soups) of animal’s meat, which are light, are useful in this condition. Abhyanga, udvartana, snāna, dhūpana, anjana and ghee prepared boiling with bitter drugs are useful in the treatment of jwara, which has reappeared in a patient.

If the fever reappears because of the intake of food which is guru (heavy), abhiṡyandī (which cause obstruction in the channels of the body) and unwholesome; then langhana (fasting) and hot therapies should be administered for its treatment as described before. Habitual intake of the decoction of kirāta tiktaka, tiktā, mustā; parpaṭaka and amṛtā cures repeated fever. (333-343)

−

~~–Guidelines~~ for management:

+

==== Guidelines for management ====

+

तस्यां तस्यामवस्थायां ज्वरितानां विचक्षणः|

ज्वराक्रियाक्रमापेक्षी कुर्यात्तत्तच्चिकित्सितम्||३४४||

Line 2,960: Line 3,035:

jvarAkriyAkramApekShI kuryAttattaccikitsitam||344||

The wise physician should treat the patient in different stages of jwara, according to the line of treatment of jwara. (344)

+

रोगराट् सर्वभूतानामन्तकृद्दारुणो ज्वरः|

तस्माद्विशेषतस्तस्य यतेत प्रशमे भिषक्||३४५||

Line 2,967: Line 3,043:

tasmAdvisheShatastasya yateta prashame bhiShak||345||

Jwara is the king of diseases and it causes the death of all creatures and is of serious nature. Therefore, the physician should make special efforts for its treatment. (345)

−

~~–Summary:~~

+

==== Summary ====

+

तत्र श्लोकः-

यथाक्रमं यथाप्रश्नमुक्तं ज्वरचिकित्सितम्|

Line 2,980: Line 3,058:

With a desire for the welfare of the living creatures, Atreya has furnished the replies to the queries of Agniveśa regarding the treatment of jwara. (347)

−

Tattva vimarsha:

+

=== Tattva vimarsha ===

+

· All diseases including jwara occur due to disequilibrium of dosha. If the dosha are in equilibrium state, health is maintained and disease cannot occur.

· The origin of all diseases is because of the tendency for greed or attachment (parigraha).

Line 3,011: Line 3,091:

¨ If a person, who has become free from jwara, resorts to prohibited factors (as described before) before gaining strength, then the jwara reappears.

−

Vidhi vimarsha :

+

=== Vidhi vimarsha ===

+

Jwara in Ayurveda is not merely rise in body temperature, but a complex syndrome associated with some other features of the body, mind and the sense organs. Elevated body temperature or feeling of heat is part of the manifestation of jwara. Because of this feature of elevated body temperature, jwara is closely related to FUO of modern medicine.

Fever is defined as a state of increase in core body temperature, often as defense response of host to invasion of micro-organism or inanimate matter known as pathogen. This involves many reactions such as cytokine mediation, numerous physiologic, endocrine, immunological and autonomic responses. However, in the clinical setting and the public perception fever is typically defined as a pyrogen mediated rise in body temperature above the normal range. This definition ignores the fact that the rise in body temperature is but one component of this multifaceted response. Further, the body temperature is an agglomeration of the many different temperatures the body has, each representative of a particular body part.

Line 3,021: Line 3,102:

Heat generated in the vital organs lying deep within the body core is distributed throughout the body with the help of circulatory system. This description of the distribution of heat with the help of circulatory system supports the notion that the ashraya of pitta is rakta (ashraya – ashrayi bhava). The importance of ashraya – ashrayi bhava is that the increase/ decrease/ alteration in the amount or qualities of one affect the other (in the case of kapha and pitta) and that we are visualizing here. According to the response derived from the nervous system, the circulatory system, determines and regulates the temperature of the various body parts and the rate of heat loss from the body surface to the environment. This whole description is about the regulation of ushma of the body by the pitta under the control and the regulation of vata dosha.

If the external temperature is raised in atmosphere (as in summer or near fire or wearing too much clothigs), the body temperature is also raised. This rise is conveyed to the hypothalamus by skin warmth receptors. This inhibits adrenergic activity of sympathetic nervous system, controlling the vasoconstriction and metabolic rate and resulting in vasodilatation. The cutaneous blood flow increases to transport more heat from core to dissipate it at skin surface through heat loss mechanisms by conduction, convection and radiation. This leads to increase in heat loss and decrease in core body temperature.

−

If the heat is sufficiently intense, then the cholinergic sympathetic fibers innervating the sweat glands stimulate sweating which causes heat loss. Behavioral responses to heat also occur which help with heat loss as wearing loose light clothes, fanning, drinking cold drinks, etc. The description made in this paragraph supports another fact stated in Ayurveda that the second ashraya of pitta is sweda.

+

If the heat is sufficiently intense, then the cholinergic sympathetic fibers innervating the sweat glands stimulate sweating which causes heat loss. Behavioral responses to heat also occur which help with heat loss as wearing loose light clothes, fanning, drinking cold drinks, etc. The description made in this paragraph supports another fact stated in Ayurveda that the second ashraya of pitta is sweda.

In response to the cold environment, the cold skin receptors are stimulated and the blood is diverted into the skin which also gets cooled. These signals are received by the hypothalamic thermostat and the higher cortical centres, which then initiate responses promoting heat gain and inhibit centers promoting heat loss. The sympathetic centers are activated resulting in several body responses –

• Constriction of blood vessels of skin by norepinephrine

Line 3,040: Line 3,121:

If all these heat-conserving and production mechanisms do not suffice to raise the core body temperature adequately, then shivering (a means of heat production by the muscles) as well as non – shivering thermogenesis by the liver may also commence. Behavioral activities such as putting on more clothing, bedding or drinking hot beverages may also help raise body temperature by decreasing heat loss.

−

Diagrams representing the mechanisms for heat conservation and production mechanisms of fever.

All these processes of vasoconstriction and heat production continue until the hypothalamus detects that the new set point has been achieved (by the temperature of blood bathing its neurons).

This whole description of the pathogenesis of fever resembles, to some extent, to the samprapti of jwara and the advised treatment schedule of jwara. The description of regulation of temperature by the hypothalamus is not present in our texts of Ayurveda, but it has been described before that whatever activities are taking place in our body are due to vata dosha because it is the sole initiator, controller, and regulator. It is the one who can move the agni from the amashaya to the whole body via the circulation (rasa). The circulation of rasa has been described due to vyana vata and in the pathogenesis of jwara no specific mention of vata dosha has been made. So, should we regard its role as absent? We don’t think so. Under the control of vata dosha, the pitta/agni/ushma is moved increasingly from the koshtha to the shakha to produce the desired increased body temperature. The description of swedavarodha is also present in Ayurveda, which scientifically speaking is the effect of peripheral vasoconstriction occurring to conserve the heat for the production of raised body temperature; this points to their observance of this phenomenon. Jwara has been defined as one in which there are features of santapa (raised body temperature/uneasiness or displeasure of the senses and the mind/displeasure or discomfort in the mana), swedavarodha (absence of sweating) and the feature of sarvang grahana (uneasiness/feeling of heaviness/pain in the whole body).The feature of sarvang grahana is like the non – specific arthralgias and myalgias occurring during fevers. Here we would once again like to highlight the concept of fevers as considered in modern science which makes them very close to that stated in Ayurveda – “The febrile response is a complex physiologic reaction to a disease (of which temperature rise is a component) involving many mechanisms as cytokine-mediated rise in core temperature, generation of acute phase reactants and the activation of numerous physiologic, endocrinologic, autonomic and immunologic systems or processes. However, in the clinical setting and the public perception fever is typically defined as a pyrogen mediated rise in body temperature above the normal range. This definition ignores the fact that the rise in body temperature is but one component of this multifaceted response.”

−

Then, the hypothalamus maintains the temperature at the febrile level by the normal thermoregulatory mechanisms and after some time a reduction in the pyrogens (or the administration of the antipyretic medication) resets the hypothalamic set point back towards normal. In this case, the hormones as arginine, vasopressin, alpha-melanocyte stimulating hormone and corticotropin releasing factor are given out, acting as endogenous antipyretics, which result in heat loss process, vasodilation and sweating which continue, until the lower set point of the hypothalamus is achieved. This process may also be aided by behavioral processes such as removal of clothing etc. which aid in heat dissipation. The other features associated with increased core temperature as non – specific myalgias and arthralgias are associated with the peripheral production of PGE2 by the influence of circulating cytokines.

+

Then, the hypothalamus maintains the temperature at the febrile level by the normal thermoregulatory mechanisms and after some time a reduction in the pyrogens (or the administration of the antipyretic medication) resets the hypothalamic set point back towards normal. In this case, the hormones as arginine, vasopressin, alpha-melanocyte stimulating hormone and corticotropin releasing factor are given out, acting as endogenous antipyretics, which result in heat loss process, vasodilation and sweating which continue, until the lower set point of the hypothalamus is achieved. This process may also be aided by behavioral processes such as removal of clothing etc. which aid in heat dissipation. The other features associated with increased core temperature as non – specific myalgias and arthralgias are associated with the peripheral production of PGE2 by the influence of circulating cytokines.

−

Effects of Fever:

+

==== Effects of Fever ====

+

Studies have demonstrated that fever is caused by the chemicals produced by our body cells, it’s a body’s complex physiological response/reaction to some insult. In this context, it is supposed to be beneficial to the multicellular organism in which it is being produced.

A growing body of research in immunology and neurophysiology has led to the recent understanding that fever is generally an adaptive physiological response to some threat.

Line 3,051: Line 3,133:

With the advent of advanced molecular techniques and increasing interest of the scientists in the febrile response as an adaptive host response, much knowledge about the benefits of fever has been gained. Acute phase responses including fever results in increased and improved immune system. Such adaptations include increased neutrophil migration, increased secretion of inter – leukin 1, proliferation of T lymphocyte, increased production of interferon, hypoferremia and increased secretion of chemicals that are antibacterial, antitumour and/or antiviral in nature (Duff and Durum 1982, Cunha et al. 1984, Fletcher 1987, Styrt and Sugarman 1990, Holtzclaw 1992 etc.). Further evidence about the beneficial effects of fever comes from several studies conducted on patients diagnosed as having sepsis. The study revealed that patients with bacteremia or fungemia who were able to mount a febrile response had a higher survival rate as compared to those who were not (Byranit et al. 1971, Weenstein et al., 1983). The ability of patients with sepsis to react with a febrile response has been associated with a survival rate nearly double to that of hypothermic patients (Arons et al. 1999). A study done by Graham et al. (1990) demonstrated that patients treated with antipyretic therapy as aspirin, acetaminophen, and ibuprofen during infection with rhinovirus had an extended period of viral shedding. Dorn et al. (1989) also showed that children with chicken pox who were given acetaminophen took a significantly longer time for the total crusting of lesions as compared to those treated with a placebo. These two studies though do not demonstrate a firm causal link between non – treatment of fever and improved clinical outcome, but they do provide additional support for the theory that fever is beneficial to patients.

Even animal models have demonstrated repeatedly that fever is an important feature of the acute phase response and is associated with shortened duration of illness and improved survival (Jiang eta l. 2000). In another study, Jiang et al. 2000 induced bacterial peritonitis in mice and found decreased bacterial load and improved survival in animals with febrile core temperatures as compared to normothermic controls.

−

Antipyretic therapy:

+

==== Antipyretic therapy ====

+

Antipyretic therapy might be justified at least in theory, if the metabolic cost of fever exceeds its physiologic benefit, if the treatment provided gives symptomatic relief without adversely affecting the course of the febrile illness or if the toxicological costs of the antipyretic regimen (side effects) were lower than its beneficial effects.

Antipyretic therapy is commonly administered to enhance patient comfort. If the temperature is greater than the 41 0 C other physical cooling measures as evaporative cooling with tepid water mist, cooling blankets, sponging with various solutions, exposure to circulating fans, etc. should be started. These physical methods of antipyresis promote heat loss by conduction, convection, and evaporation. Traditionally evaporation has been considered as the most superior method of physical antipyresis because such methods are deemed to be least likely to induce shivering. However, with external cooling methods, it has to be kept in mind that these methods lower the temperature of the febrile patients by overwhelming effector mechanisms which have been evoked by an elevated thermoregulatory set point. Therefore, unless concomitant antipyretic regimens have been started or used or shivering is inhibited by other pharmacological means, external cooling may be vigorously opposed in the febrile patients by thermoregulatory mechanisms endeavoring to maintain elevated body temperatures.

−

An analysis of the line of treatment described in Ayurveda for jwara:

+

==== An analysis of the line of treatment described in Ayurveda for jwara ====

+

When we observe the line of treatment of jwara, we find that the principles stated here are meant to let the body reach the raised set point of body temperature and also aid the body in achieving it. This is the reason why Ayurveda has described langhana (fasting/light diet), swedana (fomentation), kala (passage of time), yavāgū (medicated gruels) and tikta rasa drugs (drugs having bitter taste) – all of these help in the pācana of avipakwa doshās in the initial stage of jwara management. The scientific explanation is available for the first three of these. Scientifically some data is available which reports that fasting or calorie restriction helps in the reduction of the inflammatory mediators. Many studies suggest that long-term CR improves several components of immune function including responses of T cells to mitogens, natural kill-cell (NK) activity, cytotoxic T lymphocyte (CTL) activity and the ability of mononuclear cells to produce pro-inflammatory cytokines. CR attenuated the age-associated increase in the ratio of memory to naïve T cells in monkeys, and this was associated with a reduction in the pro-inflammatory cytokines, TNF-α, etc. (). Though the authors want to specify that no study quoted has been done on the Ayurvedic parameters of langhana, but some clue to the possible benefits of this process of langhana is obtained by the above studies. As per Ayurveda, the indication of langhana is not intended for some patients of jwara and all patients of jwara don’t have to perform langhana for the same amount. Individualized basis has to be followed for it also.

+

Further, the process of swedana (fomentation) refers to methods which aid in the production of sweating such as covering oneself with warm beddings, putting on more clothing, etc., and not hot sudation as is commonly understood. All these measures might be intending to help the body reach the desired set point in jwara and let the raised body temperature perform their functions.

+

Kala refers to waiting for a certain period, and we are sure this was meant to allow the body to have its own time to resolve its intended purpose. Numerous studies have reported that the raised body temperature has several beneficial effects on the body and it seems that the purpose of kala was also the same ref. Further, the authors would like to highlight that this waiting for a certain period was also done with the proper supervision of the physician and as per the requirement of the patient. In a patient with a very high grade of temperature, the line of treatment was not all which is stated above. There the line of treatment described is that of external cooling measures as per the facilities available at that time (in the verse of treatment of paittika jwara). So, here we can see that the principles for the management of jwara in Ayurveda allowed the body to have its due reaction at the same time keeping an eye on the patient’s condition.

Unless this was the reason why did they pick the story of Lord Shiva transforming to his Rudra form (agitated form)? The mythological story described for the beginning of jwara shows that the system (the body) which was in Shiva (balance/beautiful/harmonious/homeostatic) form, due to some insult or challenge (could be internal or external) has converted into an agitated form (Rudra) to counteract it. Again this Rudra has to revert to Shiva for the person to be healthy in the true sense.

−

Current practices in treatments of jwara (referred from Chikitsa Pradeep):

+

==== Current practices in treatments of jwara (referred from Chikitsa Pradeep) ====

+

Principles of treatment: 1. Langhana (fasting) 2. Swedanam (fomentation) 3. Kala ( waiting period of six days) 4. Yavagu (thick gruel) 5. Tikta rasa (bitter taste drugs)

Principal drugs: 1. Vatsanabha 2. Maricha 3. Malla 4. Bitter drugs like Guduchi

Line 3,083: Line 3,173:

There are many other formulations used in clinical practices. The list of formulations can be referred from the list of formularies given below:

−

~~1. Bhaishajya ratnavali – Authored by Govindadasa and commented by Ambikadatta Shastri~~

−

~~2. Sidhdha Yoga samgraha – Authored by Yadavji Trikamji Acharya~~

−

~~3. Chikitsa pradeep – Authored by B.V.Gokhale~~

−

~~4. Ayurvedic formulary of India~~

−

~~5. Ayurvedic Pharmacopoea of India~~

−

Glossary ~~of jwara~~

+

#Bhaishajya ratnavali – Authored by Govindadasa and commented by Ambikadatta Shastri

+

#Sidhdha Yoga samgraha – Authored by Yadavji Trikamji Acharya

+

#Chikitsa pradeep – Authored by B.V.Gokhale

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#Ayurvedic formulary of India

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#Ayurvedic Pharmacopoea of India

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=== Glossary ===

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Prakriti (prakRuti; प्रकृति) - the nature of the disease

Pravritti (pravRutti; प्रवृत्ति ) – the origin of the disease

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Vijwara (Vijwara; विज्वर) - jwara subsides

Anupasthita doshanam (anupasthitadoShANAM; अनुपस्थितदोषाणां) - the doshās have not reached the stage of utklesha (verge of coming out) and thus are not presenting themselves for being removed out of the body.

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References :

Pallavmishra

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Jwara Chikitsa (view source)

Revision as of 19:50, 8 February 2018

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